ACFM Position Statement on assisted suicide and euthanasia

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When a person perceives a need to be healed, that person becomes a patient and consults the physician. It is the physician’s first duty to affirm and to preserve the patient’s life. The Hippocratic Ethic, first embraced more than 2,400 years ago, recognized two fundamental duties of the physician: When possible, the physician is to assist in restoring the patient to a state of health. The second is to do no harm when caring for the patient. These principles are the foundation for all healthcare.

A corollary of the Hippocratic Ethic for the physician is to cure, when possible, relieve symptoms often, and to care always. When cure is no longer possible, the physician is to demonstrate compassion by striving to alleviate symptoms and suffering and to continue to care for the patient until natural death. 

The Hippocratic Ethic incorporated the moral injunction – “do not kill” – into the center of this mission, ensuring that physicians protect and care for human life and do not take life. This injunction necessarily protects patients from potential abuses of power by the physician. The Hippocratic Ethic fosters trust in the doctor-patient relationship.

Historically, graduating physicians would profess their allegiance to the Hippocratic Oath, which states, “I will not participate in euthanasia or help a patient commit suicide, nor will I suggest such courses of action.” Until the latter part of the 20th century, this Ethic was considered inviolable. Today, some learners and practitioners of medicine are abandoning the Hippocratic Ethic. In some jurisdictions in the U.S. and in a small number of other countries, governments have decriminalized assisted suicide and euthanasia. There is disagreement amongst physicians regarding the ethics of assisting a patient in taking their own lives. 

History has demonstrated that when medicine forsakes the Hippocratic Ethic for a utilitarian ethic, untold harms occur. There is an inevitable widening of criteria for lives that are no longer worth living. Physicians abuse the power to take lives. Eugenics, euthanizing the infirm, deaths of despair by prescription, and abandonment of the disabled become acceptable. Yet, when the inherent dignity of humans and the Hippocratic Ethic are embraced, high quality palliative care for those suffering with life limiting diseases is practiced. 

As members of the American College of Family Medicine, we reaffirm the necessity of faithful adherence to the Hippocratic Ethic and declare the following:

1. All those providing healthcare should profess the Hippocratic Ethic, faithfully practice according to its precepts, and affirm the inherent dignity of their patients. 

2. Healthcare professionals should never participate in the killing of a patient by prescribing or administering a lethal substance. Likewise, they should not instruct patients how to prematurely end their lives.

3. Healthcare professionals should practice high quality palliative care for all those suffering from serious life-limiting disease. They should strive to alleviate symptoms and suffering, and to improve the quality of life for patients to the point of natural death. 

4. All in healthcare should vigorously oppose attempts to legalize assisted suicide or euthanasia.  Likewise, the use of euphemisms such as “medical assistance in dying” or “death with dignity” should be avoided. 

Date Adopted: March 11, 2024

References

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