1360 South Beretania Street Honolulu, Hawaii 96814 Telephone (808) 536-7702 Fax (808) 528-2376 http://www.hmaonline.net/

HMA Position Paper Opposition To Physician-Assisted Suicide/Death

Issue: In the last several decades, medical technology has made tremendous advances in saving and extending lives. As a result, life expectancy has increased dramatically. However, because the quality of end-or-life care has not advanced as quickly, there has been a surge in proposals to legalize physician-assisted suicide.

Position: Consistent with the policies of the American Medical Association AMA the HMA strongly opposes any bill to legalize Physician assisted suicide or death.

The issue of physician assisted suicide is a highly charged and emotional issue. Oftentimes, there is confusion as to the distinction between withholding or withdrawing treatment and assisted suicide. There is a critical difference, both ethically and in practice, between a patient's right to refuse unwanted medical treatment and active medical intervention which brings about death.

AMA's Board of Trustees Report (#48) issued in 1996 articulates well the HMA's views on this issue: It states:

"Physicians, by the nature of their calling, have compassion for those who suffer pain and indignity at the end of life. Instead of assisting those patients in committing suicide, this compassion and respect for patient dignity instills a demand on the profession to focus on providing quality care at the end of life the cost to society of physician-assisted suicide is simply too high. The physician’s primary obligation is to advocate for the individual patient. At the end of life. this means that the physician must strive to understand and assist patients with the various and unique existential, psychological and physiological factors that play out over the course of end-of life care. Permitting physician involvement in assisted suicide would impose a significant and irreversible course change in the patient/physician relationship."

There are preferable alternatives to end-of-life care rather than helping patients to kill themselves. Physicians need to learn to better recognize when pain is not being sufficiently treated as well as signs of depression. In fact, extreme pain and depression are two of the main reasons patients request physician-assisted suicide. This is why last year the AMA initiated an ambitious, two-year project known as the Education for Physicians on End-of-Life Care (EPEC) program. The goal of EPEC is to help improve the care given by physicians to dying patients by developing a standardized, core curriculum that will train physicians in the basic knowledge and skills they need in order to appropriately care for patients at the end of life. The curriculum will focus on communication, ethical decision-making, palliative care, psychosocial considerations and symptom management.

In addition to better physician education on end-of-life care, the HMA supports the following:

• increased public education and awareness of end-of-life care issues;
• more effective pain management;
• greater use and availability of hospice care;
• more widespread use of advanced directives/living wills and legislation to make these documents more binding;

It is unwise to rush into an unprecedented change in a profession's calling without allowing time to see the effect of physician and public educational programs, better pain management, greater hospice availability and use of living wills on end-or-life care. We believe these initiatives are a more rational response than allowing physician-assisted suicide to become an accepted "therapeutic alternative."

The words of ethicist Hans Jonas summarize well the consequences of embarking upon the dangerous path of legalized physician-assisted suicide: "The role of taker of life must
never be assigned to a physician; in any case, the law must never pern1it him to perform it, for this would jeopardize and perhaps destroy the physician's role in society...A patient must never have to suspect that his physician might become his executioner. (Hastings Center Report, Vol. 25, No.7 - Special Issue 1995).

HPACC members are:

• Hawaii Medical Association
• Hawaii Nurses Association
• Healthcare Association of Hawaii
• Hawaii Cancer Pain Initiative
• Not Dead Yet (Disability Rights Organization)
• Disability Rights Hawaii
• Hawaii Centers for Independent Living
• Hawaii Family Forum
• Hawaii Catholic Conference
• Hawaii Right to Life

6301 Pali Highway
Kaneohe, HI 96744-5224
Phone: (808) 203-6704
Fax: (808) 261-7022
hpacc@hpacc.org