AMA: Ethics Code Supports Opponents, Proponents of Physician-Assisted Suicide

The AMA Code of Medical Ethics supports physicians who oppose as well as support physician-assisted suicide, according to a report by the AMA’s Council on Ethical and Judicial Affairs (CEJA).

The report, which addresses one of the most divisive issues in contemporary medicine, was adopted by the House of Delegates at its Annual Meeting last month in Chicago by a vote of 360-190.

The council recommended no change to the Code of Medical Ethics as currently written. Opinion E-5.7 of the code states, “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.” Yet the council also found that the so-called “conscience code,” expressed in Opinion 1.1.7, provides support to physicians who choose to participate in physician-assisted death in jurisdictions where it is legal. That opinion states: “Preserving opportunity for physicians to act (or to refrain from acting) in accordance with the dictates of conscience in their professional practice is important for preserving the integrity of the medical profession as well as the integrity of the individual physician, on which patients and the public rely. Thus, physicians should have considerable latitude to practice in accord with well-considered, deeply held beliefs that are central to their self-identities.”

(Opinions within the code are deliberated by the council as issues emerge and reviewed by the House of Delegates.)

Crafting a report that offered ethical guidance on such a divisive issue was a difficult needle to thread. While the report was the third iteration of CEJA’s effort, it differed little from the one that the House sent back to the council last year.

Importantly, CEJA emphasized that physicians approach the issue of physician-assisted suicide with “irreducible differences of opinion.” The report stated: “While supporters and opponents of physician-assisted suicide share a common commitment to ‘compassion and respect for human dignity and rights,’ they draw different moral conclusions from the underlying principle they share.”

Even the name given to the practice is contentious, with proponents insisting that patients with terminal illness seeking to end their lives with medical assistance should not be conflated with individuals who are suicidal when they have years of life yet to live.

“The council recognizes that choosing one term of art over others can carry multiple, and not always intended, messages,” the report stated. “However, in the absence of a perfect option, CEJA believes ethical deliberation and debate are 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.”

The subject of physician-assisted suicide/death has become important for psychiatrists who may be called upon to perform competency assessments (Psychiatric News) for patients seeking assisted death.

This year’s report was endorsed in the House by several past AMA presidents, and a majority of physicians in the House appeared to recognize that the CEJA report was a judicious expression of ethical opinion on a topic that raises the most fundamental questions of what it means to be a doctor.

“When a physician prescribes a lethal dose of drug to a patient in full knowledge of the express wish of that patient to take that dose in order to end [his or her] life, we are all faced with a moral dilemma,” said Jeff White, M.D., an internist from Louisiana. “CEJA has done our profession a great service by not running away from that dilemma, but it has done an even greater service by recognizing that physicians hold divergent moral convictions as to the rightness or wrongness of that act and that a physician may act in a proper exercise of conscience if the physician chooses this act in a jurisdiction where the greater society has legalized it.

“The report is a wise and just compromise,” White said. ■

The CEJA report is posted here. Three articles in Psychiatric News that examine this subject are posted here, here, and here.