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AMA Grapples With Assisted Suicide

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By Thomas E. Sullivan, M.D.

American Medical Association (AMA) grapples with assisted suicide debate.

I am surprised, having dedicated my life to healing, that we in the House of Delegates of the American Medical Association did not reach consensus at our annual meeting in Chicago recently, to ratify the recommendation of our Council on Ethical and Judicial Affairs (CEJA) that the AMA remain opposed to physician assisted suicide.

However, this is far from over as the House of Delegates, which creates the AMA’s official policy, actually voted to refer the report back to CEJA for clarification. It was felt that the body of the report was not accurately and clearly reflected in the conclusion and recommendation that there should be no change in the policy opposing physician assisted suicide. AMA

Delegates said that the ethical guidance was confusing, especially for those physicians practicing in the small number of states that have legalized assisted suicide.

I invite every physician and any interested party to read the CEJA Report: bit.ly/AMAEndofLife The report comes out of a two-year extensive re-examination of this complex dilemma. No stone is unturned – suicide movements, not only in the US, but around the world, are examined. CEJA did a superb job of addressing all the issues in their report to the AMA House of Delegates. Their treatment of the issue is as delicate as it is nuanced.

They first address language, affirming that “the term ‘physician assisted suicide’ describes the practice with the greatest precision,” and therefore reject using the euphemistic alternative language of proponents, such as “death with dignity” or “medical aid in dying,” because it “could be used to describe either euthanasia or palliative/hospice care at the end of life, and this degree of ambiguity is unacceptable for providing ethical guidance.”

While deftly allowing for moral differences in ethical debates, CEJA draws attention to the unintended consequences of physicians assisting patient suicides and a public policy that removes all liability for doctors. They pose the question: can the safeguards in assisted suicide laws actually protect patients and sustain the integrity of medicine? With all of the documented cases of mistakes, abuse, and coercion and the obvious paucity of data and reporting involved, it is clear that the answer is a resounding NO!

CEJA concludes that “oversight of practice may not be adequate,” and that safeguards in the six states that have legalized the practice ought to be improved, which I believe indicates that they are hollow and circumventable.

No matter what you “fix” in these deeply flawed laws, however, I still find there are inherent issues consequent to subverting the physician’s role as healer, not the least of which is that people of economic disadvantage can and will be denied coverage for expensive care for which they cannot pay out of pocket yet offered coverage for suicide instead. SUICIDE IS NOT MEDICAL CARE.

Building upon the report, I can add my personal experience of 44 years in direct patient care as a cardiologist, primarily in the Boston area. I was also the medical director of a long-term care facility in Ipswich where death was an ever-present, common occurrence among our frail, elderly residents.

But there are growing numbers of patients in mundane, non-personal environments where life has lost its meaning in the individual’s mind. I must acknowledge that our system does not do enough currently for those who have “given up on life” and need the compassionate, palliative and hospice care alongside professional, psychological and psychiatric support that should be available to everyone when appropriate. This must not be conflated with the doctor assisted suicide perversion of “end of life care.”

“The profession of medicine is distinguished from all others by its singular beneficence.”

William Osler, MD, often recognized as one of the greatest physicians worldwide during the late 19th and early 20th centuries. Osler urged us all to be compassionate and kind to patients before we apply our considerable technical knowledge, skills, and tools to alleviate suffering and disease burdens. Without this personal touch, the clear view to what’s best for the patient, above all, medical care becomes mechanized, impersonal and uninspired.

A future with physician assisted suicide and the requirement in some legislative language mandating that physicians who object, must refer their patients – against their conscience – to those practitioners willing to collaborate, paints a bleak picture. No wonder many patients with chronic life-threatening illness are driven to request assisted suicide rather than having to face their mortality and the indignity to which our broken system subjects them. They deserve better – we certainly owe our patients more than a handful of suicide pills at the end of their time on Earth.

I’ve practiced medicine with compassionate care and dignity for all patients remaining at the forefront of my mind for my entire four-decade career. I will not submit to those who want to distort the English language and the “sacred” relationship we physicians have with patients by substituting assisted suicide for compassion, palliation, and support when it is needed most.

The defense and support for recommendations from the recent CEJA report to maintain the AMA’s current policy and the AMA’s longstanding position opposing physician assisted suicide is critical in shaping both legal and ethical guidance worldwide.

In rare occasions, the AMA Code of Ethics may differ from House of Delegates votes and policy. This would mean that CEJA would file their “view” on the matter but it would not be official AMA policy. It has never happened, but most of the delegates eagerly anticipate a revised conclusion and recommendation over the next 6-12 months. Our next formal meeting is in November in Washington, D.C.

For now, the AMA still remains formally opposed to physician-assisted suicide without any vote to overturn the policy. And I trust that delving further into the issue, both CEJA and average citizens alike will continue to see the inherent dangers of any change to our patients and the very practice of medicine.

Locally, last fall, the House of Delegates of the Massachusetts Medical Society voted by a small margin to change our long-established opposition to assisted suicide to one of “neutrality.” As a past president of the oldest medical society in our country, founded in 1781, I was happy to see that none of the other past MMS presidents supported this change. The Massachusetts House of Delegates firmly rejected using “Medical Aid in Dying” as a term that includes physician assisted suicide. Unfortunately, the proposed Massachusetts Legislature inappropriately titled their bill, Medical Aid in Dying.

Finally, after visiting the Massachusetts State House with several other physicians to voice our opinions, I was pleased to see that in the wisdom of our legislators, the recent bill addressing this topic was “sent to study,” effectively closing any legal change for the time being.

Dr. Thomas E. Sullivan, MD, of Beverly, is a board-certified cardiologist. He is a past president of the Massachusetts Medical Society, and currently an American Medical Association delegate and past chair of the New England Delegation to the AMA. He is the founding medical director of Peabody Medical Associates and served as the medical director of the Caldwell Home in Ipswich for 35 years. His undergraduate degree is from the College of the Holy Cross in Worcester.

Jul 22, 2018 at 3:01 AM