The American College of Physicians, the second-largest physician group in the United States with 152,000 members, has declared that physician-assisted suicide (PAS) is unethical.
The ACP takes a forthright stand in the latest issue of the Annals of Internal Medicine. Supporting appendicies covering most of the arguments for and against physician-assisted suicide (PAS). Currently PAS is legal in Oregon, Washington, Montana, Vermon, California, Colorado and the District of Columbia, followiing ballot initiatives, legislation or a court order. Although the ACP recognises the depth of feeling in the debate, it has not budged from opposition. Its conclusion is:
The ACP does not support the legalization of physician-assisted suicide, the practice of which raises ethical, clinical, and other concerns. The ACP and its members, including those who might lawfully participate in the practice, should ensure that all patients can rely on high-quality care through to the end of life, with prevention or relief of suffering insofar as possible, a commitment to human dignity and management of pain and other symptoms, and support for families. Physicians and patients must continue to search together for answers to the challenges posed by living with serious illness before death.
In a sense, the ACP position paper is very “traditional” in its concerns and arguments. It even jibs at woolly terminology used in the debate:
Terms for physician-assisted suicide, such as aid in dying, medical aid in dying, physician-assisted death, and hastened death, lump categories of action together, obscuring the ethics of what is at stake and making meaningful debate difficult; therefore, clarity of language is important.
and it endorses concerns about “slippery slopes”, even though this is often ridiculed by supporters of PAS:
research suggests that a “slippery slope” exists in jurisdictions where physician-assisted suicide and euthanasia are legal.
The position paper asks whether the goal of medicine is the elimination of all suffering:
Just as medicine cannot eliminate death, medicine cannot relieve all human suffering; attempting to do so ultimately leads to bad medical care.
It also points out that physicians gain power when PAS is legalised – it could be viewed as a return to paternalism. And it suggests that legalisation neglects other priorities: “advocating for physician-assisted suicide where there is no general right to health care and access to hospice and palliative care services is limited, especially in an era of health care cost containment, is ironic.”
Would legalisation change the ethics of PAS for doctors? The ACP says No:
Despite changes in the legal and political landscape, the ethical arguments against legalization of physician-assisted suicide remain the most compelling. We are mindful that ethics is not merely a matter for a vote. Majority support of a practice does not make it ethical. Medical history provides several cautionary examples of laws and practices in the United States (such as racial segregation of hospital wards) that were widely endorsed but very problematic.
This position paper is an thoroughly-researched document from an authoritative source. It deserves to be read and spread wherever euthanasia is discussed.
Michael Cook is editor of MercatorNet and also of the online bioethics newsletter BioEdge, where this article was first published.