PAIN RELIEF PROMOTION ACT SUBSTITUTE GARNERS NEW MEDICAL SUPPORT

On April 5 the formerly hostile Pain Care Coalition, including the American Academy of Pain Medicine and the American Pain Society, endorsed a significantly rewritten version of the Pain Relief Promotion Act. This new version had been developed in negotiations that included representatives of the American Medical Association, sponsor Senator Don Nickles

(R-Ok.), and Senate Judiciary Committee Chairman Orrin Hatch (R- Ut.). The substitute is expected to be reported favorably from the committee at a meeting scheduled for April 13, 2000. It could come up for a vote on the Senate floor after April 25, when Congress returns from its Easter recess.

The bill, which passed the House of Representatives 271-156 on October 27, 1999, would end the use of federally controlled drugs to assist suicide, while establishing programs to advance the positive alternative of good pain care. All of the 43 patients whose suicides have been officially reported as legally assisted under Oregon's unique-in-the-nation law were killed by federally controlled drugs.After opposing a 1998 predecessor bill, the Lethal Drug Abuse Prevention Act, the American Medical Association (AMA), the National Hospice and Palliative Care Organization, and other medical groups endorsed its substantially reworked successor, the Pain Relief Promotion Act, in 1999. In December 1999, the AMA House of Delegates rejected efforts to reverse the AMA's support for the bill. But the House of Delegates did adopt a resolution calling for changes to deal with a perceived concern that under it the federal government might be authorized to "establish federal protocols and/or regulations for pain management and palliative care." (See details in sidebar.)

The substitute has new provisions clarifying that the bill does not authorize the imposition of federal standards of medical practice relating to pain management or palliative care and also strengthening protections for physicians who prescribe controlled substances to control pain.

In a letter provided to Sen. Hatch endorsing the substitute, the AMA wrote, "your Substitute includes essential clarifications of the original bill, specifically expressing the sponsors' intention to honor the existing authority of the states to regulate legitimate medical practice, while exercising the concurrent federal authority to regulate the prescribing and administration of controlled substances. [The] bill makes a strong statement against assisted suicide, while minimizing the potential for inappropriate intrusion into patient care decisions."

Forty-three senators have co-sponsored a companion measure to the House-passed bill that was introduced by Senators Don Nickles (R-Ok.) and Joseph Lieberman (D-Ct.) last year, and others have pledged their support. Since Senator Ron Wyden (D- Or.) has promised to filibuster the bill (debate it endlessly to prevent a vote), under Senate rules 60 senators will have to support cloture (limiting debate) to enable it to pass. The cloture vote could be very close.