ACP reaffirms opposition to physician-assisted suicide

ACP issued a position paper this week reaffirming its opposition to physician-assisted suicide.

The paper, from the Ethics, Professionalism and Human Rights Committee, is an update of the College's 2001 position paper on this topic. It noted that there are arguments on both sides of the issue, with those in support of physician-assisted suicide highlighting respect for patient autonomy and “a broad interpretation of a physician's duty to relieve suffering” and those opposed stressing that physicians should provide care and comfort and should not participate in intentionally ending a life. However, the paper noted that the arguments against legalization of physician-assisted suicide “remain the most compelling.”

The College affirmed a professional responsibility to improve the care of dying patients and their families but does not support the legalization of physician-assisted suicide and noted that its practice raises ethical, clinical, and other concerns.

“The ACP and its members, including those who might lawfully participate in the practice, should ensure that all patients can rely on high-quality care through to the end of life, with prevention or relief of suffering insofar as possible, a commitment to human dignity and management of pain and other symptoms, and support for families,” the paper stated. “Physicians and patients must continue to search together for answers to the challenges posed by living with serious illness before death.”

The position paper also offers a list of 12 steps that physicians should take when caring for patients near the end of life, such as facilitating advance care planning and surrogate decision making and ensuring that the patient is fully informed of the right to refuse treatments and what that entails.

Two editorials accompanying the position paper examined both sides of the issue. One editorial expressed support for the steps for clinicians outlined by ACP but said that “Given the rapidly changing legal environment with regard to physician-assisted suicide and voluntary active euthanasia, we are concerned that concluding a guideline by stating ‘physicians should not do this' is a problematic public health response.” The authors recommend ongoing debate about the ethical and moral implications of allowing or prohibiting potentially life-ending medical practices and believe that all legally available last-resort options should be explored if a patient's requests persist and he or she continues to suffer.

The second commentary called legalization of physician-assisted suicide a “slippery slope” that may lead to abuse and took a strong stance against the practice. The author noted that the tide of opinion may be turning, with more emphasis given to autonomy and self-determination. “Nonetheless, physicians opposed to the provision of euthanasia and medically assisted suicide should not be cowed by attempts to place them ‘outside the mainstream,’” the editorialist wrote. “Where these practices are legal, I believe that physicians should firmly decline to participate.”

In addition, a related review discussed Oregon's Death with Dignity Act, the first law in the United States to allow physicians to prescribe medications to be self-administered by terminally ill patients to hasten death, and looked at the type and number of patients and clinicians who have participated in physician-assisted suicide in the 20 years since the Act was passed. The position paper, the editorials, and the review were published by Annals of Internal Medicine on Sept. 19.