Q. In states where medical aid in dying is authorized some physicians choose not to participate. What is the physician’s professional responsibility to her or his patient?
A: The definition of medical professionalism is to put the patient first.
Shared medical decision making requires the competent and compassionate doctor to listen, to teach, to explain, and to offer standards of care to the patient. If a medical treatment or procedure does not fall within the personal beliefs of a practitioner, she or he is obliged to refer the patient to another physician for counsel and care. (An example in family medicine might be a referral for consideration for a circumcision if the attending physician does not believe that it is in the best interest of the child. Recall, the referral is not for the procedure, but for the consideration of it.)
All referrals should be timely and urgent; if there is one thing that the dying patient does not have, it is time. If a terminal patient might consider medical aid in dying, I recommend that this patient and his or her family have a conversation about this with their personal physician well in advance of the need. They must be prepared for the possibility that their primary care physician will not support them. If a physician practices medicine within a limited religious ideology or institution, that should be disclosed to the patient at an early visit.
