Pubdate: Fri, Jun 11, 1999
Source: Oregonian, The (OR)
Copyright: 1999 The Oregonian
Contact:  1320 SW Broadway, Portland, OR 97201
Fax: 503-294-4193
Website: http://www.oregonlive.com/
Forum: http://forums.oregonlive.com/
Author: Dave Hogan, the Oregonian

ASSISTED SUICIDE AGAIN TARGETED

Key U.S. Lawmakers Have The Support Of A National Hospice Group To Change
Oregon's Use Of Drugs

Key members of Congress are preparing to renew their attacks on Oregon's
physician-assisted-suicide law with legislation to be introduced as soon as
next week.

They have already gained support from the National Hospice Organization,
one of the groups that led the successful fight against their proposals
last session.

Like the bills that stalled in the House and Senate last year, the new
legislation would outlaw the use of controlled substances for assisted
suicide while permitting the aggressive use of pain medication, even when
it hastens death.

The staff of Sen. Don Nickles, R-Okla., said his upcoming legislation
succeeded in striking that balance.

"This is a completely new piece of legislation," said Nickles' spokesman,
Brook Simmons. "It's a comprehensive look at long-term palliative care and
how we address those issues and how we promote relief."

The new legislation adds provisions for research and training in
end-of-life care, according to a summary of a bill proposal by Nickles, the
assistant Senate majority leader.

Oregon voters approved physician-assisted suicide in 1994 and reaffirmed
the law in 1997. In 1998, 15 patients died through use of the law, the only
one of its kind in the United States.

The Nickles' proposal has picked up important support from the National
Hospice Organization. The organization was a leader among more than 35
medical and patient advocacy groups that attacked similar legislation
proposed last year by Nickles and Rep. Henry Hyde, R-Ill., who is chairman
of the House Judiciary Committee.

Last year, the hospice organization and the other groups said they were
concerned the bills would discourage doctors from aggressively treating
their patients' suffering out of fear they could inadvertently cause a
patient's death with high doses of medication and spark a federal criminal
inquiry.

But this week, the organization decided to support the Nickles legislation,
based on a draft provided to the organization.

"In our estimation, it is a positive bill in helping hospices treat
terminally ill patients and address their families' concerns," said Jon
Keyserling, director of public policy for the organization.

Other medical groups, including the American Medical Association, are
waiting to see the final bill before deciding whether to support it.

Thomas Reardon, a Portland physician and president-elect of the AMA, said
his organization's concerns had not changed since last session.

"We support aggressive use of pain management, but the intent is to treat
and not to kill," Reardon said. "The issue is, where is that line and do
you have the Justice Department looking over your shoulder and accusing
physicians of assisted suicide when it wasn't."

Oregon health leaders and public officials share some of Reardon's concerns.

"I cannot imagine a system that you could target only those involved in
assisted suicide and have no impact on prescribing practices" for other
dying patients, said Dr. Susan Tolle, director of the Center for Ethics in
Health Care at Oregon Health Sciences University.

Tolle and others expressed concern that the bill, which would affect
federal drug enforcement only in Oregon, singles out the state.

The bill would also provide $5 million in grants for end-of-life care
training to medical schools, hospices and other programs that will not
espouse assisted suicide in that training.

"This clarifies existing law to retain a uniform national standard over
controlled substances," said Simmons, Nickles' spokesman. "In those states
that do not legalize assisted suicide, the application of the Controlled
Substances Act is not changed whatsoever."

Ann Jackson, director of the Oregon Hospice Association, said, "It's really
very scary. Oregon is going to be hung out to dry."

Despite her national organization's support for the bill, Jackson worries
about its impact on all dying Oregonians.

Gov. John Kitzhaber, who testified against last year's legislation before a
congressional panel, is equally concerned, said Mark Gibson, the governor's
health policy adviser.

"I think Oregon will be in an uphill struggle once again to prevent the
federal government from eroding authority that the state has traditionally
had to make decisions about the practice of medicine within it's own
borders," Gibson said.

Whether the proposed bill would stop assisted suicide under Oregon's law is
also being debated, particularly by those eager to avoid a battle over
state's rights.

Some say doctors could give a patient federally controlled drugs such as
morphine or sedatives to make the patient comfortable. Then the patient
could self-administer an infusion of a non-federally controlled drug such
as potassium chloride to stop the heart, similar to Dr. Jack Kevorkian's
tactics. But whether the Oregon law would allow such an infusion has never
been tested, and the willingness of doctors and patients to try such a
route is unknown.

Nickles is expected to introduce his legislation this month. Simmons,
Nickles' spokesman, said the senator had been working very closely with
Hyde on the assisted suicide legislation.

Hyde's office did not return telephone calls Thursday.

Sens. Gordon Smith, R-Ore., and Ron Wyden, D-Ore., have not taken positions
on the Nickles proposal. But Wyden's chief of staff, Josh Kardon, expressed
skepticism about its aim, even though it includes a focus on palliative care.

"This appears to be nothing more than a stalking horse to undermine the
will of Oregon's voters," Kardon said.
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