Oversight Needed on Physician-Assisted Suicide for Hospice Patients, Lawmakers Say

When it comes to the use of physician-assisted suicide for hospice patients, more guardrails are needed to avoid discrimination against the vulnerable and disabled, several members of Congress told the Trump administration.

“Physician-assisted suicide raises significant informed consent issues as well as concerns about disability and age discrimination,” wrote senators James Lankford (R-Okla.) and Tim Kaine (D-Va.) and representatives Greg Murphy, MD (R-N.C.), and J. Luis Correa (D-Calif.) in a letter Thursday to HHS Secretary Robert F. Kennedy Jr. “The vast majority of patients receiving physician-assisted suicide are enrolled in hospice … This poses challenges for HHS and CMS’ regulation of patient health and safety within the hospice program.”

In the letter, which was also sent to CMS Administrator Mehmet Oz, MD, MBA, the lawmakers urged “HHS and CMS to implement reporting requirements in the hospice program to monitor physician-assisted suicide for discriminatory practices against vulnerable populations.” Specifically, the letter requested that HHS and CMS “establish reporting requirements within hospice programs regarding physician-assisted suicide” and to consider monitoring physician-assisted suicide practices for:

• Discrimination against individuals with disabilities, older adults, and other vulnerable populations
• Proper disposal of unused medication and prevention of drug diversion
• Insurance denials of life-sustaining medical care that offer to cover physician-assisted suicide drugs instead
• Drug complications
• Consistency of drugs prescribed “off-label” for use in physician-assisted suicide
• Compliance with federal restrictions on using funds, directly or indirectly, for healthcare items or services for physician-assisted suicide

“All hospice patients — regardless of disability, age, or financial means — deserve compassionate end-of-life care that is free of coercion and discrimination,” the authors concluded.

“Hospice should be a place of compassion, comfort, and care, where the suffering are surrounded by loved ones and quality healthcare, not a place where they feel quietly pressured to end their lives through assisted suicide,” Lankford said in a press release. “Federal law is clear that taxpayer dollars cannot pay for assisted suicide, and discrimination against the aged and disabled is prohibited. HHS and CMS have a responsibility to make sure vulnerable people are protected. We’re simply asking them to do that job.”

Murphy took a stronger stance. “As a practicing physician of 35 years, I have dedicated my career to saving lives and comforting my patients,” he said in the release. “The oath all physicians take is ‘to do no harm.’ Physicians who take part in assisting suicide are breaking that oath. It is a great tragedy that people feel that life offers them no recourse other than to end their lives.”

“Rather than suicide we should invest more in palliative care and hospice which are much more acceptable forms of medical care,” he said. “Sadly, abuses such as the lack of informed consent and discriminatory practices have occurred, and patients and their families have been wronged. The House of Medicine should not participate in assisted suicide when we have other humane alternatives to offer.”

John Maa, MD, a San Francisco surgeon, said in an email he thought the letter was helpful “in the current state of conflicting and variable state laws without federal legislation on this topic.”

“There needs to be assurance of safe disposal of the medications [as well as] an understanding of the financial factors at play and the costs patients bear, the historical trends, the costs to the patient and the most impacted populations,” he wrote, adding that “congressional action on the topic would be helpful to ensure that all relevant laws are complied with, to protect those patients who choose to utilize this process, and to ensure that pharmacy practices are conducted in the safest manner (some require pickup of the meds and delivery by a physician, while others send by mail). A process as complex as this should have federal oversight.”

Maa recently wrote for MedPage Today about being present when a friend underwent physician-assisted suicide — also known as medical aid in dying, or MAID — following a long battle with pancreatic cancer. He said that a few weeks later, as a delegate to the American Medical Association (AMA), he chaired a discussion held during an AMA committee meeting about a request to formally change the way the AMA referred to the procedure from physician-assisted suicide to MAID. “Some opposed physician-assisted suicide for ethical and religious reasons, or viewed it as violating the Hippocratic Oath … Others praised the intent to alleviate suffering and restore patient autonomy.”

AMA policy opposes physician-assisted suicide; eventually, the delegates voted in favor of keeping the current name and continuing the AMA’s opposition.

“Fundamentally, the question remains whether physicians should be involved at all,” Maa concluded. “Perhaps one option is to end physician involvement after certifying that a patient qualifies, and delegate the remaining steps to others like a pharmacist or the coroner. Physicians should instead focus on supporting terminal patients and finding new cures to push the limits of medical knowledge.”