Source: Orlando Sentinel

By Dr. Frederick J. White

While deeply committed to effective relief of the pain and suffering of the terminally ill, the American Medical Association has long held a position that I share — that physician-assisted suicide and euthanasia are “fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”

But now the AMA is studying whether to retreat from that position into the mirage of moral neutrality. State medical societies in Colorado and Maryland have recently done so, abandoning authority, agency, principle and position in one fell swoop. But the wink and nod of neutrality is beneath the demands of this issue and the dignity of the medical profession.

The central premise of physician-assisted suicide is this: A doctor should be allowed to kill certain patients. That is a stark reality, but it is the essence of the physician-assisted suicide movement. Let us not quibble over causation. A doctor who purposefully writes lethal prescriptions and gives them to patients intends to cause their deaths.

And when the patients die from those intentionally toxic doses, the doctor is a proximate cause of death just as certainly as if the doctor had injected lethal drugs directly.

Despite what advocates of physician-assisted suicide claim, this debate is not about autonomy. Patients with terminal conditions already have the autonomy to direct limitation or withdrawal of life-sustaining care, to request palliative and hospice care, and to even take their own lives. Physician-assisted suicide is about a method of death, about whether that method of death should allow a conspirator, and about whether that conspirator should be a doctor.

Our society is grappling with these questions, and decision makers are interested in what the doctors think. When doctors tell society that they do not have an opinion about physician-assisted suicide, they are abdicating a critical responsibility.

Society has vested doctors with special rights and privileges concerning matters of life and death. Doctors decide whether to recommend a risky surgery. Doctors decide when to counsel a patient’s family that life-sustaining treatment should be withdrawn. Society allows doctors that special standing by virtue of their training and experience, but also by virtue of their moral agency. Society expects that doctors will form moral judgments guided by their ethical codes. And on the most pressing life-and-death issue of our day, doctors cannot take a pass. They must choose — either a doctor will or will not be allowed to kill certain patients.

And as for medical societies — if those organizations make even a passing effort to set ethical standards and codes for the medical profession, then they should not tell society that they are “neutral” on physician-assisted suicide. If the American Medical Association Principles of Medical Ethics truly are “standards of conduct that define the essentials of honorable behavior for the physician,” and if the AMA Code of Medical Ethics truly is “guidance that identifies the essentials of ethical behavior for physicians,” then the AMA cannot dodge this question: Will or will not a doctor be allowed to kill certain patients?

If medical societies cannot answer this most fundamental of ethical questions, then how can they purport to answer anything else?

If doctors and their medical societies think that doctors should be allowed to kill certain patients, then they should say so. And if not, then they should say so. Anything else is cowardice.

Frederick J. White, M.D., is chair of the Institutional Ethics Committee, Willis-Knighton Health System in Shreveport, La.