In an editorial 19 September, 2000 the New York Times called for President Clinton’s veto should the Senate pass the so-called “Pain Relief Promotion Act.” The bill would make it a federal crime to prescribe drugs to assist a patient’s suicide, and points out that “any doctors convicted would serve a mandatory 20 years in prison.”
“The bill is an effort to outlaw physician-assisted suicide nationwide, thereby pre-empting an Oregon state law that allows such medical assistance. The bill’s broader effect would be to discourage doctors from giving appropriate pain relief to terminally ill patients. Its language attempts to soften that impact by stating that alleviating pain through drugs is a legitimate medical purpose “even if the use of such a substance may increase the risk of death.”
On the same day the Washington Post argued that no matter how Senators “feel about the issue of allowing terminally ill patients help to end their lives, members should resist the temptation to pass this measure.” Not only did the Post object to Congress interfering with Oregon’s assisted suicide law, but that the potential harm of the Pain Relief Promotion Act reaches beyond Oregon. The Post argued that “the bill would put the Drug Enforcement Agency in the position of judging a physician’s intent in prescribing painkilling drugs.”
“The upshot is that doctors may limit their prescription of drugs desperately needed by thousands of patients. A number of medical groups, including the American Medical Association, think it contains adequate safeguards against federal intrusion into patient care, and have expressed support. But many others, including the American Cancer Society, oppose it on the grounds that doctors fearful of possible DEA investigation will be unwisely constrained. This division in the medical community ought to give the Senate pause. Undertreatment of pain is a documented and serious national problem. Senators shouldn’t take a chance on making it worse under the guise of trying to make it better.”
Meanwhile, the New York Times argued that: “The bill is an effort to outlaw physician-assisted suicide nationwide, thereby pre-empting an Oregon state law that allows such medical assistance. The bill’s broader effect would be to discourage doctors from giving appropriate pain relief to terminally ill patients. Its language attempts to soften that impact by stating that alleviating pain through drugs is a legitimate medical purpose “even if the use of such a substance may increase the risk of death.”
“This safe harbor is inadequate because the law gives federal drug enforcement agents new power to investigate whether there was “intent” to cause death. But intent is not easily determined when aggressive pain relief may hasten death and when dosage levels for an individual patient may well deviate from the norm to achieve relief. The likely result is that doctors will be discouraged from providing adequate dosages for fear that they will be targeted for investigation and prosecution.
The New York Times called the bill “an inappropriate attempt to usurp the power of states to address the profound question of the right to die.”
“Oregon voters have made the decision to allow physician-assisted suicide as a reflection of their needs and values. Oregon’s Death With Dignity law allows a terminally ill patient to receive a lethal dose of drugs only if judged by two physicians to be of sound mind and to have less than six months to live. Other states may choose not to legalize assisted suicide. But Oregon voters should be allowed to act on this sensitive medical issue without Congressional interference.
Meanwhile, in another editorial, the Los Angeles Times said the legislation is “Painfully Deceitful,” and called it “one of the most misleadingly named bills in Congress.”
The Los Angeles Times pointed out that the Pain Relief Promotion Act, by Sen. Don Nickles (R-Okla.), is true to its name in one respect–it sets aside funding, if only a paltry $5 million, to further research in pain management, particularly into how to discourage terminally ill patients from committing assisted suicide to escape intractable pain.
The Times went on to say, “but the bill’s real fiscal impact would be to authorize the Drug Enforcement Administration to spend up to $80 million launching an investigation of physicians that would inhibit, not encourage, effective pain management.
“Specifically, Nickles wants the DEA to prosecute doctors who have intentionally used controlled substances like morphine to hasten a person’s death. That could have a chilling effect on palliative care. Fear of prosecution is already leading many doctors to undermedicate for pain. For instance, in 1998 a New York state task force on pain management polled 3,000 physicians and found 71 admitting that they had undermedicated patients for pain to avoid punishment by state medical boards.
“Proponents of the Nickles bill say it would not encourage overly zealous prosecution, for it has a provision recognizing that in some instances pain medication may unavoidably increase the risk that a patient will die. But that provision also asks DEA agents–who are law enforcement officials, after all, not doctors–to do something that would daunt the best of medical experts: determine whether a physician intentionally or unintentionally used pain medications to hasten death.
“Nickles’ bill might seem badly timed, coming in the wake of studies showing that U.S. doctors tend to undermedicate for pain. But “pain relief promotion” is really just a fig leaf covering the bill’s real purpose: to override Oregon’s 1994 Death With Dignity Act. Still the only one of its kind in the United States, the Oregon law makes it legal for a doctor to assist in the suicide of a person, under very specific circumstances, if that person is terminally ill.
“The pain-relief angle is useful to the main supporters of the Nickles bill because it distracts from the fact that they–all devout supporters of states’ rights–are proposing federal regulation that would trump state laws. One co-sponsor of the bill, Sen. Jeff Sessions (R-Ala.), as Alabama’s state attorney general even filed a 1996 “friend of the court” brief in which he argued that state governments, not Congress, should determine whether their citizens have a right to physician-assisted suicide.
“Atty. Gen. Janet Reno used similar reasoning in 1998 when she rightly barred the DEA from prosecuting Oregon physicians who helped terminally ill patients commit assisted suicide. Reno pointed out that the federal Controlled Substances Act was intended to prevent illegal trafficking in drugs, not to prevent states from determining appropriate contexts in which those drugs can be used.
“The needless prosecutions the Nickles bill would encourage are a poor pretext for violating the principles that Reno correctly affirmed in 1998.