Oct. 13, 1999 (Washington) -- Federal legislation that would explicitly bar physicians from dispensing drugs to assist patient suicide was under the Capitol Hill spotlight today at a Senate hearing of the Health, Education, Labor and Pensions Committee.
A bipartisan bill from Sen. Don Nickles (R, Okla.) and Sen. Joseph Lieberman (D, Conn.) would essentially gut Oregon's controversial assisted-suicide law. The federal legislation would alter the Controlled Substances Act such that assisted suicides could only legally continue if physicians performed them using substances that are not under Drug Enforcement Agency (DEA) authority.
The bill would, however, include the specification that physicians could administer drugs for pain "even if the use of such a substance may increase the risk of death." The measure would require training programs for government workers on the "means by which investigation and enforcement actions by law enforcement personnel may accommodate such use."
The American Medical Association (AMA) endorses the bill, as does the American Society of Anesthesiologists (ASA), the Hospice Association of America, and the National Hospice Organization. AMA trustee Hank Coble, MD, today testified that the bill's allowance for medicating that brings the risk of death "provides a new and important statutory protection for physicians prescribing controlled substances for pain."
The legislation would also call for federal research on palliative care and the distribution of protocols and evidence-based practices and would authorize federal money for training programs in pain management for health professionals.
The AMA's support for the bill is in marked contrast to its bitter opposition last year to a stronger Nickles measure. The association says that the changes have "largely" alleviated its concern that new DEA authority would chill aggressive pain management practices.
But 10 state medical associations strongly disagree, including those representing California, Florida, and South Carolina. The associations wrote Nickles on Monday to explain their opposition -- and to emphasize that the state medical societies for Massachusetts, Texas, and Vermont also have "deep concerns."
"This bill would have a negative impact on patients and physicians in all 50 states," Steve DeToy, the Rhode Island Medical Society's director of government and public affairs, tells WebMD. "It gives a federal law enforcement agency medical oversight in how physicians treat patients in a very, very difficult time in the relationship between a physician and a patient."
DeToy is critical of the AMA's endorsement: "They made a misjudgment here that is not consistent with their own policy and many of us in the states."
Sen. Jack Reed (D, R.I.) also questioned the AMA's move. "This whole path ... is in the wrong direction," he told Coble. "You'll have Texas Rangers figuring out what is 'legitimate medical practice.'"
"We hope the position we're taking is a positive one," said Coble, adding that the AMA is interested in some changes to the language of the bill.
Other advocates of the bill say it is the right medicine. Gregory Hamilton, MD, president of the Oregon-based Physicians for Compassionate Care, tells WebMD that the argument that the bill would chill physician pain management is "bogus." "None of us are scared of that anyway," he says. "The bill even improves our security by making it very clear that the intent is the issue. We're protected because we can claim our intent."
Hamilton also praises the provider education elements of the bill. "This is a very well-balanced bill that provides education to health care workers to help them improve their skills," he tells WebMD. "The ability to treat pain ... far outstrips the current practice."
James Rathmell, MD, an associate professor of anesthesiology at the University of Vermont College of Medicine, testified for the ASA that he supported the bill but with hesitations. "Making a clear distinction between legitimate use of opioids and physician-assisted suicide might not be so clear in all cases," he noted. Nevertheless, he said, the legislation's promotion of pain management education "outweighs our fears about the DEA ... and the chilling effect."
But David Joranson, director of the pain and policy studies group at the University of Wisconsin's Comprehensive Cancer Center, testified about his serious worries over the bill's implications. "It seems likely that the Attorney General and the DEA would be faced with decisions which involve medicine and science," he testified. "The chances for conflict between law enforcement and medicine [will] increase, as does the likelihood that patient care will be harmed."
Although Oregon Sen. Ron Wyden (D) has vowed to fight to the end against what he says is the measure's inappropriate Washington meddling in his state's decision, Nickles has powerful support in the House for his approach. Similar legislation is pending there from Judiciary Committee Chairman Henry Hyde (R, Ill.).