Pubdate: Sun, 07 Nov 1999
Source: Houston Chronicle (TX)
Copyright: 1999 Houston Chronicle
Contact:  http://www.chron.com/
Forum: http://www.chron.com/content/hcitalk/index.html
Author: Ellen Goodman

WAR ON DRUGS ON THE WRONG BATTLEFIELD

And you thought the war on drugs was about keeping cocaine out of the
country and heroin out of kids. Guess again.

If a bill that flew out of the House recently becomes law, the Drug
Enforcement Administration will be encouraged to go after doctors as
if they were dealers.

The bill is titled -- in the best Orwellian fashion -- the Pain Relief
Promotion Act.

The bill to prevent the use of federally controlled substances by
doctors assisting suicides is deliberately aimed at overthrowing a law
approved in Oregon. Sponsors added a few strokes for the notion of
pain management and convinced their colleagues that this was an easy
way to oppose doctor-assisted suicide while showing some sympathy for
dying patients, as in "I feel your pain."

According to the spin, the bill that passed wouldn't affect doctors
who prescribe substances like morphine for pain relief, even if the
drug unintentionally causes death. But it would punish doctors who
prescribe these substances intentionally to cause death.

As Illinois' Henry Hyde declaimed, "We believe doctors should help
people cope with the pain and terror of death, not thrust death upon
them." A fellow sponsor, Charles Canady of Florida, added, "We draw a
bright line here."

A bright line? The line between a dose that controls pain and a dose
that ends up hastening death is one of the murkiest in medicine. The
bill doesn't say how doctors should walk this line or how they would
prove intent.

If a companion law in the Senate passes and the whole mess survives a
states' rights test, doctors could be sentenced to 20 years in prison.
Anybody could drop a dime, and the DEA could be left to decide
doctors' motives.

Joanne Lynn, head of Americans for Better Care of the Dying, opposes
both assisted suicide and this law. She can imagine signs posted
around hospitals saying: 1-555-CALLDEA. To put it bluntly, she says,
"Ordinary record-keeping and conversations would be insufficient to
protect us from prosecution."

The House bill was described by the media and its sponsors as a litmus
test on assisted suicide. It gave Hyde et al. a chance to thumb their
noses at Oregon, not to mention voters in California and Maine, where
doctor-assisted suicide is going on the ballot.

Ironically, the law wouldn't actually ban all assisted suicide; it
would just prohibit the use of certain barbiturates. Remember Jack
Kevorkian? He used carbon monoxide -- an uncontrolled substance -- in
his "practice."

The bill for "pain relief" could increase pain. Says Oregon Sen. Ron
Wyden, another opponent of both assisted suicide and this bill, "The
undertreatment of pain is a documented crisis. If the DEA can
second-guess doctors who are already reluctant, we'll see pain-relief
programs set back."

The tragedy is this: We know that in the last week of life, a third of
all people suffer moderate to severe pain -- pain that prompts the
despair that underlies many requests for a merciful death.

In the past several years, with all the discussion about the end of
life, Oregon has actually pulled ahead of the country in both hospice
care and pain management. Only one in 10,000 Oregon deaths has been an
assisted suicide.

If Congress actually is interested in pain relief rather than
political grandstanding, there are two other bills -- the
Compassionate Care Act and the Conquering Pain Act -- that would build
family-support networks, fund centers for pain-management research,
and require report cards on treatment for pain. Neither is given a
chance of passage.

In the past, the war on drugs has done enormous collateral damage to
sick civilians. We keep marijuana from cancer patients, heroin from
the dying. Now Congress wants to push the DEA to sniff around doctors'
prescriptions.

Whatever happened to that old slogan of the drug war, "Just Say
No"?

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Goodman is a Pulitzer Prize-winning columnist for the Boston
Globe.

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