Assisted suicide, aka “Death with dignity” or “aid in dying”, seems to be gathering pace in the United States, now that Hawaii has joined the list of states which permit it. But how does the American Medical Association stand? It is the most influential voice in the debate because its members will be charged with assisting people to die (which is often described as killing their patients)
According to a recent decision by its Council on Ethical and Judicial Affairs, squarely against it.
The AMA has been under pressure to modify its stand. The American Academy of Hospice and Palliative Medicine has adopted a position of “studied neutrality”. Physicians from Oregon are lobbying within the AMA for neutrality, if not outright endorsement.
The CEJA studied the growing literature on “death with dignity” and recently issued a report which gave it a resounding thumbs-down.
In report 5-A-18, the CEJA declared firmly that
in its current form the Code offers guidance to support physicians and the patients they serve in making well-considered, mutually respectful decisions about legally available options for care at the end of life in the intimacy of a patient-physician relationship. The Council on Ethical and Judicial Affairs therefore recommends that the Code of Medical Ethics not be amended.
The tone of the report was studiously calm and respectful. It acknowledged that “thoughtful, morally admirable individuals hold diverging, yet equally deeply held, and well-considered perspectives about physician-assisted suicide”.
However, it made several pointed observations.
Terminology is important. Should a doctor’s participation in a patient’s death be called “assisted suicide,” “physician assisted suicide”, “aid in dying,” or “death with dignity”? The CEJA insists that the term should be “assisted suicide”. Why?
“ethical deliberation and debate is best served by using plainly descriptive language. In the council’s view, despite its negative connotations, the term “physician assisted suicide” describes the practice with the greatest precision. Most importantly, it clearly distinguishes the practice from euthanasia. The terms “aid in dying” or “death with dignity” 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.”
Neutrality is out. From an ethical point of view, “studied neutrality” is a way of escaping from “irreconcilable differences”. Instead of debating issues, they are ignored. But the CEJA notes that “studied neutrality has been criticized as being open to unintended consequences, including stifling the very debate it purports to encourage or being read as little more than acquiescence with the contested practice”.
The evidence suggests that there are “unintended consequences”. Supporters of “death with dignity” argue that claims that physician-assisted suicide is hard to manage and puts society on a slippery slope are “flawed, inadequate, or distorted” But the CEJA believes otherwise. “Current evidence from Europe does tell a cautionary tale,” it says. Fears of euthanasia for psychological problems, the slippery slope, lack of government control. The report says:
Medicine must also acknowledge, however, that evidence (no matter how robust) that there have not yet been adverse consequences cannot guarantee that such consequences would not occur in the future. As a recent commentary noted, “[p]art of the problem with the slippery slope is you never know when you are on it”
Surprisingly, the AMA's position has not been widely publicised. Perhaps this is because it has not changed and therefore has no news value in the eyes of some journalists. Or perhaps because the media assumes that the momentum for change is unstoppable. Whatever the reason, the news that the leading organisation for physicians in the US stands firm on its opposition to assisted suicide ought to be spread far and wide. It ought to be congratulated.
Michael Cook is editor of MercatorNet.