[Congressional Record Volume 142, Number 133 (Tuesday, September 24, 1996)]
[Senate]
[Pages S11175-S11177]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DORGAN (for himself, Mr. Ashcroft, Mr. Biden, Mr. Breaux, 
        Mr. Coats, Mr. DeWine, Mr. Faircloth, Mr. Ford, Mr. Grassley, 
        Mr. Hatfield, Mr. Inhofe, Mr. Lott, Mr. Mack, Mr. McConnell, 
        Mr. Murkowski, Mr. Pressler, and Mr. Thurmond):
  S. 2108. A bill to clarify Federal law with respect to assisted 
suicide, and for other purposes; to the Committee on Labor and Human 
Resources.


              THE ASSISTED SUICIDE FUNDING RESTRICTION ACT

  Mr. DORGAN. Mr. President, I rise today, along with my colleague, 
Senator Ashcroft, to introduce a piece of legislation. We understand 
that it is late in the session, but we have just completed work on the 
legislation, and we hope that introducing it now and reintroducing it 
in the next Congress will allow us to make some progress toward 
enacting this bill.
  There are 15 original cosponsors besides myself and Senator Ashcroft: 
Senators Biden, Breaux, Coats, DeWine, Faircloth, Ford, Grassley, 
Hatfield, Inhofe, Lott, Mack, McConnell, Murkowski, Pressler, and 
Thurmond.
  This is obviously a bipartisan group of Senators who are today 
introducing this legislation. I will describe it briefly, and then I 
will ask my colleague, Senator Ashcroft from Missouri, with whom I am 
pleased to introduce this today, to add to that description.
  Our legislation is called the Assisted Suicide Funding Restriction 
Act. That is a rather long name, but simply stated, what this bill 
ensures is that Federal tax dollars will not be used to pay for 
assisting in suicide.
  We are in a circumstance in this country where only one State--the 
State of Oregon--has legalized physician-assisted suicides. The State 
has every right to do that. And Oregon is now engaged in the courts in 
a challenge of its law. When and if the court challenge is dismissed 
and it becomes law in Oregon--as is expected based on an earlier Ninth 
Circuit Court of Appeals decision--the folks who run the Medicaid 
Program in Oregon indicate that the State fully intends to use its 
Medicaid dollars to pay for physician-assisted suicides.
  Some of us here in Congress believe that we ought not to in any way 
countenance the use of Federal dollars in the furtherance of physician-
assisted suicides. We are not telling the States what their policies 
ought to be with respect to whether physician-assisted suicides should 
be allowed. Most States have already made that judgment and decided 
that assisted suicide is not appropriate. But to a State that has said 
it intends to use Federal dollars to further their State policy 
allowing assisted suicide, we say no. That is not what we would expect 
Federal dollars, especially Federal health care dollars, to be used 
for. We would expect Federal health care dollars to be used to advance 
the health of patients and the delivery of medicine to those in this 
country who need it--not to advance Federal payment for those who would 
elect physician-assisted suicide.
  Some might say, ``Well, why do you have to legislate on this?'' I say 
to them, if we do not, when the courts resolve the legal questions with 
respect to the Oregon law, we likely will immediately be using Federal 
dollars to pay for physician-assisted suicide in that State, regardless 
of whether Congress and the public want them to or not. The officials 
in that State have indicated that will be the case. So with this 
legislation we say we think it is inappropriate from a public policy 
standpoint and we would not want scarce Federal dollars used for that 
purpose.
  I would like to describe what this legislation is not because it is 
as important as describing what it is.
  This legislation does not limit the withholding of, or the withdrawal 
of, medical treatment, or of nutrition, or hydration from terminally-
ill patients who have decided they do not want their lives sustained by 
medical technology. Most people and States recognize that there are 
ethical, moral, and legal distinctions between actively taking steps to 
end a patient's life and withholding or withdrawing treatment in order 
to allow a patient to die naturally. Again, this legislation 
specifically states that we are not interfering with the ability of 
patients and their families to end or withdrawal treatment.
  This legislation also does not prohibit Federal funding for any care 
or service that is intended to alleviate a patient's pain or 
discomfort, even if the use of this pain control ultimately hastens the 
patient's death. I think we would all agree that we should make the 
utmost effort to ensure that terminally ill patients do not spend their 
final days in pain and suffering, and this legislation does not hinder 
that.

  Finally, this legislation does not prohibit a State from using its 
own dollars to assist in suicide. If a State decides that it wants to 
allow and pay for physician-assisted suicide as a matter of policy, it 
can use its own money to further that aim. This bill simply says we do 
not want Federal dollars used for that purpose.
  Mr. President, I understand that the issue of assisted suicide is an 
enormously emotional one. All of us in this country have read the news 
accounts of a doctor who is actively involved in assisting in his 
patients' suicides and of those who have taken him to court saying he 
has violated their State law. People have very strongly held opinions 
about this subject because issues of life and death reach to the inner 
core of people's moral beliefs. But regardless of one's personal views 
about assisted suicide, there is little disagreement on the broader 
question of whether we ought to use Federal health care dollars to pay 
for physician-assisted suicide.
  In fact, a national survey earlier this year found that 83 percent of 
the American people believe that tax dollars should not be used for 
assisted suicide. I believe this legislation should and will have wide 
support. The National Conference of Catholic Bishops and the National 
Right to Life Committee have both endorsed the bill. The American 
Medical Association and the American Nurses Association have position 
statements opposing assisted suicide. President Clinton has also 
indicated his opposition to assisted suicide, and Senator Ashcroft and 
I hope that our colleagues will join us as cosponsors of this 
legislation. We hope to advance this legislation in the intervening 
days, and also, if necessary, to reintroduce it early in the next 
session to see if we can get the Congress to enact this legislation 
soon.
  Let me again sum up what this bill would and would not do, along with 
why it is necessary. Mr. President, this legislation will prohibit 
Federal funds from being used for the costs associated with assisted 
suicide.
  Let me say again that I am pleased to work with my colleague, Senator 
Ashcroft of Missouri, who I know feels strongly about this issue as 
well.
  Mr. President, this legislation will prohibit Federal funds from 
being used for the costs associated with assisted suicide.
  I understand that the decisions that confront individuals and their 
families when a terminal illness strikes are among the most difficult a 
family will ever have to make. At times like this, each of us must rely 
on our own religious beliefs and conscience to guide us. But regardless 
of one's personal views about assisted suicide, I do not believe that 
taxpayers should be forced to pay for this controversial practice. The 
majority of taxpayers I have talked to do not want their tax money used 
to assist in suicides. In fact, when asked in a poll in May of this 
year whether tax dollars should be spent for assisting suicide, 83 
percent of taxpayers feel tax money should not be spent for this 
purpose.
  The Assisted Suicide Funding Restriction Act prevents any Federal 
funding from being used for any item or service which is intended to 
cause, or assist in causing, the suicide, euthanasia, or mercy killing 
of any individual. The programs covered under this bill include 
Medicare, Medicaid, the military health care system, Federal Employees 
Health Benefits [FEHB] plans, Public Health Service programs, programs 
for the disabled, and the Indian Health Service.

[[Page S11176]]

  This bill does make some important exceptions. First, let me make 
clear that this bill does not limit the withholding or withdrawal of 
medical treatment or of nutrition or hydration from terminally ill 
patients who have decided that they do not want their lives sustained 
by medical technology. Most people and States recognize that there are 
ethical, moral, and legal distinctions between actively taking steps to 
end a patient's life and withholding or withdrawing treatment in order 
to allow a patient to die naturally. Every State now has a law in place 
governing a patient's right to lay out in advance, through an advanced 
directive, living will, or some other means, his or her wishes related 
to medical care at the end of life. Again, this bill would not 
interfere with the ability of patients and their families to make clear 
and carry out their wishes regarding the withholding or withdrawal of 
medical care that is prolonging the patient's life.
  This bill also makes clear that it does not prevent Federal funding 
for any care or service that is intended to alleviate a patient's pain 
or discomfort, even if the use of this pain control ultimately hastens 
the patient's death. Large doses of medication are often needed to 
effectively reduce a terminally ill patient's pain, and this medication 
may increase the patient's risk of death. I think we all would agree 
that the utmost effort should be made to ensure that terminally ill 
patients do not spend their final days in pain and suffering.
  Finally, while I think Federal dollars ought not be used to assist a 
suicide, this bill does not prohibit a State from using its own dollars 
for this purpose. However, I do not think taxpayers from other States, 
who have determined that physician-assisted suicide should be illegal, 
should be forced to pay for this practice through the use of Federal 
tax dollars.
  I realize that the legality of assisted suicide has historically been 
a State issue. Thirty-five States, including my State of North Dakota, 
have laws prohibiting assisted suicide and at least eight other States 
consider this practice to be illegal under common law. Only one State, 
Oregon, has a law legalizing assisted suicide.
  However, two circumstances have changed that now make this an issue 
of Federal concern. First, Federal courts are already handing down 
decisions that will have enormous consequences on our public policy 
regarding assisted suicide. Second, we are on the brink of a situation 
where Federal Medicaid dollars may soon be used to reimburse physicians 
who help their patients die. Should this occur, Congress will not have 
considered this issue. I believe it was never Congress' intention for 
Medicaid or other Federal dollars to be used to assist in suicide, and 
I hope we will take action soon to stop this practice before it starts. 
If Congress does not act, a few States, or a few judges, may very well 
make this decision for us.
  In two separate cases this year, Compassion in Dying versus State of 
Washington and Quill versus Vacco, the Federal Ninth and Second Circuit 
Courts of Appeal, respectively, have struck down Washington and New 
York State statutes outlawing assisted suicide. In the Compassion in 
Dying case, the ninth circuit held that the ``right to die'' is 
constitutionally recognized and that Washington State's law prohibiting 
physicians from prescribing life-ending medication therefore violates 
the ``due process'' clause of the 14th amendment for terminally ill 
adults who wish to end their life. In Quill versus Vacco, the second 
circuit also found that a State law prohibiting physician-assisted 
suicide violates the Constitution, but it did not agree with the ninth 
circuit's reasoning that such a law violates the due process clause. 
Rather, the second circuit held that the New York State law was 
unconstitutional because it violates the ``equal protection'' clause of 
the Constitution. The Supreme Court could decide to take up one or both 
of these cases as early as next year.
  Ironically, in a third case, Lee versus Oregon, a Federal district 
court judge also used the ``equal protection'' clause as the basis for 
his decision--but he ruled that Oregon's 1994 law allowing assisted 
suicide for the terminally ill violates the Constitution, and the judge 
enjoined the implementation of Oregon's law. However, this decision has 
been appealed to the Ninth Circuit Court of Appeals, which has already 
affirmed a constitutional ``right to die.'' The ninth circuit's 
decision, which is expected to overturn the district court and lift the 
injunction against Oregon's law, could be handed down any day. The 
State's Medicaid director has already stated that, when the injunction 
against Oregon's law is lifted, Oregon will use Medicaid dollars to pay 
for the costs associated with a physician assisting in suicide.
  I hope you agree with me and the vast majority of Americans who 
oppose using scarce Federal dollars to pay for assisted suicide. I 
invite you to join me, Senator Ashcroft and 15 of our colleagues in 
this effort by cosponsoring the Assisted Suicide Funding Restriction 
Act.
  I yield the floor.
  Mr. ASHCROFT addressed the Chair.
  The PRESIDING OFFICER. The Senator from Missouri is recognized.
  Mr. ASHCROFT. Mr. President, let me begin by commending my colleague 
form North Dakota for his excellent remarks, and his clear explanation 
of this important concept that I believe the American people would have 
us do. And, after all, we come to this body as servants of the people. 
The people are overwhelmingly aware of this issue, and the vast 
majority of American citizens do not believe that tax dollars should be 
used in the conduct of medicine in such a way as to take lives rather 
than to save them.
  I thank my colleague from North Dakota and those who have joined us 
in cosponsoring this particular measure.
  Mr. President, President Jefferson wrote in words that are now 
inscribed on the Jefferson Memorial that the ``care and protection of 
human life, and not its destruction'' are the only legitimate 
objectives of good government. Thomas Jefferson believed that our 
rights were God-given and that life was an inalienable right.
  In this spirit and understanding, I join today with Senator Dorgan in 
sponsoring the Assisted Suicide Funding Restriction Act. It is a modest 
and timely response to a challenge to our legal system and a challenge 
to the moral character of this country. What this bill says simply is 
that Federal tax dollars shall not be used to pay for and promote 
assisted suicide, or euthanasia.
  This bill is urgently needed to preserve the intent of the Founding 
Fathers and the integrity of Federal programs as they now exist and 
serve the elderly and seriously ill in America--programs which were 
intended to support life and to enhance human life, not to promote its 
destruction.
  Government's role in this culture should be to call us to our highest 
and best. I do not believe Government has a role in hastening Americans 
to their graves.
  Our court system is in the process now of litigating serious issues 
in this respect, and, as a result, we find ourselves with the need for 
this kind of clarifying legislation dramatized. This bill is intended 
to prevent the morally contemptible injustice of taking money from an 
American citizen and then using that money to kill another American 
citizen through assisted suicide.
  This is a bill which is very narrowly focused. It is clearly 
targeted. It only affects Federal funding for actions whose direct 
purpose is to cause or assist in causing suicide--actions that are 
clearly condemned as unethical by the American Medical Association and 
also illegal in the vast majority of our States. Again, this bill 
simply prohibits any Federal funding for medical actions that assist 
suicide.
  This bill is needed because, in March, the Ninth Circuit Court of 
Appeals contradicted the positions of 49 States, when it found a 
``Federal constitutional right'' to physician-assisted suicide in a 
case involving Washington State law. Similarly, the State of Oregon 
passed Measure 16, the first law in America to authorize the dispensing 
of drugs to terminally ill patients to assist in their suicide.
  Although a Federal court in Oregon struck down the law that Oregon 
had enacted, the case is being appealed to that same ninth circuit, 
which has already signaled that it believes in a right, a 
constitutional right, to assisted suicide.
  Oregon's Medicaid director and the chairman of Oregon's Health 
Services

[[Page S11177]]

Commission have both said that whenever the ninth circuit allows the 
Oregon law to go into effect, that the federally funded Medicaid 
Program in Oregon will begin paying for assisted suicide with Federal 
taxpayers' funds. According to Oregon's authorities, the procedure 
would be listed on Medicaid reimbursement forms under the grotesque 
euphemism of ``comfort care.''
  That is a rather startling, almost Orwellian label to put on assisted 
suicide. I would think if I were going over an insurance policy and 
someone said, ``Do you want to be covered for comfort care,'' I would 
say, ``Oh, yes, throw in the comfort care.'' But comfort care turns out 
to be a phrase that is destined to be used for assisted suicide, and I 
do not believe it is intended by this Congress or previous Congresses, 
or in the law of the United States, that tax dollars from Federal 
resources be used to support that kind of ``comfort care.''
  The problem is greatly magnified when we consider that Oregon will be 
drawing down Federal taxpayers' funds to help pay for such assisted 
suicides. Neither Medicaid nor Medicare nor any other Federal health 
program has explicit language to prohibit the use of Federal funds to 
dispense lethal drugs for suicide, primarily because nobody in the 
history of these programs felt that we would be appropriating money or 
creating a program to provide for suicide. We felt we were providing 
for individuals, developing therapeutic approaches to health problems, 
not providing for something that the American Medical Association would 
say was unethical and inappropriate, and which would shock the 
conscience of most Americans.
  When Oregon's ninth circuit reinstates measure 16, Federal funds will 
be used for comfort care, a.k.a.--also known as--assisted suicide. As a 
result, I think it is important for us to step up and to define and to 
place into law the kinds of restrictions which I think we felt were 
implied in all of our activities prior to this time. We would be 
derelict in our duty if we were now to ignore this problem and allow a 
few officials, either in a Federal circuit or in a specific State, to 
decide that the taxpayers of all other States and jurisdictions would 
have to help subsidize a practice which they have never authorized and 
that millions find to be morally abhorrent.
  It is crystal clear that the American people do not want their tax 
dollars spent on dispensing toxic drugs with the sole intent to assist 
suicide. Recently, a Wirthlin Poll showed 83 percent of the public 
opposed such use of Federal funds. Even the voters of Oregon, who 
narrowly approved Measure 16 by a vote of 51 to 49 percent, did not 
consider the question of public funding. Voters of two other west coast 
States, California and Washington, soundly defeated similar initiatives 
to legalize assisted suicide. Since November of 1994, when Oregon 
passed its law, 15 other States have considered and rejected bills to 
legalize assisted suicide. Of course, the Federal funding question has 
never been placed before the people in a ballot initiative.

  I would like to say a few words about the way this legislation is 
crafted. It is very carefully limited, and it is very modest. It does 
not in any way forbid a State to legalize assisted suicide. If a State 
like Oregon chooses to do so, the Federal Government does not choose to 
intrude under this bill, or even forbid the State to provide its own 
funds.
  If the State were to provide for assisted suicide and were to fund 
that with State dollars, in spite of the fact that is not my idea of 
good State government, it would be allowed under this bill. This bill 
simply would prevent Federal funds and Federal programs from being 
drawn into and providing support for and promoting assisted suicide. 
After the passage of this bill, States may choose to legalize or even 
fund assisted suicide. They simply could not choose to draw down 
Federal funds to promote or develop that program.
  The bill also does not attempt to resolve the constitutional issue 
that is on its way to the Supreme Court, that issue being whether there 
is a right to assisted suicide or euthanasia. Nor would this 
legislation be affected by what the Supreme Court might do when it 
decides that issue. Congress would still have the right to prevent 
Federal funding of such a practice, even if the Supreme Court found 
that there was a constitutional right to assisted suicide.
  It is also important to understand what this bill does not cover. As 
its rule of construction clearly provides, it does not affect abortion. 
It does not affect complex issues, such as the withholding or 
withdrawal of life-sustaining treatment, even of nutrition and 
hydration. Nor does this bill affect the disbursing of large doses of 
morphine or other pain killers to ease the pain of individuals with 
terminal illnesses, even though the administration of such drugs does, 
in some cases, carry the risk of hastening death as a side effect. The 
administration of pain killers is a long-acknowledged, legally accepted 
practice in all 50 States--and is ethically accepted by the medical 
profession and even pro-life and religious organizations as well.
  What we are dealing with here is the Federal funding of actions whose 
direct purpose is to cause or assist in causing the suicide of a 
patient.
  I am pleased that in spite of the fact the Democrats and Republicans 
may disagree on how to reform Federal programs like Medicaid and 
Medicare, there are things on which we do agree. One thing we should be 
able to agree on is the measure in this bill. Of course, our agreement 
is reflected in the cosponsorship of this measure by individuals on 
both sides of the aisle. These Federal programs should provide a means 
to care for and to protect our citizens, not become vehicles for the 
destruction of our citizens, especially as a result of Federal funding.
  I would like to close by quoting the hallmark of Jeffersonian 
principles embodied in the Declaration of Independence:

       We hold these truths to be self-evident, that all men are 
     created equal, that they are endowed by their Creator with 
     certain unalienable Rights, that among these are Life, 
     Liberty, and the pursuit of Happiness.

  I therefore urge all my colleagues to support this bill, an effort to 
uphold congressional responsibility, to defend the foremost of our 
unalienable rights, the right that citizens have to life.
                                 ______