Pubdate: Tue, 16 May 2000
Source: San Francisco Chronicle (CA)
Copyright: 2000 San Francisco Chronicle
Contact:  http://www.sfgate.com/chronicle/
Forum: http://www.sfgate.com/conferences/

THE INVISIBLE EPIDEMIC OF PAIN

THERE ARE many reasons why doctors under-treat pain. As Dr. Eric Chevlen, 
director of palliative care at St. Elizabeth Hospital in Youngstown, Ohio, 
explained: ``They're treating a symptom which is invisible, and so it's 
easy to dismiss. They say, `Oh, she's exaggerating.' A person's not going 
to die of pain. There's not a big downside for doctors who are doing a bad 
job; it's a minority of their practice. It's easy for them to blow it off.''

A recent survey found that four in 10 dying patients were in severe pain 
most of the time. A New York study found that 71 percent of doctors said 
they had under-medicated for pain for fear of running afoul of the 
authorities. As Chevlen noted, ``If pain were uncontrollable, it would be a 
tragedy; that it is controllable makes it not a tragedy, but a scandal.''

Rep. Henry Hyde, R-Ill., and Sen. Don Nickles, R-Okla., have introduced 
legislation that should result in improved pain control. Say, ``Amen.'' 
Last year the House passed the Pain Relief Promotion Act by a 271-156 vote. 
Soon the Senate is expected to vote on the measure, which recognizes that 
``the dispensing or distribution of certain controlled substances for the 
purpose of relieving pain and discomfort even if it increases the risk of 
death is a legitimate medical purpose and is permissible under the Control 
Substances Act.''

When necessary pain control can hasten death, that's known as the ``double 
effect.'' In recognizing the legitimacy of drugging patients

- --not to hasten death, but to relieve suffering -- the measure would give 
doctors added legal protections. That's why the American Medical 
Association supports the bill.

If the Pain Relief Promotion Act doesn't become law, it will be because it 
also prohibits the use of controlled substances in assisted suicides, which 
Oregon voters legalized when they passed a 1994 initiative. Critics say 
that it steps on Oregon state law. Being a believer in states' rights, I 
should be thrilled to see Democrats clamoring for state self-determination.

Except when Attorney General Janet Reno ruled in 1998 that the Oregon law 
does not violate federal drug laws, she contradicted herself. Earlier, she 
had ruled that California's Medical Marijuana Act is invalid because a 
``state initiative cannot supplant the will of the people of the United 
States.'' So which is it? How can Uncle Sam see states' rights in Oregon, 
but federal supremacy over California law?

Also, the Hyde-Nickles bill need not hinder Oregon doctors -- those who 
choose to help kill their patients instead of treat their pain -- because 
they could prescribe lethal drugs that do not fall under the Controlled 
Substance Act. The measure only deals with drugs covered under the 
Controlled Substance Act.

Besides, states do not have a right to pass laws that essentially 
countenance the killing of sick people. Killing the sick and disabled is 
not right, it's not constitutional and it's not compassionate.

Of course, assisted suicide advocates like to pose as if they are the 
compassionate ones and opponents are mean-spirited people who have no 
problem with sick people living in pain. To the contrary, their rhetoric on 
this bill shows who cares and who will say anything to make a point. 
Unwilling to stick to the arguments, Pain Relief Promotion Act opponents 
have begun a scare campaign that warns that if the bill passes it will have 
a ``chilling effect'' on pain control management. That is, in order to 
defeat the bill, they're telling doctors that the bill should or could 
cause them to under-prescribe needed pain medication.

Bunk. As the AMA noted: ``We see the bill as providing a new statutory 
protection for physicians who aggressively prescribe controlled substances 
to help patients in pain at the end of life. We never had that before.'' 
Says something doesn't it? If they can't use the drugs to kill people, they 
are ready to reduce the chances that the drugs will be used to kill other 
people's pain.
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MAP posted-by: Keith Brilhart