Shane E. Macaulay, MD, is a radiologist with Center for Diagnostic Imaging in Washington state, twice selected as one of Seattle’s Top Doctors, and an AMA Alternate Delegate from Washington state. Dr. Macaulay wrote an excellent article that was published by the MedPage on December 21.
Macaulay comments on the American Medical Association (AMA) assisted suicide debate. For more than two years pro-assisted suicide members of the AMA have been working to change the AMA position on Physician Assisted Suicide (PAS) from opposed to neutral.
Macaulay opposes a change in the AMA position on PAS) and argues that the AMA is moving towards maintaining its opposition to PAS) rather than moving to a neutral position. Macauley wrote:
PAS advocates were dissatisfied by the balanced recommendations offered by the CEJA [Council on Ethical and Judicial Affairs] report, instead insisting that the report be reconsidered until CEJA agree to changing AMA medical ethics. But, increasingly, the AMA delegates are moving towards a rejection of the idea of PAS.
At the AMA meeting in June of 2018, the HOD [House of Delegates] declined to endorse the CEJA report, referring it back for further study by a margin of 10% of votes cast. However, at the recent November 2018 AMA meeting, the CEJA report was nearly accepted, missing by only 3%. As the delegates hear the logical flaws in the arguments used to push PAS, these arguments are losing appeal. Among the pro-PAS arguments debunked by physicians defending the 2,400-year-old Hippocratic tradition that physicians “give no deadly medicine” are the argument of neutrality and the argument that patient autonomy should determine medical ethics.
Macauley continued, “PAS advocates claim that the AMA must adopt neutrality because there are divided views on PAS. Eminent bioethicist and physician from Georgetown University, Dr. Daniel Sulmasy, decisively debunked the neutrality argument in his recent article in the Journal of General Internal Medicine.
In that article Dr. Sulmasy maintained that
“Neutrality is not neutral. To change from opposition to neutrality represents a substantive shift in a professional, ethical, and political position, declaring a policy no longer morally unacceptable; the political effect is to give it a green light.
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“Some might argue that neutrality is necessary because there are jurisdictions in which members of medical organizations can prescribe PAS legally. But exceedingly few physicians engage in the practice even in jurisdictions where it is legal, and the fact that some members do so does not require any professional body to be ‘neutral’ with respect to that practice. As a logical counter-example… to the thesis that professional neutrality is required if a medical practice is legal, consider the fact that physician participation in capital punishment is legal in 30 states. This fact does not affect the ethical opposition that the profession takes, nor has organized medicine felt compelled to give instructions on how to execute prisoners well for those few members who do this.”
Macauley went on to explain
Patient autonomy has been suggested as a justification for PAS. However, no physician would amputate a patient’s healthy limb just because the patient wishes it done. Physicians don’t give certain drugs or perform certain procedures that are absolutely contraindicated, even if the patient requests it, because physicians are required to use their knowledge to protect the patient. Patient autonomy is important, but never the only factor in a decision, and is never used to determine overarching professional ethics.
PAS advocates also want to “hide the ball” on PAS, obscuring the fact that it is suicide by giving it pleasant but unclear names like “physician aid in dying.” CEJA rightly rejected this, noting that “the term physician-assisted suicide describes the practice with greatest precision. More 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 AMA is moving towards a reaffirmation of its historic and vital policy opposing PAS, which will best guide physicians and protect patients.