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
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
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
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
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.