[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

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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.

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