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06/11/2018

AMA Rejects Recommendation to Reaffirm Opposition to Medical Aid in Dying

The American Medical Association (AMA) House of Delegates
today voted 53 to 47 percent 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…”
In
contrast, the CEJA report implicitly acknowledges that medical
aid-in-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…” said the report. “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.” (See
lines 38-45).
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.” (See lines 10–14).
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,”
said neurologist Lynn Parry, an AMA delegate from Colorado, just before the
vote. “We don’t care how long it takes you.”
“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 Dr. Roger Kligler, an AMA member and retired internist in
Falmouth, Mass., living with stage 4 metastatic prostate cancer who supports
medical aid in dying.
Medical
aid in dying has been authorized in Washington, D.C. and seven states —
Colorado, Hawai‘i, Montana, Oregon, Vermont, Washington, and California —
although the California law currently is under legal challenge
based on a technicality. Collectively, these eight jurisdictions represent
nearly one out of five 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 Dr. David Grube, 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.”
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 PhysiciansAmerican Pharmacists AssociationOncology Nursing AssociationCalifornia Medical Association, California Hospice and Palliative Care
Association
Colorado Medical SocietyMaine Medical AssociationMaryland State Medical SocietyMassachusetts Medical SocietyMedical Society of the District of
Columbia
Minnesota Medical AssociationMissouri Hospice & Palliative Care
Association
Nevada State Medical AssociationOregon Medical AssociationVermont Medical SocietyHospice and Palliative Care Council of
Vermont
, Washington Academy of Family Physicians, and Washington State Psychological Association.
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 the report
published in the 
New England Journal of MedicineMore than 40 percent of
terminally ill patients in Oregon were enrolled in home hospice in 2013,
compared with less than 20 percent 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
percent of people elsewhere in the nation. 
Research shows over 85
percent of Americans say they want to die at home.
According
to a May Gallup poll, 72 percent 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.”

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