A new survey indicates that 71 percent of U.S. physicians who perform physician-assisted suicide (PAS) find the practice “rewarding.”
The survey published by Academic Medicine included 28 graduates of a residency program offering training in medical aid in dying (MAID). Of the twenty-one who responded, twelve were practicing MAID where it has been permitted.
Seven participants continued providing life-ending treatment after their training. Of the seven, five said they found the work “more rewarding than their other clinical responsibilities,” the survey found.
Tiny ‘Representative’ Group
One reason for the survey was to measure the outcomes of clinical training programs in MAID.
“As more states legalize medical aid in dying (MAID), there is an ever-increasing need of physicians trained in this type of end-of-life care,” wrote the authors.
Academic Medicine is published by the Association of American Medical Colleges (AAMC).
The study’s authors say it is significant that seven of the twelve physicians who chose to train in PAS continued to provide it as part of their professional service.
“Overall, we found preliminary evidence that suggests such training is highly desirable among residents and may be effective at producing MAID-practicing physicians after residency,” the authors write.
The data do not support that claim, says Tim Millea, M.D., a member of the health care policy committee and chair of the conscience rights protection task force at the Catholic Medical Association.
“The recent study published in the online journal Academic Medicine admits that there is no convincing data demonstrating that physicians ‘want to be trained’ to provide PAS, and that their small sample size is not conclusive for that assessment,” said Millea.
The study also did not examine why residents declined MAID training.
Slow-Spreading Legalization
First legalized in the United States in 1997 through Oregon’s Death with Dignity Act, PAS is now legal and available in 10 states and the District of Columbia, with a dozen more bills pending elsewhere.
Since 1997, at least 11 states have banned PAS.
“I don’t think there has been a ‘spread in access’ but rather an expansion of ‘interest in access,’” said Millea. “It has been a few years since another state has approved PAS. In 2024, bills promoting PAS were introduced in more than two dozen states, and undoubtedly that trend will continue and likely increase in the years to come.”
Reluctance of Professional Groups
Relatively few U.S. medical organizations have openly supported PAS. Those that do include the American College of Legal Medicine, American Medical Student Association, and GLMA: Health Professionals Advancing LGBTQ Equality.
The American Medical Association (AMA) opposes the practice, although measures to adopt a “neutral” stance have come up for votes in recent years.
A neutral position would be “tantamount to approval,” said Millea. “PAS will continue to be a topic of debate within the AMA for the foreseeable future.”
Suicide As Care Rationing
Canada has become increasingly permissive about physician-assisted suicide. In 2024, legislation went into effect allowing the practice to extend to patients with mental illness and no underlying physical illness beginning in 2027.
The increased access to life-ending drugs and encouragement within medical schools to train in suicide assistance may have a more nefarious purpose, and authorities should review special interest support of organizations such as Death with Dignity and Compassion & Choices, says Millea.
“In any controversy like this, the adage of ‘follow the money’ warrants consideration,” said Millea. “If that applies in the case of PAS, the insurance industry would likely have a clear interest in supporting it. It is much cheaper to pay for a single lethal prescription than ongoing treatment until natural death.
“We have seen cases already where PAS was recommended over continued treatment in some states, and extensively in Canada,” said Millea.
Encouraged to ‘Choose’
“Physician-assisted suicide has been used as the ‘cheaper’ option in states where it is legal,” said Genevieve Marnon, legislative director at Right to Life of Michigan, where the state is considering a PAS bill. “[It] gives insurance companies and governments the ability to save money by pushing lethal drugs that are less expensive than treatment.”
Marnon cites the case of a woman who was told by her insurance company that lifesaving treatment would not be covered, but PAS could be an option with a one-dollar deductible.
Rising health care costs will increase pressure on patients to consider suicide, says Millea.
“Medical resources and personnel supply continue to decline, and that leads to shortcuts in care, both in practice and in morals,” said Millea. “That is why the disabled community is one of the most vocal opponents of PAS. If ‘quality of life’ is the criteria, who is to determine that for one individual? The eugenics considerations in this debate are inescapable.”
Saying Yes to Harm
All patients deserve the best care possible, says Marnon.
“Treating patients at the end of life to alleviate pain and suffering is compassionate care, not a waste of resources,” said Marnon.
Medical schools are discarding the longstanding principle that physicians should not harm their patients, says Millea.
“Promotion of unethical methods such as PAS is undertaken in medical schools and residency programs, leading our youngest colleagues to conclude that PAS is just the way things are,” said Millea. “The option of caring for the dying person, rather than simply ending their life, is considered less and less.”
Ashley Bateman (bateman.ae@googlemail.com) writes from Virginia.