Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate

Daniel P. Sulmasy, Ilora Finlay, Faith Fitzgerald, Kathleen Foley, Richard Payne, Mark Siegler

Abstract

Journal of General Internal Medicine

It has been proposed that medical organizations adopt neutrality with respect to physician-assisted suicide (PAS), given that the practice is legal in some jurisdictions and that membership is divided. We review developments in end-of-life care and the role of medical organizations with respect to the legalization of PAS since the 1990s. We argue that moving from opposition to neutrality is not ethically neutral, but a substantive shift from prohibited to optional. We argue that medical organizations already oppose many practices that are legal in many jurisdictions, and that unanimity among membership has not been required for any other clinical or ethical policy positions. Moreover, on an issue so central to the meaning of medical professionalism, it seems important for organized medicine to take a stand. We subsequently review the arguments in favor of PAS (arguments from autonomy and mercy, and against the distinction between killing and allowing to die (K/ATD)) and the arguments against legalization (the limits of autonomy, effects on the patient-physician relationship, the meaning of healing, the validity of the K/ATD distinction, the social nature of suicide, the availability of alternatives, the propensity for incremental extension, and the meaning of control). We conclude that organized medicine should continue its opposition to PAS.


Sulmasy DP, Finlay I, Fitzgerald F, Foley K, Payne R, Siegler M. Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate. J Gen Intern Med. 2018 Aug;33(8):1394-1399. doi: 10.1007/s11606-018-4424-8. Epub 2018 May 2.

Tolerance, Professional Judgment, and the Discretionary Space of the Physician

Daneil P. Sulmasy

Arguments against physicians’ claims of a right to refuse to provide tests or treatments to patients based on conscientious objection often depend on two premises that are rarely made explicit. The first is that the protection of religious liberty (broadly construed) should be limited to freedom of worship, assembly, and belief. The second is that because professions are licensed by the state, any citizen who practices a licensed profession is required to provide all the goods and services determined by the profession to fall within the scope of practice of that professional specialty and permitted by the state, regardless of any personal religious, philosophical, or moral objection. In this article, I argue that these premises ought to be rejected, and therefore the arguments that depend on them ought also to be rejected. The first premise is incompatible with Locke’s conception of tolerance, which recognizes that fundamental, self-identifying beliefs affect public as well as private acts and deserve a broad measure of tolerance. The second premise unduly (and unrealistically) narrows the discretionary space of professional practice to an extent that undermines the contributions professions ought to be permitted to make to the common good. Tolerance for conscientious objection in the public sphere of professional practice should not be unlimited, however, and the article proposes several commonsense, Lockean limits to tolerance for physician claims of conscientious objection.


Sulmasy DP. Tolerance, Professional Judgment, and the Discretionary Space of the Physician. Camb Q Healthc Ethics. 2017 Jan;26(1):18-31.

The Role of Conscience in Medical Decisions

Daniel P. Sulmasy, M.D.
Center for Practical Bioethics
6 August, 2009.

Does conscience ever clash with professional duties? What do we mean by terms such as ‘conscience’ and ‘conscientious objection’? How should one approach a request from a patient that conflicts with one’s individual conscience?


Conscience and Clinical Care: The Role of Conscience in Medical Decisions

Daniel P. Sulmasy, M.D.
Center for Practical Bioethics
6 August, 2009.

Does conscience ever clash with professional duties? What do we mean by terms such as ‘conscience’ and ‘conscientious objection’? How should one approach a request from a patient that conflicts with one’s individual conscience?

Physicians, nurses, pharmacists, and a host of other health care professionals face this dilemma all across America. While recently there has been great interest in conflicts of conscience based upon religious beliefs, conscience is a universal phenomenon, conflicts are ubiquitous, and, fortunately, generally resolvable.

In this lecture, Dr. Daniel Sulmasy will discuss how medical professionals can strive to preserve their moral integrity while also respecting and serving patients with whom they might have deep moral disagreements.

Trailer. For the full lecture, visit the Center for Practical Bioethics