Monday, July 23, 2018

AMA grapples with assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Worchester Telegram published an excellent article on July 22, 2018 by Dr Thomas E. Sullivan concerning the American Medical Association (AMA) assisted suicide debate. 

Dr Sullivan is the Past President of the Massachusetts Medical Society, the past chair of the New England delegation to the AMA and he is currently an American Medical Association delegate.

Sullivan begins his article by expressing his surprise that the AMA House of Delegates sent recommendations from the AMA Council on Ethical and Judicial Affairs (CEJA) back for clarification. Sullivan explains:
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.
Sullivan encourages people to read the CEJA Report (Link) which represented a two-year extensive re-examination of this complex dilemma. Sullivan states that 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. Sullivan then address some of the issues contested by AMA delegates:
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.”
... 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.
Sullivan adds his own opinion to the assisted suicide debate:
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.”

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.
Sullivan strongly supports for the CEJA assisted suicide report:
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.
...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.
The Euthanasia Prevention Coalition recognizes that the assisted suicide lobby is working to have their supporters become delegates at the AMA annual convention. It is the responsibility of our supporters to also work to become AMA convention delegates.

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