Health on the Hill – Annals of Internal Medicine: Support Engaged Neutrality on Aid in Dying

October 17, 2016

Our healthcare system should put the informed patient in charge of the decision-making process. Unfortunately, that is not always the case, particularly for end-of-life care.

An example of patient-centered, patient-driven care is when a terminally ill individual asks their doctor to write a prescription for aid-in-dying medication that they can ultimately choose whether to take to peacefully end their suffering if it becomes unbearable. In fact, nearly 7 out of 10 Americans (69%) support medical aid in dying.

Currently, 1 out of 6 Americans (16%) — those who happen to live in California, Montana, Oregon, Vermont and Washington — are authorized to use this end-of-life care option. And this option will be even more available when  Colorado voters and the District of Columbia lawmakers authorize medical aid in dying later this year; in fact, medical aid-in-dying bill introductions will most likely be introduced in over 20 states this next year.

It has been a challenge for many medical organizations to respond to this consumer demand for the option of medical aid in dying in the growing number of states where it is authorized.

The Annals of Internal Medicine recently addressed this issue in an article, “A Call for a Patient-Centered Response to Legalized Assisted Dying,” authored by two ethicists at Case Western Reserve Medical School: John Frye, MA, and Stuart J. Youngner, MD.

Frye and Young challenge professional organizations to develop a policy of engaged neutrality to educate their physicians about the practice, and provide them with clinical practice guidelines and organizational support:

“Like it or not, [medical aid in dying] is here and is not going away. Given this reality, it is problematic that professional organizations have left physicians without sufficient support and guidance on how to provide the best possible care to dying patients seeking to exercise this legal right … Engaged neutrality allows for diverse views (including the physician’s right to refuse to participate) as much as studied neutrality, but engagement is key for responsible patient care.

Having practiced family medicine for 35 years in Oregon, I know from experience that medical aid in dying is a personal issue for physicians. No doctor wants their patient to die any more than the patient wants to die.

In some cases, a patient will be diagnosed with a terminal disease that no surgery or treatment can cure, and no amount of hospice, pain control or palliative care can provide relief from their suffering. In these cases, the terminally ill individual should have the right to request medical aid in dying. Frye and Youngner recognize this reality:  

“A state medical association’s response to legalization might have to account for both a divided membership and the opposition of its parent association, but the imperative to provide for the real needs of patients and the community justifies taking a position beyond rigid opposition or hands-off neutrality. When confronted with a patient’s request for assisted dying, physicians who consider moving forward should not feel unprepared or isolated. Their profession should support them in supporting their patients.”

I couldn’t agree more.

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