The California Medical Association Wednesday became the first state medical association in the country to shift from opposing physician aid-in-dying to adopting a neutral stance—a move that supporters of legalizing the practice hope will improve its chances there and in other states.
The 40,000-member CMA said it no longer opposes a bill now before the California Legislature to allow physicians under certain conditions to prescribe lethal drugs for terminally ill patients who want to die with assistance, which some call physician-assisted suicide. It previously considered the practice unethical and unacceptable.
Opposition from the American Medical Association and other medical associations has long been a major obstacle for groups seeking to legalize the practice.
“As physicians, we want to provide the best care possible for our patients,” said CMA President Dr. Luther F. Cobb, in a written statement. “However, despite the remarkable medical breakthroughs we've made and the world-class hospice or palliative care we can provide, it isn't always enough. The decision to participate in the End of Life Option Act is a very personal one between a doctor and their patient, which is why CMA has removed policy that outright objects to physicians aiding terminally ill patients in end-of-life options.”
Some experts believe better access to and awareness of palliative and hospice care could lead to fewer patients seeking physician-assisted suicide. But many say that some patients will always want this option no matter how good their care is.
California is one of more than 20 states that are considering or have recently considered bills to legalize physician aid-in-dying this year. That political momentum followed the case of Brittany Maynard, a young California woman suffering from brain cancer who chose to end her life under Oregon's Death with Dignity Act last November. Before her death, her blogs and videos explaining her decision, which were produced in collaboration with Compassion & Choices, a group advocating end-of-life choices, were seen by millions of people.
“The California Medical Association's new 'neutral' position on medical aid in dying is a major milestone because its prior opposition to this legitimate medical practice doomed previous bills,” said Barbara Coombs Lee, president of Compassion & Choices, in a written statement. “We are seeing an enormous shift among medical organizations that is more reflective of the opinion of practicing physicians. This shift helps advance medical aid-in-dying legislation in California and throughout the nation.”
Lawsuits seeking to legalize the practice also have been filed in California, New York and Tennessee.
Aid in dying is now legal in five states including Montana, New Mexico, Oregon, Washington and Vermont.
Unlike the CMA, the American Medical Association strongly opposes legalizing the practice. “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,” according to the AMA's policy statement on the practice. “Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.”
Fifty-four percent of doctors who responded to an online survey published by Medscape in December said doctors should be allowed to help patients end their lives.
“Laws in states that allow assisted suicide… run contrary to ethical principles that have guided medicine from the time of Hippocrates,” Dr. Aaron Kheriaty, director of the medical ethics program at University of California Irvine, told Modern Healthcare.
The American Academy of Hospice and Palliative Medicine has adopted a neutral position on physician-assisted suicide.
In response to the CMA's announcement, the Democratic authors of the California legislation seeking to legalize the practice, Sens. Lois Wolk and Bill Monning, issued a statement Wednesday saying: “We are pleased to learn that the medical community is making a historic shift from its previous position on this issue as a result of our efforts to work with them while continuing to prioritize a patient's autonomy to control end-of-life decisions.”
Under their bill, modeled on the Death with Dignity laws in Oregon and Washington, patients must make two separate oral requests and a written request for the lethal medication. In addition, two doctors must independently determine that patients who request aid in dying have six months or less to live, are mentally competent and have made an informed decision. The physicians must refer the patient for psychiatric or psychological counseling if one or both of them thinks the person is depressed or suffering from a psychological disorder.
