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PRINCIPLES REGARDING DEATH AND DYING

The American Medical Student Association:

1.             BELIEVES that patients have the right to refuse treatment when they have been fully informed of the consequences, even if such refusal results in the patient’s death;

2.             BELIEVES that patients who are comatose, and in whom there is no reasonable expectation of recovery, have the right, through prior written documents such as living wills, to refuse treatment and to be allowed to die and not be kept alive by artificial means;

3.             SUPPORTS a statutory definition of death, and BELIEVES that such a definition should consist of a dual system of criteria, including the cessation of circulatory and respiratory function or brain death criteria, as outlined in the United States Collaborative Study of Cerebral Death and the so-called Harvard Group Study, which should only be applied when all reversible causes and conditions such as hypothermia and drug intoxication have been excluded;

4.             BELIEVES that the quality of life is an important parameter in the health care management of the patient with terminal or severe chronic illness and, further, SUPPORTS the use of medications that are necessary to relieve a terminally ill patient’s suffering despite their having an inseparable dual effect of hastening the patient’s death. (1993)

5.             BELIEVES that the role of the physician primarily responsible for the care of the terminally ill should extend beyond the patient to those close to the patient when his/her needs for counseling and support arise;

6.             BELIEVES that counseling and support services should be offered to immediate family members or significant others by staff and physicians in cases of sudden or emergency room deaths.

7.             STRONGLY URGES all medical schools and residency programs to offer electives to educate medical students and residents in issues of death and dying. (1996)

8.             BELIEVES that all patients have the right to know all options available to them before they make end of life decisions.  These options include, but are not limited to, hospice care, withdrawal of treatment, continuation of treatment, comfort measures and self-deliverance.  The patient should be made aware of the implications of each of these options. (1996)

9.             BELIEVES that counseling and support services should be made available to physicians and medical students who are dealing with issues of death and dying, whether the issues are related to patient care or their personal lives. (1996)

10.           SUPPORTS an interdisciplinary approach to the study and care of patients with active, progressive, far advanced disease for whom the prognosis is limited and the focus of care is the quality of life.  AMSA further RECOGNIZES the multidimensional nature of suffering, with an ultimate goal of responding to this suffering with care that addresses all of these dimensions and communicates in a language that conveys mutuality, respect and independence. (1997)