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