The Pain Relief Promotion Act of 1999

The Pain Relief Promotion Act seeks to amend the Controlled Substances Act to promote pain management and palliative care without permitting assisted suicide and euthanasia. Section 101 of the bill specifically states that the use of controlled substances for alleviating pain and discomfort is a legitimate medical purpose, even where the use of these drugs may have the unintended effect of increasing the risk of death. The bill also reinforces the existing standard that the use of controlled substances with the intent of assisting in a suicide is not authorized by the Controlled Substances Act and provides that the Attorney General, in implementing the act, shall employ a uniform standard in enforcement of the Act, without regard to state law permitting assisted suicide or euthanasia.

We do not endorse physician-assisted suicide. However, we have a number of concerns about this bill. The first relates to the lack of a subcommittee hearing or mark-up on the bill. Palliative care is an important and difficult issue for patients and families across the country, yet the Committee has not given this bill full and thorough consideration. The bill is supported by the American Medical Association and the National Hospice Organization, but opposed by the California Medical Association, the American Nurses Association, the Oncology Nursing Society, the National Association of Orthopaedic Nurses, the American Pain Foundation, and others. This contentious area of public policy demands careful subcommittee consideration and expert testimony by educated witnesses. H.R. 2260 clearly has not gone through the appropriate committee process.

We are troubled that Title I of this bill raises the prospect of the Drug Enforcement Agency (DEA) "second guessing" a physician or a health care professional's intent in prescribing and using large doses of opiates for patients who are in severe pain. Title I of the bill could turn the DEA into a medical oversight body charged with investigating the "intent" and "purpose" of a physician's care for a patient. The threat of investigation alone could scare health care professionals away from providing quality care to the neediest patients. This bill could inadvertently harm the 50 million American patients who suffer from serious pain and other distressing symptoms.

Many sick patients require extremely large doses of pain medications to assure that they are comfortable and can maintain a high quality of life and interaction with their family. These large doses are not prescribed to assist in suicide, but to assure aggressive pain control and quality care. Many patients are able to tolerate the extremely high doses of controlled substances needed to manage their pain and other symptoms, but the same doses in another patient would be lethal.

This gray area poses the problem. H.R. 2260 attempts to end the practice of assisted suicide, but it may just have the opposite effect. Many caregivers believe it could increase suicides, assisted and otherwise, by patients who can no longer bear the unrelieved pain caused when practitioners, threatened by possible DEA investigation into their intent in prescribing pain-killing medication, are deterred from providing necessary pain relief. Other caregivers do not believe this could result. Regular and full consideration by the Subcommittee would have given us an opportunity to resolve these differing views, and to produce better legislation.

JOHN D. DINGELL
HENRY A. WAXMAN
EDOLPHUS TOWNS
PETER DEUTSCH
EDWARD J. MARKEY
SHERROD BROWN
TED STRICKLAND
ALBERT R. WYNN
LOIS CAPPS
TOM SAWYER
TOM BARRETT