Physician-assisted dying has deeply divided the medical community. Photo courtesy of Creative Commons

Why American doctors need to hold the line on physician-assisted suicide

Physician-assisted dying is a deeply divisive issue in the medical community. Photo courtesy of Creative Commons

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(RNS) — The American Medical Association’s official opposition to physician-assisted suicide is admirable and clear: “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 AMA currently insists, in other words, that health care providers focus on killing the pain, not the patient.

But in June, at their annual meeting in Chicago, the AMA's House of Delegates voted to continue to review the policy, with assisted-suicide supporters arguing for the group to take a neutral stance. In a move last month that was called "startling" by the president of the Catholic Medical Association, the American Association of Family Physicians — whose New York chapter already supports the practice — changed its official position on physician-assisted suicide from opposed to neutral.

Then, this week at the AMA House of Delegates’ interim meeting, the discussion over assisted suicide was so vociferous that it “could split the association,” reports say. The debate was so divisive that delegates, while at least temporarily leaving the current opposition to physician-assisted suicide intact, were forced to yet again refer the discussion back to committee, thus setting up an even more disruptive battle for next summer’s meeting.

The trend has been running in this direction for several years. Eight U.S. states have now passed laws permitting physician-assisted suicide, and a younger group of resident physicians appears ready to abandon the wisdom of nearly every professional code of medical ethics going back to the Hippocratic oath.

The intense debate on this issue touches the very foundations of the profession. What counts as health care? What does it mean to be a professional physician? Should eminent medical organizations bend their views to provide access to what a handful of states have legalized? What do patients have a right to demand of medical teams?

Much of the opposition to physician-assisted suicide comes from religious health care providers. A huge number of Catholic hospitals and clinics see their religious vocation and mission as totally incompatible with killing. They are committed to nonviolent health care that models the love of a God-man who commanded Christians to see his face in the sick.

It is anything but surprising, then, that professional groups such as the Catholic Medical Association, Ascension Health and the Christian Medical and Dental Associations did their best to activate their members against changes in the AMA’s view.

But as the AMA’s current code demonstrates so well, opposition to physician-assisted suicide need not be explicitly religious.

A patient receives medication. Photo via Shutterstock

Many of us are sympathetic to end-of-life cases where someone is wracked with terrible pain. According to Oregon's public health department data, however, physical pain doesn't make even the top five reasons people request physician-assisted suicide:

  1. Loss of autonomy (91.4 percent)
  2. Decreased ability to engage in enjoyable activities (86.7 percent)
  3. Loss of dignity (71.4 percent)
  4. Loss of control of bodily functions (49.5 percent)
  5. Becoming a burden on others (40 percent)

A study of Canadian practices found something similar. People who requested relief “tended to be white and relatively affluent and indicated that loss of autonomy was the primary reason for their request. Other common reasons included the wish to avoid burdening others or losing dignity and the intolerability of not being able to enjoy one’s life.”

It is no surprise that, unmoored from a Hippocratic understanding of health care, younger physicians would support assisted suicide. Like other privileged populations, they disproportionately consider the loss of autonomy and bodily function — along with becoming a burden on others — to make life so undignified as to be unlivable.

Disability rights groups such as Not Dead Yet are leading efforts to educate people to see how legal assisted suicide affects the value of the lives of the disabled. Indeed, disability rights groups have been the most effective opponents of the practice worldwide.

Sick and disabled people despairing of life in an ableist, consumerist, youth-worshiping consumer culture are already made to think they don't matter — that they are “takers rather than makers.” Paving the way for them to kill themselves is diabolical. We should instead provide nonviolent physical and mental health care and attempt to become a culture that welcomes rather than discards our most vulnerable.

Traditionally marginalized groups tend to understand this better than privileged populations. The overwhelming majority of those who request physician-assisted suicide are white — 96 percent in Oregon.

Overall, 53 percent of whites support legal physician-assisted suicide, compared with only 32 percent of Latinos and 29 percent of African-Americans, according to Pew Research.

More study needs to be done, but it is likely that racial minorities’ well-placed distrust of the medical community plays a significant role. Georgetown Law professor Patricia King argues that racial minorities have a justified fear of becoming “throwaway people” in medical contexts.

But law shapes culture for us all, and physician-assisted suicide is bound to shape culture in ways that are not good for the most vulnerable. Countries like the Netherlands and Belgium began with strict limits on assisted suicide, but uncritical respect for patient autonomy now has legalized it for patients who are not dying, including those who have mental illness. Even for children.

Physicians have a professional obligation to uphold an objective standard of what counts as health care. The AMA has refused to blindly support multiple procedures that have been legalized by U.S. states. The organization has insisted, for instance, that physicians must not participate in the death penalty.

So it should remain with physician-assisted suicide. Physicians are not Burger King cashiers from whom you “have it your way.” The professional practice of medicine requires a coherent and nonviolent commitment to patients' health, one that bears with them in ways that refuse to conclude anything other than it is good they exist.

(Charles C. Camosy is associate professor of theological and social ethics at Fordham University. A board member of Democrats for Life, he is author of Too Expensive to Treat? Finitude, Tragedy, and the Neonatal ICU. The views expressed in this commentary do not necessarily represent those of Religion News Service.)