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Dear PCC members:
The following is a fine editorial written by a nationally prominent hospice physician and published in the Cleveland Plain Dealer today.
William L. Toffler MD
National Director, Physicians for Compassionate Care


Pain Relief Should be Nonpartisan
Wednesday, June 07, 2000
From The Cleveland Plain Dealer
By Eric Chevlen, M.D.

"I never thought I'd say this," sighed my conservative friend, "but where are the liberal Democrats when you need them?"

His dismay is understandable. The elderly, women, minorities and people with AIDS are facing a crisis of poor pain control. But their usual Democrat defenders are quietly collaborating in a plan to create a federal license to kill those very people whose poor pain control or depression has made them despair of life. The details of the case are fascinating - and alarming.

For 30 years, the prescribing and dispensing of opioid (narcotic) pain relievers and similar drugs has been regulated by the Controlled Substances Act. Until recently, its main feature, that the drugs be dispensed only for "legitimate medical purposes," has been uncontroversial. For 30 years, doctors have known that the federal law does not permit them to simply sell drugs for cash, to exchange drugs for sex or to use the drugs to commit homicide, even if the victim of the homicide cooperates in the act.

When Oregon passed its physician-assisted suicide law in 1998, the Drug Enforcement Agency administrator correctly ruled that the state law does not supersede the federal one. It might be legal to commit physician-assisted suicide in Oregon, he said, but federally controlled substances may not be used to do it. However, in a bizarre decision that left legal scholars scratching their heads, he was overruled by Attorney General Janet Reno. She said that in 49 states it would continue to be against federal law to intentionally kill a patient with controlled substances. In one state, Oregon, the federal law would be different.

Those who thought that the Civil War had put an end to the theory that states could nullify federal law were surprised, to say the least. Congressmen from both sides of the aisle took a dim view of this executive branch usurpation of congressional authority to decide the nation's laws.

The Pain Relief Promotion Act was introduced as a bipartisan measure to reunite a nation divided against itself. It simply reiterates the law as it had been for 30 years, saying that federally controlled substances may not be used to kill people, no matter what the state law says. The PRPA gives no new authority to the DEA to supervise or second-guess medical decisions. In fact, by raising the standard of proof that the DEA must bring to punish doctors for infringing the law, it creates a broader safe harbor for doctors to use their best know-how in relieving pain.

Study after clinical study has shown how this pain relief is less available for the classes and races who do not wield power in society. It's not just that racial minorities, women, the elderly and people with AIDS have less effective pain medicine prescribed for them, although that would be bad enough. Pharmacies in minority neighborhoods are less likely to stock the powerful pain relievers needed to treat severe pain. The PRPA, for the first time, includes long-overdue federal funding to educate doctors, pharmacists and law-enforcement officials of the safe and legitimate use of powerful pain relieving medication. It declares the next 10 years as the Decade of Pain Management.

While many Democrats have recognized that pain relief is a nonpartisan issue, some, surprisingly, have turned their backs on their traditional constituents to oppose the legislation. Sen. Ron Wyden, the Democrat from Oregon, has been pressuring his party members to block this bill in order to please the people who sent him to office. Since the bill can hardly be opposed on its merits, these Democrats have incredibly argued that the PRPA would intimidate doctors and interfere with their practice. Yet, the bill has won the endorsement of the American Medical Association, hardly a group known to welcome federal interference in its work. The opponents say that it would worsen the care of the dying. Why, then, would the National Hospice and Palliative Care Organization be lobbying for its passage?

The truth is that this bill, like the Civil Rights legislation of the past, will restore and extend the full protection of federal law to all the citizens, even in states that have neglected their duty to do so. Except for helping their buddy from Oregon, there is no reason why liberal Democrats should oppose this legislation.

If the PRPA is not passed, then a doctor's DEA license becomes, in effect, a federal license to kill, state law permitting. It is unconscionable that the liberal wing of the Democrat Party, which is rightly proud of its historic role in speaking up for those excluded from the corridors of power, should participate in this travesty. Those who do not want their federal tax dollars to support this perversion of the law should let their senators know that they should support the Pain Relief Promotion Act.

Chevlen, a specialist in hospice and palliative medicine based in Youngstown, is a founding member of Americans for Integrity in Palliative Care.

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