June 12, 2018
Physicians argued passionately for and against assisted dying here at the American Medical Association (AMA) 2018 Annual Meeting after a report on the subject was introduced on the first day of reference committee hearings.
"This one has more online testimony than everything else we have, put together," said Peter Rheinstein, MD, JD, chair of the reference committee on amendments to constitution and bylaws, as dozens of speakers lined up at the microphones.
The report — by the Council on Ethical and Judicial Affairs — is the result of 2 years of study on how to interpret the Code of Medical Ethics in light of the increasingly polarized debate on physician-assisted dying.
The conclusion of that work is that the code should not be amended because it already provides support to physicians and patients making "mutually respectful decisions" about legal options for end-of-life care.
On Monday, the House of Delegates voted to refer the report for additional information and discussion at a future policy-making meeting, so the existing guidance in the Code of Medical Ethics remains unchanged.
"Physician-assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks," the code states.
'There's No Care in Assisted Suicide'
Luis Alvarado, MD, an internist representing the Louisiana State Medical Society, spoke in opposition to amendments to the code.
He read the following statement from his delegation: "Change in the position on physician-assisted suicide would be in direct opposition to [the Hippocratic] Oath. As physicians, we are granted the opportunity and the skill to help our patients live. We should not decide when our patients should die. The physician–patient relationship has always been rooted in care, and there's no care in assisted suicide, only death."
Elizabeth Morrison, MD, a psychiatrist in private practice in Chevy Chase, Maryland, urged the committee to send the report back for review. She said suicide is "fundamentally different" from what doctors are being asked to assist with.
"I have treated many, many suicidal patients over the course of my career and physician-aided dying is not suicide in the way I treat suicidal patients who have a future and have a future quality of life that people at the end of life do not," she explained. "People at the end of life are not suicidal. They want to live but for their pain and suffering. They wish to have options to have autonomy and control over the end of their life. That is fundamentally different from suicide."
Report's Conclusion 'Unacceptable'
Timothy Fagan, MD, an internist and an alternate delegate from the Arizona Medical Association, speaking for himself, called the conclusion of the report "unacceptable."
"The rest of the code of ethics has been modernized, but the end-of-life issues are about 25 years old," he said. "The code begs to be rewritten."
The code suggests dire ramifications for society if physician-assisted suicide is allowed, but "we have 20 years' experience in Oregon that shows that doesn't happen," he pointed out.
In 1997, Oregon passed the Death With Dignity Act, through a voter-approved ballot initiative, and became the first state to allow physician-assisted dying. In the 20 years since, 0.2% of the deaths in Oregon resulted from death with dignity prescriptions, as reported by Medscape Medical News.
Kenneth Stevens, MD, an oncologist from Portland, Oregon, said that that the AMA position should not change because sometimes patients' wishes do.
He described a woman who came to him 18 years ago with inoperable anal cancer. Because her surgeon had given her as few as 6 months to live, she was eligible for assisted dying, which she had voted for.
He laid out her treatment options and she declined medical therapy. But she came back weekly for 3 weeks and, in that time, Stevens convinced her to undergo treatment.
The woman had a son in his 20s who was going to the police academy and didn't know about her diagnosis.
"I asked her, wouldn't you like to see him get married and graduate from the police academy? he told Medscape Medical News. "That made her realize she had something to live for."
'You Saved My Life'
The treatment was successful and, "5 years later, when she saw me at a restaurant, she said, 'Dr Stevens, you saved my life. If I had gone to a doctor who believed in assisted suicide, he would have agreed with me and I'd be dead.' Instead, she's alive and now 73 years old.
A 2015 Gallup poll reported that 68% of people in the United States said physicians should be able to help patients end their lives, up 10 percentage points from the year before.
Alvarado, Morrison, and Fagan have disclosed no relevant financial relationships. Stevens is vice president of the Physicians for Compassionate Care Education Foundation.