[Congressional Record Volume 143, Number 45 (Wednesday, April 16, 1997)]
[Senate]
[Pages S3249-S3257]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ASSISTED SUICIDE FUNDING RESTRICTION ACT OF 1997
Mr. ASHCROFT addressed the Chair.
The PRESIDING OFFICER. The Senator from Missouri.
Mr. ASHCROFT. Mr. President, I ask unanimous consent that the Senate
now proceed to the consideration of H.R. 1003 relating to assisted
suicide.
The PRESIDING OFFICER. The clerk will report.
The assistant legislative clerk read as follows:
A bill (H.R. 1003) to clarify Federal law with respect to
restricting the use of Federal funds in support of assisted
suicide.
The PRESIDING OFFICER. Without objection, the Senate will proceed to
its immediate consideration.
Mr. ASHCROFT addressed the Chair.
The PRESIDING OFFICER. The Senator from Missouri.
Mr. ASHCROFT. Mr. President, rarely do we see a showing of bipartisan
agreement similar to the one we witnessed last Thursday when the House
of Representatives voted 398 to 16 to pass H.R. 1003, the Assisted
Suicide Funding Restriction Act. I look forward to the same showing of
bipartisanship today as the Senate considers identical legislation.
Except for a minimum of differences, H.R. 1003 is substantively the
same as S. 304, which Senators Dorgan, Nickles, and I introduced in
February; 33 Senators are now cosponsors of this bill, which simply
says and directs that Federal tax dollars shall not be used to pay for
or to promote assisted suicide.
This bill is urgently needed to preserve the intent of our Founding
Fathers. The integrity of our Federal programs serving the elderly and
seriously ill are at stake without this measure. These are programs
which were intended to support and enhance health and human life, not
to promote their destruction. Government's role in our culture should
be to call us to our highest and our best. Government has no place in
hastening Americans to their graves. However, our court system is on
the brink of allowing Federal taxpayer funding for assisted suicide.
On February 27, the Court of Appeals for the Ninth Circuit reinstated
Oregon's law known as Measure 16. It was the first law in America to
authorize the dispensation or the giving of lethal drugs to terminally
ill patients to assist in their suicide. Oregon's previous Medicaid
director and its Health Services Commission chair have both said
independently that once assisted suicide is legal--in other words, when
the legal obstacles have been cleared away--assisted suicide would be
covered by the State's Medicaid plan, which is paid for in part by
Federal taxpayers, individuals from all across America. According to
the Oregon authorities, the procedure will be listed on Medicaid
reimbursement forms under what I consider to be a misleading but
grotesque euphemism. The administration of lethal chemicals to end the
lives of individuals will be listed as comfort care.
Although the ninth circuit ruling is subject to further appeals,
Oregon may soon begin drawing down Federal taxpayer funds to pay for
assisted suicide unless we, the representatives of the people, take
action to pass the Assisted Suicide Funding Restriction Act.
Additionally, a Florida court recently found a right to assisted
suicide in the State's constitution on the right to privacy. If upheld
by the Florida State Supreme Court, this decision would raise the
question of State funding for assisted suicide. Such actions would
implicate Federal funding in matching programs, just as would the
situation in Oregon, programs such as Medicaid. And they would raise
questions about the permissibility of assisted suicide in federally
owned health care institutions in that State.
So action in Congress is needed at this time to preempt and
proactively prevent this imminent Federal funding of assisted suicide
which effectively may take place at any moment in the event that the
courts clear the way in regard to the situation in Oregon and in
Florida.
It is important to note that there was overwhelming approval for this
measure in the House of Representatives. As I stated earlier, the House
passed this measure by a resounding vote of 398 to 16. Shortly after
that vote, the White House issued a policy statement saying, ``The
President has made it clear that he does not support assisted suicides.
The Administration, therefore, does not oppose enactment of H.R. 1003,
which would reaffirm current Federal policy prohibiting the use
[[Page S3250]]
of Federal funds to pay for assisted suicides and euthanasia.'' In
light of these events, the Senate should act swiftly to pass this
legislation so that it will become the law of the land.
I would like to give the legislative history for the Assisted Suicide
Funding Restriction Act in order to respond to some people who might
say that the Senate is taking up this legislation too quickly.
The Assisted Suicide Funding Restriction Act is not new. It has
received more than adequate consideration. It was introduced in both
Houses in the last session of Congress. On April 29 of last year the
House held hearings. On February 12, 1997, the Senate introduced its
bill. On March 6, the House held hearings on the topic of ``Assisted
Suicide: Legal, Medical, Ethical and Social Issues.'' On March 11,
1997, the House introduced legislation. On March 13, the House Commerce
Committee Subcommittee on Health and Environment met in open markup
session and approved H.R. 1003 for full committee consideration. On
March 18 the bill was ordered favorably reported by the Ways and Means
Subcommittee to the full committee by a voice vote. Because he found
the legislation to be noncontroversial, Chairman Archer decided that a
markup in the full Ways and Means Committee was unnecessary, and he
turned out to be a prophet in suggesting its lack of controversy when
in fact on April 10 the House of Representatives passed the measure by
a vote of 398 to 16.
Of course, the House legislation is virtually identical to S. 304,
and the intention of the bill simply is to say that we do not think it
appropriate that funds which were gathered and taxed in order to
provide medical assistance to individuals to enhance their lives should
be used to end their lives.
It is important also, though, to take a look and clearly develop an
understanding of what this bill does not do. While it is clear that the
Assisted Suicide Funding Restriction Act prevents Federal funding and
Federal payment for or promotion of assisted suicide, it is also just
as important to understand there are things this bill is not designed
to do. This is a proposal that is very limited and very modest.
No. 1, it does not in any way forbid a State to legalize assisted
suicide or even to provide its own funds for assisted suicide. It
simply says Federal resources are not to be used to promote or conduct
assisted suicides. After passage of this bill, States might choose to
legalize or fund assisted suicide, but they would not be able to draw
on Federal resources normally drawn upon in joint efforts between the
State and the Federal Government for the provision of health services.
No. 2, this bill also does not attempt to resolve the constitutional
issue that the Supreme Court considered in January when it heard the
cases of Washington versus Glucksberg and Vacco versus Quill. Those
cases involved the question of whether there is a right to assisted
suicide or whether there is a right to euthanasia.
This bill does not try to answer that complex question. This bill
simply says the Federal Government should not be involved in funding or
paying for assisted suicides or paying for the promotion of assisted
suicide.
As the bill's rule of construction clearly provides as well, it does
not affect abortion. It is not designed to deal with the question of
abortion. Members of this body have a widely divergent set of views on
that important issue, as I do personally, but this bill is not designed
to affect that issue. It does not affect complex issues such as the
withholding or withdrawing life-sustaining treatment, even of nutrition
and hydration. Those issues are not affected by this measure.
Nor does this legislation affect the dispensation of large doses of
drugs that are designed to ease the pain of terminal illness. We know
that virtually all medical procedures have some risk of not achieving
the therapeutic impact desired but as a matter of fact may impair the
health of an individual. This bill is not designed for those situations
and instances. This bill is designed to prohibit Federal funding of the
administration of lethal doses of drugs and other methods used for the
purposes of assisting in suicide or for using Federal funding to
promote such assisted suicide.
It is with that in mind that we believe there should be a broad
bipartisan consensus which will support this bill and we hope will
carry it forward in a way similar to the way in which the House of
Representatives has so done. This legislation has wide support from the
public and important organizations as well and has wide support in the
Senate.
It is crystal clear to me and I think to most around us that the
American people do not want their tax dollars spent on dispensing toxic
drugs with the sole intent of assisting suicide. Recently, a national
Wirthlin poll showed that 87 percent of the public opposed such a use
of public funds. We would be derelict in our duty were we to allow a
few officials in one or two States to command the taxpayers of all the
other jurisdictions in America to subsidize the practice of assisted
suicide, especially when that practice is against the intention of the
individuals in those other States.
The Assisted Suicide Funding Restriction Act has been endorsed by
such groups as the American Medical Association and the National
Conference of Catholic Bishops, both of which have submitted letters of
support to the Congress.
I ask unanimous consent that these letters be printed in the Record.
There being no objection, the letters were ordered to be printed in
the Record, as follows:
American Medical Association,
Chicago, IL, April 15, 1997.
Hon. Trent Lott,
U.S. Senate, Washington, DC.
Dear Senator Lott: The American Medical Association (AMA)
is pleased to support H.R. 1003, the ``Assisted Suicide
Funding Restriction Act of 1997,'' as passed overwhelmingly
by the House of Representatives on April 10th, and the
companion bill, S. 304, sponsored by Senators Ashcroft and
Dorgan. We believe that the prohibition of federal funding
for any act that supports ``assisted suicide'' sends a strong
message from our elected officials that such acts are not to
be encouraged or condoned.
The power to assist in intentionally taking the life of a
patient is antithetical to the central mission of healing
that guides physicians. While some patients today regrettably
do not receive adequate treatment for pain or depression, the
proper response is an increased effort to educate both
physicians and their patients as to available palliative
measures and multidisciplinary interventions. The AMA's
Ethics Institute is currently designing just such a far-
reaching, comprehensive education effort in conjunction with
the Robert Wood Johnson Foundation (see attached materials).
The AMA is particularly pleased to note that H.R. 1003
acknowledges--in its ``Rules of Construction'' section--the
appropriate role for physicians and other caregivers in end-
of-life patient care. The Rules properly distinguish the
passive intervention of withholding or withdrawing medical
treatment or care (including nutrition and hydration) from
the active role of providing the direct means to kill
someone. Most important to the educational challenge cited
above is the Rule of Construction which recognizes the
medical principle of ``secondary effect,'' that is, the
provision of adequate palliative treatment, even though the
palliative agent may also foreseeably hasten death. This
provision assures patients and physicians alike that
legislation opposing assisted suicide will not chill
appropriate palliative and end-of-life care. Such a chilling
effect would, in fact, have the perverse result of increasing
patients' perceived desire for a ``quick way out.''
We are fully supportive of the amendment to H.R. 1003,
adopted by the House Commerce Committee, which would provide
for further opportunity to explore and educate physicians and
patients on avenues for delivering improved palliative and
end-of-life care. We caution, however, against any amendment
that may be offered during the bill's Senate consideration
which might have the effect of mandating specific medical
education curriculum in this area. The AMA has a long
standing policy against federal mandates being placed on
medical school education.
The AMA continues to stand by its ethical principle that
physician-assisted suicide is fundamentally incompatible with
the physician's role as healer, and that physicians must,
instead, aggressively respond to the needs of patients at the
end of life. We are pleased to support this carefully crafted
legislative effort, and offer our continuing assistance in
educating patients, physicians and elected officials alike as
to the alternatives available at the end of life.
Sincerely,
P. John Seward, MD.
____
National Conference of Catholic Bishops, Secretariat for
Pro-Life Activities,
Washington, DC, April 15, 1997.
Dear Senator: Having been approved 42-to-2 by the House
Commerce Committee and 398-to-16 by the full House of
Representatives, the Assisted Suicide Funding Restriction Act
(H.R. 1003) will soon be considered
[[Page S3251]]
on the Senate floor. I write to urge your support for this
important legislation.
While no federal funds are being used for assisted suicide
at present, federal programs generally lack a written policy
on the issue; those few programs which address it do so only
in program manuals or interpretive memoranda. Current efforts
to legalize assisted suicide by referendum (Oregon) or
interpretation of state constitutions (Florida) have raised
questions about the use of federal funds and health
facilities with a new intensity. In our view, this
fundamental issue deserves and demands clear policy guidance
from Congress.
This bill will prevent the use of federal funds and health
programs to support and facilitate assisted suicide, even if
the practice becomes legal in one or more states. It will not
prevent a state from legalizing assisted suicide or
supporting it with state funds. The bill also clearly states
that it will have no effect on distinct issues such as
abortion, withdrawal of medical treatment, or the use of
drugs needed to alleviate pain even when life may be
shortened as an unintended side-effect. Due to its clear and
limited scope, H.R. 1003 has received strong bipartisan
support and been endorsed by religious, medical and
disability rights leaders who may differ on other issues.
Section 12 of H.R. 1003 encourages the Department of Health
and Human Services to fund demonstration projects for
improved care for persons with disabilities and terminal
illness. This section also urges HHS to emphasize palliative
care in its programs and to study the adequacy of current
medical school curricula on pain management. Information
gathered through these modest efforts will, we hope, lead to
more extensive and carefully formulated improvements in care
for these vulnerable populations in the future.
No one should see H.R. 1003 as a complete response to the
inadequacies of our health system in its treatment of
disability and terminal illness. The bill's central goal is
both modest and urgently necessary: ensuring that the federal
government will play no part in legitimizing and
institutionalizing assisted suicide as a response to health
problems. As acting Solicitor General Walter Dellinger
recently said in opposing the idea of a ``right'' to assisted
suicide, ``the least costly treatment for any illness is
lethal medication.'' In a health care system too often driven
by cost pressures, Congress should say loud and clear that it
does not hold human life to be so cheap.
Sincerely,
Richard M. Doerflinger,
Associate Director for Policy Development.
Mr. ASHCROFT. Additionally, groups such as the National Right to
Life, the American Geriatrics Society, Family Research Council and
Physicians for Compassionate Care have endorsed this legislation, and
nearly one-third of the Senate has signed on as cosponsoring the
Assisted Suicide Funding Restriction Act, 33 Senators from both sides
of the aisle. I am confident that our vote later today will prove that
an even greater number of Senators will support and do support this
measure.
This is not just something which I feel should be prohibited because
most Americans are against it. I feel it is wrong for Kevorkian's house
calls to be paid for by Federal tax dollars. The next time Kevorkian
decides to end a life, we should not foot the bill. And unless we take
action, that can happen.
I feel it is wrong and would argue against allowing for assisted
suicide altogether. In cultures where the focus is on assisted suicide,
there is not much emphasis on how to ease pain or how to help people
confront those life-ending illnesses through hospice programs. There
are some dramatic differences among European countries that have
differing policies on assisted suicide. England, which prohibits
assisted suicide, has a substantial effort directed at helping people
in the terminal stages of disease, while the Netherlands, which allows
assisted suicide, has not made such efforts.
So public policy in this arena does make a difference, and it makes a
difference on moral grounds. Really, we are focused on very narrow
grounds in this particular instance. We are focused on the idea of
whether or not tax resources of the Federal Government should be used
to assist in suicide.
Obviously, there are practical reasons not to allow Federal funding
for assisted suicide. There are cases, many of them in the literature,
where there was an improper diagnosis, so that it appeared there was a
terminal disease but when someone's autopsy was conducted after an
assisted suicide, it was found it was not a terminal disease.
That is a mistake which is irreversible. I believe that for us to
fund assisted suicides is to be involved in an extremely risky
business; it is to deny the will of the people of the United States; it
is to engage in the ending of life rather than the enrichment of life,
which is what these medical programs were all about when they were
created and funded in the Congress.
I believe it is clear we should signal our intention, an intention
consistent with the President of the United States, who has basically
endorsed this measure after its passage by the House, consistent with
the American Medical Association and a wide variety of other groups
that indicate that Federal funding of assisted suicide would be
inappropriate.
Our Government's role should be to protect and preserve human life.
Federal health programs such as Medicare and Medicaid should provide a
means to care for and protect our citizens, not become vehicles for
their destruction. The Assisted Suicide Funding Restriction Act will
ensure that our policy in this area will continue.
Today, the Senate has an opportunity to act proactively, to take the
right steps in advance of these threats which are imminent but are not
quite upon us, the threat that these legal obstacles might be cleared
away and we would be called upon to participate in the funding of
assisted suicide under something as misleading and grotesque as the
concept of ``comfort care'' in the State of Oregon.
Today, the Senate has an opportunity to act responsibly before the
situation arises in which Federal health care dollars would be used to
end the lives of citizens of this country. I urge my colleagues to join
together to pass the Assisted Suicide Funding Restriction Act.
We should not hook up Dr. Kevorkian to the U.S. Treasury, especially
when he tries to sever the lifeline to individuals who are in distress.
The next time Dr. Kevorkian makes a house call, taxpayers should not
foot the bill. It is time for us to respond to what we know the
American people's desire to be. It is time for us to say we will not
allow the use of Federal funds to assist in suicide.
Mr. BOND. Mr. President, today, I rise in strong support of the
Assisted Suicide Funding Restriction Act, which would prevent Federal
funds and Federal programs from promoting and paying for the practice
of assisted suicide.
We must send a clear signal that Federal tax dollars should not be
used for a practice which is neither universally permitted nor
accepted, and one which is clearly immoral and unethical.
Many people may be wondering, ``Why do we need Federal legislation to
prohibit the use of Federal funds for such an abhorrent practice?'' Let
me take a few moments to lay out the reasons.
Both the Second Circuit Court of Appeals in New York and the Ninth
Circuit Court in San Francisco have struck down State laws that
criminalized assisted suicide in the States of New York and Washington
on the grounds that the laws violate the due process clause and the
equal protection clause of the U.S. Constitution.
In January of this year, the U.S. Supreme Court entered this
emotional debate by hearing oral arguments on the aforementioned cases.
A highly anticipated decision is expected within the next couple of
months.
The plaintiffs are contending they have a constitutional right to
physician assisted suicide. If these circuit court decisions are
upheld, then there would be a nationwide constitutional right to
assisted suicide, euthanasia, and mercy killing and the issue of
whether Federal funding, under Medicare, Medicaid, title XX, and other
programs, for such an action would immediately be at hand.
Moreover, Oregon has passed the Oregon Death with Dignity Act, which
makes it legal for physicians to prescribe lethal doses of drugs in
certain circumstances. Although a preliminary injunction blocking the
law's enactment has been granted, Oregon's Medicaid director and Health
Services Commission chair have both said that once assisted suicide is
legal, the State would begin subsidizing the practice under Oregon's
Medicaid plan.
The Health Care Financing Administration has said that killing
patients is not a proper form of treatment and therefore should not be
covered under
[[Page S3252]]
Medicare. I am, of course, pleased that we have those administrative
interpretations out there.
But there are others who are prepared to go to court to fight for a
different interpretation. A March 6 Reuters newswire story quotes
Hemlock Society spokeswoman Dori Zook as saying, ``Obviously, we feel
that Medicaid and Medicare should be used for assisting suicide.''
All it takes is for one district court judge to concur with that
belief. Federal law uses broad language in determining what Federal
programs will and will not pay for. For instance, Medicare pays for
services that are ``reasonable and necessary for the diagnosis and
treatment of illness or injury.'' If just one judge agrees with the
Hemlock Society and believes that assisted suicide is appropriate
medical treatment, then Federal tax dollars could fund assisted suicide
in a State where the practice is legal.
If the Supreme Court were to rule that there is a constitutional
right to assisted suicide, euthanasia advocates will certainly bring
suit for it to be considered just another medical treatment option that
must be eligible for funding under Medicare, Medicaid, and other
Federal programs.
We need this legislation to prevent this from happening.
And it is not too soon to do so. Far too often, Congress reacts to
problems. Today, however, we have an excellent opportunity to be pro-
active, not simply reactive. We do not want to wait until the money is
already flowing and then try to stop it. We want to stop it before it
even starts.
On a related note, it is imperative that we focus this debate on how
we, as a decent society, can support and comfort life instead of
promoting destructive practices such as euthanasia and assisted
suicide. We must work together to ensure the provision of compassionate
care for dying persons and their families. We must practice effective
pain management, encourage patient self-determination through the use
of advance directives, promote the utilization of hospice and home
care, and offer emotional and spiritual support when necessary.
Five Catholic health care systems and the Catholic Health Association
of the United States have set out to achieve these goals and have
formed Supportive Care of the Dying: A Coalition for Compassionate
Care. The coalition, including Carondelet Health System, Daughters of
Charity, Franciscan Health System, PeaceHealth, Providence Health
System, and CHA, is developing comprehensive delivery models, practice
guidelines, and educational programs--all with the goal of promoting
appropriate and compassionate care of persons with life-threatening
illnesses and their families.
These are the goals our Nation must strive for and support. We must
promote death with dignity and respect, and not death by the draconian
means of assisted suicide.
Let me close with a quotation from an eminent bioethicist at
Georgetown University who believes that assisted suicide, and therefore
the funding of assisted suicide, tears down the moral structure of our
society. He has written that rules against killing ``are not isolated
moral principles, but pieces of a web of rules that form a moral code.
The more threads one removes then the weaker the fabric becomes.''
And indeed, assisted suicide is a form of killing, and if we allow
for the federal funding of this horrific act, then we risk minimizing
the importance of life.
Mr. ENZI addressed the Chair.
The PRESIDING OFFICER. The Senator from Wyoming.
Mr. ENZI. Thank you, Mr. President. I appreciate and am impressed
with the thoroughness with which the two Senators from Missouri have
covered this particular issue, but I do have a few additional comments
I would like to add.
I do rise in support of the Assisted Suicide Restriction Act of 1997,
H.R. 1003. I am reminded of the story that I heard when I was very
young, and it had an impression which has carried over the years.
It is a story of a kid out playing, and he saw his father carrying
this large basket. He went over and asked his dad what it was all
about.
He said, ``Well, you know, your grandfather had not been very well,
not doing well at all, not able to contribute anymore. We sensed he
really did not enjoy life anymore. So he is in the basket, and I am
taking him down to the river.''
The little boy was not impacted much from that. The kid said, ``What
are you going to do with the basket when you are done?"
He said, ``Why are you so concerned about the basket?"
He said, ``Because some day I am going to need it for you.''
It is important that we as a Congress reaffirm our commitment to the
sanctity of human life in all its stages. This is one of the primary
duties of the U.S. Senate and as members of a civilized society. The
sanctity of human life was clearly articulated in our Nation's charter.
The Declaration of Independence counts the right to life as one of the
self-evident and unalienable rights with which we have all been endowed
by our Creator.
By safeguarding the right to life, our Government fulfills its most
fundamental duty to the American people. By violating that right to
life, we violate our sacred trust with our Nation's citizens and the
families of our country and the legacy that we will leave to those not
yet born.
The legislation now before us takes an important step in restoring
our Nation's commitment to the importance of the lives of all
Americans, especially those who suffer from serious illnesses. This
bill would prohibit the direct or indirect use of any Federal funds for
the purpose of causing the death of a human being by assisted suicide.
It would assure the American people that their hard-earned tax dollars
would not be used to fund a principle that they do not believe in--
suicide. It would also help Federal dollars to be provided in the form
of grants to public and private organizations to help people with
chronic or serious illnesses who may be considering suicide.
This legislation would not affect individual States' living will
statutes regarding the withholding or withdrawing of medical treatment
or medical care. It simply prohibits the Federal Government from
directly, or indirectly, funding assisted suicides. We, as a society,
must demonstrate our respect for the life of all Americans, especially
those who are sick and needy.
Mr. President, when I ran for office, I campaigned on the pledge that
I would fight for all life. I was elected on that pledge and sent to
Washington where I took an oath to uphold and defend the Constitution
of the United States. Physicians also take on the rigors of a campaign
to become doctors. Although they are not voted into office, they work
just as hard to fulfill their commitments and receive their degrees.
Upon graduation, all physicians are intimately familiar with the
Hippocratic Oath and its basic premise: First, do no harm. If I might
quote from that oath specifically, it says:
I will use treatment to help the sick according to my
ability and judgment, but I will never use it to injure or
wrong them. I will not give poison to anyone though asked to
do so, nor will I suggest such a plan.
Those powerful words reflect a great insight and wisdom into the
human condition. Though they were written so many years ago, they still
resonate today. I share them with my colleagues as I urge their support
for this legislation. It is our future, too.
I yield back the remainder of my time.
Mr. DORGAN addressed the Chair.
The PRESIDING OFFICER. The Senator from North Dakota.
Mr. DORGAN. Mr. President, I am pleased today to rise to join my
colleague from Missouri, Senator Ashcroft, in support of this
legislation. This piece of legislation was passed by our colleagues in
the U.S. House with overwhelming and bipartisan support last Thursday,
April 10. The Senate version of this legislation was introduced on
February 12 by Senator Ashcroft and myself, and we had 33 bipartisan
cosponsors for that version.
This is not the first time this bill has been introduced in the
Senate. Senator Ashcroft and I also introduced this legislation in the
last Congress, but that Congress was not able to take up this
legislation, so we reintroduced it earlier this year. I am pleased the
Senate is today considering this legislation as it has been passed by
the House of Representatives.
This legislation is very, very simple. It will ensure that Federal
tax dollars
[[Page S3253]]
are not used to pay for the costs associated with assisted suicides.
Mr. President, I do not know about all of the anguish, the torment and
difficulties that are faced by terminally ill individuals toward the
end of life who must make critical decisions. I recall before my
father's death sitting in the hospital one evening in North Dakota and
hearing the cries of pain suffered by someone in a room down the hall,
someone who mercifully died the next morning.
I thought that evening about some of these issues, and I do not know
what I or others might do in a similar circumstance. I am not here to
make judgments about those types of decisions. The decision about
whether assisted suicide is protected by the Constitution will be made
across the street by the Supreme Court. We do not attempt in this
legislation to address the question of whether someone has a right to
end one's life. This bill does not address that at all, and I do not
stand here today making judgments about it.
Rather, the decision we are faced with today in the Senate, about
whether Federal funding should pay for this practice, is a decision
that was really presented to us by an action one State has taken. The
State of Oregon has decided it will sanction and pay for physician-
assisted suicides through its Medicaid program, which is paid for with
matching Federal dollars. As a result of these decisions by the State
of Oregon, Federal health care dollars may soon be used to pay for
those physician-assisted suicides without Congress ever having made an
affirmative decision to allow that.
When Oregon's referendum to legalize assisted suicide passed by a
narrow margin, it was contested in the courts, and its implementation
has been held in abeyance since then. However, the Ninth Circuit Court
of Appeals dismissed the challenge to Oregon's law on a technicality in
late February. That decision is being challenged by opponents of
Oregon's law, but this action means that Federal funding for assisted
suicide in Oregon could soon be a reality.
What Senator Ashcroft and I and others are saying is that we do not
want Federal tax dollars, through the Medicaid Program or any other
program, to ever be used to help pay for physician-assisted suicides.
We do not believe that is what American taxpayers ever intended should
be done with their tax dollars that come to Washington, DC. Tax dollars
used for health care purposes ought to be used to enhance life, not end
life. So again, our legislation very simply says that we will prohibit
the use of Federal funding to assist in suicides.
I have told you what this legislation does. Now let me tell you what
it does not do. First of all, this legislation says that the ability of
terminally ill patients to decide to withhold or withdraw medical
treatment or nutrition or hydration is not limited for those who have
decided they do not want their life sustained by medical technology. In
other words, this legislation does not address this issue at all. The
withdrawal of medical treatment or services, which is already legal in
our country and which patients in conjunction with their families and
doctors decide they want to do, is not prohibited at all by our
legislation. Our legislation does not speak to this issue. Our
legislation speaks to the narrow, but important, issue of Federal
funding for physician-assisted suicides.
Our legislation also does not put limits on using Federal funding for
health care or services that are intended to alleviate a patient's pain
or discomfort, even if the use of this pain control ultimately hastens
the patient's death.
Finally, our legislation does not prohibit a State or other entity
from using its own dollars to assist a suicide. We are not saying what
a State may or may not do. We are only saying that a State may not use
Federal money to pay for assisted suicide. We have raised and
appropriated money at the Federal level to do certain things in our
Federal system. One of these important purposes is to help pay for
health care, and I am convinced that our constituents want this funding
to be used to extend life, not to end life. This legislation is
important because it reaffirms the principle that Federal health care
dollars should be used to improve and prolong life. This bill will
reaffirm that all people are equal and deserving of protection, no
matter how ill or disabled or elderly or depressed a person may be.
Some might say, ``Well, you have come to the Congress with a bill
that is premature, because there is not now Federal funding for
assisted suicide.'' That is correct for now but that situation may soon
change. The law already exists in one State that forms the basis for
requiring Federal funding of assisted suicides if Congress does not
act. Therefore, the Congress must intervene to say that is not our
intention that Federal money be used for that purpose. So this is not
premature at all.
Those who say, ``Federal funding of assisted suicide is not
happening, therefore, you need do nothing,'' do not understand that if
we do not act, we effectively allow the use of Federal funds for use in
assisted suicides. I think we speak for the vast majority of the
American people when we say that tax money should not be used to
facilitate assisted suicides.
Let me end where I began by saying that this is not legislation that
intends to make legal of moral judgments about assisted suicide. For
States and citizens around our country, this is a very difficult and
wrenching issue, and it has gotten a lot of press because of one doctor
who facilitates assisted suicides.
I expect behind all of those news reports are patients and families
who are faced with these very difficult decisions about pain they
believe cannot be controlled, life they think is not worth living. I
have seen too many circumstances in which I feel really unqualified to
pass judgment on the decisions of others. But I do stand here with a
great deal of certainty about what uses we ought to be sanctioning for
limited tax dollars. When we raise precious tax dollars to spend in
pursuit of public health care, I am convinced that the vast majority of
the American people do not believe those dollars ought to be spent in
the pursuit of assisted suicides. And that is what our legislation
reaffirms simply and plainly.
I am pleased to have worked with the Senator from Missouri, Senator
Ashcroft, who has done a substantial amount of work in this area. I
hope and expect we will enact our legislation here today in the Senate
and send this bill to the President. When we pass this bill later this
afternoon, we will have done something that is worthy and has great
merit.
Mr. ASHCROFT addressed the Chair.
The PRESIDING OFFICER (Mr. Gregg). The Senator from Missouri.
Mr. ASHCROFT. Likewise, I would like to extend my thanks and the
thanks, I believe, of the American people, to Senator Dorgan for taking
this important step and for having the foresight to do it in advance of
some commitment of the Treasury. We are perilously close to having
Federal funds used in this respect. A court decision stands between us
and that potential. But having the foresight to prepare in advance is
appropriate, and I thank him for his excellent work.
I am pleased to note that there are others who want to speak on this
issue. I look forward to hearing Senator Hutchinson's remarks.
I would just say that one of the reasons I am not eager to see
Federal funding provide the resource for assisted suicide is that in so
many cases that I have known, the diagnosis was missed. It seems to me
particularly tragic to think you would seek to fund a suicide on one
set of facts and to find out that it was not the case.
I am reminded of a case reported in the Washington Post--and I make
reference to it and will submit it for inclusion in the Record--from
July 29, 1996.
A twice-divorced, 39 year-old mother of two from California,
allegedly suffering from multiple sclerosis, checked into a Quality Inn
and received a lethal injection--becoming the most recent person to die
with Dr. Kevorkian's help. Though her death warranted little notice
nationwide, authorities at least had one major question.
According to the doctor who autopsied her body--``She doesn't have
any evidence of medical disease.'' The county medical examiner said in
an interview, ``I can show you every slice from her brain and spinal
cord,'' obviously, from the pathology reports, ``and she doesn't have a
bit of MS. She
[[Page S3254]]
looked robust, fairly healthy. Everything else is in order. Except
she's dead.''
From the Washington Times, Tuesday, October 1, 1996, another
individual, Richard Faw, who reportedly suffered from terminal colon
cancer.
The medical examiner wrote: ``There was some residual cancer in the
colon but none present in the kidney, lungs or liver. . .'' He went on
to say, ``He could have lived another 10 years, at least.''
It seems to me it would be particularly ironic to be forced to spend
resources that we have committed to protecting and preserving health if
we were to be committing those resources unduly and inappropriately
based on mistaken diagnoses to destroy individuals.
Mr. President, I ask unanimous consent that these two articles be
printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From The Washington Post, Monday, July 29, 1996]
Just How Sick was Rebecca Badger?; Jack Kevorkian Helped End Her Life,
and That's When the Questions Began
(By Richard Leiby)
There's no question that Rebecca Badger wanted to die. At
39, she was using a wheelchair, losing bowel and bladder
control, and enduring what she called ``excruciating'' pain.
Multiple sclerosis, her doctors said--a debilitating disease
that can be treated but not cured.
There's also no question that Badger suffered from episodes
of depression, as many MS patients do. In her misery, she
turned to the man she considered her only hope for release:
Jack Kevorkian, the retired pathologist widely known as ``Dr.
Death.''
On July 9, the twice-divorced mother of two from California
checked into a Quality Inn here and received a lethal
injection--becoming the most recent person to die with
Kevorkian's help, No. 33 for those keeping track.
Though her death warranted little notice nationwide, for
authorities here at least one major question persists: Was
Badger actually sick?
Not according to the doctor who autopsied her body. ``She
doesn't have any evidence of medical disease,'' L.J.
Dragovic, the county medical examiner, said in an interview
last week. ``I can show you every slice from her brain and
spinal cord, and she doesn't have a bit of MS. She looked
robust, fairly healthy. Everything else is in order. Except
she's dead.''
If Dragovic's findings are accurate, the Badger case
presents an intriguing medical mystery amid an ongoing debate
over how to ensure that people who choose euthanasia are
mentally competent and not hastening their deaths because of
depression.
Kevorkian's screening methods were examined in three
criminal trials involving five deaths, and he was acquitted
each time. Those cases included a 58-year-old woman with a
history of psychiatric problems who suffered from severe
pelvic pain for which doctors could find no physical
cause.
Multiple sclerosis, which afflicts an estimated 350,000
Americans, is a disease of the central nervous system that
tends to strike young adults. It is often difficult to
diagnose and sometimes cannot be confirmed until the patient
has died and the brain and spinal tissue can be examined.
Attorneys for Kevorkian would not make their client
available for comment. One of them called the medical
examiner ``a liar,'' insisting that ``hundreds'' of medical
records proved that Badger had an advanced case of multiple
sclerosis. Christy Nichols, Badger's 22-year-old daughter,
who held her mother's hand as she died, said: ``All I know is
that her pain was insurmountable. I would not want to inflict
that on anyone.''
``She was constantly hospitalized with constant and
crippling MS,'' said lawyer Geoffrey Fieger, who has
represented Kevorkian for six years. Fieger petitioned the
U.S. Supreme Court last week to end Michigan's ban on
Kevorkian's work. Today they will appear at the National
Press Club in Washington as part of their crusade to legalize
what Kevorkian calls ``medicide.''
That crusade has gathered increasing support since
Kevorkian's first assisted suicide six years ago. Earlier
this year, federal appeals courts struck down laws against
physician-assisted suicide in the states of Washington and
New York, ruling that mentally competent, terminally ill
adults have a constitutional right to assistance in ending
their lives.
Even proponents of euthanasia say the ambiguities of some
of the Kevorkian cases point to the need for tight
regulation. An Oregon law, approved by voters in 1994 but
blocked by a federal judge, forbids a doctor to write a
lethal prescription for a terminally ill patient if the
doctor suspects that the person suffers from depression.
``The Badger case is clearly worrying,'' said Derek
Humphry, founder of the pro-euthanasia Hemlock Society and
author of the million-selling book ``Final Exit.'' ``There
must be the most careful evaluation of such cases. We need a
sound, broad law which permits hastened death in justifiable
cases, and we need very thoughtful guidelines that the
medical profession can work with.''
Interviews with Badger's doctors and daughter leave several
questions unresolved: Most important, what was the cause of
her illness? Also, how severe were her psychological
problems? Were her California physicians properly consulted
by Kevorkian's advisers? And could Badger's suffering have
been solely the result of a psychiatric disorder--a
possibility not discounted by one of her doctors?
``Would a competent psychiatrist have been better than a
lethal injection? I understand the question--I've been asking
it myself,'' said Johanna Meyer-Mitchell, a family
practitioner in Concord, Calif., who treated Badger for
nearly 11 years. ``There never was any objective evidence as
to why she was in as much pain as she said she was in.''
Meyer-Mitchell said she was unaware that her patient was
seeking the services of Kevorkian when Badger recently
requested that her medical records be sent to two Michigan
doctors. ``If I had known this is what she was planning or
thinking of, I would have tried to intervene to get her
psychiatric help,'' Meyer-Mitchell said.
Badger didn't want to take antidepressants and was
displeased with the outcome of an earlier consultation she'd
had with a psychiatrist, according to Meyer-Mitchell. ``She
said, `They think this is all in my head.'''
Fieger released some of Badger's medical records to the
Washington Post, saying they would prove that Dragovic's
autopsy results were false. But the records--which included
case summaries from Badger's two primary physicians--and
interviews with other experts left open the possibility that
Badger did not have MS.
A case summary by Meyer-Mitchell states there was ``fairly
minimal'' evidence that Badger had the disease. Badger's
doctors said her brain scans were inconclusive, and spinal
fluid tests suggested MS but were not definitive. In such
cases doctors render a diagnosis of ``possible MS'' because
nothing else explains the patient's symptoms.
``She didn't have the nice, well-wrapped-up package of MS
symptoms that many other patients have,'' said neurologist
Michael Stein, of Walnut Creek, Calif. Stein said he made the
diagnosis of possible MS in 1988 and said his confidence
increased because of progressive symptoms that included limb
weakness--Badger limped and also used a walker--and bladder
and bowel dysfunction. By June 24, when he wrote a note to
accompany Badger's medical records, his diagnosis was
unqualified: ``She has multiple sclerosis.''
But in a interview Friday, Stein said he was never
absolutely sure. ``There was concern, and there was a
question about it. That an autopsy didn't find it, I'm
surprised, is all I can say.''
Stein also stated in the June 24 note that Badger never
suffered from depression ``to my knowledge.'' In an
interview, he said, ``I concerned myself with MS.'' But he
acknowledged that Badger followed the typical pattern of
what is called ``relapsing, remitting'' MS, during which
symptoms--and spells of depression--come and go.
Meyer-Mitchell's records explicitly state a diagnosis of
depression. And a May 20, 1996, record of Badger's visit to
Meyer-Mitchell's office shows that the patient herself
checked off ``depression,'' ``confusion'' and ``trouble
concentrating'' among her problems.
Badger also was ``a survivor of sexual abuse as a child,''
Meyer-Mitchell wrote, and had ``a history of chemical
dependency and alcoholism.''
On July 2, Stein said, he received a fax from Georges
Reding of Galesburg, Mich., who identified himself as a
``psychiatric consultant'' to Kevorkian and stated that
Badger was a candidate for physical-assisted suicide.
According to Stein, Reding inquired about putting Badger on
Demerol for pain control. Stein said he faxed back a note
saying that Reding should contact Meyer-Mitchell. Reding
never contacted her, Meyer-Mitchell said.
``The next thing I hear [on the radio eight days later] is
that she's an assisted suicide,'' recalled Stein. ``I said,
`What!?' * * * I presumed they would talk her out of it. I
was dead wrong.''
Reding, who in May signed a death certificate in another
Kevorkian-assisted suicide of an MS patient, did not respond
to a request for comment.
Since that May 6 suicide, Kevorkian has been advised by a
small group of doctors calling itself Physicians for Mercy.
The group, which since then apparently has been involved in
six assisted suicides, has developed guidelines that promise
a thorough review of a patient's medical records, a
consultation with a ``specialist dealing with the patient's
specific affliction'' and an evaluation by a psychiatrist
``in EVERY case.''
``If there is any doubt about it--the slightest doubt--the
patient will be turned down,'' said internist Mohamed El
Nachef of Flint, Mich., a member of the group. He added that
patients approved for doctor-assisted suicide ``are making
rational decisions. They are not depressed and they are not
lunatics, and their requests are very reasonable. You cannot
deny them their request to stop suffering.''
El Nachef would not comment on whether he medically
evaluated Badger or was present at her death but said, ``I
don't think there is any doubt about the extent of her
disability or about her diagnosis.''
[[Page S3255]]
a hard life
Badger's adult life, by several accounts, was one of
disappointment, recurring medical woes and financial worries.
Married at 17, divorced by 19, she raised two girls largely
on her own in Contra Costa County, east of Oakland. In 1985
she was diagnosed with cancer and rarely was able to work
after that.
Badger had a hysterectomy to remove the cancer and surgeons
later removed her ovaries. She was free of cancer, Meyer-
Mitchell said, but the MS symptoms and other maladies
persisted.
Doctors prescribed Badger morphine and Demerol for pain and
Valium for spasms. But according to Nichols, her elder
daughter, some physicians also believed her mother might have
been abusing drugs.
``She lost total faith in the system,'' Nichols said.
Badger's second marriage, in the early '90s, broke up after
only a year. Her symptoms worsened steadily after that, she
grew despondent, and by 1994 she mentioned to Nichols that
she might want to seek out Kevorkian. In January, Badger
moved south to live with her daughter near Santa Barbara.
Nichols said it's ``ridiculous'' for anyone to conclude
that her mother did not have a major physical disease. ``I
would literally have to drag her to the restroom. She would
have her arms wrapped around my neck--who wants a life like
that?
``She was sick. Do you think I would let my mother go [to
Michigan] and I would hold her hand while she was dying if it
wasn't true?''
Nichols and her mother flew to Detroit on July 8, a Monday.
About 8 the next morning, Kevorkian and three others joined
Badger and her daughter in a suburban hotel room.
Nichols said Kevorkian asked her not to discuss in detail
what happened that night, or identify any other participants.
But they included a psychiatrist who had talked with her
mother on the telephone ``numerous times'' in the past, she
said.
The psychiatrist's on-site assessment lasted about a half-
hour, Nichols said. The result?
``He told my mother she was more sane than he was.''
Badger signed forms and some of the proceedings were
videotaped, as is Kevorkian's custom. He often asked Badger,
``Are you sure this is what you want?'' and told her she
could ``stop the process at any time.'' Nichols recalled.
Badger's right arm had a dime-size bruise consistent with
an injection, autopsy photos show. In previous deaths,
Kevorkian has used a so-called ``suicide machine'' that
delivers a heart-stopping does of potassium chloride, and
also allows the patients to press the button that delivers
the poison.
Nichols doesn't recall her mother's exact last words. ``She
said she loved me, repeatedly.''
Kevorkian wheeled Badger's body into the emergency room at
Pontiac Osteopathic Hospital around 11:45 p.m. He was
accompanied by another doctor whose identity has not been
released.
Departing this life, Badger wore dark leggings and a loose
T-shirt advertising ``Time Warner Interactive.'' In the
coroner's snapshots, her brown hair was unkempt and her face
bereft of makeup.
the autopsy dispute
Dragovic, the medical examiner, said it was still unclear
what killed Badger. Her blood contained morphine and it was
``highly likely that potassium chloride was part of the
combination,'' he said. Police have filed no charges.
Fieger, Kevorkian's attorney, has often publicly criticized
Dragovic, whose office has performed autopsies in 26 of the
33 cases Kevorkian has been involved with since 1990.
Fieger once offered to wager $1 million that the
pathologist's findings were wrong in the autopsy of a woman
whose breast had been removed because of cancer. Dragovic
said his examination showed no invasion of the cancer to
vital organs, but Fieger insisted that her body was ravaged
by the disease.
``Dr. Dragovic is a liar,'' Fieger said last week about the
Badger case, again offering a bet: ``I will put up a million
dollars that Rebecca Badger had severe and crippling MS.''
``Could he double the stakes?'' Dragovic responded,
laughing. ``With $2 million, we could improve the building
here. She did not have MS, and that's the end of it.''
Two multiple sclerosis experts contacted by The Post
agreed that symptoms of severe MS are almost certain to
show up in a properly conducted autopsy.
``It's inconceivable to me that the autopsy wouldn't pick
it up. I would be very skeptical as to whether this woman had
MS,'' said Aaron Miller of Maimonides Medical Center in New
York, who chairs the professional education committee for the
National Multiple Sclerosis Society.
Miller said certain characteristics of Badger's cerebral-
spinal fluid, cited as evidence of MS in her medical records,
``don't make the diagnosis.'' Those signs could be indicative
of Lyme disease, syphilis or other inflammatory diseases, he
said. ``And it might be seen where the patient has no
clinical disease.''
``The very best confirmatory test for MS'' is the autopsy,
said Fred Lublin, a professor of neurology at Thomas
Jefferson University in Philadelphia. ``At death, that's how
one proves it.''
Kevorkian's ``patients'' have included six persons with MS
diagnoses. Spokesmen for the National Multiple Sclerosis
Society point out that the disease is not terminal and that
most patients do not develop cases that result in disabling
paralysis.
The group recently issued a statement on suicide that says
in part, ``Although we respect our clients' right to self-
determination, we as a Society affirm life.''
In an interview with a Santa Barbara television station two
days before she died, Badger made a different kind of
declaration. She cried out in agony and said, ``The pain that
I live with is excruciating.
``I know what the future holds,'' she added. ``I know
finally there is a man out there with a heart of gold who
will help me.'' Asked about Kevorkian's ``Dr. Death''
nickname, Badger said: ``I hate when he's called that. He's
just the opposite.''
Meyer-Mitchell, who knew Badger better than any other
doctor did, has no ready answers to the questions surrounding
her patient's death. She only wishes that the Michigan
doctors who received her June 24 letter had paid more
attention to the last line:
``I hope you are able to assist this unfortunate woman to
have a more comfortable life.''
____
[From the Washington Times, Oct. 1, 1996]
Terminal Illness Absent in Kevorkian Suicide
Pontiac, Mich.--A medical examiner said yesterday an
autopsy reveals a North Carolina psychiatrist who took his
life with Dr. Jack Kevorkian's help was not terminally ill.
Dr. Richard Faw, 71, who reportedly suffered from terminal
colon cancer, took his life Sunday, becoming Dr. Kevorkian's
41st known assisted suicide.
``There was some residual cancer in the colon but none
present in the Kidney, lungs or liver--none of the vital
organs,'' said Medical Examiner Ljubisa Dragovic. ``There
could be some cancer in the bone which could have caused
pain, but this man was not terminal. He could have lived
another 10 years, at least.''
Mr. ASHCROFT. I am pleased to note the presence of Senator Hutchinson
from Arkansas. I look forward to his remarks.
Mr. HUTCHINSON addressed the Chair.
The PRESIDING OFFICER. The Senator from Arkansas.
Mr. HUTCHINSON. Mr. President, I rise to express my strong support
for H.R. 1003. I want to commend the Senator from Missouri for his
outstanding leadership on this issue, his willingness to be proactive
about an issue that is very important to the future of our Nation, and
also the Senator from North Dakota for his support of this measure as
well.
H.R. 1003 will prohibit Federal funding and promotion of assisted
suicide and euthanasia. It is critically important that the Federal
Government not appear to sanction suicide as a form of medical
treatment in our varied Federal health care programs. Without this
bill, that would be the very message we could be sending as we would
potentially find ourselves funding and covering so-called mercy killing
with Federal tax dollars.
It should be mentioned that this bill passed overwhelmingly in the
House of Representatives by a vote of 398 to 16. It enjoys obvious
overwhelming bipartisan support. It involves only a prohibition of
funding and does not affect the legality of assisted suicide or
euthanasia. The bill simply says that the Federal Government will not
be a part of the practice of assisted suicide and will not force all
taxpayers to be a part of that practice.
The Clinton administration should also be able to support this bill.
When asked in the 1992 campaign about legislation to allow assisted
suicide, President Clinton said, ``I certainly would do what I could to
oppose it.''
On November 12, 1996, the Clinton administration filed a friend-of-
the-court brief with the Supreme Court in opposition to physician-
assisted suicide. In the brief for the administration, Solicitor
General Walter Dellinger wrote:
[T]here is an important and commonsense distinction between
withdrawing artificial supports so that a disease will
progress to its inevitable end, and providing chemicals to be
used to kill someone.
Given these statements, the President should be able to sign
legislation that has the very modest effect of simply not funding
assisted suicide.
I agree with the statement of Walter Dellinger, Solicitor General. A
patient may always decline or discontinue medical treatment even if
that may incidentally lead to the patient's death. But that is a far
cry from administering a lethal injection or providing lethal drugs to
that patient. The former is a longstanding and recognized medical
practice; the latter is medicalized
[[Page S3256]]
killing. The Federal Government must not make all taxpayers be involved
in such killing.
Some may object that neither suicide nor the attempt at suicide are
illegal. If people have a legal right to kill themselves, they
continue, then it makes no sense to deny them the help of a physician
in doing so, or to cut off the payment for doing that as this bill
does. That is the logic.
But it is incorrect to say that people have a right to kill
themselves simply because we do not throw them in jail if they attempt
to do so.
Think of the following. We have a first amendment right to protest
and denounce the policy choices of our elected officials in, say, a
public park. If a supporter of that politician tried to physically
restrain such speech, that person would be subject to criminal charges
of assault and battery.
On the other hand, suppose someone else tries physically to restrain
another from committing suicide. As the Minnesota Supreme Court said in
a 1975 case:
[T]here can be no doubt that a bona fide attempt to prevent
a suicide is not a crime in any jurisdiction, even where it
involves the detention, against her will, of the person
planning to kill herself.
In fact, if public authorities detect someone in the act of
attempting to commit suicide, they will typically not only interfere,
but also place the person in the custody of mental health authorities.
And posing a danger to oneself is a basis for involuntary commitment
for mental health treatment.
In short, it is not accurate to say that at present people have the
legal liberty to commit suicide because they can be, and frequently
are, legally restrained from doing so.
Others may suggest that this is only for suicide attempts by the
healthy. Everyone deplores the suicide of young, healthy people. But
they contend some suicides are rational, like those of terminally ill
patients.
Contrary to the assumptions of many in the public, a scientific study
of people with terminal illness published in the American Journal of
Psychiatry found that fewer than one in four with terminal illness
expressed a wish to die, and of those who did, every single one
suffered from a clinically diagnosable depression. We must remember
that it is the depression, not the terminal illness, that prompts a
desire to die or to commit suicide. And that depression is treatable in
the sick, the terminally ill, as well as in the healthy.
Psychologist Joseph Richman, former president of the American
Association of Suicidologists, the professional group for experts who
treat the suicidal, points out that ``[E]ffective psychotherapeutic
treatment is possible with the terminally ill, and only irrational
prejudices prevent the greater resort to such measures.''
Dr. David C. Clark, a suicidologist, observes that depressive
episodes in the seriously ill ``are not less responsive to medication''
than depression in others.
So the solution for those among the terminally ill who are suicidal
is to treat them for their depression, not pay to send them to Dr.
Kevorkian.
This bill sends us on the way to just that: not paying for patient
killing so that we can focus on real medical treatment for the patients
who need it.
So I am glad to urge my colleagues to join me in supporting H.R.
1003, and in so doing, to send a very important message to the people
of our Nation and to the culture of our country.
Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. SMITH of Oregon. Mr. President, I ask unanimous consent that the
order for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. SMITH of Oregon. I ask to be recognized for 5 minutes.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. SMITH of Oregon. I appreciate this opportunity to speak briefly
on this issue before the Senate. I begin by thanking my colleagues,
Senator Ashcroft and Senator Dorgan, and their staffs for their
leadership on this issue.
As yet, only one State, the State of Oregon, my State, has passed
legislation to allow assisted suicide. In 1994, Oregon voters approved
ballot measure 16, called the Death With Dignity Act, which exempts
from criminal and civil liability physicians who assist their patients
in committing suicide. Since its approval, a ruling in March by the
Ninth Circuit Court of Appeals has prevented the law from taking
effect, leaving the ultimate decision to the Supreme Court of the
United States.
However, I believe it is our responsibility to address this issue
before other States, including New York and Washington, have to face
the dilemma that now confronts Oregon. Oregon has taken the initiative
in meeting the health care needs of our most needy and vulnerable
citizens. Through the implementation of the Oregon health plan, I was a
legislator who helped to enact and to pass and to fund that act.
However, ballot measure 16 threatens the lives of those we have worked
so hard to help.
The Oregon health plan rations medicine in an honest way. What it
does is rank the procedures that promote and provide preventive
medicine. I am concerned, as an Oregonian, as an American, as a
taxpayer, that this system that has been enacted with the very best of
motives will provide a slippery slope that will make the right to die
into a duty to die. In a time when we have few health care dollars and
so many of those dollars are expended late in life, I fear the
financial incentive that is built into the system if soon the right to
die becomes, under financial extremis, a duty to die.
Now, lest you think that I am exaggerating in my fears, the Oregon
Medicaid director has recently publicly stated that once the legal
issues have been resolved, Oregon will begin subsidizing physician-
assisted suicide through the Oregon health plan. As one of Oregon's
Senators, I cannot, on ethical, moral and other grounds, allow this to
happen when I have the opportunity to prevent it.
H.R. 1300 and Senate 304 is legislation that is not an attempt to
circumvent the Supreme Court. Rather, this legislation is to determine
whether we should require the American taxpayer to pay for these
services through Medicare, Medicaid, the Federal Employees Health
Benefit Program, health care services provided to Federal prisoners
under the military health care system.
The potential legal practice of physician-assisted suicide sets a
standard for our entire Nation. We should, instead of subsidizing a
path to death, try to strengthen the quality of hospice and end of life
care. Let's offer support, not suicide, as the acceptable and
responsible, viable option.
Mr. President, my colleagues, it is with great concern and with a
heavy heart that I ask your support in passing this important and
timely legislation. Oregon is a beautiful State in which to live, to
visit, to raise a family. I ask today that you do not help Oregon
become a State where people now come to die.
As I have said to the people and press of Oregon, the only thing that
we should be killing around here is Federal funding for assisted
suicide. Mr. President, I thank my colleagues. I urge their support for
this legislation.
I yield the floor and the remainder of my time.
Mr. ASHCROFT. Mr. President, some people have asked me whether this
bill would create any new restrictions or limitations on such practices
as the withholding or withdrawing of medical care; the withholding or
withdrawing of nutrition or hydration, abortion, or the administration
of drugs or other services furnished to alleviate pain or discomfort,
even if the drugs or services increase the risk of death.
Mr. DORGAN. That is an important question, and one I want to clarify.
H.R. 1003 would not create any new restrictions in those areas.
In fact, section 3(b) of the bill explicitly states that none of
those practices or services would be affected by the bill. This means
that we do not create any new limitations, and none of the practices
and services you described would be prohibited or further restricted by
this bill. I also want to make clear that this bill would not place any
new restrictions on the provision of hospice care, which I strongly
support.
Mr. ASHCROFT. I have also been asked about whether the bill would
prohibit legal services lawyers or other
[[Page S3257]]
legal advocates receiving Federal funds from talking to their clients
about assisted suicide.
Mr. DORGAN. H.R. 1003 prohibits the use of Federal funds for legal or
other assistance for the purpose of causing an assisted suicide;
compelling any other person or institution from providing or funding
services to cause an assisted suicide, or advocating a legal right to
cause or assist in causing an assisted suicide.
However, the bill does not impose any kind of gag rule on legal
services or other attorneys receiving Federal funding to provide legal
services. An advocacy program could provide factual answers to a
client's questions about a State law on assisting suicide, since that
alone would not be providing assistance to facilitate an assisted
suicide. Similarly, the bill does not prohibit such programs from
counseling clients about alternatives to assisted suicide, such as pain
management, mental health care, and community-based services for people
with disabilities.
In addition, the bill is not intended to have the effect of defunding
an entire program, such as a legal services program or other legal or
advocacy program, simply because some State or privately funded portion
of that program may advocate for or file suit to compel funding of
services for assisted suicide. The bill is intended only to restrict
Federal Funds from being used for such activities.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. DORGAN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DORGAN. Mr. President, inasmuch as there are no Members wishing
to speak on the pending legislation, I ask unanimous consent to speak
for 5 minutes as if in morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.
____________________