The Emerging Conversation About Physician-Assisted Death

TON - May 2017, Vol 10, No 3

Orlando, FL—Providers caring for dying patients should be prepared to discuss physician-assisted death (PAD), according to R. Garrett Key, MD, Assistant Professor of Psychiatry, The University of Texas at Austin Dell Medical School, and Psychiatrist, Seton Mind Institute, Austin. The topic has garnered increasing attention in recent years, but is still surrounded by controversy.

In general, proponents of PAD focus on the prevention of unnecessary suffering and autonomy as superseding principles, whereas opponents raise significant concerns about the vulnerability of dying people and inadequate palliative care as a driver for the desire to die.

“Either way, I think we owe it to our patients to be able to participate in this conversation in an informed and meaningful way,” Dr Key said at the American Psychosocial Oncology Society 14th Annual Conference.

Euthanasia versus PAD

Euthanasia and PAD are not synonyms. Euthanasia refers to “an action by one person performed on another with the intent of ending his or her life for the purpose of alleviation of suffering.” PAD refers to “involvement of a physician in offering advice, expertise, or material support to a person to aid them in ending their own life.” Euthanasia is against the law in the United States, whereas PAD is legal in 5 states, including Oregon, Washington, Vermont, Montana, and California.

The public conversation around PAD has been framed by controversial figures such as Jack Kevorkian and Philip Nitschke. Brittany Maynard was an especially sympathetic and compelling voice on the subject, as she chose to take her own life in 2014 because of terminal illness. Other public figures, such as Desmond Tutu and Stephen Hawking, have also spoken out in support of a person’s right to choose to die with dignity and on his or her own terms.

Where Do Medical Societies Stand on This Issue?

Currently, the majority of medical associations and professional organizations oppose PAD. The American Medical Association has a long-held and firm position against any act of physicians to hasten death, but in 2016 the organization approved a study resolution to put the policy under review for 1 year, and the researchers will report back in 2017.

“This is not a guarantee that the American Medical Association will soften or change their stance, but for the first time in many years they’ve said, ‘We’re going to think about it,’” said Dr Key. He noted that this decision may greatly impact the current landscape in the United States regarding the topic.

There has also been a shift in culture among the Royal College of Physicians, as the number of members in favor of PAD has increased significantly between 2006 and 2014, whereas the number in opposition has remained the same. A smaller number of medical organizations take a neutral stance, such as the American Academy of Hospice and Palliative Medicine, and the Academy of Psychosomatic Medicine.

Medical societies in support of PAD are few, but support is growing. Of note, the American Medical Student Association issued a statement in 2008 in support of PAD.

“In another 15 years or so, the members of American Medical Student Association from 2008 will be in positions of influence and authority in the medical community, so I think we can anticipate further shift,” Dr Key observed.

Three major advocacy groups work in this realm to promote PAD. Exit International promotes the right of individuals of sound mind to be able to end life at a time of their choosing. Compassion & Choices takes a broader focus and advocates for the inclusion of PAD as part of the full spectrum of palliative care services, and Death with Dignity works to promote and advance death with dignity laws in the United States.

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