Delegates of the American Medical Association (AMA) voted by a supermajority on June 9 to reaffirm the association’s opposition to physician-assisted suicide (PAS), while also strengthening conscience protections for all physicians who work in states where PAS is legal.

The approximately 700 elected delegates, representing more than a quarter million U.S. physicians, residents and medical students, voted to maintain the position of the nation’s largest non-profit professional association that PAS is “incompatible with the physicians’ role as healer,” during their annual House of Delegates meeting in Chicago, June 6-11.

AMA delegates and members told the Register they hope the association’s reaffirmed opposition will help stop the spread of PAS, as Delaware last month became the 12th U.S. jurisdiction to legalize it.

"The AMA Code of Medical Ethics states that physician assisted suicide is 'fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks,'” said Dr. Dennis O’Hare, who practices geriatrics and family medicine in Minnesota. “This is strong language that implies: Do not spread this! It is harmful for our culture and our communities.” 

The AMA’s reaffirmed opposition to PAS comes as other state and national medical organizations have taken, or are considering adopting, neutral positions. These other organizations’ move toward neutrality may have boosted support for legalization among the public and legislators in Delaware, where PAS was legalized in May, and in New York, whose state senate passed a bill to legalize PAS on June 9. The state’s governor, Kathy Hochul, has not indicated yet whether she will sign the bill. 

Bills to legalize PAS are introduced regularly in about 25 state legislatures but most have failed to pass, though a 2024 Gallup poll revealed that 66% of Americans overall and 44% of U.S. Catholics believe doctors should “be allowed by law to assist the patient to commit suicide” for terminal patients living in severe pain who request it.”

But more recent media reports are revealing previously unseen realities of patients’ experiences and PAS’s impact, including on the poor and disabled.

AMA delegates voted to reaffirm the position the association has maintained in its Code of Medical Ethics since 1994, which was reaffirmed in 2019. Delegates this year voted on a resolution presented after an in-depth analysis of PAS issues by its Council on Ethical and Judicial Affairs, as well as many oral and written member testimonies. The report was commissioned in response to a 2023 resolution brought by AMA medical student members who, among other requests regarding PAS, asked the association to consider moving to a neutral stance.

 

Conscience Protection

Delegates also voted to strengthen the protection of the conscience rights of physicians who provide PAS, agreeing that physicians should not be criminalized for the practice in states where this is legal.

“Conscience rights are at the heart of the patient-physician relationship and should be protected and strengthened,” O’Hare said. “This resolution helps improve this core principle. ”
“Physicians should not be at legal risk for damage,” he said. “We still have conscience rights as physicians that need to be protected, especially when they’re doing something that’s regarded as legal.”

Conscience rights are also affirmed more broadly in the AMA’s Code of Medical Ethics, which states that “physicians should have considerable latitude to practice in accord with well-considered, deeply held beliefs that are central to their self-identities.”

Many equate conscience protection with religious freedom but it is broader, said Dr. Tim Millea, a retired orthopedic surgeon and senior AMA member who lives in Davenport, Iowa. Millea also chairs the Catholic Medical Association’s Healthcare Policy Committee.

Millea said, “It makes sense and particularly if you’re looking at it from not just a religious standpoint but from a free society standpoint, that’s really why America was started because someone else was telling us what to think, what to say, what not to think, what not to say, and that’s unacceptable.”

Delegates also approved the association’s use as common language in its policies and directives of the term “physician assisted suicide,” which the council concluded “offers a clear delineation of intent and action.” Other terms, the council stated, including “Medical Aid in Dying,” could be confused with other types of care that do not involve intending patients’ death.

 

Doctors’ Testimonies

More than 70 AMA members sent written testimonies on the PAS resolution and over 25 members, including medical students and three physicians who belong to a religious women’s community, presented oral testimonies at the meeting before the vote.

When Ali Mauritsen, who is studying medicine and public health at Creighton University’s School of Medicine in Omaha, Nebraska, learned that AMA’s delegates would be voting on the association’s PAS position, as one of AMA’s more than 52,000 medical student members, she wanted to contribute to the conversation.

Mauritsen also testified in person at the meeting.

While Mauritsen said she views PAS as fundamentally contrary to physicians’ role of healer, she said not all medical students, and possibly those on the AMA medical student committee who proposed the Nov. 2023 resolution to soften AMA’s opposition to PAS, are being trained to see it that way.

“When I read that the [AMA] medical student committee had proposed the resolution [to soften the AMA’s PAS stance], it didn’t surprise me because I think the thrust of our medical ethical education is heavily, heavily focused on patient autonomy. … The pendulum has swung from a very paternalistic model of medicine for what the doctor says goes with little patient input, to one of patient autonomy, what the patient says goes.”

Mauritsen, who is Catholic, drafted a letter about PAS to the association, which about 50 other student AMA members at schools across the country later signed.

The letter states, “Our support is grounded on the principle that the internal integrity and public trust in the medical profession depends upon guarding fiercely the healing mission of medicine through nonviolence. Thus, we affirm that never and for no reason should a physician act with the intention of ending a patient’s life or helping another (including the patient themself) to do so.”

Mauritsen also recognized in the letter medicine’s power for good but also for harm, and the need for ethical boundaries, particularly with a commitment to nonviolence, to protect the vulnerable, safeguard the trustworthiness of the medical profession and prevent weaponization of the tools of medicine.

“Demonstration of this commitment requires coherence in both the opinions and the formal policies of the AMA,” she wrote. 

 

Shaky ‘Guardrails’

Some of the more than 190 state and specialty medical societies and other critical stakeholders that the AMA convenes have voted to take a neutral stance on PAS. But in reality, O’Hare said, a “neutral” position is temporary because there is no neutrality on the issue.

"In the AMA Board of Trustees Report, it was clarified that the AMA's position is NOT a position of neutrality,” he said. “And if we observe actions in our states and other countries, decisions of neutrality are found to be temporary over time. It is a stage in the journey toward legalizing physician assisted suicide."

Another major medical association, the American College of Physicians, adopted a resolution this spring that its board of regents review its PAS position from a legal and health policy standpoint and revise its stance from opposition to PAS to a neutral stance, along with developing policy and legal guidance to protect patients from misuse. 

The AMA, in contrast, maintains in its Code of Medical Ethics that PAS would be difficult to control and would pose serious societal risks. O’Hare said this is because the protections or “guardrails” placed on PAS laws are often temporary. 

Medical organizations considering or taking a neutral stance on PAS may have helped legislators gain the support of other legislators for passing the state’s legalization bill, said Dr. Mike Vest, a critical care physician in Newark, Delaware, who is also a member of both the AMA and Catholic Medical Association, and associate professor at Sidney Kimmel Medical College in Philadelphia.

Two “guardrail” provisions were proposed as amendments to Delaware’s PAS law: that patients be given an opportunity to talk to a mental-health professional before receiving PAS; and a provision for communication with the state’s medical board in monitoring compliance with the law, said Vest. Both were defeated. “The guardrails that they say exist actually don’t even really exist, like in the Delaware law,” he said.

One thing that state’s law does stipulate is that patients must have a six-month terminal prognosis, with or without treatment, and aren’t required to accept treatment, Vest said. An unintended effect of this provision is the fact that generally people with end-stage renal disease have a less than six-month prognosis without dialysis treatment, he noted. With dialysis, by contrast, a patient’s life can be extended indefinitely. 

But Delaware doesn’t offer medical assistance to undocumented immigrants who may not otherwise be able to afford regular dialysis. 

“The only place they can come to get dialysis is the emergency room and only when they have symptoms,” Vest said. “So it’s kind of this very undignified situation where they have to wait till they’re symptomatic, come into the emergency room and hope that they can get dialysis there. But of course, all these people will now be eligible in Delaware to end their life through suicide if they want.”

 

‘Wild, Wild West’ Scenario

The risk also exists that PAS could move toward euthanasia, without a patient’s prior consent, as happened in Canada, Mauritsen stated in her letter. She also recognized in the letter how depression can influence patients’ decision-making. 

“These concerns are not speculative, and they reflect a commitment to protect the most vulnerable and deserve careful, ongoing consideration,” Mauritsen wrote.

Millea said another medical student’s comment, which he heard some time ago, encapsulates his own opposition to PAS. The student said, “I don’t have any classmates that go to medical school looking forward to making people die.’

“I think that kind of sums it up that it is antithetical to what we’re called to do,” he said. 

The work to stop PAS must continue in the face of the ongoing push to legalize it in other jurisdictions, the Catholic doctor added.

“It’s not over there, they continue their efforts to expand it,” Millea said. “It just becomes the ‘Wild, Wild West’ for end-of-life care.”