Anti-PAS bill threatens pain management
A threat last fall by the federal Drug Enforcement Administration (DEA) to use the Controlled Substances Act to sanction physicians for participating in legalized physician-assisted suicide has been effectively neutralized. In June, Attorney General Janet Reno ruled that the DEA did not have such authority. However, Congressional opponents of assisted suicide, including Rep. Henry Hyde (R-IL) and Sen. Don Nickles (R-OK) promptly introduced legislation to circumvent Reno's ruling.
The Lethal Drug Abuse Prevention Act of 1998 would revoke the license to prescribe pharmaceuticals from any physician who has dispensed or distributed a controlled substance with the purpose of causing or assisting in suicide or euthanasia. Although the bill specifically exempts the use of controlled substances for relieving pain, pain advocates have grave concerns about its chilling effect on physician prescribing practices.
At press time, the bill had been assigned to both houses' Judiciary Committees, with a hearing scheduled for mid-July on the House side. The National Right to Life Committee has assigned three staff members to promote this bill. Despite declared opposition by the American Medical Association (AMA) in Chicago, National Hospice Organization (NHO) in Arlington, VA, and other provider groups, House Judiciary chairman Hyde was expected to push the bill forward on a fast track.
The AMA, while reaffirming its "adamant opposition" to physician-assisted suicide, opposes the Hyde-Nickles bill or any regulation involving the DEA in this way, according to an AMA press release
"It's a big mistake to attempt to use federal controlled substances authority to regulate use of controlled substances - which is the responsibility of the state," and of state medical boards, explains David Joranson, MSSW, director of the Pain and Policy Studies Group at the University of Wisconsin in Madison.
"This bill is ill-conceived," adds Ann Jackson, executive director of the Oregon Hospice Association in Portland, which also opposed legalizing assisted suicide in that state. "It will more likely undo the work we've done in improving the care of the dying than it will undo physician-assisted suicide." She also points out that the states with the highest per capita rate of morphine use for pain management, including Oregon, have relatively less restrictive prescribing laws, while those with the lowest morphine use tend to have more restrictive requirements.
In July, NHO hand-delivered a letter to all members of the House and Senate Judiciary Committees outlining its opposition to the Hyde-Nickles bill. The NHO observed that the bill would deter many physicians from treating pain aggressively, and would cause many terminally ill patients to suffer increased physical and emotional pain. "The bill proposes the wrong answer to how we should protect and help people in such pain that they seek help to commit suicide," says NHO President Karen A. Davie. NHO calls on Congress instead to engage in a dialogue with the industry on how to promote broader access to hospice care, to prevent the demand for assisted suicide.
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