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Dear PCC members:
Some of you may have been confused about some media reports regarding the recent action taken by the AMA House of Delegates last week in regards to the Pain Relief Promotion Act (PRPA). To clarify any misrepresentation of the action taken by the AMA House of Delegates, I am forwarding both the relevant portions of the Reference Committee report as well as the actual resolutions that were passed after extensive testimony (over 2 1/2 hours).

It is very clear from the official report of the resolutions (below) that the AMA delegates voted to "reaffirm" the AMA support of the Pain Relief Promotion Act as well as the Act itself. The House of Delegates did approve of a resolution to keep an "open dialogue" about wording issues that have little to do with the substance of the bill. The substance of the bill, which is unequivocally supported by the AMA, remains to improve pain care, to provide for education and research in this area, to clarify that aggressive pain management can be appropriate medical care even if it might increase the risk of death and to clarify that using controlled substances for assisted suicide instead of pain care is not allowed. In fact, the delegate support for the PRPA was exceptionally strong. So strong that a separate resolution calling for the AMA to withdraw its support for the bill (if it is unable to have the PRPA in it present form revised) was specifically voted down.

The Reference Committee made it clear that the emotional claims of the opponents were overstated and unsubstantiated. The committee report (below) repeatedly stated that many of the claims of opponents were simple "without legal merit." Thus, the action taken by the AMA House of Delegates was clearly to continue the AMA support of the Pain Relief Promotion Act. Please share this information with anyone who may find it of interest.

William L. Toffler MD
National Director, PCC
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Excerpts from Reference Committee B report:


Resolution 215 asks that our American Medical Association oppose legislation which gives the government the responsibility to define appropriate medical practice and regulate that practice through the use of criminal penalties. Resolution 216 asks that our American Medical Association Board of Trustees, through its Council on Legislation, reconsider the matter of the AMA's position with respect to the Pain Relief Promotion Act of 1999. Resolution 217 asks that our American Medical Association's Board of Trustees reconsider the AMA's position on the Pain Relief Promotion Act of 1999. Resolution 220 asks (1) that our American Medical Association Board of Trustees, through its Council on Legislation, reconsider its position regarding the Pain Relief Promotion Act of 1999; and (2) that our AMA, state and specialty societies continue to strive to ensure that all lobbying efforts in Congress are initiated as a collaborative effort incorporating the views of the Federation so that the "House of Medicine" is not divided by our efforts.

Your Reference Committee heard extensive testimony relating to our AMA's support of H.R. 2260/S. 1272, the "Pain Relief Promotion Act of 1999," sponsored in the U.S. House of Representatives by Judiciary Committee Chairman Henry Hyde (R-IL) and in the Senate by Assistant Majority Leader Don Nickles (R-OK). For the record, your Reference Committee notes that the House passed its version of the bill on October 27, 1999, by a substantial bi-partisan vote of 271-156.

Despite differing opinions about the bill's content, there appeared to be near consensus among the speakers at the Reference Committee that physician-assisted suicide is not an acceptable medical practice and that every effort should be made through proactive legislation or other means to encourage the rendering of effective and compassionate palliative and end-of-life care to all patients in need of such. Indeed, those who differed with our AMA's support of this measure generally voiced both disapproval for state legislation that would permit physician-assisted suicide and continued support for our AMA's broad-based policy in this regard. Multiple specific and positive references in testimony were made to the importance of the AMA's EPEC project (Educating Physicians on End-Of-Life Care), which includes a means of more broadly ensuring that pain medication is appropriately prescribed. It was also generally agreed that such programs should be expanded.

Turning to the actual bill and existing law, the majority of testimony centered on several major issues including the scope of DEA authority, the need to oppose the criminalization of medical practice, and promoting, while not hindering, state palliative and end-of-life care guidelines.

Your Reference Committee notes that our AMA's process for reviewing and taking positions on important federal health-related legislation is substantially similar to that employed by the state medical societies on relevant state measures. Legislative matters coming before our AMA's Council on Legislation are reviewed in-depth and appropriate recommendations are fashioned for the Board of Trustees' review and action. Testimony was heard that appropriate policy review process was followed on this bill. From a political standpoint, your Reference Committee believes that this process should be respected absent the most compelling circumstances to change a publicly declared position. At the same time, your Reference Committee encourages our AMA, consistent with policy, to consult in advance with the affected stakeholders to the maximum extent possible, so that its legislative actions can be broadly respective of differing opinions.

In the spirit of moving forward in a positive manner and with the recognition that the substantial weight of testimony argued in favor of continued support for the "Pain Relief Promotion Act of 1999," your Reference Committee urges the adoption of the substitute resolution based on the facts presented at the hearing, including:
First, your Reference Committee agrees with the bill's sponsors that the "Pain Relief Promotion Act of 1999," would for the first time establish in federal law substantial new protections for physicians prescribing controlled substances in the ordinary course of patient treatment. This position is substantiated by a Department of Justice letter dated October 19, 1999, wherein it is affirmatively stated that:

H.R. 2260 would eliminate any ambiguity about the legality of using controlled substances to alleviate the pain and suffering of the terminally ill by reducing any perceived threat of administrative and criminal sanctions in this context. The Department accordingly supports those portions of H.R. 2260 addressing palliative care.

Second, because the bill would amend existing statutory law in the Controlled Substances Act, in existence for decades, the suggestion that the bill would extend DEA authority or create new penalties, although passionately stated, is without legal merit. The bill would do neither of these things by a "plain meaning" reading of its language. Instead, it would legislatively acknowledge the legitimate medical purpose of prescribing controlled substances, even if one effect were ultimately to cause death, the so-called "double effect." This intent has been confirmed by debate on the House floor relating to the bill, as well as in a comprehensive Congressional Record statement by Senator Nickles. As it currently stands, physicians are potentially susceptible to DEA scrutiny any time they prescribe controlled substances. This new bill would truncate this authority, but retain DEA authority to investigate instances where controlled substances are used to effectuate a physician-assisted suicide.

Finally, your Reference Committee finds without legal merit allegations that state palliative care guidelines would be overridden by the "Pain Relief Promotion Act of 1999", or that the DEA would have any new authority to promulgate federal guidelines under this bill.

(8) RESOLUTION 215 - OPPOSITION OF GOVERNMENT DETERMINATION OF APPROPRIATE MEDICAL PRACTICE RESOLUTION 216 - OPPOSITION TO THE PAIN RELIEF PROMOTION ACT OF 1999 RESOLUTION 217 - FEDERAL PAIN RELIEF PROMOTION ACT RESOLUTION 220 - PAIN RELIEF PROMOTION ACT OF 1999

RECOMMENDATION:

Mr. Speaker, your Reference Committee recommends the adoption of Substitute Resolution 215 to read as follows:

RESOLVED, that our AMA reaffirm AMA policy H-160.954; and be it further

RESOLVED, that our AMA continue to support the Pain Relief Promotion Act of 1999 and work with interested state and national specialty societies to improve the bill's language, as necessary.

HOD ACTION: Adopted

RESOLVED, That our AMA work with interested state and national specialty societies to improve Titles I and II of the Pain Relief Promotion Act of 1999 by deletion of those provisions which establish federal protocols and/or regulations for pain management and palliative care (including the proposed amendment to Section 502a of the Controlled Substances Act regarding educational and training programs for local, state, and federal personnel; Section 201(a)(2) of the proposed Act regarding the collection and dissemination of protocols and evidence-based practices for palliative care; and any other such objectional provisions of the proposed Act); and be it further

HOD ACTION: Adopted as amended.

RESOLVED, That if the above changes to the Pain Relief Promotion Act are not achieved, the AMA will withdraw its support for this legislation; and be it further

HOD ACTION: Not adopted.

RESOLVED, That henceforth our AMA will oppose any future legislation which gives the federal government the responsibility to define appropriate medical practice and regulate such practice through the use of criminal penalties.

HOD ACTION: Adopted as amended.


 


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