Pain Relief Promotion Act Of 1999

Key Points

BACKGROUND

Congress clearly spoke on the issue of assisted suicide when it passed the Assisted Suicide Federal Funding Restriction Act of 1997. The President signed the bill, saying it "will allow the Federal Government to speak with a clear voice in opposing these practices," and warned that "to endorse assisted suicide would set us on a disturbing and perhaps dangerous path."

Since 1914 Congress has enacted legislation relating to the control and diversion of drugs.

The Controlled Substances Act (CSA) of 1970 gave jurisdiction to the Drug Enforcement Administration (DEA) and charged it with the responsibility of overseeing narcotics and dangerous drugs.

The CSA standards for use of a federally controlled substance are:

· It must be prescribed for a legitimate medical purpose." (21CFR §1306.04)

· It must be in the interest of "public health and safety." (21 USC §823)

· It must be within the physician's "usual course of his professional practice."

In 1984 Congress passed amendments to the Controlled Substances Act with specific concerns regarding the use of prescription drugs in lethal overdoses. The chairman of the health subcommittee in the House agreed: "Drugs legally manufactured for use in medicine are responsible for a substantial majority of drug-related deaths and injuries" (Rep. Waxman, Hearing Record).

Congress's view was that while the states are the first line of defense against misuse of prescription drugs, the federal government must enforce its own objective standard as to what constitutes such misuse-and it must have the authority to enforce that standard when a state cannot or will not do so.

The Controlled Substances Act requires a physician to obtain a federal registration, separate from the physician's state medical license, from the DEA in order to prescribe or distribute controlled substances. A physician may practice medicine with only a state medical license but he can only prescribe controlled substances if he has a DEA registration.

On June 5, 1998, overturning an earlier policy determination by her own Drug Enforcement Administration, U.S. Attorney General Janet Reno announced that the federal Controlled Substances Act establishes no uniform national policy against the use of federally regulated drugs for assisted suicide. Thus, she said, these drugs may be used to assist patients' suicides in any state which, like Oregon, allows the practice under state law.

The Attorney General's ruling distorts and disregards current federal law, which prohibits any use of these drugs to endanger "public health and safety" or for anything other than a "legitimate medical purpose." 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.

Federal law is clearly intended to prevent use of these drugs for lethal overdoses, and contains no exception for deliberate overdoses approved by a physician.

The DEA pursues cases in which a physician's negligent use of controlled substances caused a patient's death. It was inconsistent for the Attorney General to allow for the intentional use of controlled substances to cause the death of a patient.

The Controlled Substances Act was intended by Congress to creat uniform federal standards for protecting public health and safety which are not rescinded or modified by enactment of a state law to the contrary.

Governors request a "uniform national standard."

Last year the governors of Ohio, Montana, Nebraska, and Iowa and the Attorney General of New York state asked for a "uniform national standard." Governor Terry Branstad of Iowa wrote, "The federal Controlled Substances Act has established a uniform national standard for protecting people from dangerous drugs, forbidding the use of controlled substances for anything other than a legitimate medical purpose. Any signal that the federal government now sees assisted suicide as falling within the definition of "legitimate" medicine could undermine efforts by the vast majority of states to protect vulnerable patients from this practice."

LEGISLATION IN THE 105TH CONGRESS

In 1998, legislation to reverse Attorney General Reno's ruling was approved by House and Senate Judiciary Committees but did not receive floor votes. The Lethal Drug Abuse Prevention Act (H.R. 4006, S. 2151) was criticized by the National Hospice Organization and others who claimed that it might cause some medical professionals to be less aggressive in using drugs for legitimate pain control.

LEGISLATION IN THE 106TH CONGRESS

New legislation to clarify the federal Controlled Substances Act and address last year's concerns has now been endorsed by the National Hospice Organization. This new legislation, which is also strongly supported by NRLC, will do the following:

· Affirm and support aggressive pain management as a legitimate purpose for the use of federally controlled drugs - - even in cases where such use may unintentionally hasten death as a side effect ("principle of double effect") - - and provide funding for education and training for health professionals in palliative care.

· Recognize that this policy promoting pain control does not authorize the use of federally regulated drugs for intentional assistance in suicide or euthanasia.

· Encourage practitioners to dispense and distribute controlled substances as medically appropriate to relieve pain and other distressing symptoms, by clarifying that such conduct is consistent with the Controlled Substances Act.

· Provide that a state law authorizing or permitting assisted suicide or euthanasia does not change the federal government's responsibility to prevent misuse of potentially dangerous drugs. The government's responsibility to prevent such misuse in states which have not legalized assisted suicide is already conceded by the attorney general and would not change.

· Provide education and training to law enforcement officials and health professionals on medically accepted means for alleviating pain and other distressing symptoms for patients with advanced chronic disease or terminal illness, including the legitimate use of controlled substances.

All members of Congress should be encouraged to support Senator Don Nickles (R-Ok.) and Rep. Henry Hyde (R-Il.) in their efforts to clarify federal law to affirm the use of controlled substances to control pain and reject their use to kill patients.