AAFP Debates Medical Aid-in-Dying Laws
Some family physicians want the American Academy of Family Physicians (AAFP) to spike the term "assisted suicide" and recognize medical aid-in-dying as "an ethical, personal, end-of-life decision."

SAN ANTONIO -- Some family physicians want the American Academy of Family Physicians (AAFP) to spike the term "assisted suicide" and recognize medical aid-in-dying as "an ethical, personal, end-of-life decision."

California delegates presented and argued for their resolution here at the AAFP's Congress of Delegates meeting, inciting vigorous debate on Monday afternoon.

While the AAFP currently abides by the American Medical Association's code of ethics -- and in 20 years the AMA has not altered its position on the issue -- Heather Paladine, MD, a New York delegate, and sponsor of the "ethical" resolution said the AAFP should take the lead. Others "wholeheartedly" agreed.

"To use the term 'assisted suicide' is arrogant and I also believe it's judgmental. We as physicians do not have the right nor the power to decide what life is and the quality of that life for a patient," said Karla Booker, MD, an alternate delegate from Georgia, who noted that she wasn't willing to "stand by" as her husband suffered from terminal lung cancer.

Critics of the resolution said it directly contradicts the Hippocratic Oath and could lead to a "slippery slope." Others opposed the resolutions arguing that the term "medical aid-in-dying" is inaccurate, since hospice care providers also help patients through the dying process, minus the "lethal prescription."

Delegates also explored arguments for repealing the Hyde amendment, endorsing a single-payer system and improving the public's perception of physicians in relation to opioids.

The Hyde Amendment prohibits the federal government from providing coverage for abortion, and delegates from California want it scrapped. They argued that health plans funded by the states or the federal government that offer coverage for continuing a pregnancy should also provide coverage for ending a pregnancy.

Not everyone agreed.

"The murder of a child has not yet been defined as healthcare," said James "Jim" Taylor, MD, an alternate delegate from Louisiana, who added that now is not the time to bring up a "settled issue."

Wanda Filer, MD, board chair for the AAFP, speaking neither for or against, said the group typically opposes laws when they are applied in ways that restrict patients' access to legal medical services.

However, Filer suggested that a separate resolution, proffered by New York, which aimed to prohibit laws that ban or limit telemedicine's use for medication abortion, would likely need further study, due to "complicated and variable" state laws.

California, Colorado, Illinois, New Hampshire, New York, Massachusetts, and Maine all put forward some version of a resolution supporting healthcare as a human right.

Taylor, a Louisiana alternate delegate, opposed the idea. " If this is a right, that creates an open-ended demand on your labor," he said, warning members to be careful what they wish for.

However, Filer recommended the resolution be referred "until we have a sense of where our membership resides."

Lastly, a resolution to "Stop the Blame the Doctors Game," sponsored by Mississippi, and aiming to engage public relations staff to reframe public perception of physicians' role in the opioid epidemic, was panned by some delegates.

"This is a multifactorial problem, and we don't want to lower ourselves to that level," said Domenic Casablanca, MD, a Connecticut delegate.

The AAFP Congress will review these and other resolutions when it re-convenes Tuesday to begin voting on proposed new policies.

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