PHYSICIANS FOR COMPASSIONATE CARE NEWS
Affirming An Ethic That All Human Life is Inherently Valuable
Vol.2, No.4, Winter 1999
AMA CONTINUES TO BACK PAIN RELIEF BILL
The American Medical Association (AMA) delegates meeting in December
ended with a victory for ethical medical practice. The AMA voted
to continue support of the Pain Relief Promotion Act. AMA support
for federal legislation that would prevent doctors from prescribing
controlled substances for patient suicides is a blow to suicide advocates
around the nation. While some AMA doctors requested that the AMA
reverse its stance of support for the Pain Relief Promotion Act,
their arguments, though passionate, according to an AMA reference
committee report, were unfounded and failed to convince the delegate
majority to overthrow AMA support. Now the Pain Relief Act, stronger
than ever, enjoys the continued support of the nation’s largest
medical organization, as well as other state and national medical
groups, disability rights groups, pro-life groups and advocates for
the nation’s poor.
“This is a good law,” said Dr. Rex Greene, an AMA delegate
and cancer specialist from Los Angeles. “I am firmly convinced
that the opposition’s campaign was orchestrated by the euthanasia
movement,” said Greene. “There is substantial protection
for physicians here (to prescribe appropriate pain medications),” Greene
said after the vote. Other AMA supporters agreed that concerns about
the Pain Relief Act were blown out of proportion by assisted suicide
Many dedicated physicians committed to the well-being of their patients,
and to the ethical practice of medicine, stood together around the
country this month and lobbied their state delegates, letting the
AMA know just how many doctors were behind them in their opposition
to assisted suicide and their support of the Pain Relief Promotion
PCC, with it’s more than one thousand physicians in Oregon
and nationwide, has worked tirelessly to uphold terminally ill patients’ right
to live with dignity and doctors’ right to practice ethical
medicine. Drs. Gregory Hamilton and William Toffler, co-founders
of Physicians for Compassionate Care, attended the AMA meetings in
San Diego; they were armed with letters of support by pain and palliative
care experts and cancer specialists. Dr. Hamilton presented data
in the form of charts demonstrating that in recent cases where a
state has passed a new ban on assisted suicide, the use of pain control
drugs like morphine increased. For example, in Rhode Island, enactment
of a state law very similar to the federally proposed Pain Relief
Promotion Act was followed by a greater than twofold increase in
statewide morphine use. This fact proved embarrassing to some Rhode
Island doctors who tried to say the Pain Relief Act would discourage
doctors from using pain medications. Documentation, facts, and a
voice of reason amidst the emotionally laden charges against the
bill gave PCC and all who support the Pain Relief Act the high ground.
The Pain Relief Promotion Act passed the US House of Representatives
in October with solid bipartisan support and will soon come before
the US Senate. If passed and signed by the president, the Pain Relief
Act will promote improved pain care by increasing knowledge of pain
management in both public and private health programs and by providing
5 million dollars a year for training in palliative care for physicians,
nurses and other health professionals. It also adds new protections
for doctors and nurses who use medications under the federal Controlled
Substances Act by clarifying that aggressive pain management is appropriate
medical care even if, in the rare case, it may have the unintended
side-effect of increasing the risk of death.
1999 - Year of the Elderly
In this the final month of the International Year of the Elderly,
PCC honors Ann Bowar, 84. Ann’s daughter, Margaret Caldwell,
called PCC in January of this year for referral to a physician who
respects the inherant value of each human life. Margaret was also
seeking emotional support after her mother, Ann Bowar, had a stroke.
PCC nurse volunteers have kept in touch with Ann’s family through
its follow-up phone call program.
Ann Bowar was a homemaker. She was committed to being a “stay-at-home
mom,” because she wanted to have a strong influence on her
children. “Children are your most precious possession,” Ann
has always said. And that’s why she chose to stay home with
her children rather than have a job outside the home. Ann’s
husband was a civil engineer at Bovnneville Power for more than 30
years. The couple has four daughters.
Ann loves family. Her children and grandchildren have always been
the center of her life. When her grandchildren were young, Ann made
sure that they came to visit her for overnights. Ann is a gentle,
quiet women, always thinking of others. Ann is currently living at
Maryville Nursing Home, where she says, “Yes, I am happy.” All
Ann’s children and grandchildren visit her several times every
Edwards, MJ; Garland, M; Bonazzola, M; Crawshaw, R (1999). “Care
that Cares: Medicine’s Essential Patient-Centered Ethic.” The
December finds her heart to be more fierce than
was her thorn, the winter rose.
And ones who long for spring, to them she brings a
Her blush, now faded, still does hold,
Through rain and wind, until at last the heavens all
But for a glimpse into her bloom, I walked the
garden moss and rock.
Then, when upon my visit, her thorn did snatch my
sweater sleeve and hold me there.
And though she didn’t speak a word, she took me
to her soul;
It was then that I discovered happy-peace
was living there.
Oh winter rose, in my old age, I hope that I can be,
Half as sweet and tender as the blossom that you sing.
And that I’ll stand, where my life turns, like you stand,
A gift divine.
Dedicated to Lily Monson, by Catherine Hamilton
AMA REFFERENCE COMMITTEE REPORT
The AMA Reference Committee heard testimony on the Pain Relief Promotion
Act in San Diego this month. The following paragraphs are excerpts
of the committee’s conclusions:
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. (These
excerpts and the complete report can be found at www.AMA-assn.org.)
1999 -- International Year of the Elderly
On December 10th, 1999, at the National Theater in Warsaw, Poland,
PCC president, Gregory Hamilton, joined with Jerzy Buzek, Prime Minister
of Poland, Maria Smereczynska, Minister of the Family, and other
doctors and representatives of various nations for the International
Year of Seniors Conference, in honor of the elderly. Issues such
as the importance of the role of the elderly in family life, special
medical needs, and the psychological, spiritual and social needs
of the elderly were addressed. The convention also featured a filmed
historical documentary of Post WWII euthanasia and it’s dangers.
The film, which will be aired on Poland’s public television
broadcasting network in January, takes a look at assisted suicide
in Oregon. Interviewed from Oregon were Drs. Richard Thorne and Greg
Hamilton. Other PCC members featured in the program were Drs. Herbert
Hendin, founder of American Foundation for Suicide Prevention and
Richard Fenigsen. Dr. Fenigson once practiced medicine in the Netherlands
and has written extensively on the abuses of euthanasia in Holland.
The daylong conference closed with a panel discussion. The panel
included Wanda Poltawska, MD, psychiatry, Anna Adamczyk, MD, hospice,
and Gregory Hamilton, MD, psychiatry. Moderating the discussion was
radio announcer, Piotr Semka. Following is a summary of Dr. Hamilton’s
pre-panel lecture in Warsaw:
I am honored to be here in Poland, this great country, which, through
her sacrifice, has restored hope throughout the world. Your country,
with its long, courageous history, has arisen once again to independence
only ten short years ago.
But I must tell you today, I am sorely grieved, that in my own state
of Oregon, a state I love, in a country I love, the grand words of
the Declaration of Independence which states: “We hold these
truths to be self-evident, that all men are created equal, that they
are endowed by their Creator with certain unalienable rights, that
among these are life, liberty and the pursuit of happiness,” that
these noble words are no longer honored in Oregon. At least one class
of people is no longer equal. Their unalienable right to life is
no longer recognized. Aged or seriously ill people, who are stigmatized
by the label "terminally ill" can now be put to death through assisted
suicide. They are no longer afforded the same protections against
discouragement and despair that everyone else shares. Instead, those
who are ill or aged or vulnerable in my state can now be handed a
lethal overdose instead of the help they deserve.
Your elderly, whom you are honoring this year, these brave men and
women who survived the Nazi occupation with its policies of euthanasia
and extermination, who survived without ever surrendering to the
enemy, and lived through and eventually cast off Soviet communism,
not only for themselves, but for the whole world, these men and women
deserve love and respect and help -- not poison pills.
Let me tell you some of the things that are happening in my state
since assisted suicide has been legalized.
The United States Supreme Court wrote that "...it turns out that
what is couched as a limited right to 'physician assisted suicide'
is likely, in effect, a much broader license, which could prove extremely
difficult to police and contain." We predicted that once intentional
killing through assisted suicide was accepted, it would become nearly
impossible to prosecute virtually any killing in the medical setting.
One example of the blatant failure to investigate and prosecute
illegal killing in the medical setting in Oregon was the Gallant
case, in which a Corvallis doctor was found by the Oregon Board of
Medical Examiners clearly to have ordered a lethal injection for
an elderly woman who did not even request it. Such an action is clearly
illegal, even in Oregon. Nevertheless, the Eugene district attorney
declined to prosecute him, because he did not think he could get
a conviction in my state with its official sanctioning of assisted
The people of Oregon were told that government reports about assisted
suicide were somehow going to function as a safeguard for assisted
suicide. They have failed to provide protection. There is no penalty
for doctors who do not report. What reports there are, such as the
Oregon Health Division report of the first 15 cases of assisted suicide,
seem to base their claims more on a lack of information than on clear
data. For example, the report claims depression played no part in
the first 15 cases when the medical literature documents that the
first publicly reported assisted suicide case was diagnosed as depressed.
Yet another case just came to light last month about a women named
The psychiatrist who evaluated Kate Cheney, an elderly woman with
growing dementia, declared her ineligible for assisted suicide, because
of her cognitive impairments and because her family appeared to be
pressuring her, according to an October 17, 1999, Oregonian article.
She could not remember recent events and people. When the psychiatrist
said she was not eligible for assisted suicide, the daughter and
the new doctor (the new doctor had been assigned to Mrs. Cheney when
her daughter demanded a different physician for her mother, after
her original doctor appeared less than enthusiastic about an assisted
suicide for her) did not accept the opinion, as the safeguard it
was supposed to be. Instead, they sought another opinion from a second
mental health professional, since there is nothing in the Oregon
law to stop them from doing so. The psychologist admitted the patient
could not even remember when she was diagnosed with terminal cancer
and that the patient's "choices may be influenced by her family's
wishes and her daughter, Erika, may be somewhat coercive." Nevertheless,
she approved the suicide.
The final decision about Kate Cheeney’s suicide came down
to a Kaiser administrator, Dr. Robert Richardson. He gave the go-ahead
for giving a lethal overdose to this elderly woman under pressure
from her family. Kaiser Permanente is a fully capitated health maintenance
organization with a profit sharing plan for its doctors. It always
saves money if the patient dies early. The estimated cost of an overdose
is $45.00, according to government reports. As predicted, it can
be seen that once assisted suicide is legalized, there is no way
to protect the vulnerable and mentally ill.
What elderly and ailing patients need is good care. They need their
physical concerns addressed, including the treatment of any pain
they may have. They need practical help with day-to-day needs, such
as food and shelter. They need people around them who value and respect
them and who want them to live, not to commit suicide. They need
their spiritual issues taken seriously and addressed. And they need
a witness to their passage through this important stage of life.
We have much to learn from sitting with those who are entering a
stage of life we will all experience.
To provide good care for the aging and seriously ill, doctors, nurses,
hospice workers, and clergy need training in good palliative care.
There have been wonderful new pain treatments developed in the past
several years. Doctors and nurses need training in these techniques.
Health care personnel also need additional training in recognizing
and treating depression in the elderly. It is these things the elderly
and seriously ill need from us -- not poison pills.
I believe that western Europe and America have much more to learn
from your country than to teach it about honoring and caring for
the elderly. I am here to learn. And I am tremendously honored and
grateful that you have invited me to be a part of this occasion honoring
the International Year of the Elderly.
N. Gregory Hamilton, MD
William M. Petty, MD
Mark Kummer, MD
Miles J. Edwards, MD
William L. Toffler, MD
Pamela J. Edwards, MD
Thomas Pitre, MD
Kenneth R. Stevens, MD
Paul D. Stull, MD
Gerald B. Ahmann, MD
Thomas Comerford, MD
Carl R. Jenson, MD
Marvin M. John, MD
Robert DuPriest, MD
Richard M. Thorne, MD
George Middlekauf, MD
P.O. Box 6042
Portland, Oregon 97228
PCC News Editor: Catherine Hamilton