Aid in Dying Debate Reignites at AAFP

Marcia Frellick

September 25, 2019

PHILADELPHIA — Two proposed resolutions to the American Academy of Family Physicians (AAFP) neutral aid in dying stance churned up lengthy and sometimes contentious debate this year at the AAFP 2019 Congress of Delegates, this time over which terms to use in official communications and documents.

Last year, in a break from American Medical Association policy, the AAFP declared that it would adopt a neutral stance on whether individual states should permit medical aid in dying, as reported by Medscape Medical News. Delegates also rejected the term "assisted suicide," and replaced it with "medical aid in dying" in all official AAFP communications and documents.

But two resolutions presented on Monday in a reference committee hearing ask that the decision restricting wording be reversed. On Tuesday, both resolutions were referred to the board for further consideration.

All physicians should be able to use their language of choice, said Jennifer Brull, MD, from the Kansas delegation, an author of one of the resolutions.

"We have to use the terms we are comfortable with," said David Walsworth, MD, from the Michigan delegation, which authored a companion resolution.

In its argument for reversal, the Michigan resolution says that the AAFP should "avoid the use of vague and euphemistic terms when referring to lethal medications prescribed with the intention of ending a patient's life" and not prohibit use of the phrases "physician-assisted suicide" and "assisted suicide" from statements or documents.

Gary Plant, MD, a delegate from Oregon, said he opposes both resolutions, and argued that only "medical aid in dying" should be used — "assisted suicide" should not — because the phrases have different connotations and legal considerations.

Legal Implications

"Suicide and assisted suicide remain illegal in all 50 states," said Plant, who explained that "in every state that authorizes the practice of medical aid in dying, the statute includes this language: Actions taken in accordance with this act shall not for any purpose constitute suicide, assisted suicide, mercy killing, or homicide under the law."

Another reason to keep the "medical aid in dying" language is that there is a clinical difference in the terms, he pointed out. Suicide is the result of depression in most cases, a condition that is potentially reversible and treatable. The goal is self-destruction and the end is often violent.

"Physician aid in dying is the terminal event in a terminal disease," Plant said. "It is a patient who desires to live but is dying. The goal is self-preservation rather than self-destruction. It is a peaceful death, not a violent death."

A delegate from New Mexico, Dion Gallant, MD, testified that "ultimately, the congress spoke very clearly last year with a supermajority, and words do matter. We've chosen some neutral words that remove some of the value-laden judgments and that are very important legally," he said.

But James Taylor, MD, an alternate delegate from Louisiana, said he supports both resolutions to reverse the medical aid in dying wording choice.

He emphasized that legalization of the contentious practice has not happened in every state. In June, Maine joined nine states and the District of Columbia in legalizing the practice.

"In my own personal opinion, if you have chosen to step over that line, to help your patients die, then the legal consequences are yours and not this academy's," Taylor said. "To state that this academy owes protection for that sort of behavior — I opposed it then, I oppose it now. This is not currently neutral policy. A policy that prohibits the use of a certain word by definition is not neutral."

Lisa Gilbert, MD, an AAFP member from Kansas, offered that perhaps both terms — medical aid in dying and physician-assisted suicide — could be used together with a slash, although she noted that that could confuse patients. But medical aid in dying should not stand alone, she said.

"Voting against this will indicate to myself and the countless other people that the academy just doesn't care what we think about one of the most contentious issues that goes to the root of the Hippocratic oath," she said.

Brull, Walsworth, Plant, Gallant, Taylor, and Gilbert have disclosed no relevant financial relationships.

American Academy of Family Physicians (AAFP) 2019 Congress of Delegates. Presented September 23, 2019.

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