AAFP Breaks from AMA, Adopts Neutral Aid-in-Dying Stance

Marcia Frellick

October 10, 2018

NEW ORLEANS — Delegates broke away from American Medical Association (AMA) opposition to physician-assisted dying here at the American Academy of Family Physicians (AAFP) 2018 Congress of Delegates and instead took a neutral stance, opting to let families, physicians, and states decide.

The voice vote met the bylaw requirement for a two-thirds majority when a resolution differs from the AMA Code of Ethics.

The AAFP resolution states that "medical aid in dying is an ethical, personal, end-of-life decision when the patient is terminally ill, is suffering, and capable of making an informed decision to end his/her suffering through medical aid in dying, and that such decision should be made in the context of the doctor–patient relationship."

It adds that the AAFP "is neutral regarding whether individual states should permit medical aid in dying."

Delegates also rejected the term "assisted suicide," and replaced it with "medical aid in dying."

Testimony was passionate during reference committee hearings on Monday, but largely favored the option of choice.

Ravi Grivois-Shah, MD, an AAFP member from Arizona, spoke about his personal experience when his mother had to make decisions weeks before her death last month, and explained why he thinks a neutral stance is the right choice.

As a physician and a son who always supported aid in dying, in theory, but had many unanswered questions, he helped his mother navigate 12 years of cancer care.

"You see what it means to someone to have that option available to them — to take control when there is so little control over the disease, especially at the end of life," he told Medscape Medical News.

His mother had been very conservative in her healthcare choices, he said, but when she went into hospice around Labor Day, he found her surprisingly open to many options.

"Unfortunately, in Arizona, where we live, aid in dying wasn't available to us. It would have been nice to have that option available, whether or not she decided that's what she wanted to do," he said. "It's really up to each family to decide what their own values are. For others to decide for us, I think, is unethical. It really needs to stop."

Ethical Debate

"We have to understand the power of family physicians," said Arnold Pallay, MD, a delegate from New Jersey. "We have an ethical and personal role, and everyone has a different take on this. To be opposed to something that some people think is valuable, we should at least move to the neutral."

During testimony on the resolution, some people worried that the AAFP was telling them that if they don't support aid in dying and agree with the AMA stance, they are "unethical." There was also concern that all family physicians would now have to provide the service.

"I would encourage continuing to work with the AMA so we can speak with one voice, especially in this really important area," said Douglas Curran, MD, a delegate from Texas.

According to the current AMA stance, "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."

But discussion at the AMA annual meeting in June was heated and emotional at times, as reported by Medscape Medical News. And the House of Delegates rejected a recommendation from its Council on Ethical and Judicial Affairs that the AMA maintain its opposition to medical aid in dying and referred the report back for review, with the possibility of action at the interim meeting in November.

American Academy of Family Physicians (AAFP) 2018 Congress of Delegates. Presented October 9, 2018.

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