by Richard Doerflinger
December 10, 1999
On December 8, celebrated by Catholics as the Feast of the Immaculate Conception, a much more mundane event took place that should be welcomed by seriously ill patients and their caregivers. The American Medical Association (AMA) voted to reaffirm its support for the Pain Relief Promotion Act pending in Congress.
The Act would promote improved knowledge of pain management in public and private health programs, and provide $5 million a year for training in palliative care for physicians, nurses and other health professionals. It would also write into the federal Controlled Substances Act, for the first time, a declaration that federally controlled drugs can legitimately be used for aggressive pain management -- even in those rare cases where their use may unintentionally shorten life as a side-effect. Finally, the bill would clearly provide that deliberately killing one's patient or assisting his or her suicide is not an authorized purpose for the use of these drugs.
Thus doctors in Oregon, the only state to have legalized physician-assisted suicide, could not use federally regulated drugs such as morphine and barbiturates for this lethal practice. Doctors in all 50 states would be encouraged to use these drugs to relieve pain and suffering.
As such, this legislation achieves an important goal of the pro-life movement, preventing government endorsement of assisted suicide, as well as an important goal of patients and doctors, advancing pain management for terminally ill patients who need it. For their part, the Catholic bishops support both goals and so enthusiastically welcomed the Pain Relief Promotion Act.
The Act was overwhelmingly approved by the House of Representatives this fall, 271 to 156, and is poised for Senate action when Congress resumes in late January. It has enjoyed broad medical support, most notably from the AMA and hospice and pain management groups.
But a few medical groups, influenced by the misleading arguments of assisted suicide supporters, organized a campaign to defeat the bill. A linchpin in their campaign was to persuade the AMA House of Delegates, convening in San Diego for its semi-annual convention, to rescind the AMA leadership's decision to support the bill.
That they failed in their campaign is a tribute to some dedicated and courageous physicians who care deeply about the well-being of their patients and the ethical integrity of their profession. These doctors lobbied their state delegates to the AMA, wrote to the Reference Committee hearing testimony on the issue, and in some cases flew to San Diego to present compelling testimony in person.
Deserving special mention are Drs. N. Gregory Hamilton and William Toffler, co-founders of Physicians for Compassionate Care (PCC). Their alliance of over a thousand physicians in Oregon and other states has worked for years to uphold terminally ill patients' right to live with dignity. They appeared in San Diego armed with supportive letters by experts in palliative care, and documentation calmly presenting facts and arguments to disprove the emotional charges of those attacking the bill.
Witnesses opposing the Pain Relief Promotion Act knew that the AMA has a firm position against physician-assisted suicide -- so they generally did not claim that Oregon's policy of allowing the practice is a good policy. Instead they resorted to other arguments.
For example, they said such efforts to forbid the use of controlled substances for assisted suicide will only discourage physicians from using the drugs at all, and hence have a "chilling effect" on pain management. But Dr. Hamilton presented charts showing that in every recent case where a state passed a new ban on assisted suicide, use of pain control drugs like morphine increased. Once doctors were reminded that killing the patient is not an option, but that they may use these drugs to alleviate pain, they improved their commitment to pain control. In Rhode Island, Dr. Hamilton showed, enactment of a state law very similar to the Pain Relief Promotion Act was followed by a greater than twofold increase in statewide morphine use. This fact proved embarrassing to the Rhode Island Medical Society, which opposes the federal bill (and opposed its own state's ban on assisted suicide that has had such positive effects).
Opponents also said the new bill would expand the authority of federal drug agents and lead to new penalties against physicians. After revewing the facts, however, the Reference Committee rightly concluded that this claim, "though passionately stated, is without legal merit." In the end, the Reference Committee urged a reaffirmation of the AMA's support for the bill; this was approved by the full House of Delegates, with added assurances that the AMA will monitor the bill and suggest improvements as necessary.
Thus the bill now has stronger medical endorsement than if the dispute had never occurred. An unprecedented array of pro-life, medical and disability rights groups is urging U.S. Senators to follow the House's lead and approve this much-needed and compassionate proposal.
Faced with the serious problems of terminal illness, a caring physician's concern should be to kill the pain, not the patient. Declaring that this is also the federal government's understanding of sound medicine would be a good way to begin the first legislative session of the Third Millennium.
(Mr. Doerflinger is Associate Director for Policy Development at the Secretariat for Pro-Life Activities, National Conference of Catholic Bishops.)