The topic of physician-assisted suicide (PAS) has created controversy in the house of medicine, the public, and among some APA members. The recent article with esteemed APA leaders taking diametrically opposed views exemplifies the debate. As the articles notes, APA adheres to the AMA Principles of Medical Ethics per its Constitution. The AMA has reaffirmed its position opposed to PAS. There are some additional points that are worth mentioning as our members consider these issues.

When there have been controversies between APA and the AMA, we have been able to negotiate our differences and achieve an agreed-upon outcome. There may come a time when an ethical position of APA is diametrically opposed to the AMA's position. If that time comes, the Board of Trustees will need to address the issue as a constitutional dilemma and take whatever steps are necessary to support the views of APA. That time, however, is not now.

The ethical positions of APA and the AMA are constructed to not only support our mission of current patient care, but also protect the integrity of the profession and all patients present and future. It was for that reason that Drs. Hartmann, English, and I strongly endorsed an APA position statement on confidentiality of patient records after the death of the patient. Consistent with that view of protection of future patients, we must assure that physicians do not need to think through each individual case where a PAS is requested. No amount of regulations and guidelines has prevented the abuse of PAS in the Netherlands.

We certainly cannot hope for the best intentions of our health care system (as currently evolving) to protect patients. There are already examples surfacing of physicians failing to provide aggressive treatment to elderly patients who might survive and continue with a meaningful quality of life. How will we adequately measure countertransference in the decision-making process in PAS? Who is PAS to benefit--the patient or the caretakers? Who will teach our physicians about how to assist in the death of their patients? The questions go on and on with inadequate answers.

We need to work together with our medical colleagues to assist them in advocating appropriate pain treatment of patients, the use of advance directives, and not providing futile treatment, but not condoning withdrawal of treatment that is beneficial or agreeing to assist a patient in suicide. After all, PAS is mostly in the potential practice of other physicians, not psychiatrists. We do, however, need to advise our colleagues about the psychological pitfalls of support for PAS and utilize our organization to support our colleagues in the AMA who are trying to protect the integrity of medicine.

Hippocrates, the AMA, and Dr. English are on the right side of this issue--that of protecting the integrity of the profession of medicine. Let's make sure that the APA Board and our AMA delegates continue to bring our unequivocal support to the AMA on this issue.

Jeremy A. Lazarus, M.D.
Speaker-elect of the Assembly

(Psychiatric News, April 18, 1997)