October 4, 2000
As the 106th Congress nears its end, it must deal with much unfinished business. The most critically important of these is the long overdue task of passing the Pain Relief Promotion Act (H.R. 2260, S. 1272), to clarify the federal government's policy on pain management and assisted suicide.
This Act would restore the uniform application of federal drug laws, so the authority of the Drug Enforcement Administration (DEA) is no longer invoked in any state to promote suicides using lethal overdoses of federally controlled drugs. It would also promote use of these drugs for pain management, providing a clearer and more explicit "safe harbor" in the federal Controlled Substances Act even when the use of large doses of these drugs for pain control may increase the risk of death. Thus the medical-moral principle of "double effect" will be formally affirmed in federal drug laws – as it has been affirmed in many state laws on assisted suicide, and in all other federal programs through the Assisted Suicide Funding Restriction Act of 1997, with very positive effects on palliative care.
A great deal of misinformation has been disseminated to media, medical groups and Congress by those who want the federal government to continue facilitating assisted suicides in Oregon. Medical groups which oppose all laws against assisted suicide – American Pharmaceutical Association, state medical societies in Rhode Island and Vermont, etc. – have worked with Oregon Death with Dignity and other suicide advocacy groups to appeal to physicians' fears of federal scrutiny and legal liability. They have misrepresented the Pain Relief Promotion Act as a new grant of authority to the DEA, as an unwarranted intrusion into medical practice that will have a "chilling effect" on physicians' willingness to relieve pain. In response we offer the following observations:
- The proposed Act does not create federal scrutiny over physicians but reins it in. Ample documentation is available on this point. Everything that opposing groups say would be introduced into federal policy by the proposed Act has already been in place for many years under the Controlled Substances Act.
- The charge is not new, but is the standard argument made for years by medical and other groups opposing laws against assisted suicide. The same charges about a "chilling effect" on pain control were made by the Rhode Island Medical Society in 1996 to oppose a ban on assisted suicide in that state. When the law passed despite these objections, use of morphine for pain control in Rhode Island more than doubled; the state rose from 46th rank among states in use of morphine up to 18th in one year. Other states have seen similar results. The current ban on assisted suicide in all federal health facilities, which Congress adopted in 1997 (with language on "double effect" similar to that found in the proposed Act), has led to dramatic improvements in palliative care in Veterans Administration hospitals. Assisted suicide proponents had testified against that bill as well, insisting that it would have a "chilling effect" on end-of-life care.
- This Act is strongly supported by the American Medical Association, National Hospice and Palliative Care Organization, American Pain Society, Hospice Association of America, American Academy of Pain Medicine, American Academy of Pain Management and other medical and hospice organizations. These groups are fiercely protective of health professionals' right and duty to offer effective pain management. All of them unhesitatingly opposed a previous bill to end federal support of assisted suicide in 1998, because they feared it may have had an adverse effect on pain management. They support the present Act because it was drafted to their specifications, to ensure that the Act's impact on pain control and hospice care will be completely positive.
- Coordinating the campaign against the proposed Act is the American Pain Foundation, a small Baltimore-based group funded by major drug companies and billionaire assisted suicide proponent George Soros. When asked what change in the Act would address its concerns about a "chilling effect" on pain control, the APF demanded deletion of one sentence in the section providing a safe harbor for pain management: "Nothing in this section authorizes intentionally dispensing, distributing, or administering a controlled substance for the purpose of causing death or assisting another person in causing death." APF's position, in effect, is that if the federal government provides legal protection for cases where use of pain control drugs may "increase the risk of death," it must protect cases where the drugs are deliberately used to kill patients. That is, federal policy is not allowed to distinguish pain control from assisted suicide, but should promote both. If this is not a pro-assisted-suicide position, I do not know what is.
Some have claimed that other bills on end-of-life care, such as Senator Wyden's "Conquering Pain Act," may achieve the benefits of this legislation without broaching the controversial issue of assisted suicide. This is untrue. Senator Wyden has refused to clarify his bill's definition of palliative care to exclude assisted suicide. His staff has confirmed that when his bill is implemented in a state like Oregon, whose Medicaid program defines "comfort care" to include assisted suicide, its programs will follow the state definition. By avoiding mention of assisted suicide, the Wyden bill would maintain and increase federal promotion of that practice.
Others say Congress has higher priorities in its last days, such as prescription drug coverage. With due respect for concerns about the cost of prescription drugs, a very serious issue in its own right, it is absolutely essential to decide whether these drugs will be used to heal and comfort or to kill.
The need for legislation improving pain management and other aspects of end-of-life care is enormous, and will not be exhausted by one bill. We will be happy to work with a broad array of medical and other groups in the 107th Congress to continue to address these issues. But first, the federal government must stop supplying the means for intentionally causing the deaths of vulnerable patients. Please do not adjourn without passing the Pain Relief Promotion Act.