American Medical Association: Call It ‘Physician-Assisted Suicide,’ Not ‘Aid-in-Dying’

Patrick Goodenough | June 12, 2019 | 4:45am EDT
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(Photo by Carsten Koall/ Getty Images)

( – Advocates of assisted suicide are dismayed that the largest association of physicians in the U.S. has decided to continue using the term “physician-assisted suicide” rather than euphemisms such as “medical aid-in-dying.”

Meeting in Chicago on Monday, the American Medical Association, by a vote of 360-190, adopted a report by its Council on Ethical and Judicial Affairs (CEJA) recommending that the term “physician-assisted suicide” continue to be used.

Significantly, the AMA also voted to reaffirm its Code of Medical Ethics’ current policy on assisted suicide – the view that allowing doctors to help patients to die “is fundamentally incompatible with the physician's role as healer.” That vote was 392-162.

In contrast to euthanasia – where a doctor actively ends a patient’s life – physician-assisted suicide occurs when a doctor provides the means or information that enables a patient to commit suicide.

CEJA had been commissioned to review the policy on physician-assisted suicide, which is now permitted in seven states and the District of Columbia, and also to examine “the need to distinguish between ‘physician-assisted suicide’ and ‘aid-in-dying.’”

Its report noted that the terms used by people on either side of the issue, “not surprisingly,” reflect the different ethical perspectives.

“Proponents of physician participation often use language that casts the practice in a positive light,” CAJA said, adding that the term “‘aid in dying’ invokes physicians’ commitment to succor and support.”

This can be seen in the terminology featured in relevant state legislation: “Death with Dignity” appears in legislation enacted in Oregon, Washington and D.C.; “End of Life Options” in California and Colorado; “Our Care Our Choice” in Hawaii; and “Patient Choice and Control at the End of Life” in Vermont.

CEJA observed that those on the other side of the argument say such language is euphemistic and “obscures or sanitizes the activity.”

They in turn favor “physician-assisted suicide,” a term which the report said has “negative connotations regarding patients’ psychological state and its suggestion that physicians are complicit in something that, in other contexts, they would seek to prevent.”

CEJA concluded, however, that it’s best to use “plainly descriptive language,” and that, “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.”

Word choice in the assisted suicide debate has long been contentious, mirroring the situation in the debate over abortion (“pro-life” vs. “anti-abortion,” “pro-choice” vs. “pro-abortion,” “fetal heartbeat” vs. “embryonic pulsing,” and “partial-birth abortion” vs. “intact dilation and extraction.”)

Compassion & Choices – an advocacy group whose name points to the deliberate use of language in the euthanasia debate – criticized the AMA decisions.

“Leading AMA member societies that provide care for dying patients have adopted value-neutral terminology to describe medical aid in dying, including the American Academy of Hospice and Palliative Medicine, the American Academy of Family Physicians, and the American Academy of Neurology,” said the group’s national medical director, Dr. David Grube.

“Yet, sadly the AMA ignores this fact and clings to ‘physician-assisted suicide’ despite its Council on Ethical and Judicial Affairs’ admitting the term has ‘negative connotations.’”

‘A prescription for death’

The AMA’s current policy on assisted suicide, retained by vote on Monday, is based on an ethics “opinion” stating that allowing physicians to help patients to end their lives “is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks.”

“Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life,” it adds.

However the AMA has a separate “opinion” on the broader issue of “physician exercise of conscience,” which stresses the importance of “[p]reserving opportunity for physicians to act (or to refrain from acting) in accordance with the dictates of conscience in their professional practice.”

That opinion does not refer directly to assisted suicide. It does say physicians are expected to “honor patients’ informed decisions to refuse life-sustaining treatment.”

In its report, CEJA cited both “opinions,” saying that the first “powerfully expresses the perspective of those who oppose physician-assisted suicide,” while the second “articulates the thoughtful moral basis for those who support assisted suicide.”

“CEJA recommends that the Code of Medical Ethics not be amended.”

Pointing to the two opinions, Grube said, “It defies basic logic for the AMA [to] maintain that medical aid in dying is unethical, but that ethical physicians can provide it.”

(Photo by Sandy Huffaker/Getty Images)

The Patients’ Rights Action Fund, which opposes assisted suicide, applauded the AMA decision.

“Today was a big win for patients as the AMA sides with them and people with disabilities who would be at risk for deadly harm through mistakes, coercion, and abuse, all the while carefully guarding the trust upon which the patient-physician relationship is based,” said the group’s executive director, Matt Vallière.

“Patients deserve care and protection, not a prescription for death.”

Euthanasia Prevention Coalition executive director Alex Schadenberg also welcomed the fact the AMA’s policy “continues to refer to assisted suicide as unethical.”

“Prescribing lethal drugs to patients is a form of abandonment because it denies a person, at the most vulnerable time of their life, the care and support that they need,” he said in an email.

“Assisted suicide is not healthcare because it replaces effective treatment and care with harsh lethal drugs,” Schadenberg said. “I hope that the decision of the AMA delegates will enable politicians to also reject assisted suicide.”

Grube of Compassion & Choices is a former president of the Oregon Medical Board. He wrote “medical aid-in-dying” prescriptions in that state, after it became the first jurisdiction in the U.S. to legalize doctor-assisted suicide, 22 years ago.

Beyond Oregon, assisted suicide is now legal in D.C. and California, Colorado, Hawaii, Montana, Vermont, and Washington. New Jersey’s “Aid in Dying for the Terminally Ill Act” is due to take effect on August 1, and legislation is awaiting the signature of Maine Gov. Janet Mills, after narrowly passing the state’s Democratic-controlled House and Senate.

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