Great news: American Medical Association affirms it's opposition to assisted suicide.

The American Medical Association (AMA) has affirmed it's opposition to assisted suicide on June 9 at their House of Delegates Annual Meeting.

The following text is from the HOD Handbook as approved at the AMA meeting. This text can be found, starting on page 7 and is referred to as Report 18-A-25.

Of note, the AMA’s position on physician assisted suicide is not a position of neutrality and establishes that the profession of medicine should not support the legalization or practice of physician assisted suicide or see it as part of a physician’s role.

Physician assisted suicide occurs when “a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform a life-ending act”. This act is sometimes referred to using other terminology such as medical aid in dying. Currently, there is no federal law governing physician assisted suicide; therefore, individual states are permitted to determine their own legal stance. At this time, 10 states and the District of Columbia permit this practice; however, most states have legislation banning this practice. Furthermore, two states have removed their residency requirement, effectively opening the practice of physician assisted suicide more broadly to patients throughout the US. 

Our AMA has a long-standing policy (H-270.965) opposing the legalization of physician assisted suicide. That said, our AMA is also opposed to the criminalization of physician medical judgement and the regulation of medical practice through criminal penalties (H-160.954, D-160.911, D27 275.944, H-5.980, D-5.999). Additionally, our AMA has policy preserving a physician’s right to exercise their autonomy (H-405.958, Code of Medical Ethics Opinion 1.1.7).

DISCUSSION 

The referred resolution addresses several issues encompassed within the broad context of physician-assisted suicide: terminology, opposition to the legalization and practice of physician assisted suicide, and opposition to the criminalization of physician participation in assisted suicide. This report addresses these topics in the context of our AMA’s current HOD policies and Code of Medical Ethics guidance. In addition, the Council on Ethical and Judicial Affairs has produced two informational reports to further discuss the ethical complexity of these topics as they relate to physician assisted suicide and the practice of medicine. 

Terminology 

The terminology used in the AMA Code of Medical Ethics and HOD policy to describe this practice offers a clear delineation of intent and action. The use of other terminology to describe this practice has the potential to confuse patients and unduly influence decision making [5]. Descriptors such as Medical Aid in Dying (MAID), physician aid-in-dying, and death with dignity could apply to palliative care practices and compassionate care near the end of life that do not include intending the death of patients. In CEJA Report 2-A-19, “Physician Assisted Suicide,” the Council determined that PAS was the terminology which described the practice best. The report supported this supposition with the following analysis which remains valid:

The Council recognizes that choosing one term of art over others can carry multiple, and not always intended messages. However, in the absence of a perfect option, CEJA believes 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. 

Opposition to the legalization and practice of physician assisted suicide 

AMA policy opposes the legalization and practice of physician assisted suicide stating that it is “fundamentally incompatible with the physician’s role as a healer”. In developing CEJA Report 2 (A-19) which informed our AMA’s current ethics standards on physician assisted suicide, the Council on Ethical and Judicial Affairs analysis and deliberations were informed by available data and research. However, its decision was not an empirically dictated one, but rather, it was driven by the core values of medicine preserved within the Code of Medical Ethics. 

Although legislative developments since 2019 have occurred, recent empirical data reviewing physician assisted suicide practices in US and international jurisdictions where PAS and/or euthanasia are legal are subject to varied interpretations. As a matter of ethical reasoning, the data does not settle the ethical issue. Additionally, the relevant core ethical values at stake have not changed since the adoption of CEJA Report 2 (A-19). As such, the AMA’s position on physician assisted suicide should remain unchanged. 

Of note, the AMA’s position on physician assisted suicide is not a position of neutrality and establishes that the profession of medicine should not support the legalization or practice of physician assisted suicide or see it as part of a physician’s role.

Previous articles on the AMA assisted suicide position:

• American Medical Association (2023) maintains its opposition to assisted suicide (Link).
• Psychiatrists must prevent euthanasia, not provide it (Link).
• American Medical Association (2019) opposes assisted suicide (Link).
• American Medical Association (2019) overwhelmingly upholds its opposition to assisted suicide (Link).
• American Medical Association (AMA) (2018) Ethics Committee maintains opposition to assisted suicide (Link).