Another State Medical Society Stops Fighting Assisted Death

December 01, 2017

The Vermont Medical Society (VMS) recently became the eighth state medical association — the ninth if one counts the group for Washington, DC — to depart from the profession's long-standing opposition to physician-assisted dying.

The VMS was playing catch-up with state lawmakers. In 2013, the Vermont legislature passed a "death with dignity" bill that allows a physician to prescribe a lethal dose of narcotic to a terminally ill patient who requests it. VMS opposed the bill at that time because it held that there should be no law either banning or permitting physician-assisted death, also called medical aid in dying, assisted dying, and physician-assisted suicide, a term deemed misleading and pejorative by proponents of the practice.

Four other states — California, Colorado, Oregon, and Washington — along with the District of Columbia have enacted legislation like Vermont's. Physician-assisted dying is also legal in Montana by virtue of a state supreme court ruling.

A resolution passed at the VMS annual meeting on November 4 says that the society "is committed to protecting its member's freedom to decide whether to participate in medical aid in dying," which it recognizes as a "legal option."

The VMS joined state medical associations in California, Colorado, Maryland, Maine, Minnesota, Nevada, and Oregon and the Medical Society of the District of Columbia in taking a neutral stance on physician-assisted death. Its position mirrors growing acceptance of the practice among physicians. The Medscape Ethics Report 2016  found that 57% of physicians believe medical aid in dying should be available to terminally ill patients, up from 46% in 2010. The general public is even more supportive. Sixty-eight percent of Americans favored legalizing physician-assisted death in a 2015 Gallup poll.

Organized medicine on a national level continues to brand physician-assisted death as a violation of the Hippocratic "do no harm" principle. The American College of Physicians (ACP), for example, recently reaffirmed its opposition  to the practice, which it continues to call physician-assisted suicide. The ACP position paper warned that substituting other terms, such as "medical aid in dying" muddles "the ethics of what is at stake."

Other national medical societies show signs of relenting. The American Medical Association (AMA) directed its Council on Judicial and Ethical Affairs to review the medical literature and hear from clinicians on physician-assisted death, all in response to the AMA's Oregon delegation asking the association in 2015 to consider taking a neutral position. This study is still underway, an AMA spokesperson told Medscape Medical News.

And at its annual Congress of Delegates meeting this fall, the American Academy of Family Physicians entertained a resolution asking the AMA to swap out the expression "physician-assisted suicide" for "medical aid in dying" in its policy discussions and to accept the practice. The resolution didn't pass, but it didn't exactly die either. Instead, delegates voted to study the issue further.

Putting Aside Personal Beliefs

The resolution passed by the state medical society in Vermont accommodates medical aid in dying as a last resort. It calls on clinicians to "aggressively respond to the needs of patients at the end of life" with palliative care, adequate pain control, and emotional support, and to consider interventions such as hospice care and specialty consultations.

However, the resolution recognizes that "even when physicians use all the tools at hand to care for pain and suffering, a small number of patients still suffer." Accordingly, such terminally ill patients may want to exercise their legal right to end their life with a physician's help.

VMS President Trey Dobson, MD, told Medscape Medical News that the resolution easily passed at the society’s annual meeting in November. A shift in nomenclature — from "physician-assisted suicide" to "medical aid in dying" — over the years made it easier for physicians to vote yes, said Dr Dobson, an emergency medicine practitioner.

"It helps us understand the problem," he said. "It's not about suicide. It's about helping patients who are suffering."

At the same time, passage of the resolution does not mean that most Vermont physicians are willing to write a fatal prescription for a patient who requests —and qualifies for — medical aid in dying, said Dr Dobson. He described receiving phone calls from a dozen or so colleagues who expressed personal discomfort with the Vermont law but nevertheless felt that a patient warranted evaluation for medical aid in dying and wanted to refer him or her "to the right person."

Tellingly, the resolution approved by the VMS calls medical aid in dying a legal option but declines to call it an ethical one, which the original version of the resolution did. "We didn't want to commit a doctor to a particular ethical view," said Dr Dobson.

Like other professionals, he said, physicians sometimes put aside their own personal beliefs to act on a patient's behalf. That's the spirit of the new VMS stance on medical aid in dying.

As Dr Dobson put it: "This is the law in place, and I want to do right by my patients."

Follow Robert Lowes on Twitter @LowesRobert

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