AMA Rejects Recommendation to Reaffirm Opposition to Medical Aid in Dying
On June 11, the American Medical Association (AMA) House of Delegates voted 56% to 44% to reject a report by its Council on Ethical and Judicial Affairs (CEJA) that recommended the AMA maintain its Code of Medical Ethics’ opposition to medical aid in dying. Instead, the House of Delegates referred the report back to CEJA for further work.
The AMA Code of Medical Ethics Opinion 5.7 adopted 25 years ago in 1993—before medical aid in dying was authorized anywhere in the United States—says: “...permitting physicians to engage in assisted suicide would ultimately cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician's role as healer....”
CEJA Report
In contrast, the CEJA report implicitly acknowledges that medical aid-in-dying laws improve end-of-life care by spurring conversations between physicians and terminally ill patients about all end-of-life care options, such as hospice and palliative care: “Patient requests for [medical aid in dying] invite physicians to have the kind of difficult conversations that are too often avoided. They open opportunities to explore the patient's goals and concerns, to learn what about the situation the individual finds intolerable and to respond creatively to the patient's needs.... Medicine as a profession must ensure that physicians are skillful in engaging in these difficult conversations and knowledgeable about the options available to terminally ill patients.”
The CEJA report also acknowledges: “Where one physician understands providing the means to hasten death to be an abrogation of the physician's fundamental role as healer that forecloses any possibility of offering care that respects dignity…, another in equally good faith understands supporting a patient's request for aid in hastening a foreseen death to be an expression of care and compassion.”
Delegates Speak Out
The majority of AMA delegates felt that the AMA Code of Medical Ethics should be modified to better reflect the sentiment of the report.
“We feel that the AMA abandons all of the physicians who, through their conscious beliefs, are allowed to support patients who are in the states where it is legal and feel that that does need to be addressed regardless of how we feel.… We don't care how long it takes you,” said neurologist Lynn Parry, an AMA delegate from Colorado, just before the vote.
“Clearly, the AMA's position is evolving as delegates hear from more and more colleagues who practice medical aid in dying or believe the option should be available to their patients,” said Roger Kligler, MD, an AMA member and retired internist living with stage IV metastatic prostate cancer who supports medical aid in dying.
Medical aid in dying has been authorized in Washington, DC, and seven states — Colorado, Hawaii, Montana, Oregon, Vermont, Washington, and California—although the California law currently is under legal challenge based on a technicality. Collectively, these 8 jurisdictions represent nearly 1 out of 5 Americans (19%) and have 40 years of combined experience safely using this end-of-life care option.
“Many of the AMA's constituent societies favor neutrality in order to respect and protect doctors and patients whether they decide to participate in this medical practice or not,” said David Grube, MD, who wrote 30 prescriptions for medical aid in dying in Oregon between 1998 and 2012 and currently is the National Medical Director for Compassion & Choices. "I'm heartened that the AMA House of Delegates is open to continuing to study and learn about this issue when there is no clear consensus among AMA members.”
Evolving Positions
Numerous professional associations have dropped their opposition to medical aid in dying and adopted a neutral position. They include the American Academy of Hospice and Palliative Medicine, Washington Academy of Family Physicians, American Pharmacists Association, Oncology Nursing Association, California Medical Association, California Hospice and Palliative Care Association, Colorado Medical Society, Maine Medical Association, Maryland State Medical Society, Massachusetts Medical Society, Medical Society of the District of Columbia, Minnesota Medical Association, Missouri Hospice & Palliative Care Association, Nevada State Medical Association, Oregon Medical Association, Vermont Medical Society, Hospice and Palliative Care Council of Vermont, Washington Academy of Family Physicians, and Washington State Psychological Association.
In addition, medical groups increasingly endorse medical aid in dying, including the American College of Legal Medicine, American Medical Student Association, American Medical Women's Association, American Nurses Association of California, American Public Health Association, GLMA: Healthcare Professionals Advancing LGBT Equality, and New York State Academy of Family Physicians.
According to a 2016 Medscape online survey, more than 7,500 doctors from more than 25 specialties agreed by nearly a 2–1 margin (57% vs 29%) that “physician-assisted dying [should] be allowed for terminally ill patients.”
In fact, Oregon's medical aid–in-dying law has helped spur the state to lead the nation in hospice enrollment, according to a report published by Tolle et al in The New England Journal of Medicine. More than 40% of terminally ill patients in Oregon were enrolled in home hospice in 2013, compared with less than 20% in the rest of the United States.
Nearly two-thirds of Oregonians who died in 2013 did so at home, compared to less than 40% of people elsewhere in the nation. Research shows over 85% of Americans say they want to die at home, and according to a May Gallup poll, 72% of U.S. adults agreed that “When a person has a disease that cannot be cured, … doctors should be allowed by law to end the patient's life by some painless means if the patient and his or her family request it.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
