AMA continues to battle over whether to change its position of opposition to PAS to neutrality

By Dave Andrusko

Last June, Jennifer Popik, JD provided NRL News Today readers with a full background report on the AMA’s disappointing decision to continue to review, not maintain, its long-standing opposition to physician-assisted suicide (PAS).

Popik, NRLC Director of Federal Legislation, explained that the vote, taken at the annual meeting of the American Medical Association, came after two years of hard and detailed work examining the dangerous trends and effects of legalizing physician-assisted suicide.

Although the Council on Ethical and Judicial Affairs (CEJA) issued a report to the full AMA recommending the organization maintain their position of opposition to assisted suicide, about 56% of the delegates did not accept the report, sending it back to the CEJA for “further review.”

Which brings us to the AMA’s House of Delegates’ Interim Meeting on Sunday, where, according to Shannon Firth, Washington Correspondent for MedPage, “dozens of physicians made impassioned speeches, clashing over whether to ultimately endorse an AMA policy report that, while it reflected more nuanced views, ultimately left the association’s code intact, declaring PAS ‘fundamentally incompatible with the physician’s role as healer.’”

Firth’s account is the only one I can find, so what follows is based on her reporting and what we’ve know prior to the interim meeting.

* During a committee meeting Sunday morning, James “Jim” Sabin, MD, the CEJA chair, said the council had “revised its report and integrated ‘crucial material’ into its recommendations,’” in response to feedback. According to Firth’s account,

“We believe that the code as it exists is excellent moral guidance to our profession,” said Sabin, of Code 5.7 ,which states the AMA’s opposition to PAS/aid-in-dying and a second Code 1.17 the “Physician’s Exercise of Conscience,” which addresses the concerns of those practicing in states where PAS is legal.

For those who want the AMA to take a position of neutrality on Physician-Assisted Suicide, this “nuanced” position fell well short of the mark.

*A typical, polite critique came from Katalin Roth, MD, a geriatrician who practices in Washington D.C. In lieu of approval of the CEJA report, she urged another “referral,” which would “require the committee to once again rethink and revise its stance,” Firth reported.

Roth told a story of a patient of hers whom she had helped to commit suicide which touched on all the themes PAS supporters offer for her position. Firth noted that Roth said “that she is one of the first physicians in D.C. to write a prescription for a terminally ill patient. (D.C’s Death with Dignity Act became law in February 2017 and became applicable that summer.)”

In fact there is every reason to believe Roth is one of the very few physicians who are “assisting” patients to die in the District of Columbia. A story written by Fenit Nirappil that appeared last April in the Washington Post began:

Nearly a year after the District enacted a law allowing terminally ill patients to end their lives — over the objections of congressional Republicans, religious groups and advocates for those with disabilities — not a single patient has used it.

And just two of the approximately 11,000 physicians licensed to practice in the District have registered to help patients exercise their rights under the law. Only one hospital has cleared doctors to participate. [Underlining added.]

*One other thing from Ms. Firth’s story. She favored the pro-neutrality position by beginning with proponents before giving those who support the current position of opposition. But, to be fair, their arguments (while later in the story) were given space.

Kevin Donovan, MD, director of the Pellegrino Center for Clinical Bioethics, and a professor at Georgetown University, speaking on behalf of himself and his center, said he supported the Council’s report and argued against changing the code of medical ethics.

Donovan urged the AMA not to declare itself “indifferent to suicide.”

“If you don’t equate neutrality with indifference, you may be right … [but] silence gives assent. So, to not speak against this is indirectly an endorsement,” Donovan argued.

The AMA would never take a neutral stance on other “equivalent concerns,” such as female genital mutilation or prisoner torture, so considering a neutral stance in this situation seems irrational, he said.

“Any retreat from our Hippocratic tradition on which the AMA position rests is unwise and unnecessary,” he said.

Vernon Zurick, MD, a radiologist from Boulder, Colorado, spoke from first-hand experience. After PAS/aid-in-dying was adopted in 2016, “advocates began pressuring hospitals, ‘many of whom had ethical issues,’ to carry out the practice, Zurick said.”

He flatly declared “Neutrality is permissibility.”

He also expressed concern that health systems worried about reining in costs could influence the practice of PAS and could hurt the patient-physician relationship. He cited “abuses” by the late Jack Kevorkian, MD, who spent 8 years in prison after being convicted of second-degree murder for assisting in the deaths of roughly 130 people suffering from chronic and usually terminal illnesses who sought his help in ending their lives, according to the New York Times.

“The AMA has wisely stated that we should not help in the execution of prisoners. I think there needs to be a very careful look at whether or not people are being coerced into an early death for reasons [that are not justified] … I think we have other ways to deal with this issue,” Zurick said and urged adoption of the report.