by Richard M. Doerflinger
May 26, 2000
The most urgently needed pro-life legislation of this Congress now stands ready for Senate floor debate. The lives and well-being of countless vulnerable citizens hang in the balance as Senators decide what action to take next.
The bill is the Pain Relief Promotion Act (H.R. 2260, S. 1272), a measure to encourage use of federally controlled drugs for pain management without allowing assisted suicide and euthanasia. It was overwhelmingly approved by the House of Representatives last fall; now it has finally been approved by the Senate Judiciary Committee and cleared for Senate floor action.
The Act contains much that should be welcomed by doctors and patients concerned about good care for dying patients. It takes a first step toward "mainstreaming" palliative care as an integral part of good medicine: establishing an information exchange on guidelines for optimum care, and providing $5 million a year in training grants for health professionals to improve pain control for the chronically and terminally ill. It also provides a legal "safe harbor" for physicians working in the usual course of professional practice to alleviate intractable pain, including cases where the large doses needed for pain control may unintentionally risk hastening death.
Under current law, the federal Drug Enforcement Administration (DEA) can scrutinize all use of controlled substances like morphine, to ensure that they are used only for "legitimate medical purposes" and are not abused to endanger "public health and safety." The problem is, the law is not clear on where "legitimate medicine" ends and threat to "health and safety" begins. So a doctor who uses large doses of painkillers may be suspected of "excessive prescribing" and investigated for wrongdoing. The result: Many doctors become overly cautious in prescribing these powerful drugs -- or never obtain a DEA prescribing license to use them at all.
The new Act tells the DEA to defer to doctors' medical judgment in this area, freeing health professionals to use whatever dosage will effectively relieve pain. It is no surprise, then, that the Act is endorsed by the American Academy of Pain Medicine, American Pain Society, National Hospice and Palliative Care Organization, and American Medical Association (AMA).
So why is it taking Congress so long to pass the Act? It has to do with two sentences in this ten-page bill. To clarify the outer limit of the "safe harbor" for physicians, the Act reaffirms that federal law does not "authorize" intentional use of these drugs for the purpose of killing patients. It adds that this federal standard remains intact even if a state drops its own legal penalties for assisting suicides.
These are modest and sensible provisions, restating that the federal government does not want to get into the business of assisting suicides. But it has ignited a firestorm of protest from Oregon Senator Ron Wyden, whose state has legalized physician-assisted suicide, and from a few medical groups who don't think assisted suicide is such a bad idea.
Opponents of the bill claim to be concerned about other issues. They say the bill will somehow actually suppress pain control instead of promoting it – a difficult claim to take seriously, when states enacting similar laws against assisted suicide have seen dramatic increases in use of morphine for pain control. They say the bill infringes on "states' rights," although it simply clarifies the scope of the "legitimate" purposes for which a federal prescribing license may be used. The bottom line is that if these opponents prevail, the federal government will keep actively assisting the killing of patients in Oregon by providing the lethal means.
Increasingly, it is clear that such groups are driven by a particular view of assisted suicide itself. A few state medical societies oppose the bill, but generally they are the same state affiliates -- Oregon, Vermont, Rhode Island -- that dissent from the AMA's position against assisted suicide. The American Pharmaceutical Association opposes the bill, but has a policy opposing any law that forbids pharmacist-assisted suicide. The California Medical Association is urging the AMA to reverse course and oppose the bill – but its chief argument is that the federal bill would counter Oregon's "important and overdue effort" to legalize assisted suicide!
Finally, as revealed in an article by Wesley Smith in the May 29 issue of the Weekly Standard, Senator Wyden himself is working hand-in-glove with the assisted suicide movement. His top advisor on the bill, psychologist James L. Werth, has served on the board of the Nebraska Hemlock Society and written books justifying "rational suicide" for sick and depressed people.
These findings should strengthen the resolve of Congress to pass what may be the only pending pro-life bill with a good chance of being signed by President Clinton. The only reason now for the Senate not to move this bill is that it simply can't work up sufficient concern about the federal government's current role in helping to kill terminally ill patients in Oregon.
The fact is this: Each of the 43 patients committing state-approved suicides thus far in Oregon received their lethal doses by federal authorization, using federal prescribing licenses. If that doesn't send a chill up the spines of lawmakers concerned about abuse of government power, nothing will.
Once you find an abuse this egregious, you put a stop to it. The Senate's Republican leadership should not delay, but bring up the Pain Relief Promotion Act now.
(Mr. Doerflinger is Associate Director for Policy Development at the Secretariat for Pro-Life Activities, National Conference of Catholic Bishops.)