105th Congress: Democratic Perspectives House Committee on Energy and Commerce Democrats Welcome Page
Concern about federal funding for physician-assisted suicide has escalated as a result of fears that current court and State legislative activity could result in legalization of assisted suicide. These concerns persist despite the fact that no current federal policy or extant legislation permits payment or reimbursement for items or activities related to assisted suicide, or for the provision of services intended to result in suicide. In other words, no federal funds support assisted suicide. Thus, H.R. 1003 does not produce a change in current policy or practice, but merely, as the bill states, "continue[s] current policy."
However, there is at stake in this debate a social policy issue that is of great significance. It is the question, raised by every witness the Subcommittee on Health and Environment called to its hearing on assisted suicide, of why people request assisted suicide and what can be done to prevent this. These witnesses -- who included health care providers, religious leaders, and advocates for the ill and the disabled -- emphasized that people who are desperately ill, severely disabled, exceedingly frail, or in unrelenting severe pain require special care. And the witnesses lamented that, in many cases, such care is not available. This is not because health care providers lack compassion, but because they often are poorly equipped to identify the unique needs of these patient populations and to respond in the most effective ways to those needs. Simply stated, better training of health professionals is needed, in the very specialized and sensitive skills and knowledge needed to provide the best care to people who are dying.
During the mark-up of H.R. 1003, an amendment was offered that was designed to turn this legislation into something that will accomplish a goal more valuable than simply restating the current situation: the goal of preventing assisted suicide by addressing the reasons that people are driven to seek an end to their lives. It would have required that health professions training programs funded by the federal government incorporate training in how to deal with death and dying, and, as well, authorized research, demonstration, and training on related issues. A small part of this amendment, which authorizes further study related to suicide and its causes, was adopted and is included in the legislation the House will consider. Although this is a positive step -- and we look forward to working with our Republican colleagues to ensure that funds are allocated for the purpose of supporting these kinds of activities -- it falls well short of meaningful public policy designed to prevent the conditions that cause people to seek suicide in the first place.
The part of our amendment which related to appropriate training of health care providers in how to recognize and treat the conditions that lead to suicide, regrettably, failed. This was despite the fact that the provision would have done nothing more than require, as a condition of receiving federal discretionary grant funds, that grantees include this critically important component in their programs to train primary care providers. This provision would not have prescribed how such training should be provided, or the content of curricula. Nevertheless, the amendment failed by an essentially party-line vote, with every Republican voting against it and every Democratic Member of the Committee except one voting for it.
As legislators and policy makers, we have an obligation to get to the root of a problem and try to solve it. Improving health professions training to achieve more appropriate care of people who are so desperate as to be seeking suicide is a significant positive step. Our amendment could have set us on the road to achieving that goal. It would have been the right thing to do. To quote the Subcommittee's witness, Professor Felicia Cohn of the George Washington University Center to Improve Care of the Dying, this legislation "falls far short of what is needed. ... Congress has the opportunity -- and the obligation -- to set policy to improve care at the end of life. ... The care of persons at the end of their days in this country is a national disgrace. Much can and should be done, and the Congress has special opportunities and obligations to do so." Unfortunately, we have neither seized that opportunity nor fulfilled those obligations in this legislation.
JOHN D. DINGELL
EDWARD J. MARKEY
RICK BOUCHER
THOMAS J. MANTON
EDOLPHUS TOWNS
FRANK PALLONE, JR.
SHERROD BROWN
BART GORDON
ELIZABETH FURSE
PETER DEUTSCH
RON KLINK
BART STUPAK
ELIOT L. ENGEL
THOMAS C. SAWYER
ALBERT R. WYNN
GENE GREEN
KAREN MCCARTHY
TED STRICKLAND
The issue of physician-assisted suicide is controversial not merely because it implicates fundamental ethical questions and challenges our social norms, but because our country is in the midst of an unfinished debate over its merits and perils. Patients, families, health care providers, courts and legislatures are all actively engaged in a search for the place of assisted suicide in our society. The Congress has an important role to play in this inquiry, but the bill reported by the Commerce committee is nothing more than a precipitous attempt to curtail exploration of the sensitive ethical and cultural questions raised by assisted suicide.
These questions are critical to an informed public judgment, but are as yet unanswered. Should individuals be entitled to choose for themselves how and when they may end their own lives? Is there a constitutional right to privacy or to equal protection which warrants such a policy? Are health care providers obligated to help mentally competent and terminally ill patients end their lives? What protections are required to assure that such choices are informed and freely made? Would there be a potential for abuse against older Americans and our most vulnerable citizens?
Most importantly, as the witnesses before the committee uniformly emphasized, timely reforms to our systems of health care delivery and medical education would best serve patient interests by averting the pain and despair which so often compel patients to seek an end to their lives. Efforts to increase research and improve education in palliative care, recognition and management of the needs of dying patients, physician-patient communication, and pain management are urgently needed and long overdue. Moreover, as the American Geriatrics Society testified, "Congress should lead these efforts."
Rather than assist in resolving unanswered questions or fulfilling unmet needs, H.R. 1003 simply prohibits Federal funding of assisted suicide. The bill is a solution in search of a problem. Today, assisted suicide is not a legal practice in any jurisdiction in the United States. The courts have enjoined the Oregon referendum legalizing assisted suicide from taking effect. Nor does the federal government or the States subsidize or compensate for the practice of physician-assisted suicide.
For want of any substantial effect, the bill's actual purpose is easier to ascertain. As a congressional statement of disapproval, the bill is meant to curb our society's debate over assisted suicide. Just as the courts and States are engaged in the complex and serious work of establishing law and policy underlying assisted suicide, the Congress intends to restrain this enterprise with premature legislation. George Will recently wrote that we should allow "the 50 state legislatures [to] proceed with the increasingly urgent task of educating themselves and the public through deliberations" on assisted suicide.
Broad public discussion is precisely what is needed, and what the Congress should encourage. It is not enough for us to ban funding or enact prohibitions. We have an obligation to dedicate time and careful attention to giving every patient a meaningful choice of health care alternatives to assisted suicide. Until then, we have acted too narrowly to protect the interests of patients and their families.
As Justice Brandeis once observed, "To stay experimentation in things social and economic is a grave responsibility. Denial of the right to experiment may be fraught with serious consequences to the Nation... [W]e must be ever on our guard, lest we erect our prejudices into legal principles. If we would guide by the light of reason, we must let our minds be bold."
HENRY A. WAXMAN
DIANA DEGETTE
105th Congress: Democratic Perspectives
House Committee on Energy and Commerce Democrats Welcome Page