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Recently, AMSA filed an amicus curiae with the United States Supreme Court on the matter of physician assisted suicide currently before the court, supporting physician assisted suicide. This action was based on a resolution previously passed in 1989 by the AMSA House of Delegates. As a recent member of the AMSA (Fall, 1996), I believe that support for this resolution may have changed substantially, within the medical student community, and that advances in hospice and palliative medicine have also changed, rendering AMSA current position open to question. I have been professionally involved with the treatment of cancer patients both curative and palliative radiation therapy as a clinical physicist. I have been personally involved in the care of the terminally ill, caring for my wife until her death from ovarian cancer at age 34.
Whereas these advances in pain control abrogates the need for suicide to end intractable suffering and makes it only one option to consider, and
Whereas studies clearly show that terminally ill patients that initially desire suicide do so most often because they are depressed, hopeless and fear being abandoned and being a burden on their families, and
Whereas with palliative and hospice care these conditions can be alleviated and adequately treated, and
Whereas medicine is now recognizing the proper place of palliation and hospice and the need for specialized end of life, care, and
Whereas physicians play a central role in the assistance of those who are healthy and capable as well as those who are ill, infirm or feeble and that further, physicians may be their only advocate, and
Whereas the physician assisted suicide option does not recognize the duty of society and the medical profession to protect the weak, particularly those who are suicidal, and
Whereas the physician assisted suicide option incorrectly presupposes that a patient can be "rational" and "suicidal" at the same time, and
Whereas an individual has a right to refuse life extending medical care, and
Whereas an individual has a right to palliative medicine and appropriate compassionate care at the end of life, and
Whereas true compassion means "coming along to suffer with" the patient and suicide is an escape from compassion for the physician, the family and society, and
Whereas physicians have an affirmative duty to treat their patients in a holistic manner, considering both physical and nonphysical aspects of a patient's condition, the relationship between body and mind, including emotional, spiritual and social aspects of their lives, and
Whereas physicians have a moral obligation to deal with physical pain before emotional and social healing can occur and effective and vigorous physical symptom control is essential before issues of mental and emotional health can be addressed, and
Whereas the physician assisted suicide option wrongly contends that this issue is about the "right to die," when patients can and do legally refuse any treatment and doctors are routinely taught not to prolong the dying process, and
Whereas the physician assisted suicide issue is actually about giving physicians the right to kill, and
Whereas emotional healing can continue even as the natural history of disease processes continue, and
Whereas physicians have a duty to do no harm (primum, non nocere), and actions which deliberately end life contravene this duty, and
Whereas the intentional taking of a life prior to natural death is an act of harm, and
Whereas society has reserved the right to kill to the state under rigid, explicit and precise circumstances, that to extend this right to any physician or any other individual, with or without counsel grants inappropriate plenipotentiary powers to an individual,
BE IT THEREFORE RESOLVED that the American Medical Students Association, having carefully considered this issue, finds that an irrevocable trust between physician and patient exists and that this trust is jeopardized by the practice of physician assisted suicide, and that the practice of physician participation in the taking of a life is contrary to primum, non nocere, and creates a clear and convincing violation of the physician's ethical responsibility to do no harm and creates a clear and convincing conflict of interest on the part of the physician as patient advocate and physician assisting in death prior to natural death.
Be it further resolved that the American Medical Students Association opposes any attempt at extending the right to kill or assist in killing to any physician or health care worker for any cause, including but not limited to assisting in suicide or euthanasia.
Be it further resolved that the American Medical Students Association considers unethical the taking of actions of any kind that would directly cause the death of any person including but not limited to assisting, supervising or contributing to the ability of another individual to directly cause the death of another individual, regardless of circumstances and that these actions constitute a breach of professional ethics.
Be it further resolved that the American Medical Students association is directed to take such actions as is deemed necessary to encourage medical school curriculums to include training in end of life medical care, including palliation and hospice medicine.
Be it further resolved that the American Medical Students Association repeals any prior resolution in conflict with this resolution.
Dr. Girsh states that active euthanasia would in some cases be justified. I can think of no medical circumstance where the active taking of a human life is justified, particularly against a person's will. When we as a society fail to protect the weak, we will have failed as a people. Mr. Kevorkian has already demonstrated his willingness to flaunt the laws in the matter in Michigan, and is on record in at least one case of killing a man who asked that the procedure be stopped.
Dr. Girsh claims that more than half of Michigan's physicians supported legislation in this arena. The unique circumstances in Michigan, due to the actions of Jack Kevorkian create a compelling need for legislation, and, in my opinion, a strong ban on these actions. Dr. Girsh also claims that critical care nurses have hastened a patient's death. This statement, if true is very troubling. In 1974, two nurses were prosecuted and convicted of murder for these types of actions in Michigan.
Dr. Girsh states that the American Medical Women's Association and several state societies have remained neutral on this issue. Remaining neutral on an issue is a far cry from endorsement of euthanasia. Dr. Girsh also cites the AMSA amicus brief to the Supreme Court supporting assisted suicide. I am a new member of the AMSA and have been in contact with AMSA leadership on this issue. I am deeply troubled by the AMSA position on this issue as are many of my colleagues at Wayne State University and University of Michigan. We believe that the AMSA position is ill considered and not reflective of all medical students. According to AMSA, this brief was a result of a resolution passed in 1989, and we are asking AMSA to reconsider its position on this issue.
As a first year medical student and practicing radiation oncology physicist, I applaud the AMA efforts and strongly encourage the AMA and all physicians to continue the efforts to educate the public on the perils of euthanasia in any of its forms.
Walter A. Roberts, M.Sc.
Wayne State University School of Medicine
Karmanos Cancer Institute
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Posted 12 Sep 2000.
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