American Academy of Neurology Praised for New Neutral Stance on Lawful Physician-Hastened Death
The American Academy of Neurology (AAN) received praise for a new position statement published in late February 2018 that rescinds the AAN 1998 position against medically-assisted suicide, or lawful physician-hastened death (LPHD). In the new, current position, the AAN leaves the decision of whether to practice LPHD to “the conscientious judgement of its members acting on behalf of their adult patients dying of neurologic illness."
The authors of the new position statement chose the term LPHD in lieu of physician-assisted suicide to avoid ambiguity about patient and physician motivation, which is “not to end life, but to hasten death in order to relieve suffering.”
The Ethics, Law, and Humanities Committee deliberated the issues for two years before unanimously recommending that the 1998 position be retired and issuing the new position, which also states that the committee undertook this difficult consideration while respectfully acknowledging that there remain cogent opinions on both sides of the issue.
LPHD is the letter of the law in six states and the District of Columbia, and the position paper states that the position was taken in part because of a 2014 survey of AAN members in which a significant percentage of AAN members stated that they might feel bound by conscience to comply with the wishes of dying patients for assistance in hastening death. In the same survey, more than 70% of AAN members who responded from states where LPHD was authorized said they found participating in LPHD an "ethically permissible behavior," and more than 50 percent of those same respondents said, "they would be willing to assist their patients in hastened death." The Ethics, Law and Humanities Committee also recognized that the AAN was potentially providing conflicting guidance between their code of professional conduct that includes directives to relieve suffering and follow dying patients’ wishes and the existing 1998 Position Statement.
"The American Academy of Neurology is to be commended for supporting choice for their members who participate in 'lawful physician-hastened death' when acting on the behalf of their patients," said Robert Varipapa, MD, Chairman of the Department of Medicine, Bayhealth, Kent Campus, Secretary and Board Member of the Medical Society of Delaware and member of the American Medical Association and the American Academy of Neurology. "The Ethics, Law and Humanities Committee did not consider this issue lightly, taking two years to carefully deliberate this important policy change." (The views expressed in this quote are Dr. Varipapa's and do not necessarily represent those of the American Academy of Neurology, American Medical Association and Medical Society of Delaware).
"The American Academy of Neurology's new position is the latest in a marked movement within the medical community regarding medical aid in dying over the past several years," said Rebecca Thoman, MD, campaign manager for Doctors for Dignity for Compassion & Choices. "The American Academy of Neurology's new position is especially relevant because patients suffering from neurodegenerative diseases like ALS are the most likely to seek the option of medical aid in dying to ensure they can die peacefully. More and more professional societies are acknowledging the primacy of patient-centered care, especially at the end of life, including medical aid in dying."