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Physician-Assisted Suicide and Euthanasia

Since the time of Hippocrates, a fundamental tenet of medical ethics, a cornerstone of professionalism, and an expectation of the public, has been that those who profess to accept the responsibilities of providing healthcare do not deliberately kill their patients. This commitment, coupled with the other virtues of the healing arts, has allowed society to trust and empower healthcare professionals with unique and tremendous yet restricted freedoms, expecting that those professionals would use those freedoms to pursue the best interests of their patients and the public health.  

 

Despite the proven importance of the well-established principle that healthcare professionals must not, and will not, kill, and the clear historical record of the tragedies that have occurred when this boundary has been breached, there is a growing movement within and outside of medicine for the legalization of assisted suicide (the use of medical knowledge, judgment and licensure to provide the patient with the means for committing suicide, usually a prescription for a lethal overdose of medications) and euthanasia (the direct provision of lethal quantities of medications into the patient for the sole purpose of causing death). The stark nature of these killing acts has been obscured by euphemistic yet ethically equivalent terms such as “mercy killing,” “aid in dying,” and ‘’assistance in dying” based on a putative "right to die." 

 

The unifying term "medical killing" is hereafter used to denote inclusively physician-assisted suicide, euthanasia, and all variations in which medical expertise or assistance deliberately causes the death of the patient, in contrast to end-of-life circumstances in which disease processes or medical events are the unintended proximate cause of death.

 

The relaxation or eradication of the historical prohibitions against healthcare professionals' deliberate killing is unethical, places unnecessary and inappropriate power in the hands of fallible human beings, and will result in the corruption of medicine as an enterprise worthy of individual and public trust. Medical killing by any name turns healthcare professionals into killers.

As healthcare professionals, the members of the AAME acknowledge that:

  1. Whereas, taking innocent human life is an affront to human dignity and a violation of the universal laws of humankind,
  2. Whereas, being given the legal option for medical killing may be understood by the patient or others as an obligation to die, and…
  3. Whereas, medical killing is purported to advance the autonomy of the patient, in fact, this requires participation by health care professionals who are themselves independent moral agents, and…
  4. Whereas, the claim that the patient's decision to end his or her life is autonomous is an illusory claim because such decisions may not be free from coercive factors, and...
  5. Whereas, decision-making capacity has often been absent in patients who have been killed by euthanasia, and requests for assistance in suicide have been coerced in jurisdictions where these acts are legally permissible, and…
  6. Whereas, patients have been killed without their consent or against their will in these same jurisdictions, clearly violating reputed respect for patient autonomy, and…
  7. Whereas, holding an ethical line of demarcation between assisted suicide and euthanasia is untenable; both require the consent, medical knowledge, judgment, and licensure of health care professionals utilizing medical means to deliberately end the life of a patient; and further, laws intended to ensure equal access will logically evolve to extend the alleged "benefit" of medical killing to those physically or decisionally incapable of ending their lives, and...
  8. Whereas, the role of medicine is always to heal, palliate, support and comfort human beings – never to deliberately take, or support taking, their lives – allowing the option of medical killing discourages accessing appropriate medical care, and...
  9. Whereas, lethal interventions occasionally fail to secure death without additional suffering, and…
  10. Whereas, in order for medicine to be trusted or worthy of trust, it must maintain its historical prohibition against deliberately killing patients, and…
  11. Whereas, violating this trust deters patients from seeking medical care because they fear their lives may be terminated without their consent, or that they will be encouraged to opt for death in order to ease financial concerns, avoid being a burden on others, or end the stress or suffering of others in relation to the patient, and…
  12. Whereas, all attempts to accept or legalize medical killing with so-called safeguards have demonstrably failed to contain the practice within those safeguards  and…
  13. Whereas, because prejudice, enmity and financial pressures exist in all human societies, medical killing will inevitably lead to unequal and unjust application against the elderly, the poor, the disabled, and other disadvantaged and devalued members of the human community, and…
  14. Whereas, we respect the right of human beings to refuse any and all forms of medical intervention, recognizing that this negative right to be left alone is altogether different morally, legally and practically from the positive request to kill a patient with a lethal overdose of toxins, medications or other direct, explicit life-ending interventions

We, as compassionate and caring healthcare professionals, therefore, reject assisted suicide and euthanasia categorically, as these practices are incompatible with the nature of medicine and would do violence to the best interests of our patients and society. Complying with a patient's request for assisted suicide is ethically indefensible. Killing a patient is not medical care.

 

AAME affirms that it is the duty of health care professionals to address the many physical, emotional, spiritual and social issues involved with illness, to ameliorate the patient’s suffering short of deliberately taking the patient’s life, and to educate all practitioners of existing tools to accomplish those ends. It is medicine’s duty to continue to search for better means of pain and symptom management.

 

AAME acknowledges that the pursuit of symptom control may require use of analgesics and sedatives that may lead to a shortening of the dying patient’s remaining life through respiratory depression, or being in a state of unconsciousness in order to adequately control pain and other forms of suffering, such as respiratory hunger.  These treatments are licit as long as they are titrated carefully to the effect of symptom control and are not used with the intent of terminating the patient’s life. 

 

AAME affirms that all human beings have intrinsic dignity that cannot be diminished by illness, pain, disability, or suffering, and which will not be augmented by deliberate killing.

 

AAME calls upon all governments and medical institutions and associations to reject laws and policies permitting medical killing in order to protect the public and the integrity of the medical profession. Medical killing must never be legal. Laws which purport to validate the acts of assisted suicide or euthanasia are themselves immoral and do not supersede fundamental medical ethics. 

 

AAME calls upon all governments and medical organizations to respect the beliefs and consciences of all health care professionals who decline participation in medical killing.  Under no circumstances should health care professionals be encouraged or coerced to participate in the killing of other human beings, nor be required to be complicit in such killing by referral to others who will comply (although a patient's request for transfer of care or sharing of medical records does not constitute a referral).

 

AAME calls upon all who speak or write about medical killing to apply language truthfully, and not use wording that dishonestly obscures the act of killing another human being. Labels such as “assistance in dying”, “aid in dying” or “mercy killing” dishonestly equate the deliberate killing of a human being with palliative care. Medical killing is not a form of palliative care. Killing a human being is not medical care. Killing a human being is a denial of the human being’s intrinsic dignity and inestimable value, and is an act of abandonment of the patient in his or her time of greatest need for care, attention, respect and affirmation. Further, in jurisdictions in which these practices are regrettably legal, death certificates, clinical notes, and other legal documents should truthfully declare the cause of death as lethal overdose, assisted suicide or euthanasia rather than list other pathology or illnesses as the cause of death. Physicians should not be compelled to lie.

 

AAME further rejects any and all claims, arguments, or language, overt or insinuated, that patients have a duty to die.

 

AAME advises that, when health care professionals are confronted with requests for medical killing, they should:

  • Affirm that the patient's life still has meaning and value despite circumstances
  • Investigate the underlying causes of the request
  • Assess symptoms and the possible presence of depression
  • Affirm that medical efforts to control pain and symptoms will be implemented
  • Assess potential coercing influences prompting the request
  • Assess the social burdens placed upon the patient and the family
  • Mobilize resources and treatments to address the needs of the patient as identified
  • Emphasize that the professional will never abandon the patient; however, remain firm about refusing to participate in medical killing