Dr. Dorkin offers clarification on new medical aid-in-dying policy

At the beginning of December, the MMS House of Delegates – the Medical Society’s policy-making arm – voted to rescind our long-standing policy of opposition to what we previously called “physician-assisted suicide.”

This was not an easy decision, of course. We represent 25,000 physicians and medical trainees, and each of those members has strong opinions based on unique factors such as their professional experiences, personal and family histories, faith identification, and more.

What made this decision possible was that on an overcast New England Saturday – concluding a year-long process of research and analysis –  hundreds of MMS members debated, discussed, and word-smithed until we felt that we had come together on a statement of policy that clearly delineated a position of “neutral engagement” on medical aid-in-dying as well as an explanation of what that means – and what its limitations are.

As the president overseeing this Interim Meeting of the House of Delegates, I was proud to watch a core group of senior physicians, physicians in practice, resident physicians, and medical students gather to debate the intricacies of language and complexities of the role of the physician in various forms of end of life care.

Unfortunately, despite this impressive collaboration, the robust parliamentary procedure that followed, and the vote of the full House of Delegates, there appears to remain some confusion regarding our policy. On this page, I’d like to provide a few thoughts regarding what the House of Delegates laid out in our newly adopted policy and how the Medical Society is moving forward on that policy.

In assuming the term “neutral engagement,” the House of Delegates stipulated that the MMS serve “as a medical and scientific resource to inform legislative efforts that will support patient and physician shared decision making regarding medical aid-in-dying, provided that physicians shall not be required to provide medical aid-in-dying that involves prescribing lethal doses of medication if it violates personally held ethical principles.”

The second point – that physicians shall not be compelled to assist patients with this particular form of medical aid-in-dying – is, of course, important. It allows physicians to maintain their autonomy and choose what level of care to provide to their patients.

But the first part is also important. It makes clear that in withdrawing our opposition, we are not assuming a position of support for legislative efforts regarding this particular form of medical aid-in-dying. Instead, we are promising to play an educational role to ensure that any such legislative efforts do not inadvertently put our patients at unintended risk of any sort. The Medical Society could weigh in on legislation per this policy, if, hypothetically, a bill were filed that did not provide assurances of patient capacity, or if clinical research showed that certain requirements of a mental health evaluation are particularly important to provide adequate safeguards in any pending bill.

In all things advocacy-related, we bring our physicians’ perspective to policy considerations and speak on behalf of patients when it is appropriate for us to provide medical insight.

The updated policy also states that the MMS “will support its members regarding clinical, ethical, and legal considerations of medical aid-in-dying, through education, advocacy, and/or the provision of other resources, whether or not members choose to practice it.”

Again, this is important. We are not at the present time promising to support this particular form of medical aid-in-dying, as that would contradict our position of neutral engagement.

We recognize, however, that just as the MMS is an advocacy organization, it is also a member-focused educational organization. If at a future time it is appropriate for our members to learn about the complex considerations associated with this form of medical aid-in-dying, we will work with relevant experts to create resources for our members to make informed decisions about their own practices – again, taking into account their own personal and professional histories and priorities.

The MMS members who brought their voices to the creation of this policy did so in the interests of positioning the Medical Society to support our members and their patients without asserting a particular legislative position in the future. I cannot emphasize enough the commitment that they showed.

That’s why it is imperative that this very carefully crafted policy be referenced accurately, and not be misinterpreted to suggest that at the present time, the MMS is taking a particular pro or con position in order to  influence the legislative process.

I’ll close with one final comment: the updated policy also makes clear that palliative, hospice, and compassionate care are essential parts of end-of-life care. We will continue to educate our members and their patients about the steps that patients can take to get the care that is right for them at the end of their lives

  • Henry L. Dorkin, MD, FAAP, President, Massachusetts Medical Society

Leave a Reply