HOUSE VOTES ON PIVOTAL
EUTHANASIA LAW EXPECTED SOON

By Burke J. Balch
Director, NRLC Dep't of Medical Ethics

On Tuesday, July 13, 1998, the House Judiciary Subcommittee on the Constitution, chaired by Representative Charles T. Canady (R-Fl.), will hold hearings on the Lethal Drug Abuse Prevention Act of 1998, H.R. 4006. The bill, sponsored by Henry Hyde (R-Il.) and James Oberstar (D-Mn.), would prevent the use of federally controlled narcotics and other dangerous drugs to assist suicide. Subcommittee and then full committee action in both the House Commerce and Judiciary Committees is expected to follow promptly, and there may be a vote on the House floor in late July or the first week of August.

"This is an extraordinarily important opportunity to prevent the spread of euthanasia," said NRLC Executive Director David N. O'Steen, Ph.D. "The next few weeks will see a critical debate on whether America chooses the road of life or death for older people, people with disabilities, and those most vulnerable in our society. Now is the time for every pro-life American to contact legislators, write letters to the editor, and call talk radio shows."

Following is a question and answer dialogue summarizing the facts and arguments relevant to the bill, the Senate version of which is reprinted on page 11.

Q. What would the Lethal Drug Abuse Prevention Act of 1998 do?

A. Federal law and regulations now generally prohibit the distribution of certain narcotics and other dangerous drugs unless a doctor who has been granted a special "registration" by the federal Drug Enforcement Administration (DEA) prescribes them for a legitimate medical purpose. The bill would prevent doctors from using this federally conferred authority to obtain controlled substances in order to kill their patients. It would authorize revoking the DEA registration of doctors who use it to prescribe drugs to assist suicide.

Q. Why is the Lethal Drug Abuse Prevention Act of 1998 needed?

A. By referendum Oregon has adopted a law legalizing certain cases of assisting suicide, which is now in force. On November 5, 1997, the DEA ruled that under the current language of the federal Controlled Substances Act doctors could not use their DEA registrations to prescribe federally controlled substances in order to assist suicide. However, on June 5, 1998, Attorney General Janet Reno reversed this ruling, instead authorizing the use of federally controlled substances to kill patients to the extent such killing is permitted by state law. The bill is needed to reinstate what in the opinion of the professionals at the DEA is current law. Otherwise, the federal government will be affirmatively facilitating euthanasia by specifically authorizing the use of federally controlled drugs to assist suicide.

Q. Where does the public stand?

A. By a margin of more than 2 to 1 (65% to 29%), Americans oppose allowing the use of "federally controlled drugs for the purpose of assisted suicide and euthanasia" (Wirthlin Worldwide poll, March 7-9, 1998; 4.3% margin of error).

Q. Has Congress already spoken on the issue of federal government involvement in assisting suicide?

A. Yes. Last year Congress passed (by 99-0 in the Senate and 398-16 in the House) and President Clinton signed the Assisted Suicide Funding Restriction Act of 1997, which prevents the use of federal funds or facilities to assist suicide or for euthanasia. The Lethal Drug Abuse Prevention Act of 1998 is a logical application of the intent of that act to avoid federal facilitation of assisting suicide through the use of federally controlled drugs.

Q. Would the Lethal Drug Abuse Prevention Act of 1998 infringe on states' rights?

A. The Controlled Substances Act was adopted almost 30 years ago (in 1970) and strengthened in 1984 because drug abuse was seen as a national problem requiring regulation beyond the state level. So when California and Arizona by referendum legalized the use of medicinal marijuana, the Justice Department acted to secure injunctions against marijuana dispensers, successfully persuading the court that regardless of state law, the distribution of marijuana for any purpose still violated federal law.

Enforcement of the Lethal Drug Abuse Prevention Act would neither nullify nor change the laws of Oregon or any other state. It is an established legal principle that the laws of one state cannot nullify federal law. If a state law were to provide that doctors could prescribe heroin or cocaine to give a "high" to patients whenever their mood was negative, that would not negate the federal prohibition on their use under the Controlled Substances Act.

Ironically, some pro-euthanasia groups raising the "states' rights" issue, like Compassion in Dying, are the same people who in 1997 brought suits to the Supreme Court that unsuccessfully sought to take away states' rights to prevent assisting suicide.

Q. Would the Lethal Drug Abuse Prevention Act of 1998 deter doctors from prescribing the large doses of controlled substances sometimes necessary to control pain for fear that they could be accused of assisting suicide?

A. On the contrary, the Lethal Drug Abuse Prevention Act would diminish the danger of deterring adequate pain relief that may be present under current law.

To promote the provision of good pain relief, the bill amends the current Controlled Substances Act by adding new language making a distinction between providing a controlled substance for the purpose of pain relief, even with the risk of death ­ which the bill specifically permits ­ and providing a controlled substance for the purpose of causing death, for which a doctor's DEA registration may be revoked. To reassure physicians that they can safely prescribe controlled substances for pain relief, the bill provides that a doctor threatened with suspension or revocation may demand a hearing before a Medical Review Board on Pain Relief composed of clinical experts in pain management, who will make findings as to whether any disputed prescription was an appropriate means to relieve pain as opposed to an act of euthanasia.

Under the Attorney General's June 5 ruling, the DEA can revoke a doctor's DEA registration for assisting a suicide contrary to state law: At present, therefore, the Controlled Substances Act will be enforced against assisting suicide in almost all of the states, but without any explicit protection or safeguards for doctors prescribing controlled substances for pain management. Even in Oregon, it will be enforced against a doctor who assists any suicide that does not fall under the circumstances in which the state has legalized assisting suicide.

Thus, the bill will not only reinstate the DEA's position that federally controlled drugs cannot be used to assist suicide - an affirmation of the status quo before the Reno decision - but also remove a perceived barrier to the provision of adequate pain relief.

Q. How do you answer this argument: "Doctors assist people's suicides everyday. It's going to happen whether it's legal or illegal. But if it is legal then it can be regulated. We need more Oregons, not more Kevorkians. We need to bring this practice out of the darkness and into the light."

A. First, laws that protect the vulnerable against assisting suicide are effective. A study published in the April 23, 1998, New England Journal of Medicine showed that while 36% of doctors would be willing to write lethal prescriptions if assisting suicide were legal, only 11% are willing to do so while it is against the law. Currently, while 18.3% of doctors have been asked to assist suicide with a lethal prescription, only 3.3% have done so. The laws against euthanasia are effectively deterring over two-thirds of doctors who otherwise might assist suicide.

Second, if some doctors are now willing to violate laws that prohibit assisting suicide, why should we suppose those same doctors would not be equally ready to violate laws regulating it whenever they think the regulations impose limits or procedures with which they disagree?

The answer to current violations of laws protecting against euthanasia is to pass more effective laws and to better enforce those we now have, not to legalize it.

Q. What right does the government have to interfere in the personal choice of people who want to end their own lives?

A. What about the 18-year-old who has been dumped by his girlfriend and thinks life isn't worth living without her? What about the 30-year-old unsuccessful in business, who thinks life isn't worth living when facing bankruptcy? Should we never intervene to save their lives?

Comprehensive studies of people who committed suicide in St. Louis, Missouri, and in the United Kingdom found that it could be demonstrated that 93-94% were suffering from a mental disorder. Of those who attempt suicide and are stopped, less than 5% have gone on to kill themselves 5 years later and less than 11% have gone on to kill themselves 35 years later. Clearly, the vast majority of those who ask for assistance in suicide are not rationally, autonomously, and definitively choosing death - - they are afflicted with psychological problems and very ambivalent. Indeed, psychologists who have carefully studied the suicidal say that a request for assistance in suicide is a cry for help.

If we as a society say to someone who asks to be killed, "Sure, that's your right," it is likely to be heard not as "We respect your autonomy" but as "We don't care if you live or die."

Q. What about those who are terminally ill?

A. A scientific study of people with terminal illness published in the American Journal of Psychiatry found that of the fewer than one in four who expressed a wish to die, all had clinically diagnosable depression. As psychologist Joseph Richman points out, "[E]ffective psychotherapeutic treatment is possible with the terminally ill, and only irrational prejudices prevent the greater resort to such measures." And suicidologist Dr. David C. Clark observes that depressive episodes in the seriously ill "are not less responsive to medication" than depression in others. Indeed, the suicide rate in persons with terminal illness is only between 2% and 4%. Compassionate counseling and assistance, such as that provided in many hospices, together with medical and psychological care, provide a positive alternative to euthanasia among those who have terminal illness.

Q. What about those in uncontrollable pain?

A. They are not getting adequate medical care and should be provided up-to-date means of pain control, not killed. Even Dr. Pieter Admiraal, leader of the successful movement to legalize direct killing in the Netherlands, has publicly observed that pain is never an adequate justification for euthanasia in light of current medical techniques that can manage pain in virtually all circumstances.

Why, then, are there so many personal stories of people in hospitals and nursing homes having to cope with unbearable pain? Tragically, pain control techniques that have been perfected at the frontiers of medicine have not become universally known at the clinical level. What we need is better training in those techniques for health care personnel - - not the legalization of physician-aided death.

Q. What about those with severe disabilities?

A. What would it say about our attitude as a society were we to tell those who have neither terminal illness nor a disability, "You say you want to be killed, but what you really need is counseling and assistance," but, at the same time, we were to tell those with disabilities, "We understand why you want to be killed, and we'll let a doctor kill you"? It would certainly not mean that we were respecting the "choice" of the person with the disability. Instead, we would be discriminatorily denying suicide counseling on the basis of disability. We'd be saying to the nondisabled person, "We care too much about you to let you throw your life away," but to the person with the disability, "We agree that life with a disability is not worth living."

Most people with disabilities will tell you that it is not so much their physical or mental impairment itself that makes their lives difficult as it is the conduct of the nondisabled majority toward them. Denial of access, discrimination in employment, and an attitude of aversion or pity instead of respect are what may make life seem intolerable. True respect for the rights of people with disabilities would dictate action to remove those obstacles - - not "help" in committing suicide.