OPPOSITION TO ASSISTING SUICIDE REMAINS AMA POLICY

By Burke J. Balch, J.D.,
Director, Robert Powell Center for Medical Ethics

Still another attempt to reverse the American Medical Associ-ation's (AMA) long-standing position that assisting suicide is not a legitimate medical practice was thwarted last month. The AMA House of Delegates, at its annual meeting in Chicago, adopted a substitute resolution in place of one offered by the Wisconsin Medical Association that would have effectively reversed the AMA's anti-assisting suicide policy.

Instead, the committee to which the resolution was referred offered a substitute resolution focusing on protecting physicians who appropriately prescribe pain management, without any mention of a policy on assisting suicide. The House of Delegates adopted this substitute resolution June 26.

The AMA's own house newspaper outlined the issue's significance in a story published on the eve of the vote: "Passage would signal a startling change of past AMA policy, which has been staunchly against assisted suicide."

Indeed, the AMA has long opposed legalizing euthanasia. Its formal policy states, "Physician assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks."

The defeated resolution took aim at Attorney General John Ashcroft's 2001 ruling that assisting suicide is not a "legitimate medical practice," with the consequence that under federal law federally controlled narcotics and other dangerous drugs may not be used to assist suicide.

In November 2001, the AMA endorsed Ashcroft's ruling. (The ruling is not currently in effect, pending the outcome of a lawsuit challenging it.)

"Physicians have a fundamental obligation to 'do no harm,' and the AMA has consistently held that physician-assisted suicide falls outside the realm of legitimate medical practice," Dr. Yank Coble, then AMA president-elect, said in 2001. "We see nothing in this decision to concern physicians committed to aggressive pain treatment at the end of life."

Since then, the twice-yearly meetings of AMA delegates have seen repeated attempts to pass resolutions reversing this position and putting the AMA on record in opposition to the Ashcroft Directive. Proponents have argued that this would interfere with proper palliative care. To date, all such misrepresentations have failed.

Many physicians were instrumental in defeating the proposed resolution. For example, there was the letter sent by Dr. Daniel P. Sulmasy to delegates. Professor of medicine and director of the Bioethics Institute at New York Medical College, Dr. Sulmasy assured delegates, it "is thoroughly misguided" to believe that the Attorney General's position would have a "chilling effect" on physicians.

Sulmasy's letter carried particular weight because he was the author of the American College of Physicians' position paper that opposed the legalization of physician-assisted suicide.

His most trenchant comment came near the end of his letter. Dr. Sulmasy wrote,

"Third, pain is treated with opioids or other analgesics. Physicians who assist patients with suicide use lethal doses of barbiturates. No attorney general or DEA [Drug Enforcement Administration] official is going to confuse a prescription for sixty milligrams of oral long-acting morphine with a prescription for two thousand milligrams of secobarbital to be taken at once with a plastic bag wrapped around one's head."

Burke J. Balch, J.D., director of the National Right to Life Committee's Department of Medi-cal Ethics, lauded the delegates' action.

"The AMA's retention of its anti-euthanasia policy is in significant part attributable to the repeated mobilization of grassroots pro-lifers, and especially pro-life physicians, who have urged delegates not to betray the medical profession's long history of protecting vulnerable life," he said. "We must, however, remain vigilant, since this is not likely to be the last attempt to subvert the medical profession's stance as a critical bulwark against the legalization of euthanasia."