studied neutrality …

June 15, 2012

in Bioethics,Hospice & Palliative Medicine

… the BMJ joins the AAHPM in adopting a position of “studied neutrality” in their paths toward Physician Assisted Suicide.

From a letter to AAHPM from the Supportive Care Coalition at the time (2007) of the AAHPM’s change in position … “[We] oppose all efforts to legalize physician assisted suicide.  Precisely because you are a national organization affirming the best quality of life for patients, we urge you to reconsider your “studied neutrality” position. Such a position is, in fact, neither value-neutral nor helpful for the vast majority of patients who need to know that they will be cared for safely, compassionately and competently. We cannot afford to be neutral toward practices that will undermine that trust.
In addition, a position of neutrality by a national organization like yours can raise further suspicions of the hospice movement in the minds of people within our society and have the effect of weakening the cause of hospice care or of playing into the hands of those who want to write it off.”

Dear Colleagues,

We are deeply dismayed by the change in position taken by the AAHPM regarding physician assisted suicide, which you renamed “physician assisted death”, in your most recent position statement of February 14, 2007.  We know that sincere, compassionate, morally conscientious, and excellently trained members of the Academy have differing opinions on PAS. However, that is not a justification to move away from the roots and traditional philosophy of hospice and palliative medicine, which hold that we must neither hasten death intentionally nor postpone death unnecessarily while providing the best care and comfort available for patients and their families.

Hospice and palliative care organizations like AAHPM have helped improve the systemic and individual care of dying and seriously ill patients and their families, and this continues to be a large part of their mission.  While the successes have been many, the report card on care of the dying in the United States remains barely passing. Many obstacles to good care remain in our country and in our health care system. We vigorously support reform, and continue to support the recommendations for palliative care by the National Consensus Project, the National Quality Forum, and the NHPCO. The quality of living and dying in America depends on how we as a society and the healing professions respond and attend to the most vulnerable among us.

We recognize and appreciate that AAHPM supports access to high quality palliative care; patient and family autonomy and participation in decision-making; alleviating all forms of suffering; facilitating safe and comfortable dying while maximizing quality of life as defined by the patient; and not abandoning patients regardless of their views and decisions. But the Supportive Care Coalition opposes all efforts to legalize physician assisted suicide.  Precisely because you are a national organization affirming the best quality of life for patients, we urge you to reconsider your “studied neutrality” position. Such a position is, in fact, neither value-neutral nor helpful for the vast majority of patients who need to know that they will be cared for safely, compassionately and competently. We cannot afford to be neutral toward practices that will undermine that trust.
In addition, a position of neutrality by a national organization like yours can raise further suspicions of the hospice movement in the minds of people within our society and have the effect of weakening the cause of hospice care or of playing into the hands of those who want to write it off.

The rest of the AAHPM statement, specifically on how to respond to a request for Physician Assisted Suicide, provides an excellent template for professionals when the request is made.  We hope that such guidelines become integral to hospice and palliative care education.

From the AAHPM Webpage we read:  “The Academy recognizes that death is a natural and inevitable end to life, and that helping patients achieve an appropriate and easy passage to death is one of the most important and rewarding services that a physician can provide.” “Easy” certainly will not resonate as one of the most important and rewarding adjectives for the services physicians and other professionals provide their patients at end of life, and you do us and our patients and families a disservice to say so. But you also say in your definition statement that, “Palliative care affirms life…” On this we can agree.  Our best efforts may not result in an “easy” passage, but our presence with the dying must always affirm their life, even when their unintended death is inevitable.

In conclusion, we do not believe that a position of “studied neutrality” on PAS is either helpful or necessary for the Academy as you continue aggressively to support research and the dissemination of information for improving care of patients and for the effective relief of their suffering, helping them to truly live until they die. We urge you, as a national organization, to return to a position of not supporting efforts to legalize physician assisted suicide.

Peace and Hope,

Gretchen Elliott, RSM              Karin Dufault, SP, RN, PhD
Chairperson                             Executive Director

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