Pain Relief Act Poised for Senate Vote

The Senate Judiciary Committee approved the Pain Relief Promotion Act (H.R. 2260, S. 1272) on April 27, clearing it for a vote by the full Senate.

Committee action had been scheduled earlier but was blocked by opponents' procedural tactics. By April 6, prime sponsor Don Nickles (R-OK) and Committee chairman Orrin Hatch (R-UT) had negotiated new compromise language with the American Medical Association and Pain Care Coalition, ensuring strong support from medical groups that had lingering concerns about the bill's possible impact. The changes affirm states' authority to regulate medical practice and provide additional legal protection for physicians practicing pain control that may unintentionally hasten death. But a markup scheduled for that day had to be canceled, when chief opponent Ron Wyden (D-OR) invoked a rule against committee markups when the full Senate is in session. While the rule is routinely set aside by unanimous consent, in this case Senator Wyden refused his consent.

At Wyden's urging, Committee Democrats then demanded a hearing on the bill to ensure a full debate on the new language. The hearing on April 25 was attended by none of the members who had requested it – but Senator Wyden attended, to speak against the bill and to sit in as a temporary committee member to question other witnesses.

The most dramatic moment of the hearing, however, came from Wyden's Oregon colleague Senator Gordon Smith (R-OR). Observers have long speculated whether Senator Smith would vote in accord with his long-held position against assisted suicide, or with Oregon voters' decision to permit the practice. His voice cracking with emotion, Senator Smith testified that he had sought to "take comfort in the crowd," but in the end had "failed to find comfort with a troubled conscience" because he is convinced that government approval of assisted suicide is bad and dangerous public policy. He said he would support the Pain Relief Promotion Act to prevent use of federally controlled substances for assisted suicide, noting that "Oregon has no more right to write federal law than the federal government has to write Oregon law" [see page 3].

Other witnesses made arguments that have become familiar in the debate on this legislation. Arthur Caplan of the University of Pennsylvania and Dr. Kathleen Foley of Memorial Sloan-Kettering Cancer Center said the Act would do little to promote improved pain management and may pose an obstacle to such efforts. But Dr. Walter Hunter of Vista Healthcare, a national hospice network, and Dr. Eric Chevlen of St. Elizabeth's Medical Center in Youngstown, Ohio testified that the legislation marks an important first step toward a strong federal commitment to pain relief and end-of-life care. Dr. Chevlen presented evidence that states enacting laws similar to the federal bill in recent years – laws which reject intentionally assisting suicide but recognize the "principle of double effect" to allow aggressive pain relief – have witnessed dramatic increases in use of controlled substances like morphine for pain control. Rabbi David Bleich of Benjamin Cardozo School of Law in New York urged Congress to pass the Act to "remove the Federal imprimatur for assisted suicide," observing that "Federal licensure implicates the citizens of all States in an act that is morally repugnant to the majority of our populace and offensive to the traditions of this country."

Two days later, the Judiciary Committee voted 10-to-8 to approve the bill, with Senator Joe Biden (D-DE) joining the Republican majority to support it and Senator Arlen Specter (R-PA) joining the Democratic minority in opposing it. The bill is expected to reach the Senate floor for a vote this summer.

News Briefs

Kevorkian Honored as "Humanitarian"

Jack Kevorkian, serving a 10-to-25-year prison sentence for second-degree murder for giving a lethal injection to Thomas Youk, was honored as a humanitarian on April 10.

Kevorkian received the Gleitsman Foundation's Citizen Activist Award in ceremonies at Harvard University. Foundation president Alan Gleitsman calls him "a selfless believer in death with dignity" who "sacrificed his medical license and now his own freedom toward that cause." With Kevorkian unable to attend, the award was accepted for him by one of those who nominated him -- his victim's wife, Melody Youk.

Kevorkian will share the $100,000 award with Alabama attorney Bryan Stevenson, a crusader against the death penalty. Kevorkian has long favored allowing execution by lethal experiments or removal of a prisoner's vital organs.

On hearing of the award, disability rights leader Diane Coleman of Not Dead Yet commented: "It's a travesty that Jack Kevorkian, who for 33 years campaigned to do live experimentation and organ harvesting on death row prisoners without success will be honored at the same time as an anti-death-penalty activist."

One judge on the panel that chose Kevorkian, psychiatrist Robert Coles, says he disagreed with the panel's decision. Other judges included actor Ted Danson, feminist Gloria Steinem and Mothers Against Drunk Driving founder Candace Lightner [Detroit Free Press, 4/8/00].


Hawaii Suicides Linked to Humphry Video

Derek Humphry's "how-to" film on suicide, based on his book Final Exit, has been linked to two suicides in Hawaii. The two individuals killed themselves within days after the video was aired on public-access television in Honolulu, using an asphyxiation method featured on the video. The video had aired the previous month in Humphry's home state of Oregon [see February Life at Risk].

One victim was a man in his 60s depressed over a failed relationship; the other was a woman in her 40s with a history of depression. Neither had a serious physical illness. Of 99 suicides on Oahu in the last fiscal year, these were the only two by asphyxiation. "I don't think this was coincidence," says Honolulu deputy medical examiner Dr. Kanthi von Guenthner. "Once they see the method, it encourages them to practice it, or if they are contemplating [suicide], it's an easy way out."

Contacted in Eugene, Oregon, Humphry commented: "The death of any person is deeply tragic, but if these people are intent on suicide, and released them-selves in a nonviolent way from their troubles, then I can live with that" [Honolulu Star-Bulletin, 3/7].


Financial Woes Add to Stress of Dying

Writing in the Annals of Internal Medicine, researchers find that financial concerns aggravate the stress of terminal illness and are associated with a greater risk of depression in patients and their families.

The authors surveyed 988 terminally ill patients on their need for assistance in the areas of transportation, nursing care, homemaking and personal care. While 16% of patients had "substantial care needs" in these areas, this figure almost doubled for those with incomes below $15,000 a year. Patients with high care needs were much more likely than others to report that the cost of their illness and care is "a moderate or great economic hardship" for their family. They were also more likely to have considered suicide or euthanasia, and their caregivers were more likely to have depressive symptoms. The authors note that "fear of being a burden" is known to be "a primary motivation" in requests for assisted suicide. They say that interventions are needed to ease the care needs of these patients without adding to their costs; but physicians can help reduce caregivers' depression "simply by listening well" [E. Emanuel et al., "Understanding Economic and Other Burdens of Terminal Illness," Annals of Internal Medicine, 21 March 2000, pp. 451-9].

Verbatim: Senator Gordon Smith on the Pain Relief Promotion Act

It is no exaggeration to say that my views on [assisted suicide] were sought at every campaign stop prior to my election, and have been sought at every town hall since my election. And on hundreds upon hundreds of occasions, my answer was always and is always without variance: I am opposed to assisted suicide.

Today, I come before this committee to repeat that answer once again. Mr. Chairman, I am acutely aware that this position places me at odds with a majority of my constituents, and I tell you that it is a lot more comfortable to be with the majority in the business of democracy. For that reason, I admit to having wrestled for a different conclusion on this issue in order that I might once again take comfort in the crowd.

But on a matter of this magnitude – a matter of life and death – I have failed to find comfort with a troubled conscience. But more, I am loathe to let down the hundreds of thousands of Oregonians who, though a minority, heard my answers, and now count on the integrity of my word. And so, Mr. Chairman, recognizing that this places me in conflict with a majority of my constituents, but at peace with my conscience, I am here today to urge passage of the Pain Relief Promotion Act.

I am also here today to say that while on this issue I cannot give Oregon's majority my vote, I owe them my explanation.

Prior to my service in elected office, I served in a volunteer basis as a Bishop for the Church of Jesus Christ of Latter-Day Saints in my hometown... I found myself making continual rounds at St. Anthony's Hospital in Pendleton, Oregon. On many occasions I shared with parents the unspeakable joy of welcoming newborn babies into this world. On others, I suffered in heartbreaking sorrow as I tried to comfort the critically ill, or hold the hands of those who lay at the brink of eternity....

Through my experiences at that hospital, I came to believe, as never before, that men and women are not just advanced animals, but are children of divine origin and are here on earth to have all of life's experiences -- good and bad, pleasure and pain, health and sickness. I further believe that there is a natural course to living and dying, and that with some exceptions, we should not shorten or lengthen life by artificial or invasive means... It is precisely because of these beliefs and my experiences that I did the unexpected when I became an Oregon State Senator. To the chagrin of a few in the pro-life community, I co-authored one of the most liberal advanced directive laws in the United States...

I viewed then, and still view the withholding of extraordinary medical measures as an act of omission – an appropriate acquiescence to the timetable of nature's God. But I stated then – and believe still – that physician assisted suicide is an act of commission, a step over the line, in which a state should never have complicity.

It is the line of commission rather than omission that I cannot cross. I believe the United States should never cross that line, either, by allowing federally controlled substances to be used in physician assisted suicide. To do so would be bad policy and it would have consequences over time unimaginable now – consequences outlined by Derek Humphry, an Oregonian and one of the most vocal and visible advocates of assisted suicide, in his 1998 book Freedom to Die.

The final chapter of Mr. Humphry's book is entitled "The Unspoken Argument." Why it is unspoken? Because it is so awful. Let me quote from page 313 of Mr. Humphry's book, where he reveals the true reason why he believes assisted suicide's time has come:

"...one must look at the realities of the increasing cost of health care in an aging society, because in the final analysis, economics, not the quest for broadened individual liberties or increased autonomy, will drive assisted suicide to the plateau of acceptable practice."

Then he asks this chilling question: "Is there, in fact, a duty to die – a responsibility within the family unit – that should remain voluntary but expected nevertheless?"

Mr. Humphry answers yes, but I believe we must answer his vision of Orwellian ugliness with a resounding no. I will not be party to building such a society or justifying such a culture of death. In such a culture, we should never wonder why children do not value life when adults write laws that do not value it either....

Now, finally, Mr. Chairman, let me turn to the issue of state's rights. At the heart of Oregon's twice passed physician assisted suicide law is the assumption that Oregon can change, expand, and interpret a 30 year old federal statute in ways never authorized or contemplated by the national government. Not since Lee's Army surrendered to Grant's at Appomattox Courthouse has a state enjoyed such a right.

The Controlled Substances Act was passed expressly to control deadly drugs in interstate commerce to ensure "public health and safety." It was the toxic and lethal nature of these drugs that caused Congress to act, to limit and regulate their use to "legitimate medical purposes."

For a state – even my beloved home state of Oregon – to unilaterally act to use federal drugs for lethal purposes is an open invitation to the nation to reclaim and reassert its law. Oregon has no more right to write federal law than the federal government has to write Oregon law.

Mr. Chairman, I do not know if I will ever have to cast my vote on the Pain Relief Promotion Act, but if I do, Oregonians should know that I will vote "aye."...

Mr. Chairman, this weekend I will return to Oregon, and begin again the process of discussing this issue and my position with those citizens who have granted me the high privilege of serving my native state in the United States Senate. I deeply respect the fact that I do answer to them. I will share with them words that have given me courage throughout my years in public service, but most especially this past weekend in drafting this statement. The words are these:

"Democracy means much more than popular government and majority rule," wrote John F. Kennedy. "The true democracy, living and grow-ing and inspiring, puts its faith in the people – faith that the people will not simply elect men who will represent their views ably and faithfully, but also elect men who will exercise their conscientious judgment – faith that the people will not condemn those whose devotion to principle leads them to unpopular courses, but will reward courage, respect honor, and ultimately recognize right."

(From April 25 testimony to the Senate Judiciary Committee) (www.senate.gov/~gsmith/press/000425.htm)

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