REPORT OF THE COLINCIL ON ETHICAL AND JUDICIAL AFFAIRS- CEJA

Subject:
Presented
by:
Refened
to:
REPORT
OF
THE
COLINCIL
ON
ETHICAL
AND
JUDICIAL
AFFAIRS-
CEJA
Report
5_A_lg
Study.Aid-in-Dying
as
End-of_Life
Option
(Resolution
l5-A-16)
The
Need
to
Distinguish
« physician-Assisted
Suicide,,
and
,,Aid
in
Dying,,
(Resolution
14-A-tl)
Dennis
S.
Agliano,
MD,
Chair
Reference
committee
on
Amendments
to
constitution
and
Bylaws
(Peter
H.
Rieinstein,
MD,
JD,
MS,
Chair)
I
At
the2016
AnnualJVleeting,
the
House
of
Delegates
referred
Resolution
l5-A-16,.,Study
Aid-in-
2
Dyingas
End-of-Life
option, »
presented
by
thebregon
oeiegation,
which
asked:
3
4
That
our
American
Medical
Association
and
its
council
on
Judicial
and
Ethical
Affairs,
study
5
the
issue
of
medical
aid-in-dying
with
contioeratlon
oiit;
ou,u
collected
from
the
states
that
6
currently
authorite
aid-in-dyingland
(2)
input
from
some
of
the
physicians
who
have
provided
7
medical
aid-in-dying
to
quulln.o
patients,
and
report
back
to
the
HoD
ar
the
2017
Annual
8
Meeting
with
« comt.ndution
regarding
the
AMA
taking
a
neutral
stance
on
physician
,.aid-
9
in_dying.,,
10
1
I
At
the
following
Annual
Meeting
in
June
2017,
the
House
similarly
refened
Resolution
14-A-17,
12
The
Need
to
Distinguish
between
‘Physician-Assisted
suiciJe’
and
,Aid
in
Dying’,,
(presented
by
l3
M.
ZuhdiJasser,
MD),
which
asked
that
our
AMA:
14
I
5
(
1
)
as
a
matter
of
org^anizational
policy,
when
referring
to
what
it
currently
defines
as
l6
‘Physician
Assisted
suicide’
avoidany
replacement
wTth
ttre
phrase
,Aid
in
Dying,
when
17
describing
what
has
long
been
understood
by
the
AMA
to
specificall
y
be,
physician
Assisted
l8
suicide
‘;
(2)
develop
definitions
and
a
clear
distinction
between
what
is
meant
when
the
AMA
l9
uses
the
phrase
‘Physician
Assisted
suicide’andthe
ph;.
,Aid
in
Dying,;
and
(3)
fully
utilize
20
these
definitions
and
distinctions
in
organizational
policy,
discussions,
and
position
statements
3:
regarding
both’physician
Assisted
suicide’
and
‘A’icr
rnbying.,
23
This
report
by
the
council
on
Ethical
and
Judicial
Affairs
(CEJA)
addresses
the
concems
expressed
24
in
Resolutions
I
5-A-
16
and
14-A-
I
7.
In
carrying
out
its
review
of
issues
in
this
area,
cEJA
25
reviewed
the
philosophical
and
empirical
literatJre,
rougtl
inprt
from
the
House
oi
Delegates
26
through
an
I-16
educational
program
on
physician-assisied
suicide,
an
informal
,,open
house,,
at
A-
27
17,
and
its
I-17
open
Forum.
th1
council
wishes
,o
. »pr.r,
ii,
sincere
appreciation
for
28
participants’
contributions
during
these
sessions
and
for
additional
written
communications
29
received
from
multiple
stakeholJers,
which
have
enhanced
its
deliberations.
Reports
of
the
council
on
Ethical
and
Judicial
Affairs
are
assigned
to
the
Reference
committee
on
Amendments
to
constitution
and
Bylaws.
They
may
be
aoopteo]
not
adopled,
or
referred.
A
report
may
nor
be
amended,
except
to
clarifu
the
meaning
of
tire
report
and
only
with
the
concurrence
of
the
council.
O
2018
American
Medical
Association.
All
rights
reserved.
CEJA
Rep.5_A_18
__
page
2
of
8
I
The
c0uncil
observes
that
the
ethical
arguments
advanced
today
supporting
and
opposing
2
« physician-assisted
suicide »
or
« aid
in
Jying »
*.
r.rnour*tally
unchanged
from
those
examined
3
in
cEJA’s
1991
repo’t
on
this
topic
[.1].
Th;pl.* »i;;;;
doei
not
rehJarse
it.r.
urgun,, »nts
again
4
as
such’
Rather,
it.considers
ttre
imptication,
of
th.
bgtrliitionof
assisted
suicide
in
the
United
5
states
since
the
adoption
of
opinion
E-5.7,
,,physiciai-Assisted
Suicide,,,
in
1994.
6
7
« ASSISTED
SUICIDE,' ».AID
IN
DYING, »
OR
« DEATH
WITH
DIGNITY »?
8
9
Not
surprisingly’
the
terms
stakeholders
use
to
refer
the
practice
of
physicians
prescribing
lethal
l0
medication
to
be
self-administered
by
patients
in
many
ways
reflect
the
different
ethical
I
I
perspectives
that
inform
ongoing
societal
delate.
rtoion#tr
of
physician
participation
often
use
12
language
that
casts
1l:
q*:li:r
in
a
positive
light.
« Death
with
dignity,,
foregrounds
patienrs,
l3
values
u »o
tollt-1
*,nite
.'{!
in
dying ».invokeJpnysiciunr’
« o*ritmint
to
rIr.o,
and
suppo(.
14
Such
connotations
are
visible
in
iheiitles-of
r »l; »;;;
r;irtuiion
in
states
that
have’tegalized
the
l5
practice:
« o »u*
yit!-!1ryity »
(oregon,rMashington,
sistrict
of
columbia),
,,patienr
choice
and
16
control
at
the
End
of
Life »
(vermon-t),
‘lEnd
of
L »if,
6tion;,'(california,
colorado),
and
in
17
Canada’s
,,Medical
Aid
in
Dying.’,
t8
19
correspondingly,.those
who
oppose
physician
provision
of
lethar
medications
refer
to
the
practice
20
as
« physician-assisted
suicide,;’
with’iti
negativ.
« onnor*ions
regarding
patients,
psychological
21
state
and
its
suggestion
that
physicians
are
complicit
in
somethin!
that,ln
otne.
co|,te*ts,
they
22
would
seek
to
prevent.
The
ianguage
of
dignity
anJ
ui;,;i;irs
contend,
are
euphemisms
[2];
their
23
use
obscures
or
sanitizes
the
aciiviiy.
tn
thiir
ui.*
.rrn
iungrug.
characterizes
physicians,
role
in
3:
a
way
that
risks
construing
an
act
that
is
ethically
,;;;;.pt;ile
as
good
medical
practice
[3].
26
The
council
recognizes
that
choosing
one
term
of
art
over
others
can
carry
multiple,
and
not
always
27
intended
messages.
However,
in
the-absenc.
oru
prr[riopiion,
GEJA
believes
ethical
deliberation
28
and
debate
is
best.served
by
using
plainly.descripti ».
i;d;;ge.
In
rhe
council,s
view,
despire
its
29
negative
connotations
[4],
the
term' »phyiician
aisisted
r;;i]. »
describes
the
practice
with
the
30
greatest
precision,
Yotl.iTpgnantly,
it
clearly
distinguishes
the
practice
from’euthanasia
[1].
The
11
terms
« aid
in
dying »
or
« death
*ittr
oigrity »
could
be »used
io
describe
either
euthanasia
or
13
5fi[X[X,}|;pice
care
at
the
end
of
li-fe
and
this
degree
lialuiguity
i,
«  »u…ptufre
for
providing
34
35
COMMON
GROLIND
36
3’7
Beneath
the
seemingly
incommensurate
perspectives
that
feature
prominently
in public
and
38
professional
debate-about
writing
a
prescription
,o
prouiJ.
pol.nu
with
the
means
to
end
rife
if
39
they
so
choose,
cEJA
perceives
a
aeepty
and
broadly
strarei-vision
of
what
matters
at
the
end
of
40
life’
A
vision
that
is
characteri
zedby
hope
for
a
deatl
that
pieserves
dignity,
a sense
of
the
41
sacredness
of
ministering
to
a
patient
ut
ih »
end
of
life,
rr.Jlnitio »
ortf,e
reiier
of
suffering
as
the
42
deepest
aim
of
medicine’
and
fully
voluntary
participation
oi
the
part
of
both
patient
and
physician
43
in
decisions
about
how
to
approach
the
end
oilife.
44
45
Differences
lie
in
theforms
these
deep
commitments
take
in
concrete
decisions
and
actions.
CEJA
46
believes
that
thoughtful,
morally
admlrable
individuals
hold
diverging,
yet
equally
deeply
held,
and
4’7
well-considered
perspectives
about
physician-assisted
suicide
that
govern
how
these
shared
48
commitments
are
ultimately
expressed.
For.one
patient,
dying..with
dignity,,may
mean
accepting
49
the
end
of
life
however
it-comei
as
gracefully
u,
on.
can;’for »another,
it
may
mean
being
able
to
50
exercise
some
measure
of
control
over
the
circumstances’in
which
death
occurs.
For
some
5l
physicians,
the
sacredness
of
ministering
to
a
terminally
ill
or
dying
patient
and
the
duty
not
to
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