The American Medical Association’s (AMA) longstanding policy opposing physician-assisted suicide was technically reaffirmed in 2016 at the AMA Annual Meeting, when the AMA accepted the Council on Judicial and Ethical Affairs’ (CEJA) report to modernize the Opinions in the Code of Medical Ethics. However, CEJA stated, “The Council is prepared to address concerns about existing Opinions, some of which have been in the Code for decades, through the resolution process.” As a result, the House of Delegates referred an Oregon resolution which called for the CEJA to “study the issue of medical aid-in-dying with consideration of (1) data collected from the states that currently authorize aid-in-dying, and (2) input from some of the physicians who have provided medical aid-in-dying to qualified patients, and report back at the 2017 Annual Meeting with recommendation regarding the AMA taking a neutral stance on physician ‘aid-in-dying.’” (Aid-in-dying is the euphemism for physician-assisted suicide.)

Since that time, the CEJA has been meeting and hearing testimony on this topic in preparation for submitting its report at the AMA Interim Meeting in November 2017. The results of that meeting were not available at the time of this publication’s printing.

At the 2017 AMA Annual Meeting in June, Dr. David Barbe was inaugurated as President of the AMA. Dr. Barbe is a family physician, and CMDA reached out to conduct an interview with him regarding the future of AMA’s stance on physician-assisted suicide.

---

CMDA: Tell us a little about your background and your professional career.

DR. BARBE: I was raised in Mountain Grove, Missouri, a town of 5,000 about an hour east of Springfield, Missouri. I received my undergraduate degree and medical degree from University of Missouri–Columbia and later completed my master’s in health administration there also. I completed my family medicine residency in Wichita, Kansas. After residency, I returned to my hometown and started a traditional solo family medicine practice—cradle to grave—including full obstetrics, nursing home, hospital and minor procedures. I grew my practice to include two sites and several physicians. After almost 15 years in private practice, I merged my practice with Mercy in Springfield, Missouri, a large integrated health system. I still live and have my clinical practice in Mountain Grove, but I am also Vice President of Regional Operations for Mercy Springfield with responsibility for five hospitals, 75 regional practices and about 200 physicians and advanced practitioners.

CMDA: How did you get involved in the AMA and then become its President?

DR. BARBE: There are many ways for physicians to get involved and become a leader at the AMA. My path started at the state-level, serving on committees for the Missouri State Medical Association (MSMA). Working on behalf of Missouri physicians, I chaired the MSMA governing board in 2003 and served as MSMA president in 2005.

The AMA also offered valuable leadership opportunities, allowing me to get involved in shaping the medical profession’s position on social and economic aspects of medical care. I was a member of the Council on Medical Service, an influential AMA committee, and served as its chair from 2008 to 2009. My term on the council was marked by the development of AMA policy related to coverage of the uninsured, health system reform, Medicare reform and health insurance market reform.

Following my service on the council, the representatives of the nation’s physicians elected me to the AMA Board of Trustees in 2009. There I was appointed to numerous AMA committees and task forces prior to serving on the board’s executive committee, and eventually serving as board chair from 2013–2014. I was elected President-elect in June 2016 and inaugurated as President in June 2017.

CMDA: From your long history as a leader, what are the most important traits successful leaders should have today?

DR. BARBE: In several recent speeches, including at my son’s commencement at the Kentucky College of Osteopathic Medicine this past spring, I’ve reminded students and my colleagues that simply by virtue of being physicians, we are all leaders. Other members of the healthcare team look to us for leadership. Our practices and hospitals, our patients and our communities—ALL look to physicians for leadership.

In this context, leadership is not about position or authority, but more about being a positive presence and having a constructive influence on whatever situation we are in. How we look for solutions, encourage and help others adapt to change, and shape the changes that are needed are what defines us and determines our effectiveness as leaders.

I ask every physician audience this question: “As physicians, we ARE leaders…what kind of leaders will we be?”

CMDA: How does your faith impact your practice and your role as President of the AMA?

DR. BARBE: For me, my practice as a physician and my Christian faith have been very reinforcing of one another. As a Christian, I recognize the dignity and intrinsic worth of every individual. As a physician, this helps me remain sensitive to the needs of my patients—even those who are sometimes difficult—and to keep their needs first. My role as President of the AMA is a natural extension of that. As the AMA’s spokesperson, I work to shape a healthcare system that is better for both patients and physicians. For instance, in the ongoing national discussion around health system reform, my personal Christian and professional values fit nicely with the policies of the AMA and made it easy for me to advocate for improving coverage, access and affordability, protecting the safety net programs (Medicaid and CHIP) and maintaining patient protections in the market reforms of the ACA (e.g., no exclusion for pre-existing conditions).

Editor’s Note: For this next question, our original question was in regard to CEJA’s expected recommendation on the AMA’s position on legalizing physician-assisted suicide. In an effort to continue the dialogue with AMA, we allowed our question to be edited. Our understanding through multiple CMDA and AMA members in the last year has been that CEJA would make a recommendation regarding their position statement on physician-assisted suicide. Two, CMDA does not use euphuisms of aid-in-dying or end-of-life option for physician-assisted suicide.

CMDA: The CEJA’s ongoing study of aid-in-dying is of particular importance to our CMDA members. What advice would you give to our members to contribute to the discussion on this and other issues of importance to them?

DR. BARBE: In light of recently proposed or adopted state legislation on aid-in-dying, concerned physicians in the AMA House of Delegates (HOD)—our policy-making forum—proposed that the AMA study the related issues. The proposal was considered by the over 1,000 delegates and alternate delegates who comprise our HOD and ultimately referred to the AMA Council on Ethical and Judicial Affairs (CEJA).

Responding to the delegates’ need for additional information, the council is examining the current landscape surrounding the issues. In light of the complex and deeply contested nature of the issues at stake, CEJA believes it is wisest to proceed cautiously and allow ample time for thoughtful reflection in developing its report.

CEJA has begun reviewing the extensive literature, along with broad and diverse input from physicians. CEJA continues to consider physician input through email and hearings. Physicians who are CMDA members can play a role in helping inform CEJA during its deliberations.

On any medical issue, physicians can express their viewpoint by working with their representatives in the House of Delegates. This AMA assembly works from the local level up and gives every physician and medical student in the nation a representative voice. Your state or specialty medical society can help you contact your delegation.

CMDA: Many physicians are concerned about the future of healthcare, especially its cost. What would you say to them?

DR. BARBE: During ongoing discussions on the future of health reform, the AMA led a unified front to preserve health insurance coverage for 20 million Americans who were unable to secure it before. By bringing together voices from across the profession and by working with a broad coalition of patient groups, AMA created a physician vision for health reform that was overwhelmingly supported across organized medicine and proved critical to shaping the reform debate in Washington, D.C. We know the status quo is unacceptable, and we will continue to advocate for bipartisan improvements to improve our healthcare system.

While the future of the Affordable Care Act has dominated recent headlines, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has the potential to be equally transformative to our healthcare system in terms of improving quality and lowering the cost of healthcare.

Since the enactment of MACRA, the AMA has worked closely with state and specialty societies and the Centers for Medicaid and Medicaid Services (CMS) to ensure that the regulations implementing the new Medicare law are workable as physicians transition to value-based care. Those advocacy efforts paid off when CMS adopted a majority of the AMA’s recommendations to help physicians avoid penalties, while providing greater flexibility, relief for small and rural practices and reduced reporting burden. Because we know not enough physicians feel prepared for the new law’s requirements, we have released a number of tools and resources to help them be successful. (For access, visit www.ama-assn.org.)

CMDA: Is there anything else you would like to share?

DR. BARBE: As physicians, residents and medical students navigate changes in our profession, the AMA listens, supports and empowers them to succeed throughout their unique journeys. Physicians and patients can know that the AMA is advancing patient care and improving the nation’s health by speaking clearly and powerfully in Congress, in the courts and with healthcare innovators. I urge all physicians to join us and help us shape the future of medicine.

---

JOIN THE FIGHT AGAINST PHYSICIAN-ASSISTED SUICIDE

CMDA is a leading voice in the battle against the legalization of physician-assisted suicide. For resources and the latest information about the dangers of physician-assisted suicide to healthcare and your right of conscience, visit www.cmda.org/pas. More than 32 states in the U.S. are facing potential legislation this year. If you want to get involved in your local state’s grassroots efforts, contact communications@cmda.org.

---

This Feature Story Appears in:

Winter 2017 Edition of Today’s Christian Doctor