MEC 203/Euthanasia-Physician Assisted Dying/Apr2016

MEC 210/Euthanasia and PAD/Oct2018

Preamble

Preamble

1. The issue of euthanasia and physician assisted suicide is controversial. Nevertheless, given the developments worldwide it is important that the WMA engages in an open and respectful discussion in this matter.

2. Several jurisdictions in Europe, North America and South America have legalized certain forms of assisted dying under specific conditions. In these cases, such legalization has been a result of extensive legislative processes, court decisions and debate in society. In all of these locales, some physicians have agreed to provide euthanasia or assistance in dying out of compassion for their patients, in order to alleviate intractable and hopeless pain and suffering.

1. Several jurisdictions have legalized certain forms of euthanasia and assisted death under specific conditions and through a democratic process. In these cases, such legalization has been a result of extensive legislative processes, court decisions and debate in society. In all of these locales, some physicians have agreed to voluntarily provide euthanasia or assistance in dying to help meet the immediate needs of their patients, in order to alleviate intractable and hopeless pain and suffering.

3. For the purposes of this policy document, the following definitions are used:

2. For the purposes of this policy document, the following definitions are used:

Euthanasia means: the act of deliberately ending the life of a patient at his or her own request.

3.  Euthanasia means: the voluntary act of deliberately ending the life of a person at his or her own request.

Physician assisted death (PAD) means: deliberately enabling a patient to end his life by prescribing or providing medical substances to cause death.

4.  Physician assisted death means: where a physician deliberately enables a patient to end his or her life by prescribing or providing medical substances whose sole intent is to cause death.

4. The powers of modern medicine are growing. Whereas a cancer diagnosis once almost certainly meant a death sentence, nowadays it is possible to live on for years, and sometimes even be cured. However, these improvements in treating illness and prolonging life also require other considerations. Some treatments are extremely invasive, while others have severe side effects and can have damaging consequences. When are medical interventions no longer useful, and when are other types of care more appropriate?

5. The powers of modern medicine are growing. Whereas, for example, a cancer diagnosis once almost certainly meant a death sentence, nowadays it is possible to live on for years. However, these improvements in treating illness and prolonging life also require other considerations. Some treatments are extremely invasive, while others have severe side effects that can have damaging consequences and will not always cure the patient.

5. Palliative care is part of good and appropriate medical care. The physician should adopt an attitude towards suffering that is compassionate and humane, and act with empathy, respect and tact. Abandonment of the patient when he or she needs palliative care is unacceptable.

6. Palliative care when available is part of good and appropriate medical care. The physician should adopt an attitude towards pain and suffering that is compassionate and humane, and act always with empathy, respect and tact.

6. Appropriate end-of-life care should routinely respect and promote patient autonomy and shared decision-making, and be respectful of the values of the patient and his or her family. Physicians must carefully consider the views and needs of the patient and his or her family, and not merely on the medical condition or disease. Physicians must also focus on quality of care, and on the choices that can be made together with their patients as they near their end of lives. Patients must be free to decide for themselves what treatments they want and the manner and circumstances of their death and may not be forced to die in ways they would not wish.

7. Appropriate end-of-life care should routinely respect and promote patient autonomy and shared decision-making, and be respectful of the values of the patient and his or her family. Physicians must also focus on quality of care, and on the choices that can be made together with their patients as they near the end of their lives. Patients must be free to decide for themselves what treatments they want and the manner and circumstances of their death and may not be forced to die in ways they would not wish.

7. The medical profession has a centuries-long tradition of healing with the goal of preventing death when possible, alleviating suffering whenever feasible and providing care and comfort always. Euthanasia and physician assisted dying challenge these concepts, because physicians are taught that all life has value, and it is not their traditional role to prescribe, administer or provide medical substances with no therapeutic intent other than to cause death.

8. The medical profession has a centuries-long tradition of healing with the goal of preventing death when possible, alleviating suffering whenever feasible and providing care and comfort always. Euthanasia and physician assisted death challenge these concepts, because physicians are taught to respect human life, and it is not their traditional role to prescribe, administer or provide medical substances with no therapeutic intent other than to cause death.

For the majority of physicians, this is an irresolvable ethical conflict.

Therefore, euthanasia and physician assisted death for many physicians present a conflict between respecting human life and alleviating suffering.

Diverse responses to resolve this dilemma reflect the diverse cultural, legal, traditional, and regional standards of medical care throughout the world.

RECOMMENDATIONS

RECOMMENDATIONS OR PROPOSAL

9. There are several jurisdictions in the world that through extensive democratic legislative processes, court decisions and public debate have legalized certain forms of euthanasia and assisted death under specific conditions.

8. The WMA does not support euthanasia or physician assisted suicide, but WMA does not condemn physicians who follow their own conscience in deciding whether or not to participate in these activities, within the bounds of the legislation, in those jurisdictions where euthanasia and/or physician assisted dying are legalized.

The WMA does not support or sanction euthanasia or physician assisted death, but also does not condemn or label as unethical those physicians who follow their own conscience in deciding whether or not to participate in these activities, within the bounds of applicable legislation, in those jurisdictions where euthanasia and/or physician assisted death are legalized and follow a person's voluntary and well-considered request.

Attitudes toward euthanasia and physician assisted death are evolving and are a matter of individual conviction and conscience that should be respected.

9. No physician should be forced to participate in euthanasia or assisted suicide against their personal moral beliefs. Equally, no conscientiously objecting physician should be forced to refer a patient directly to another physician.

10. No physician should be forced to participate in euthanasia or assisted death against their personal moral beliefs. Equally, no physician should be forced to refer a patient to another physician in order to provide assistance in dying.

Jurisdictions that legalize euthanasia or physician assisted suicide must provide mechanisms that will ensure access for those patients who meet the appropriate requirements. Physicians, individually or collectively, must not be made responsible for ensuring access.

11. Jurisdictions that legalize euthanasia or physician assisted death must provide mechanisms that will ensure access for those persons who meet the appropriate requirements. Physicians, individually or collectively, must not be made responsible for ensuring access.

 Where the law allows euthanasia and physician assisted death to be performed, the procedure should be performed by a competent physician or other health care provider.

10. The WMA also calls on all states to work to ensure access to high quality palliative care services for those in need. Euthanasia and physician assisted suicide should never be used as a substitute for palliative care but should be seen as a last resort for those whose intractable and hopeless suffering cannot be alleviated through any other ordinary means.

12. The WMA also calls on all members to work to ensure access to high quality palliative care services for those in need. Euthanasia and physician assisted death should not be a substitute for palliative care.

13. Patients must be supported appropriately and provided with necessary medical and psychological care along with appropriate counselling at the end of their life, irrespective of the legal possibilities of euthanasia and physician assisted death.