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Dear PCC member,
The following excellent editorial was published in this week's AM News. The editors clearly underscore that the Pain Relief Promotion Act will provide a "safe harbor" for physicians to appropriately treat pain. The editors also accurately characterize the events and spirit of the discussion that occurred at the recent AMA House of Delegates meeting in San Diego. Please share this information with any individuals who may find it of interest.
William L. Toffler MD
National Director, Physicians for Compassionate Care

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Pain law: A better end

The Pain Relief Promotion Act is an antidote to physician-assisted suicide.

AMNews editorial. Jan. 3/10, 2000

In 1990 Jack Kevorkian, MD, unveiled his suicide machine and revealed that it had been used to end a life. In doing so he set off a destructive chain reaction that ricocheted all through the rest of the 1990s.

It's now the start of a new decade and with it comes a chance to set a different, better tone on matters of physician-assisted suicide and end-of-life care. The federal Pain Relief Promotion Act presents an opportunity to do just that. The bill has already received bipartisan approval in the House, and a Senate vote is expected this year. The AMA supports the legislation, as does the American Society of Anesthesiologists, the National Hospice Organization and other groups.

It is nonetheless a controversial bill, with determined opposition even from within the medical community. At the 1999 AMA Interim Meeting, three state delegations unsuccessfully attempted to persuade delegates to rescind AMA support for it.

The bill is best known for attempting to effectively negate Oregon's referendum law (or that of any state that would follow its lead) permitting physician-assisted suicide. The federal act would bar prescribing barbiturates, a staple in the fatal cocktails used in such cases, or any other controlled drugs to intentionally end a life. The result is a state's rights flap added to the already emotional philosophical debate on the issue.

Yet, in assessing this legislative approach, it's important not to lose sight of the fact that the federal government has long had an oversight role in the prescribing of drugs through the Controlled Substances Act. This bill amends this existing law. Moreover, it does so in a way consistent with the direction of the current law and of medical ethics: that the resources available to a physician only be used for legitimate medical purposes.

The Oregon element overshadows the other key element of this legislation, which contains the real, long-term antidote to physician-assisted suicide -- better end-of-life care. Among those provisions is a powerful endorsement and safe harbor -- a first statute of its kind from the federal government -- for aggressive pain relief strategies by physicians, even if those attempts end unintentionally in a patient's death. A review by the Clinton Justice Dept. (hardly a traditional ally of the Republican backers of this legislation) described the safe harbor this way: "The bill 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."

Nevertheless, caution is always warranted when lawmakers stray into medical areas (although it's also worth noting that they're making the trip this time because Oregon voters felt comfortable rewriting medical ethics in the first place). The AMA house, also at its recent meeting, directed the Association's Washington, D.C., staff to work for changes that would keep the government out of the practice of medicine, including not allowing the government to author pain management guidelines. The AMA also reaffirmed its policy not to criminalize medical decision-making.

The AMA has been working to get medicine's own house in order in the matter of end of-life care. One reason that the notion of physician-assisted suicide resonates so deeply is the less-than-ideal track record of physicians and other caregivers in helping patients face the end of life in comfort and with dignity.

The AMA has assumed a leading role in improving such care, especially through the activities of its Institute for Ethics. Recently it announced it would distribute the entire curriculum of the institute's landmark Ethics Education for Physicians on End-of-life Care course on CD-ROM, free to all new or renewing physician members of the Association. The materials contain detailed, practical information about end-of-life care and the ethical considerations in delivering such treatment. Together with the better provisions of the Pain Relief Promotion Act, such activities set the right course for palliative care for the 2000s -- and the decades beyond.


 


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