“Death with dignity” or “aid in dying” seem to be gathering pace in the United States, now that Hawaii has joined the list of states which permit it. But how does the American Medical Association stand?
According to a recent decision by its Council on Ethical and Judicial Affairs, squarely against it.
The AMA has been under pressure to modify its stand. The American
Academy of Hospice and Palliative Medicine
has adopted a position of “studied neutrality”. Physicians from Oregon are lobbying within the AMA for neutrality, if not outright endorsement.
The CEJA studied the growing literature on “death with dignity” and recently issued a report which gave it a resounding thumbs-down.
In report 5-A-18, the CEJA declared firmly that
in its current form the Code offers guidance to support physicians and the patients
they serve in making well-considered, mutually respectful decisions about legally available options
for care at the end of life in the intimacy of a patient-physician relationship. The Council on Ethical
and Judicial Affairs therefore recommends that the Code of Medical Ethics not be amended.
The tone of the report was studiously calm and respectful. It acknowledged that “thoughtful, morally admirable individuals hold diverging, yet equally deeply held, and
well-considered perspectives about physician-assisted suicide”.
However, it made several pointed observations.
Terminology is important. Should a doctor’s participation in a patient’s death be called “assisted suicide,” “physician assisted suicide”, “aid in dying,” or “death with dignity”? The CEJA insists that the term should be “assisted suicide”. Why?
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
Neutrality is out. From an ethical point of view, “studied neutrality” is a way of escaping from “irreconcilable differences”. Instead of debating issues, they are ignored. But the CEJA notes that “studied neutrality has been criticized as being open to
unintended consequences, including stifling the very debate it purports to encourage or being read
as little more than acquiescence with the contested practice”.
The evidence suggests that there are “unintended consequences”. Supporters of “death with dignity” argue that claims that physician-assisted suicide is hard to manage and puts society on a slippery slope are “flawed, inadequate, or distorted”
But the CEJA believes otherwise. “Current evidence from Europe does tell
a cautionary tale,” it says. Fears of euthanasia for psychological problems, the slippery slope, lack of government control. The report says:
Medicine must also acknowledge, however, that evidence (no matter how robust) that there have
not yet been adverse consequences cannot guarantee that such consequences would not occur in the
future. As a recent commentary noted, “[p]art of the problem with the slippery slope is you never
know when you are on it”
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