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CHICAGO -- The American Medical Association (AMA) House of Delegates voted Monday to refer discussion of the group's policy on physician-assisted suicide back to the Board of Trustees.

A report (beginning p.75 of ) developed by the AMA's Council on Ethical and Judicial Affairs (CEJA) noted that the association's Code of Medical Ethics currently states, "Physician-assisted suicide is fundamentally incompatible with the physician's role as healer." But the report also seemed to leave an opening for it, adding that while one physician may see it that way, "another in equally good faith understands supporting a patient's request for aid in hastening a foreseen death to be an expression of care and compassion."

In the end, though, the CEJA report recommended no change in current policy as stated in the ethics code. Delegates could have voted to adopt it as AMA policy. In the end, they voted 314-243 to refer the matter back to the trustees for further deliberation.

"We feel the AMA abandoned all physicians who, through conscience beliefs, want to support patients with this in states where it's legal," said Lynn Parry, MD, a Colorado delegate, on behalf of the PacWest group, which includes AMA delegates from six Western states that have legalized physician aid-in-dying. "I personally think we need to protect physicians in those states and would ask for referral back."

But not everyone agreed. "CEJA ... got it right," said F. Jeff White III, MD, a delegate from Louisiana who spoke for the delegation. "The report courageously addresses three major points: the right of conscience will apply in areas where physician-assisted suicide is legal; autonomy will not be the governing fundamental ethic or moral foundation for medicine; and the English language provides precise testimony to describe this practice. I urge the House to reject referral and expeditiously adopt this extraordinary, remarkable report."

Ted Mazer, MD, a delegate from California, emphasized that "the body of this report was excellent [but] the conclusion that this was incompatible practice with the art of healing is something I firmly and many of us firmly disagree with."

Opioid Prescribing

The delegates also approved a resolution calling for the AMA to work with the Association of American Medical Colleges, the American Osteopathic Association, and other professional organizations to establish opioid education guidelines for medical students and physicians in training, but there was some debate over an amendment -- added by the reference committee that handled the resolution -- to include training for practicing physicians as well.

"Our amendment insures the [resolution's] original focus is maintained -- to address the gap in educational materials geared toward medical students and trainees," said Maya Babu, MD, who spoke on behalf of the American Association of Neurological Surgeons. "Expansion of the scope of the resolution undermines the intent of this resolution, which is focused on medical student and post-graduate training gaps in opioid education."

"We are concerned that broadening the resolution in this manner will create an enormous, potentially unwieldy, and duplicative process to develop education materials that goes well beyond that which is appropriate for medical students and trainees."

But some delegates insisted that the training shouldn't be restricted to trainees. "Obviously, the opioid epidemic is something we all need to face," said Luke Selby, MD, a member of the Council on Medical Education. "I'm concerned about exempting practicing physicians from the target of these resources, as all opioids are prescribed by practicing physicians." In the end, the delegates voted to leave practicing physicians in.

In Other Matters ...

The delegates also:

• Referred to the Board of Trustees a report addressing the need for physicians to self-assess their competence to provide "safe, high-quality care." Several delegates expressed concern that there was not enough attention to physicians who have cognitive problems and therefore would be unaware that they were no longer able to care properly for patients.
• Approved a resolution calling for the AMA to issue a report explaining its positions and recommendations for gender equity in medicine, "including clarifying principles for state and specialty societies, academic medical centers, and other entities that employ physicians." The resolution also called for the AMA to advocate for pay structures based on objective, gender-neutral criteria.
• Approved a resolution opposing criminalization of self-induced abortion. In testimony Sunday before the reference committee, several delegates expressed support for the resolution, noting that criminalizing this action might make a women decide not to seek treatment afterward for fear of incarceration.
• Approved a resolution calling for the AMA to support state and federal laws that remove barriers to organ donation, including the addition of organ donation as a qualifying condition under the Family and Medical Leave Act.

The House of Delegates will continue its deliberations on Tuesday, capping off the day with the installation of Barbara McAneny, MD, as the AMA's 173rd president.

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