From The
Huffington Post,
AMA Opposition and the Path Ahead
By Barbara Coombs Lee
Working for social change, we run a long race through a wood, dark and deep.
The milestones tick by, yet still the path leads ahead into the thicket. We
long to break into a clearing and see the finish line ahead.
Over fifteen years ago I enlisted in the fight to secure our right to
control the timing and manner of death should end-of-life suffering become
unbearable. We have come far in those years. Nearly
two-thirds of Americans believe the law should empower terminally-ill,
competent patients to choose how they will end their lives.
With the public on our side, we must overcome the resistance of a few
powerful opponents. Conservative religious activists oppose us, as they stand
in the way of other social change. They hold firm religious beliefs about
life's end and seek to impose them on others through secular law.
But they alone could not stop us if they were not joined by the American
Medical Association. The AMA's outspoken opposition to aid in dying has been
cited by the Supreme Court and influences lower courts, state medical
societies, and most important, legislatures.
Our society naturally defers to physicians in the matter of prescribing
potent medicines. We have invested them as the keepers of, and expect them to
manage, those medicines. Yet we chafe at our deference to the medical
establishment when they withhold a vitally important choice from some patients.
To ask, "Why do our doctors oppose what the majority of Americans
support?" misstates the question. The AMA claims to speak for doctors, and
the media often echo that assertion, yet barely a quarter of the nation's
physicians are AMA members.
Many medical
and public health organizations have policies that support aid in dying,
including the American Medical Women's Association, the American Medical
Student Association, the
When pollsters ask individual doctors whether they would support legalized
physician aid in dying, their answer is a resounding yes. A number of surveys
show
nearly two-thirds of doctors are supportive, close to the percentage of
Americans in general. Even among those doctors who are members of the AMA, only
one out of three opposes legalization. In fact a majority of physicians
report they would want aid in dying available to them if they were faced with a
terminal illness. Imposing a reverse golden rule, the AMA prevents doctors from
helping others to choose what they would want for themselves.
With so many doctors supporting it, who stands against empowering dying
patients? Four hundred thirty physicians in the AMA House of
Delegates who craft its policy. Among those 430 physicians, opposition
to end-of-life choice is strong and fierce. Why does the AMA leadership stand
in the way of change? We can only speculate on their motive but it helps to ask
what benefit the AMA sees in keeping it illegal.
The answer lies in the fact that legalization empowers patients. It empowers
them to discuss end-of-life treatment. Legal aid in dying gives qualified
patients the power to ask their doctors about their options and to request a
prescription for life-ending medication. If their doctor will not honor their
choices, legalization gives patients the power to transfer their care to a
doctor who will. It breaks the bonds that hold them hostage to the religious
beliefs of their doctor. Patients however, do not gain power by taking it from
physicians. In my experience, legalizing aid in dying is not a zero sum
equation for doctors. It empowers both patients and their physicians to speak
frankly, practice medicine safely and face inevitable sadness openly.
Where physician aid in dying remains illegal, the AMA
controls both doctors and their patients. Sadly, the
AMA has long opposed progress in medical practice and treatment that
empowers patients and removes physicians from the absolute center of the
decision-making process. The AMA opposed all forms of medical insurance and
delayed Medicare enactment for years with its vigorous opposition. It opposed
birth control for women and the use of anesthesia during childbirth. Patients
fought in court for informed consent, the right that guarantees they must
understand treatments and alternatives before agreeing to them.
As with these past struggles, advocates for empowering patients through aid
in dying have faced opposition from the AMA and its affiliates that is vigorous
and even ruthless. The
The AMA's opposition to patient empowerment is frustrating, even
infuriating, but predictable. Gloria Steinem has famously said, "Power can
be taken, but not given. The process of the taking is empowerment in
itself." At Compassion and
Choices we have learned over the years from countless patients facing the
end of life, that by embracing that end and making
active decisions they forcefully take that power unto themselves. In the same
way, as advocates, we cannot expect a small yet potent group of AMA leaders to
willingly grant us the change we seek. We must take it ourselves.