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PRINCIPLES REGARDING PHYSICIAN AID IN DYING

The American Medical Student Association:

1.             SUPPORTS passage of aid in dying laws that empower terminally ill patients who have decisional capacity to hasten what might otherwise be a protracted, undignified or extremely painful death. Aid in dying should not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide. It should be a last resort option in patient care if the following criteria are met. This includes, but may not be limited to: (2008)

a.             There must be a request from the patient that is voluntary and free of coercion of any type, including financial.  If the patient is an inpatient or a nursing home resident, the voluntary nature of the request must be verified by a patient advocate, i.e., ombudsperson. (1998)

b.             The explicit nature of the patient's request must be documented and persist throughout a specified waiting period. (1998)

c.             The patient must be determined to have capacity, based on current standards of capacity. (2008)

d.             The patient must be terminally ill, as defined by current standards. (1998)

e.             The patient must have unbearable physical, mental and/or emotional suffering, as defined by the patient, whereby the patient feels that his/her quality of life is such that life is no longer worth living. (1998)

f.              Physician-aid-in-dying must be considered only as a last resort, after the following issues have been thoroughly explored by the patient: (2008)

1.             All appropriate standard and experimental allopathic and osteopathic therapies.

2.             All relevant culturally sensitive alternative therapies.

3.             All palliative care options, such as hospice.

4.             Comprehensive pain management.

5.             Comprehensive psychiatric, psychosocial and spiritual support.

g.             Assistance in death must be carried out only by a physician, through the prescription of a lethal dose of medication, as determined jointly by the patient and physician.

h.             No health care provider who is morally or otherwise opposed to the participation in physician-aid-in-dying will be obliged to assist.

i.              The physician to whom the request is made should be familiar not only with the patient’s medical condition, but also the patient’s experience of his/her illness and present state of mind.  The patient and physician must enjoy a lasting, mutually trusting and open relationship, including but not restricted to ongoing discussion about issues of death and dying.

j.              A thorough psychiatric consultation must be included in evaluating the patient’s request.  This must include, but not be restricted to, ruling out treatable affective conditions, such as clinical depression.

k.             Hospital ethics committees and ethicists may be consulted to address specific ethical concerns and areas of conflict resolution.

l.              An independent physician must be consulted to review the entire case to determine that the above criteria have been met and that the request is a reasonable option.

m.            All cases of physician-aid-in-dying must be documented on an aid-in-dying report form.  This form should include, but not be restricted to, information pertaining to the nature of the request, patient demographics, the patient’s medical and psychosocial history, and surrounding circumstances, and documentation of how the criteria have been met.

n.             A system of safeguard review must be established at both institutional and state levels.  Data on practices and patient characteristics must be made available to the public, while maintaining individual patient privacy. (1993)

2.             RECOGNIZES that the practice of physician-aid-in-dying and its safeguards must be continually evaluated by doctors, patients, families and the public, and that criteria may be adjusted according to evolving opinion among these groups. (1993)

3.             SUPPORTS enhancing public awareness of the above safeguards. (1993)

4.             RECOGNIZES a concern for vulnerable populations with regard to potential abuses and, therefore, emphasizes the importance of the above safeguards. (1993)

5.             RECOGNIZES that throughout the process outlined above, all involved parties must safeguard against the possibility that the wish to die reflects the patient’s desire to not burden others, emotionally, financially, or otherwise. (1993)

6.             RECOGNIZES that equal access to health care is one relevant issue in the aid-in-dying debate.  These guidelines are an effort to guard against potential abuse based on inequities with regard to health care access.  Therefore, it is important for AMSA to simultaneously advance its efforts in addressing both issues of health care as a right, as well as aid-in-dying. (1993)

7.             SUPPORTS open and complete communication, free from coercion, between physician and patient regarding all possible end-of-life care options for the terminally ill patient. (2008)