HOUSE REJECTS USE OF FEDERAL DRUGS TO ASSIST SUICIDE

By a resounding bipartisan vote of 271 to 156, the U.S. House of Representatives October 27 voted to prevent the prescription of federally controlled drugs to kill patients, while affirming their appropriate use to control pain.

While over three-fifths of the House - - 70 Democrats and 201 Republicans - - voted for the Nickles-Lieberman-Hyde-Stupak Pain Relief Promotion Act, debate was vigorous and sometimes heated.

Dr. Tom Coburn (R-Ok.), floor manager for the bill on behalf of the Commerce Committee, asked, "[A]re we going to abandon the principle that life has value? ... We are on a terrible slippery slope. The committee of which I am a member had testimonies about what has happened in Holland. In fact, when euthanasia and assisted suicide started in Holland, it was a very small number. It has grown progressively each year. But most importantly, because of the number of people who have been euthanized against their will, people now carry a card in Holland in their billfolds to say do not euthanize me."

Arguing against the bill, Rep. Barney Frank (D-Ma.) endorsed assisting suicide not only for a person with terminal illness, but also for someone with disabilities, "an individual who ... finds paralysis in which they could do nothing but lay in bed intolerable." He spoke of "the psychological pain of being confined, rigid, being only a mind and nothing else, being totally dependent on others for everything else."

But Representative Nick Rahall (D-WV) objected, "[W]e must stop going down that path where we put pressure on those who are vulnerable, who are poor and sick and disabled - - that they have a duty to die because they are a burden. To do otherwise is to set a dangerous, inhumane precedent."

Representative Ralph Hall (D-Tx.) said, "[S]uicide is not the solution. You don't really solve problems by getting rid of the person to whom the problems happen. Once we accept death as a solution, we begin to lose the incentive and the drive to work on positive alternatives. We can do better than that in America."

Defending Oregon doctors who implement the state's legalization of physician-assisted suicide, Repre-sentative Victor DeFazio (D-Or.) said, "They write a humane prescription for a person who is dying a horrible, horrible death and who might want relief."

But Representative Dave Weldon (R-Fl.), noting that he came "to this debate ... not only as a legislator, but as well as a physician," said his 15 years of experience treating cancer patients had taught him "it is quite possible to manage these patients quite successfully so that there is not suffering. ... [T]he patients who suffered with severe pain ... were the patients who were being managed incorrectly. ... [I]n the hands of a competent physician ... their pain can be dealt with. Their nausea as a complication of their pain medicine can be dealt with. Indeed, even if they were severely depressed as a complication of their illness, one could manage them with medications."

Representative Gary Miller (R-Ca.) told of being visited by a police officer whose back, broken in the line of duty, caused him constant pain. "He shared with me that because the pain was so unendurable, and because it seemed there was no treatment to stop the pain, he arrived at a point where he wanted to end his life. ... [Then he] finally was referred to a specialist in pain treatment. The doctor was able to prescribe high levels of pain medication, which made the pain manageable, and as a result made this police officer feel his life was worth living. ... This compassionate piece of legislation will give doctors the legal protection to take care of patients who are experiencing terrible, debilitating pain."

Recounting another personal story to illustrate the danger of euthanasia for those considered terminally ill, Representative Spencer Bachus (R-Ala) said, "I can remember my grandmother, very ill in the hospital. I can remember the doctor telling us she would not live through the night. She did live through the night. She came home and she spent three more years with my grandfather, and they were productive years."

Bachus noted, "[W]hat we are talking about here is the relationship between a doctor and a patient. ... These people are at their weakest, they are at their most vulnerable, their complete trust, in fact their life is in the hands of their doctor. They have every right to expect that their doctor is going to be a healer and not a killer, that their doctor is not going to seek a quick fix. Doctors have the right ... to alleviate pain, not to eliminate patients."

Under the 1970 federal Controlled Substances Act and its implementing regulations, the use and prescription of certain narcotics and other dangerous drugs are generally prohibited unless a doctor with a special federal "registration" to prescribe them does so for a "legitimate medical purpose."

On June 5, 1998, overturning an earlier policy determination by the Drug Enforcement Administration (DEA), the agency that enforces the Controlled Substances Act, U.S. Attorney General Janet Reno announced that these federally controlled drugs may be used to assist patients' suicides in any state which, like Oregon, allows the practice under state law. Under Reno's ruling, the federal government facilitates the killing of patients in Oregon, by acknowledging their killing as "legitimate" and providing access to the lethal drugs needed to carry it out. Indeed, the state's official report on the suicide law's first year of operation disclosed that all of the deaths under it were caused by federally controlled substances.

Representatives Henry Hyde (R-Il.) and Bart Stupak (D-Mi.) introduced the Pain Relief Promotion Act in the House both to overturn the Reno ruling, thus preventing Oregon's effective nullification of the federal law, and to foster good pain relief and palliative care as positive alternatives to euthanasia.

Besides the merits of legalized euthanasia, debate on the House floor focused on the proper interaction of state and federal law in regulating the use of drugs to kill patients, and on the bill's likely impact on pain relief.

Defending Oregonians' ability to use federally controlled drugs to assist suicides, Rep. Ron Paul (R-Tx.), said that while he personally opposes euthanasia, "it's even worse to introduce the notion that our federal congresses and our federal courts have the wisdom to tell all the states how to achieve the goals of protecting life and liberty." He insisted, "There is no way medically, legally or morally to tell the difference" between "alleviating pain" and "intentionally killing the patient."

In response, Representative Charles Canady (R-Fl.), floor manager for the bill on behalf of the Judiciary Committee, said, "The issue ... is whether we are going to have a consistent Federal policy that does not support assisted suicide or whether we are going to allow a Federal regulatory scheme to be used to support physician-assisted suicide. Are we going to allow physicians who are licensed under the Controlled Substances Act to dispense controlled substances, to use ... the prescription pads printed up by the DEA to provide controlled substances to kill their patients?"

Representative Bart Stupak (D-Mi.), prime Democratic sponsor of the bill, took issue with Paul's claim that assisting suicide cannot be distinguished from alleviating pain. "Using drugs to assist suicide is clearly different from using them to control pain. Causing a patient's death usually requires a sudden massive overdose of a potentially dangerous drug. Pain control involves carefully adjusting dosage until it achieves relief of pain with a minimum amount of side effects for the patient. ... On a broader issue of federalism, Oregon has the right to say that there will be no State penalties for certain conduct. But that does not mean that Oregon can prevent the Federal Government from restricting the use of federally controlled substances."

Representative Steve Rothman (D-NJ), a floor manager in opposition to the bill, charged that the bill "will so intimidate doctors across America that they will not prescribe the pain medications to the children, men and women who are begging for it ... because they do not want to suffer agony." He and others argued that the ability of the DEA to distinguish between alleviating pain and intentionally causing death would have a chilling effect on physicians' willingness to prescribe controlled substances to control pain.

However, Dr. Coburn emphasized, "[T]he DEA already has that power. ... The DEA, if I misuse a drug today, a controlled substance, can in fact ... take away my license to dispense drugs ... [a]nd rightly so. ... What we actually do [in this bill] is define better so that we do not put physicians at risk and give them a safe harbor." Representative Todd Tiahrt (R-Ks.) presented a series of charts showing that in eight states where new laws protecting the ability to prescribe medication to relieve pain but preventing the intentional assistance of suicide were passed during the 1990s, prescriptions for pain-relieving morphine went up, not down. "Because of experience in Kansas and other States," he said, "we can be confident that a vote for H.R. 2260 will promote and not threaten pain relief." Representative Marge Roukema (R-NJ), who advocates legal abortion, pointed out that although the Justice Department opposed the bill because it would overturn the Attorney General's ruling that Oregonians may use federally controlled substances to assist suicide, it agreed 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."

In the end, Representative Canady said, the issue came down to this question: "I submit ... that this House should not endorse the position of the Attorney General that physician-assisted suicide is legitimate medical practice. ... It is the Federal Government that authorizes the use of controlled substances. ... Is it going to be the position of this Federal Government that we will authorize them for the purpose of killing human beings?"

House passage sends the bill on to the Senate, where S. 1272, a companion measure introduced by Senators Don Nickles (R-Ok.) and Joseph Lieberman (D-Ct.), now has a total of 33 sponsors and co-sponsors. Because Senators Ron Wyden (D-Or.) and Edward Kennedy (D-Ma.) have publicly pledged to filibuster the bill, 60 of the 100 senators will need to vote for cloture in order to permit its passage in the Senate.

"We are at a critical juncture in the fight to protect vulnerable elderly persons and people with disabilities from state-sanctioned death," commented NRLC Execu-tive Director David N. O'Steen, Ph.D. "Twenty-six years of legalized nationwide abortion on demand have shown us how difficult it is to reverse a rooted evil. With this legislation, we have the opportunity to do much to prevent legalized euthanasia in America before it becomes widespread. It is vitally important that senators repeatedly hear from their constituents in support of the Pain Relief Promotion Act before the Senate reconvenes in January."