[Congressional Record (Bound Edition), Volume 145 (1999), Part 18]
[Extensions of Remarks]
[Page 26717]
[From the U.S. Government Publishing Office, www.gpo.gov]



               SUPPORT FOR THE PAIN RELIEF PROMOTION ACT

                                 ______
                                 

                          HON. JAMES A. BARCIA

                              of michigan

                    in the house of representatives

                        Monday, October 25, 1999

  Mr. BARCIA. Mr. Speaker, my esteemed colleague from Oregon, Mr. 
Blumenauer, recently presented remarks on the floor to defend Oregon's 
assisted suicide policy and to criticize the proposed Pain Relief 
Promotion Act, H.R. 2260.
  First of all, I think it is important to clarify the fact that H.R. 
2260, the Pain Relief Promotion Act, does not limit states' ability to 
legislate assisted suicide. It simply clarifies that assisted suicide 
may not take place with federally controlled substances. This allows 
states to pass their own laws while clarifying the boundaries of 
federal involvement regarding assisted suicide. This bill also does not 
establish any new authority to penalize assisted suicide. My colleague 
has every right to speak in favor of the policy his constituents have 
chosen. But by the same token, representatives of the other 49 states 
that have chosen not to follow such a policy have a right to ask: Why 
should we be voiceless participants in Oregon's experiment with 
assisted suicide?
  Mr. Blumenauer has expressed grave concern over the provision in the 
bill that makes it illegal to intentionally prescribe federally 
controlled drugs with the intent to cause a patient's death. Under this 
provision, he says, law enforcement personnel will be judging, for the 
first time, whether a doctor's ``intent'' is to cause a patient's 
death. I would like to take the time right now to respond to this 
objection.
  Currently, the Drug Enforcement Administration (DEA) routinely makes 
these judgments. They have always had the right to revoke controlled 
substance permits based on abuse by health care workers. Whenever a 
prescription is written for a federally controlled substance, a DEA 
prescription is printed using a federal DEA registration number which 
is then attached to the actual bottle of pills. In this way, the DEA 
can keep record of and check whether or not federally controlled drugs 
are being used for ``legitimate medical purposes.'' There are numerous 
instances in which physicians have had their DEA registrations 
suspended or revoked because they used these drugs in ways that led to 
patients' deaths by drug overdose. Clearly then, the DEA has the 
authority, right and experience to do what it has always been doing--
monitor the use of federally controlled substances. Even more extensive 
federal involvement, though, has been prompted by Oregon's assisted 
suicide law. It is my colleague's own state legislature, in fact, that 
has escalated federal involvement by enacting a law that freely uses 
federally controlled substances for assisted suicides. In so doing, 
Oregon has practically demanded, perhaps unintentionally, that the 
federal government review and clarify its policy regarding what 
constitutes a ``legitimate medical purpose.'' The federal government 
obviously has a right to say how federally controlled substances can be 
used. And so it is the aim of H.R. 2260 to address this question by 
clarifying the federal government's policy on the use of federally 
controlled substances in relation to assisted suicides.
  Department of Justice policy currently forces the federal government 
to implicitly endorse assisted suicide by directing the DEA to allow 
federally controlled substances to be used in any manner which a 
state's assisted suicide law may prescribe. Every time a lethal 
overdose of barbiturates is prescribed to assist an Oregon citizen's 
suicide, the federal authority of the DEA is invoked to authorize the 
prescription. Since the Controlled Substances Act requires that such 
prescriptions be used for a ``legitimate medical purpose,'' the federal 
government implicitly endorses the use of federally controlled 
substances in each case of assisted suicide as a ``legitimate medical 
purpose'' under current Justice Department Policy. It is only 
appropriate then, that we clarify how federally controlled substances 
can be used instead of letting an individual state that is heroically 
experimenting with democracy dictate how these federally controlled 
substances will be used. After all, they are federally controlled 
substances and they require federal control.
  H.R. 2260 clarifies that assisted suicide will not be performed with 
the federal government's blessing. It also ensures that enforcement of 
the Controlled Substances Act will distinguish between intentional 
killing and the unintended hastening of death that may rarely occur as 
a side-effect of aggressive pain control. (This particular distinction, 
by the way, is found explicitly in almost all state laws against 
assisted suicide enacted in recent years; it was upheld as a reasonable 
and workable legal standard by the U.S. Supreme Court in its Vacco v. 
Quill decision two years ago.) Finally, H.R. 2260 provides the funds 
needed to begin to seriously advance our understanding of pain 
management.
  Beginning with the premise that aggressive pain control is to be 
encouraged as a legitimate part of modern medical practice, the 
legislation backs up this declaration through $5 million per year for 
the training of health professionals in palliative care, and for the 
education of law enforcement personnel so that they will be sensitive 
to the legitimate needs of modern pain management when they perform 
their necessary task of preventing misuse. Because this legislation 
sends such a clear and positive message about pain management to 
physicians and patients, it has been endorsed by organizations that 
both deal with pain issues on a regular basis and are in a position to 
judge the merits of the legislation. Among a notable list of supporters 
are the American Medical Association, the National Hospice 
Organization, the Hospice Association of America and the American 
Academy of Pain Management.
  In the end, the federal government, in concert with groups that 
understand and are active practitioners of pain management, must make a 
policy decision regarding the appropriate use of drugs that fall within 
its jurisdiction. Will they be used to kill pain or kill patients? I 
believe H.R. 2260 makes the right choice.

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