(CN) — The American College of Physicians reaffirmed its opposition Monday to the expanding legalization of physician-assisted suicide and euthanasia, citing legal, clinical and other concerns in a position paper.
The Netherlands became the first nation to legalize euthanasia, in 2002. Since then several nations and U.S. states have adopted similar laws, with varying requirements and levels of independent review.
As public and expert sentiment continue to steer toward accepting a patient’s desire to end her or his own life, the American College of Physicians has updated its 2001 position paper against the practice to reflect changes in the legal landscape and points of focus for medical personnel seeking to provide legitimate alternatives.
While the group recognizes that medical decisions surrounding end-of-life care can be challenging for physicians, the authors say that improved hospice and palliative care can serve as acceptable routes for doctors and patients who are wary of medically aided death.
“The American College of Physicians acknowledges the range of views on, the depth of feelings about, and the complexity of the issue of physician-assisted suicide,” said its president Jack Ende.
“But the focus at the end of life should be on efforts to prevent or ease suffering and on the often unaddressed needs of patients and families. As a society, we need to work to improve hospice and palliative care, including awareness and access.”
Lack of awareness of alternatives is one of the primary factors that lead patients to choose medically assisted suicide, according to the position paper.
The group cites a 2015 study in the New England Journal of Medicine that found 90 percent of Americans do not know what palliative care is, though after learning about the option more than 90 percent said they would want it for themselves or family members if they were severely ill.
“Hospice and palliative care may ease apprehension about the dying process,” according to that study. “Such care requires improving access to, financing of, and training in palliative care; improving hospital, nursing home, and at-home capabilities in delivering care; and encouraging advance care planning and openness to discussions about dying.”
Though the American College of Physicians acknowledges that laws and medical ethics support a patient’s right to refuse treatment, it says medically assisted death tarnishes a physician’s role as healer and comforter, the medical profession’s role in society and the patient-physician relationship.
“Both sides agree that patient autonomy is critical and must be respected, but they also recognize that it is not absolute and must be balanced with other ethical principles,” the position paper states. “To do otherwise jeopardizes the physician’s ability to practice high-value care in the best interests of the patient, in a true patient-physician partnership.”
In addition to explaining alternative options, the paper features a list of 12 steps that physicians should follow when discussing end-of-life care with a patient. The steps include guiding a patient through the care process, explaining his or her options and avoiding ineffective or harmful treatments.
“Through effective communication, high quality care, compassionate support, and the right resources for hospice and palliative care, physicians can help patients control many aspects of how they live out life’s last chapter,” Ende said.
In an accompanying editorial, a team led by William G. Kussmaul, associate professor at Drexel University’s College of Medicine, supports the American College of Physicians’ stance. It calls legal euthanasia and physician-assisted suicide a “slippery slope” that can lead to abuse, as the authors say has happened in the Netherlands.
The editorialists wrote that “in 2015, the Dutch government reported that hundreds of persons were put to death without their express consent or because of psychiatric illness, dementia, or just ‘old age.’”
Kussmaul’s team adds that the 2004 Groningen Protocol, which outlines the criteria under which physicians can perform child euthanasia, has legalized medically aided infanticide in Holland.
“In view of these developments, it is laudable that Oregon, Canada, and other jurisdictions have built safeguards into their end-of-life legislation,” the editorial states. “However, a slope still exists, and it may be fairly steep.”
Medically aided death has become more common in the Netherlands since it was legalized, with euthanasia and physician-assisted suicide accounting for 4.5 percent of all deaths in the nation in 2015, up from 1.7 percent in 1990, when the practice was still illegal.
While the law is applicable to patients in “unbearable suffering” with no prospect of improvement, its original purpose has informally expanded beyond people with cancer and other life-threatening diseases to include people suffering from mental illness, severe depression and other debilitating health issues.
Despite opponents who call such expansion an abuse of the law, the Netherlands government is considering a bill that would allow people 75 and older to voluntarily end their lives. A draft of the “Completed Life Bill” is expected to be completed by the end of the year.