Physicians and Californians Support Aid in Dying, but the California Medical Association Doesn’t

[courtesy of California Progress Report]

CMA ignores evidence, experts, and physicians’ views

By Richard Ikeda, M.D.

When cure is no longer possible, the majority of Californians, and the majority of California physicians, want dying patients to have the right to make end of life choices in accord with their own values and beliefs. I am disappointed that my own professional organization, the California Medical Association (CMA), continues to oppose terminal patients’ end of life choices. As a physician caring for the poor and vulnerable elderly, I can tell you cancer and other terminal patients need better end of life care and choices. This week completed ten years’ experience with Oregon’s death with dignity law, and all studies show end of life care has improved for all Oregonians.

The CMA leadership continues to ignore the evidence that patient choice helps all those facing the end of life. It’s time for CMA to join other medical groups in changing its position on aid-in-dying. Peer-reviewed research from Oregon shows that after almost 10 years, there is no evidence of a slippery slope or that vulnerable populations have been harmed. A study published last month in the Journal of Medical Ethics by five researchers who exhaustively examined the effects of aid in dying in Oregon and the Netherlands debunks opponents’ arguments that legalized aid-in-dying harms disabled people and other at-risk groups. The researchers concluded that there was no evidence of harm to the elderly, the uninsured, the, poor, or the disabled. The most recent study found that no vulnerable populations have been harmed in any way from the Oregon law. Yet CMA ignores this evidence and continues to base its opposition to patient choice on a fear of a “slippery slope.” But there is no slippery slope. CMA appears to be making policy based on conservative Christian doctrine instead of relying on peer-reviewed studies and the opinion of end of life experts.

The CMA opposition ignores the views of most physicians. A national survey of 677 physicians and 1,057 members of the general public by HCD Research in October 2005 revealed that the majority of both groups believe that physicians should be permitted to dispense life-ending prescriptions to terminally ill patients who have made a rational decision to die due to unbearable suffering. The survey indicated that nearly two-thirds of physicians (62%) and the general public (64%) believes that physicians should be permitted to dispense life-ending prescriptions. The CMA policy contradicts that of the Academy of Hospice and Palliative Care Medicine (AAHPM), the organization that represents physicians on the front line of end-of-life care - changed its position from opposition to “studied” neutrality: “Excellent medical care . . . can control most symptoms . . . near the end of life. On occasion, however, severe suffering persists; in such a circumstance a patient may ask his physician for assistance in ending his life by providing Physician-assisted Death (PAD).”