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November 12, 2014

A doctor told readers he wanted to die at 75. Was it unethical?

Daily Briefing

    The American Medical Association (AMA) has rejected an effort to strip Ezekiel Emanuel of an ethics honor in the wake of a controversial article in which he expressed a preference for dying at age 75.

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    Last month, Emanuel—the chair of the department of medical ethics and health policy at the University of Pennsylvania and a former adviser to President Obama—wrote in a piece for Atlantic Monthly that age 75 would be his ideal age of death.

    "Doubtless, death is a loss... But here is a simple truth that many of us seem to resist: living too long is also a loss," he wrote.  By age 75, Emanuel writes that he expects to have lived a "complete." After that, he does not wish to experience the pitfalls of old age, including its "mental and physical limitations."

    Emanuel did not suggest he would end his life at 75, but rather that he would stop taking efforts to prolonged his life, such as heart valve transplants and treatment for cancer.

    The article sparked controversy—both inside and outside the medical community.

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    AMA considers withdrawing ethics honor

    In response, New York-based ophthalmologist Gregory Pinto introduced a resolution calling for the AMA to invalidate Emanuel's 2013 Award for Medical Ethics and Professionalism from the AMA Foundation. The award is bestowed on an individual "who has made an outstanding contribution through active service in medical ethics activities and demonstrated dedication to the principles of medical ethics and the highest standards of medical practice."

    In the resolution, Pinto claimed that Emanuel's opinion that "life is less valuable with advancing age" ran contrary to AMA Code of Medical Ethics, which encourages doctors to support access to health care for all people regardless of age. Pinto said that article is "even more disturbing because it comes from one of the architects of national health care policy."

    The resolution was debated Sunday at AMA's interim meeting in Dallas. On Monday, the AMA's House of Delegates voted it down.

    In a committee report describing the decision, members wrote, "Many of those who testified clarified the point that Dr. Emanuel was speaking about himself in his article and not patients in general," and said the witnesses "noted that Dr. Emanuel is entitled to make his own decisions about health care, as all patients are."

    In addition, the report said that rescinding Emanuel's honor "would cause undue controversy" and that the Atlantic article did not relate to the ethics award.

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    However, the committee did note that it is important to continue discussions on issues surrounding end-of-life- care and patient autonomy (Robeznieks, Modern Healthcare, 11/7 [subscription required]; Robeznieks, Modern Healthcare, 11/11 [subscription required]; Lowes, Medscape Medical News, 11/12).

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