[Congressional Record (Bound Edition), Volume 145 (1999), Part 19]
[House]
[Pages 27075-27104]
[From the U.S. Government Publishing Office, www.gpo.gov]



                   PAIN RELIEF PROMOTION ACT OF 1999

  The SPEAKER pro tempore (Mr. Hastings of Washington). Pursuant to 
House Resolution 339 and rule XVIII, the Chair declares the House in 
the Committee of the Whole House on the State of the Union for the 
consideration of the bill, H.R. 2260.

                              {time}  1149


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the State of the Union for the consideration of the bill 
(H.R. 2260) to amend the Controlled Substance Act to promote pain 
management and palliative care without permitting assisted suicide and 
euthanasia, and for other purposes, with Mr. Petri in the chair.
  The Clerk read the title of the bill.
  The CHAIRMAN. Pursuant to the rule, the bill is considered as having 
been read the first time.

[[Page 27076]]

  Under the rule, the gentleman from Oklahoma (Mr. Coburn), the 
gentleman from Michigan (Mr. Stupak), the gentleman from Florida (Mr. 
Canady), and the gentleman from Michigan (Mr. Conyers) each will 
control 15 minutes.


                         Parliamentary Inquiry

  Mr. DeFAZIO. Mr. Chairman, I have a parliamentary inquiry.
  The CHAIRMAN. The gentleman will state his inquiry.
  Mr. DeFAZIO. Mr. Chairman, is it not usual that the time is divided 
equally between proponents and opponents?
  The CHAIRMAN. The rule provided for the division of time that was 
just announced by the Chair.
  Mr. DeFAZIO. Mr. Chairman, it specified that three-quarters of the 
time would go to proponents and one-quarter, 15 minutes, would go to 
the opponents. Is that correct? Is that what the rule specified?
  The CHAIRMAN. No. The rule provided that the time would be divided 
among the chairmen and ranking minority members of the reporting 
committees.
  The Chair recognizes the gentleman from Oklahoma (Mr. Coburn).
  Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, we have heard a lot of debate already on the rule. We 
have heard a debate about the intent of our Forefathers. I would 
counter what the gentleman from Massachusetts (Mr. Frank) said during 
the debate on the rule that, in fact, that every law that we pass has a 
moral consequence; and that, in fact, if we read the writings of our 
Founders, they did not see that questions such as this would come up.
  The real thing that we are going to be debating is about life. As the 
freest Nation in the world, are we going to abandon the principle that 
life has value?
  I have come to recognize with all my own deficiencies, and especially 
how they have been exemplified my last 5 years in Congress, that we are 
all handicapped in one way or another. Some of us, we can see the 
external handicap. It is very plain and visible. Others, we hide our 
handicaps. But the fact is, all of us, handicapped as we are, have 
value, whether I agree with the philosophical point of view or not of 
that other individual, is that all of God's creation, all life has 
value.
  What we are really debating is whether or not the State of Oregon can 
ignore a law that is 28 years old and decide that, in this country, the 
freest country of the world, that they will allow other people to 
decide whether life has value.
  We are on a terrible slippery slope. The committee of which I am a 
member had testimonies about what has happened in Holland. In fact, 
when euthanasia and assisted suicide started in Holland, it was a very 
small number. It has grown progressively each year. But most 
importantly, because of the number of people who have been euthanized 
against their will, people now carry a card in Holland in their 
billfolds to say do not euthanize me.
  They have had to do that because they are worried that, if they get 
in a precarious life-threatening situation, somebody might make the 
decision about their life. Our country cannot go that direction. We 
must demand and stand for the fact that all life has value.
  Whether it is the unborn child just conceived, whether it is the 
child with multiple anomalies, it all has value. If it has no value, 
there is no real meaning to life in the beginning or in the end. I 
throw that off as a Member of this body, somebody who represents the 
great State of Oklahoma, who was brought up in a tradition that this is 
the freest country in the land, but it is only free if we preserve the 
principles of life.
  Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield myself 3 minutes.
  Mr. Chairman, first of all, I want everyone in the chamber to know 
that this bill requires that two doctors and a patient, who has the 
understanding to make the decision, would make this decision for the 
taking of his life, physician-assisted suicide. So the tragedies and 
scare stories about other countries has nothing to do with this.
  This legislation really represents a new hypocrisy by the majority 
who claim to support States' rights but would prevent the United States 
Attorney General from giving effect to State laws that allow physician-
assisted suicide. They do not say anything about that.
  The Supreme Court has said, quote, ``Americans are engaged in an 
earnest, profound debate about the morality, legality, and practicality 
of physician-assisted suicide. Our holding permits this debate to 
continue.''
  This bill prevents and excludes that debate by coming to a 
Washington-knows-best solution coming from those who claim to support 
States' right. I support States laws. Although Republicans who have 
often claimed that citizen initiative is the most revered form of 
democracy, repeatedly sponsor bills that treat them as a higher form of 
law than others, they bring a measure to the floor today that would 
overturn an Oregon initiative that has been approved twice by large 
margins.
  The 10th amendment, well, that is someone else's problem. It has 
reserved to the States those rights not given to the Federal 
Government. This is not a Federal issue. So, today, to consider a bill 
that has no grounding in interstate commerce or any other cause in the 
Constitution, in direct violation of the 10th amendment, compounded by 
the fact that they directly intend to override Oregon's law and would 
not give them a chance to make that exception in the Committee on 
Rules, this measure intrudes severely upon the essential relationship 
between a doctor and a patient.
  Moreover, numerous medical associations have already told us that 
this bill, ironically, will deter doctors from treating pain because 
they fear they may be subject to criminal prosecution at the Federal 
level if their patients die. So it is especially disturbing considering 
that doctors are already undermedicating approximately 80 percent of 
their terminally-ill patients because they believe the current drug 
laws are too strict.
  Let us not move in this direction. I commend to my colleagues the 
substitute of the gentleman from Massachusetts (Mr. Stupak) and the 
gentleman from New Jersey (Mr. Rothman), which will come up later.
  Mr. Chairman, I reserve the balance of my time.
  Mr. CANADY of Florida. Mr. Chairman, I yield 3 minutes to the 
gentleman from Florida (Mr. Weldon).
  Mr. WELDON of Florida. Mr. Chairman, I thank the gentleman from 
Florida for yielding me this time.
  I rise in support of this legislation. I come to this debate today, 
not only as a legislator, but as well as a physician. I practice 
internal medicine. About once a month, I see patients. For 15 years 
prior to coming to the Congress, I practiced internal medicine full 
time.
  One of the aspects of that for me was I had the opportunity to manage 
many patients with chronic pain and many patients, unfortunately, who 
were terminal who had, in many instances, metastatic cancer, with 
disease in their bones, and there was a lot of pain associated with 
their condition.
  One of the experiences I discovered was that, with time and attention 
from the attending physician, it is possible to manage these patients 
quite successfully so that there is not suffering. Indeed, one of the 
things that I discovered was that the patients who suffered with severe 
pain, whether they were terminal or whether they had severe pain from a 
chronic disease and they were not necessarily terminal, the patients 
who were suffering were the patients who were being managed 
incorrectly. Their physicians essentially were incompetent, and that is 
why they were suffering.
  That, in the hand of a competent physician, these patients can be 
managed correctly, and that their pain can be dealt with. Their nausea 
as a complication of their pain medicines can be dealt with. Indeed, 
even if they were severely depressed as a complication of their 
illness, one could manage them with medications. There is a whole 
plethora of drugs available.

[[Page 27077]]

  Now, the reason why some people believe that physician-assisted 
suicide is necessary is, in my opinion, the false assumption that there 
are these cases that we cannot manage and, therefore, we have to 
euthanize these people.

                              {time}  1200

  I argue today, before all my colleagues, that that is a very, very 
cruel and bogus hoax. In competent hands and in compassionate hands we 
do not have to resort to the extreme measure of managing a patient like 
we would Fido or Rover, and simply just put them to sleep; that we are 
essentially at the limits of what doctors can do.
  My colleagues, there are narcotic pain relieving drugs not only 
available in pill form, there are medications available in suppository 
form, there are medications available that are transcutaneous patches 
of narcotic pain relievers, there is even a lollipop that doctors can 
use that has a pain reliever in it. I have never seen a patient that 
could not have their pain managed. And the people who would resort to 
this are people who are lazy or perpetrating a hoax on their patients.
  Mr. STUPAK. Mr. Chairman, I yield 2 minutes to the gentlewoman from 
California (Mrs. Capps).
  Mrs. CAPPS. Mr. Chairman, I thank my colleague for yielding me this 
time, and I rise in opposition to H.R. 2260, the Pain Relief Promotion 
Act. This is a cynical title for a bill that is not about pain relief 
but about overturning State-assisted suicide laws.
  H.R. 2260 explicitly preempts State laws that govern the practice of 
medicine, even if the residents of those States have spoken on the 
issue. Understandably, this bill is opposed by the California Medical 
Association and other State medical associations.
  I strongly oppose physician-assisted suicide, but assisted suicide 
and pain management are very distinct things, and this bill blurs that 
distinction.
  Title I of this bill raises the prospect of the Drug Enforcement 
Agency, nonmedical people, second-guessing a physician or a health care 
professional's intent in prescribing large doses of controlled 
substances for patients who have very severe pain. The threat of 
investigation could scare health care professionals away from providing 
quality care to people who are living in desperate situations, living 
with uncontrolled pain. There are medical standards in place now, 
approved by the Joint Commissions Standards Committee.
  This bill is opposed by the American Nurses Association. Nurses are 
the health care professionals who are most often at the side of 
patients helping them to deal with their pain and to continue to live 
their lives. Nurses are ethically bound to oppose this legislation 
because it creates barriers to appropriate and compassionate patient 
care. By making effective pain and symptom relief more difficult to 
obtain, H.R. 2260 is likely to increase suicide as desperate patients 
seek relief from unbearable pain.
  In providing needed pain management, let us remember that we are not 
assisting patients to die, but helping them to live. I oppose H.R. 2260 
and urge support of the Johnson-Rothman-Maloney-Hooley substitute.
  Mr. COBURN. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from Iowa (Mr. Ganske).
  Mr. GANSKE. Mr. Chairman, I rise in support of the Hyde-Stupak bill.
  Sometimes on this floor Members actually have to read the 
legislation. We had a debate here a few weeks ago on managed care in 
which part of the biggest problem that we had was to get people to read 
the legislation. So let me read the pertinent point in here, and that 
is this. ``For purposes of this act and any regulations to implement 
this act, alleviating pain or discomfort in the usual course of 
professional practice is a legitimate medical purpose for the 
dispensing, distributing, or administering of a controlled substance 
that is consistent with public health and safety, even if the use of 
such a substance may increase the risk of death.''
  Those are important words that are in this bill. For various reasons, 
moral, religious, professional, ethical, I am against physician-
assisted suicide. I agree with my colleague from Oklahoma, I think this 
puts us on a very slippery slope, and testimony before the Commerce 
Committee from the Netherlands demonstrated that.
  I would also point out that the problem with pain can be handled. But 
that is not the most common reason why people request assisted suicide. 
It is not because they are having severe pain. Surveys have shown this. 
It is because they fear that they are losing control or they fear that 
they will be a burden. And I think that there are other ways we can 
approach that to help those people, but that we ought to pass the Hyde 
bill.
  Mr. ROTHMAN. Mr. Chairman, I yield myself 2 minutes.
  Mr. Chairman, a lot of people would like this debate to be about 
physician-assisted suicide because many of us are against physician-
assisted suicide. I am against physician-assisted suicide. That is not 
what this debate is about.
  This debate is about whether the underlying bill, 2260, will so 
intimidate doctors across America that they will not prescribe the pain 
medications to the children, men, and women who are begging for it. Not 
because they want to die but because they do not want to suffer agony. 
They want to live as long as they can, but not in pain.
  But my colleagues who want this bill want to make it a physician-
assisted bill. Why? Because they did not like the physician-assisted 
law in Oregon and, instead of going to the United States Supreme Court 
to get that referendum in Oregon declared unconstitutional, they have 
decided to use this route. The question is, is that so bad? Yes, it is 
bad, because by using this route and the controlled substances Federal 
law to go after the Oregon referendum that the people passed twice, 
they are affecting tens of millions of other Americans whose doctors 
will be inhibited and chilled from prescribing the pain medications 
that those tens of millions of children, men, and women are asking for.
  This is not a debate about physician-assisted suicide. If they wanted 
to get rid of the Oregon physician-assisted suicide bill, let them go 
to the Supreme Court and have it declared unconstitutional. Do not 
intrude in the doctor-patient relationship. There is already an 
untreatment of pain in America. Do not make it worse. It is not 
necessary.
  We are all against physician-assisted suicide. I urge my colleagues, 
those who are against physician-assisted but believe there needs to be 
more care for people in pain, more pain medication, then pass the 
substitute and reject the bill.
  Mr. Chairman, I reserve the balance of my time.
  Mr. CANADY of Florida. Mr. Chairman, I yield myself 2 minutes.
  I think it is very important that the Members of the House focus on 
what the language of this bill actually does, and I appreciated the 
gentleman from Iowa (Mr. Ganske) actually quoting the bill. Much is 
being said here today that has no relationship to what the bill 
actually says and what it would actually do.
  This bill is not going to do anything to intimidate doctors across 
America. That is what has been said here today. That is not the impact 
of this bill. This bill is actually going to provide additional 
protections for doctors across America. In the language of the bill we 
give a safe harbor for the appropriate use of controlled substances and 
palliative care. We are creating additional protection under the law 
for physicians who use controlled substances to control pain, even in 
circumstances where the hastening of the death of the patient may 
occur.
  We do draw the critical distinction, and we say that the deliberate 
taking of life is wrong. But if death is hastened as a consequence of 
providing appropriate palliative care, the physician will be protected. 
And that is a very important step forward in this legislation. That is 
why groups such as the American Medical Association support it.
  The focus of this bill is to help ensure that we consistently enforce 
the Controlled Substances Act. The issue before the House today, as we 
have said

[[Page 27078]]

repeatedly in this debate today, is whether we are going to have a 
consistent Federal policy that does not support assisted suicide or 
whether we are going to allow a Federal regulatory scheme to be used to 
support physician-assisted suicide. Are we going to allow physicians 
who are licensed under the Controlled Substances Act to dispense 
controlled substances, to use the pads, the prescription pads printed 
up by the DEA, to provide controlled substances to kill their patients? 
That is the issue before the House today.
  I do not think that is appropriate Federal policy. Let me quote to my 
colleagues what the President himself said upon signing the Assisted 
Suicide Funding Restriction Act. He said, ``The ban on funding will 
allow the Federal Government to speak with a clear voice in opposing 
these practices.'' We should do the same today.
  Mr. STUPAK. Mr. Chairman, I yield 3 minutes to the gentlewoman from 
Oregon (Ms. Hooley).
  Ms. HOOLEY of Oregon. Mr. Chairman, I rise today in support of 
the Johnson-Rothman-Maloney-Hooley substitute amendment to 2260, and in 
opposition to the underlying bill.
  Several months ago, I introduced 2188, the Conquering Pain Act, with 
the gentlewoman from Connecticut (Mrs. Johnson) to address the pain 
crisis, and we are having a pain crisis in this Nation. Most of the 
provisions are in this substitute. The Conquering Pain substitute 
addresses pain management from a medical perspective rather than law 
enforcement. It also expresses Congress' clear opposition to assisted 
suicide.
  Let me tell my colleagues what is in the substitute. First of all, 
patients, families, and doctors would have access to help 24 hours a 
day, 7 days a week. Our goal is to make sure that people, if they have 
a problem on Sunday, do not have to wait until Monday; that they do not 
have to be in pain. We want patients to know that they should expect to 
have their pain managed and to receive quality pain management. No one 
should have to live or die in pain because a doctor was afraid to give 
higher doses of pain medication.
  As introduced, the Conquering Pain Act also sought to identify any 
barrier in our regulatory pain system that prevents good access to pain 
management. We want the Surgeon General to provide us with a report on 
the state of pain in this country. We create an advisory committee to 
help us identify gaps in the Federal policy on pain management to force 
the different parts of government to speak to one another, to talk to 
each other, so we can create a coordinated agenda that builds on all of 
our actions of the Federal Government without wasting taxpayers' 
dollars.
  Under the Johnson substitute amendment, Congress again expresses its 
clear opposition to assisted suicide. Among the groups that sat down 
with us to help us write 2188, the Conquering Pain Act, from which this 
substitute is derived, and endorsed that bill, are the American Medical 
Association, the National Hospice Organization, American Society of 
Anesthesiologists, American College of Physicians, American 
Pharmaceutical Association.
  Among those who oppose the Hyde-Stupak bill and prefer the Conquering 
Pain substitute to the Pain Relief Promotion Act are the American 
Academy of Family Physicians, American Nurses Association, American 
Pharmaceutical Association, and the American Pain Foundation. And let 
me tell my colleagues one other group of people that is very important 
for us to understand. All of those associations that deal specifically 
with pain management and palliative care are opposed to the underlying 
bill and support this amendment.
  Ultimately, I hope we can agree that the amendment put forth by the 
gentlewoman from Connecticut (Mrs. Johnson), the gentleman from New 
Jersey (Mr. Rothman), the gentlewoman from New Jersey (Mrs. Roukema), 
the gentlewoman from New York (Mrs. Maloney) and myself should be 
approved because it will make a difference in people's lives every 
single day who are struggling with these life and death issues.
  By improving care rather than by more closely scrutinizing care, we 
can reduce patients' hopelessness at the end of life. For a medical 
solution rather than a law enforcement solution, vote for the 
substitute.
  Mr. ROTHMAN. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Chairman, I thank the gentleman from 
New Jersey for yielding me this time, and I rise to support the Scott-
DeFazio amendment, and the Johnson-Rothman-Maloney-Hooley amendment, 
and in opposition to the underlying bill.
  Mr. Chairman, I thank the gentleman from New Jersey (Mr. Rothman) for 
defining what this debate is all about. This debate is not about 
physician-assisted suicide, which all of us collectively, in many ways, 
have said that this body, this Congress, does not have the stomach for; 
in fact, the American people do not have the stomach for, or 
physicians.

                              {time}  1215

  But what this is about is to close the door of the patient's room to 
the physician before he goes or she goes in the door to serve that 
patient, and it is a jail-time-for-physicians bill in America. That is 
the name of this bill.
  It is interesting that just a few weeks ago we collectively came 
together in supporting the patients' bill of rights in reaffirming the 
relationship between patients and physicians. For once and for all, 
this Congress stood side by side with the healers of this Nation and 
said, we want them to engage with their patients.
  Now we come back just a few weeks later, and because we have some 
kind of angst and some kind of disagreement with the Oregon State law, 
which, in fact, in hearings as I have reviewed is a very good law with 
double checks, with second opinions, with the right to withdraw, with 
family members involved, with time frames there, a very strong bill; 
and yet we in the United States Congress have put ourselves in a God-
like position to, one, remove the rights of the people from Oregon but 
then, as well, tell physicians we lock them up and we do not want them 
to care for their patients.
  Pain is devastating, Mr. Chairman. Pain is devastating. The cancer 
victims have terrible pain. This is a bad bill. It should be defeated. 
We should support the amendment.
  Mr. Chairman, I rise in opposition to this bill because I am 
concerned about the negative impact it will have on patient care. This 
bill enables the Drug Enforcement Administration (DEA) to determine 
whether a prescription was intended to manage pain or to terminate a 
life. On its face, this bill may seen like an effort to improve pain 
management, but instead, this bill will compromise the ability of 
doctors to relieve patient pain.
  I understand concerns that pain management medication may be 
prescribed for assisted suicides or for euthanasia. Doctors may believe 
that by prescribing high doses of pain medication, they are easing the 
suffering of a patient close to death.
  For patients who have requested assistance in committing suicide, a 
physician may prescribe a lethal dose of pain medication as an act of 
humanity. In both cases, there is considerable debate about the ethics 
of preserving life in these instances.
  However, we already recognize certain rights of patients in 
determining end of life issues. Terminally ill patients sometimes 
decide to write living wills that alert medical personnel of their 
final wishes. People sign organ donor cards and families make life or 
death decisions concerning on-going treatment in chronically ill cases.
  In each of these situations, there is a balancing determination about 
the quality of life in terms of the wishes of the patient and the 
interests of society. Included in these decisions are the ethics of end 
of life pain management.
  There is precedent in federal law and state law concerning physician 
assisted suicide. In Washington v. Glucksberg (1997), the Supreme Court 
encouraged States to engage in this debate, ``about the morality, 
legality and practicality of physician assisted suicide.''
  The State of Oregon voted in 1994 through a ballot initiative to 
support physician assisted suicide under specific circumstances and by 
following specific guidelines.
  This bill is an attempt to address this issue by giving the DEA the 
authority to determine if pain management medication is prescribed in a 
manner that constitutes a ``legitimate

[[Page 27079]]

medical purpose.'' Its effect is to take the debate away from the 
states by regulation on the federal level.
  This is problematic because this bill may subject physicians to 
criminal prosecution when administering pain medication. Physicians who 
prescribe pain management drugs in large doses that ``may increase the 
risk of death'' would be in danger of losing their DEA license.
  I do not support this bill and I urge my colleagues to vote against 
it. The Supreme Court has already determined that the States have the 
right to legislate in this area, and I believe we should defer to that 
finding. The right of patients to request medication to manage pain, 
and the responsibility of doctors to manage the pain cannot be 
compromised.
  Mr. COBURN. Mr. Chairman, I yield 1 minute to the gentleman from 
Florida (Mr. Weldon).
  Mr. WELDON of Florida. Mr. Chairman, well, if we wanted to distill 
this down to the final issue, it is should one of the options be 
available to a doctor to go in and kill a patient if the patient has 
determined that their life is not worth living anymore. And if my 
colleagues think that is a very good law, then perhaps they should not 
support this bill.
  I think this is a cruel hoax. I think anybody who would hold out and 
say killing them is the best way to go is wrong. I can manage the 
patients. If they cannot handle them in Oregon, send them to me and I 
will retire from the House and take care of them in Florida. I mean, 
this is absurd to say we have to ultimately have the ability to just do 
that and say bye-bye.
  Mr. STUPAK. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, this bill merely reinforces current Federal policy that 
the administration, dispensation, or distribution of a controlled 
substance for the purpose of assisting a suicide is not authorized by 
the Federal Controlled Substance Act.
  We make clear that the Attorney General, in implementing the 
Controlled Substance Act, shall not recognize any law permitting 
assisted suicide or euthanasia.
  Now, this legislation has reflected many months of hard work to bring 
the hospice groups on board to support this legislation. And not only 
the National Hospice Organization. But the American Medical 
Association, the American Academy of Pain Management, American Society 
of Anesthesiologists, the American College of Osteopathic Family 
Physicians all support this legislation.
  Now, despite all the claims made on the floor by the opponents here, 
this bill really does three things. It promotes pain management and 
palliative care. It does not create any new Federal standard concerning 
the controlled substances under the Controlled Substance Act with 
respect to assisted suicide. We do not put forward any new standard. 
And it does override reliance on Oregon's Death With Dignity Act as a 
defense, we do not repeal it, but as a defense to any action pursuant 
to the Controlled Substance Act.
  If I may, one of those who supports this legislation, C. Everett Koop 
states, and I would like to quote from his statement to us, he says, 
``Clearly, controlled substances, such as narcotics, have very 
legitimate and important uses in modern medicine, not least in 
alleviating the suffering of dying patients. Just as clearly, 
Government has legitimate interests in ensuring that those substances 
are never intentionally used to take a human life. Physicians who are 
entrusted by the Federal Government with the privilege of using these 
potentially dangerous drugs in their practice should be the first to 
understand the need for laws ensuring their proper use. Their own 
ethical code instructs them always to use medications only to care, 
never to kill.''
  C. Everett Koop, in endorsing our legislation, goes on and states 
that this bill strikes the right balance by promoting the much-needed 
role of federally regulated drugs for pain relief while reaffirming 
that they should not be abused to assist patient suicide. A better 
understanding of the difference between trying to kill pain and trying 
to kill patients will be of great help to law enforcement authorities, 
to physicians, and especially to patients themselves.
  Now, if we take a look at our legislation that we have before us, 
H.R. 2266, there has been all these claims that law enforcement 
officials will be questioning the doctor's intent in using controlled 
substances for pain. That is not the case. That is not even close to 
what this bill purports to do.
  Using drugs to assist suicide is clearly different from using them to 
control pain. Causing a patient's death usually requires a sudden 
massive overdose of a potentially dangerous drug. Pain control involves 
the carefully adjusting dosage until it achieves relief of pain with a 
minimum amount of side effects for the patient. This gradual adjustment 
of the dosage is exactly what must be avoided if one's intent is to 
kill, because patients quickly build up a resistance to side effects, 
such as suppression of breathing.
  The intentional assistance in suicide is already contrary to State 
law and State licensing practices across this great Nation. This bill 
creates no new standard, no new law of the States. Even in the few 
States that do not clearly ban assisted suicide by criminal law, the 
practice is clearly contrary to medical and also to ethics and 
licensing standards. And if it is contrary to licensing standards, 
therefore, it is contrary to the Controlled Substance Act, which denies 
a license, a registration to anyone who has lost his or her own State 
license.
  So the point being that all this about we are going to put in new 
intent is simply not true.
  Now, let me just make a few comments if I may on the broader issue of 
federalism that we have heard a lot about. H.R. 2260 does not preempt 
Oregon's law legalizing assisted suicide. Its only legal effect is we 
forbid the use of narcotic drugs which are federally controlled for 
that purpose.
  On a broader issue of federalism, Oregon has the right to say that 
there will be no State penalties for certain conduct. But that does not 
mean that Oregon can prevent the Federal Government from restricting 
the use over federally controlled substances.
  Registration of a physician under the Controlled Substance Act is a 
matter entirely separate from a physician's State license to practice 
medicine. Therefore, the revocation of a registration only precludes a 
physician from dispensing controlled substances under the Controlled 
Substance Act. It does not preclude that physician from dispensing 
other prescription drugs or in his continued medical practice. And 
because the Federal Controlled Substance Act requires prescriptions to 
be for legitimate medical purpose to be valid by allowing this 
practice, the Federal Government is making a judgment that each and 
every one of those suicides was performed for legitimate medical 
purpose.
  So it is well within the power of the Federal Government to say that 
these Federal drugs are not being used for the purpose of killing 
people, notwithstanding State law.
  There is no reason why our tax dollars and our Federal law 
enforcement personnel must be drafted into assisting Oregon's dangerous 
experiment in assisted suicide.
  I hope that our colleagues will reject the arguments and vote for 
H.R. 2260. Let us end assisted suicide and let us relieve pain. I hope 
they vote yes.
  Mr. Chairman, I reserve the balance of my time.
  The CHAIRMAN pro tempore (Mr. Hastings of Washington). The Chair 
would advise Members that the gentleman from Oklahoma (Mr. Coburn) has 
9\1/2\ minutes remaining, the gentleman from New Jersey (Mr. Rothman) 
has 8\1/2\ minutes remaining, the gentleman from Ohio (Mr. Chabot) has 
10 minutes remaining, and the gentleman from Michigan (Mr. Stupak) has 
4 minutes remaining.
  Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, I would like to just go through and rhetorically ask 
some questions and answer them so we can really talk about what this 
bill does. Because we have heard everything except the essence, other 
than what the gentleman from Michigan (Mr. Stupak) just outlined, as 
the truth about what this bill does.

[[Page 27080]]

  Is it the intent of this bill to undermine States' ability to help 
patients access appropriate palliative care? No, it is not the intent 
whatsoever. Is it the intent of this bill to create a fear on the part 
of physicians so they will not do the proper thing when it comes to 
caring for end-of-life, pain-enduring patients? No, that is not the 
intent. And that is not the consequence, regardless of what has been 
said on the floor. What we actually do is define better so that we do 
not put physicians at risk and give them a safe harbor.
  Are we trying to go around guidelines for end-of-life issues in the 
State? No, we are not trying to do that at all. What we are trying to 
say is have whatever guidelines they want, but as far as the use of 
narcotics, we do not think that those narcotics ought to be used to 
intentionally take a life.
  Some have said we are going to allow the DEA agents to make a 
decision over what the intent was of the doctor. Well, that is simple. 
I am for that. I do not have any problem. Because do my colleagues know 
what? They make that decision about me right now. Whatever my intent 
is, whether I write a narcotic prescription to alleviate pain 
associated with a fracture or if I write morphine suppositories for a 
patient dying of metastatic cancer, they still get a look at it; and 
they are making a decision right now.
  And do my colleagues know what? All they want is to make sure that we 
are not violating the law. And every physician is trained in that.
  Now, what is the real question? The real question is will physicians 
in this country stand up and put their patients first? That is the real 
question, will they really go out and help their patient?
  As the gentleman from Florida (Mr. Weldon) so eloquently said, we can 
help patients. We do it all the time. The question is we have to be 
trained in it, we have to want to do it, and we have to make sure that 
the extenders of the physicians in this country will in fact carry out 
our order.
  There is no question, the American Medical Association said 2 years 
ago we have not done a good job in this country in training physicians 
in end-of-life pain control management. They have redoubled their 
efforts not only at the American Medical Association but in every 
medical school in this country.
  So what we have heard about the untoward events that will come out of 
this bill is poppycock; it is not based in fact. The fact is, if they 
are going to assume everybody is going to do everything wrong, they 
might be able to do that.
  Somehow we changed in this country. We used to assume that people 
would do things right, that they were honorable, that they had 
integrity. And then, as we start undermining the values and 
foundational principles of our country, we have to assume that 
everybody is going to do everything wrong.
  What this bill does is say, if their intent is right, they are safe-
harbored and they are protected.
  The fact is that every day good physicians are out there making great 
decisions about pain control for their patients. This bill will enhance 
their ability to do that, not take away from that.
  Mr. Chairman, I reserve the balance of my time.
  Mr. ROTHMAN. Mr. Chairman, I yield 3\1/2\ minutes to the gentleman 
from Washington (Mr. McDermott).
  Mr. McDERMOTT. Mr. Chairman, I think that we are passing the ultimate 
in Murphy's law today. Because a few weeks ago we got out here and 
talked about we wanted to have the doctor-patient relationship; and now 
we, the great medical board of medicine in the sky, are going to decide 
what goes on between patients and doctors.
  What happened in Oregon is really an attempt to deal with a very 
thorny public issue, and they tried to make explicit and say that that 
which all physicians know goes on ought to be done within the scope of 
the law so that there is no question about it.
  A patient has to ask, two physicians have to examine for competency. 
A patient can withdraw. The doctor has to register that he or she is 
going to administer medication for this purpose. We are not just 
talking about narcotics here. We are talking about a whole range of 
psychotropic drugs, everything covered by the DEA. And so now you are 
going to hand to the bureaucrats, and if I have heard one bureaucrat 
reviled on this floor, I have heard a thousand of them, so they are 
going to hand this to the Department of Justice and somebody in the 
Department of Justice is going to write the rules and regulations for 
this.

                              {time}  1230

  Now, that is where Murphy's law comes, because somebody over there is 
going to sit and say, well, if a doctor gives this number of pills 
within this period of time, that is assisting suicide and therefore we 
are going to swoop in and grab him. They will have to have some 
standard by which they grab them and take them to court and say you, 
doctor, were assisting in suicide.
  The doctor merely has to take the law out here and say, no, no, no, 
on page 5 it says here, the purpose of my care was to alleviate pain 
and other distressing symptoms and to enhance the quality of life, and 
they are wrong, right? But they are going to have to go through court 
to prove that that is what they were doing. They would have no defense. 
If they have 25 pills within 30 days, they will certainly wind up being 
dragged into court by somebody, maybe a family member, it may be 
somebody else saying, you were assisting my mother in suicide by giving 
her those pills.
  I am a psychiatrist. I have prescribed many, many, many times amounts 
of medication that people can use to kill themselves, if they took them 
all at once. You could say, well, doctor, what you have to do is let 
the patient have five pills, that is all they get. When they need five 
more, come in and get five more. I testified in a malpractice suit on 
which a physician had prescribed 100 Nembutal to somebody which were 
used for suicide. You are opening a box that you know nothing about, 
because it occurs in a room between a patient and a physician. And if 
you think you are smart enough to write a law that will control that 
situation, you simply do not know what physicians face and what 
patients face when they are faced with an overwhelming illness. For us 
to say that we know what should go on in the United States with all 
600,000 physicians and the 240 million patients in this country is 
absolute nonsense.
  The locals have worked on an issue here. I think they ought to be 
allowed to do that because they made it very explicit and made the 
doctors honest. You are going to make doctors dishonest with this law.
  Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume.
  I quote, and this testimony was also given before the constitutional 
subcommittee in the House. I want to give my colleagues the quote of a 
physician:
  ``What is the sense of having that woman here? It makes no difference 
whether she dies today or after 2 weeks. We need the bed for another 
case.''
  This is a recounting of a Catholic nun who did not want to be 
euthanized but was euthanized anyway in Holland because they needed the 
bed.
  Mr. Chairman, psychiatrists are in lawsuits every day in this country 
because they give antidepressants that have a lethal dose of 50 and 
they give too much medicine. One of the things you are taught in 
medical school is to not give too much medicine, enough medicine that 
someone could take their life. So we understand that issue and those 
arguments are fallacious. The fact remains that if we are going to 
encourage a doctor-patient relationship, I will encourage that all the 
way up to the point we decide that the doctor has the right to take the 
patient's life. That is no longer a relationship. That is not a 
relationship when I as a physician decide I am going to be the giver or 
taker of life for my patient. And if that is the foundational construct 
under how we are going to run doctor-patient relationships, we need to 
start completely over. Psychotropic drugs are controlled in this 
country and for good reason. That is called

[[Page 27081]]

mescaline, LSD. We use very few. We use antipsychotic drugs and we use 
narcotics and we use barbiturates. But most psychotropic drugs we do 
not even allow doctors to write a prescription for because they are 
significantly mind-altering drugs. The doctor-patient relationship does 
need to be preserved. This law does nothing to disturb a proper doctor-
patient relationship in Oregon. But as soon as a doctor has made the 
decision that they are the giver or taker of life, they no longer are a 
physician. They may be called doctor by our society but they no longer 
are a physician. They no longer have the ethical right to care for that 
patient.
  Mr. Chairman, I reserve the balance of my time.
  Mr. STUPAK. Mr. Chairman, I yield 2 minutes to the gentlewoman from 
New York (Mrs. Maloney).
  Mrs. MALONEY of New York. Mr. Chairman, I rise in support of the 
Johnson-Hooley-Roukema-Maloney-Rothman amendment and against the base 
bill. The first principle of the Hippocratic oath is to do no harm, yet 
the base bill before us does harm. The Pain Relief Promotion Act does 
little to relieve pain. Instead, it focuses on abolishing physician-
assisted suicide. It expands the authority of the Drug Enforcement 
Administration agents to judge the practices of well-meaning doctors. 
This means that even when death results from sincere efforts to provide 
appropriate pain relief, a doctor's intent can be questioned.
  Last night, I spoke with one of my constituents. Her name is Lisa 
Pearlman. She was just 22 years old when she developed fibromyalgia. 
This disease causes pain throughout the body. Lisa said there were days 
when she could barely function, there were times she could not even 
pick up her young child. She said she went to at least a dozen doctors 
before she found one who could manage her pain. Now for flare-ups she 
takes pain killers to manage the pain so she can take care of her two 
young children. But what if Lisa's doctor were too afraid of a criminal 
investigation to order the drugs that changed her life? Where would 
Lisa and so many patients be?
  The American Pain Foundation predicts that the base bill could 
actually increase the rate of suicide among the terminally ill because 
people who suffer from severe, chronic pain will no longer have an 
alternative. By intimidating doctors with pulled licenses and jail 
sentences, the base bill does more to threaten the lives of those who 
desperately want to live than those who do not want to live. It gives 
drug enforcement agents too much control over decisions that should be 
made by doctors and their patients.
  I ask my colleagues to consider the lives of people who depend on 
aggressive pain medication to live. It is not our place to come between 
a doctor and their patient in important decisions.
  I include for the Record the following letter from Memorial Sloan-
Kettering in support of the Johnson bipartisan bill. I urge my 
colleagues to support the Johnson bill.

       I am a neuro-oncologist and palliative care physician. On a 
     daily basis, I treat patients with cancer who have pain and 
     other symptoms in the course of their illness, including 
     patients who are dying. I am writing to urge you to oppose 
     H.R. 2260, The Pain Relief Promotion Act of 1999 (Hyde/
     Nichols). As a palliative care physician, I know that pain is 
     under-treated and that palliative care services are 
     underutilized.
       While H.R. 2260 is well intentioned, it is 
     counterproductive. It will likely have a chilling effect on 
     aggressive pain management. As the co-chairman of the Agency 
     for Health Care Policy and Research (AHCPR) expert panel on 
     cancer pain guidelines, I know that physicians often 
     prescribe inadequate amounts of pain medicines, and use less 
     potent pain medications because of fears of regulatory 
     scrutiny. I wish to make it clear that I am opposed to 
     physician-assisted suicide. Furthermore, I feel it is 
     profoundly unfair to provide an option for physician-assisted 
     suicide in circumstances where many patients do not have full 
     access to health care and quality pain management and 
     palliative care. However, in considering the issue of 
     physician-assisted suicide, Congress should not tamper with 
     the Controlled Substances Act and endanger patients in need 
     of aggressive pain and symptom management. I urge you to 
     support an amendment to strike Title 1 and thereby remove the 
     provisions that turn the Drug Enforcement Agency (DEA) into a 
     medical oversight body charged with investigating the 
     ``intent'' and ``purpose'' in a physician's care for a 
     patient.
       I also urge you to support a substitute amendment 
     incorporating the provisions of the Conquering Pain Act (H.R. 
     2188)--a bill that would constructively promote end-of-life 
     and palliative care--as long as the substitute amendment 
     includes elimination of the changes to the Controlled 
     Substances Act of Title 1 of H.R. 2260. Unless one of these 
     amendments is passed to remove the provisions that would 
     increase barriers to aggressive pain management, I strongly 
     urge you to vote against H.R. 2260 as reported by committee.
       Please do not increase the barriers for physicians to 
     provide the pain management, palliative and end-of-life care 
     that the American public needs.
           Sincerely,

                                        Richard Payne, MD,    

                                    Professor of Neurology and

                                                     Pharmacology,
                               Cornell University Medical College.

  Mr. ROTHMAN. Mr. Chairman, I yield 2 minutes to the gentlewoman from 
Connecticut (Mrs. Johnson).
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I would like to respond to 
my friend and colleague the gentleman from Iowa (Mr. Ganske) who said, 
read the legislation. Then he stopped reading the legislation at a very 
critical point. It is true that this bill allows administering 
controlled substances to alleviate pain even if they may increase the 
risk of death. The next sentence: Nothing in this section authorizes 
intentionally administering a controlled substance for the purpose of 
causing death, and later on in the definitional section, that causing 
death must be read as hastening death. So under this law, DEA agents 
will have to judge whether the intention of the physician was to 
alleviate pain, even at the risk of death, or whether the physician's 
intention was to hasten death. This is a judgment that is extremely 
difficult to make if you are a physician. It should not be made by 
nonmedical personnel, DEA agents.
  This is such a serious matter that Richard Payne, the Chief of Pain 
and Palliative Care Service, Department of Neurology, Cornell 
University, Memorial Sloan-Kettering Cancer Center says in a letter, 
``Physicians often prescribe inadequate amounts of pain medicines and 
use less potent pain medications because of fears of regulatory 
scrutiny.'' Then I have to skip some in the interest of time.
  He goes on to say, ``I urge you to support the amendment to strike 
title I,'' later he goes on to support my amendment, ``and thereby 
remove the provisions that turn the Drug Enforcement Agency into a 
medical oversight body charged with investigating the intent and 
purpose of a physician's care for a patient.''
  So if the gentleman from Oklahoma (Mr. Coburn) gets up here and says 
it is not my intent to discourage alleviation of pain, it does not 
matter what his intent is when the law says the government is now going 
to judge the physician's intention in providing care in situations in 
which there is extremely severe pain and high dosages involved.
  Mr. STUPAK. Mr. Chairman, I yield 1 minute to the gentleman from 
California (Mr. Waxman).
  Mr. WAXMAN. Mr. Chairman, I want to follow on to what our colleague 
from Connecticut had to say. This bill allegedly creates a safe harbor 
for those who administer pain medications to chronically and terminally 
ill patients. But I have heard from nurses, family physicians and 
pharmacists who say the bill will do more harm than good. They believe 
this legislation will chill their efforts to aggressively treat 
patients in pain. By raising doubts about the legality of their 
conduct, this bill will discourage them from easing the pain of AIDS 
and cancer patients across the country.
  I cannot support a bill that will at best further cloud an already 
uncertain legal environment in which doctors, nurses and pharmacists 
are trying to do what is best for their patients. This bill will make 
it harder for them to do their jobs and force them into guessing games 
over whether the DEA will turn a benevolent or a hostile eye towards 
their conduct.
  We should not gamble the quality of life of patients in pain upon who 
happens to be Attorney General. Until the bill's safe harbor is truly 
safe enough

[[Page 27082]]

for care givers, I unfortunately will oppose this legislation and 
support the amendments to it.
  This legislation was also created as a political attack on Oregon's 
Death with Dignity Act. It seeks to override the votes of Oregon 
residents, but it is patients in pain who will pay the price for this 
legislation.
  Finally, H.R. 2260 will put an end to widespread and thoughtful 
deliberation among the States about physician-assisted suicide. I do 
not think the Federal government should intrude in these important 
debates. We should allow states like Oregon to reach decisions which 
reflect the fundamental beliefs of their residents.
  I submit the following material for the Record:

                       Suicide Bill's Deep Flaws

       The House of Representatives plans to vote today on the 
     most wrenching issue before it: a bill by Rep. Henry J. Hyde 
     (R-Ill.) that is intended to effectively nullify a law in 
     Oregon that allows terminally ill patients to request drugs 
     to end their lives. However, the bill would reach far beyond 
     the Oregon law. Medical societies say it will lead many 
     doctors to under-medicate terminal patients to avoid scrutiny 
     from federal drug agents. For this reason the bill is 
     unacceptable.
       Hyde wrote the bill out of rightful concern that the Oregon 
     law, which voters passed in 1994, could lead government down 
     a slippery slope toward sanctioning the state or federal 
     legalization of physician-assisted suicide.
       Hyde's bill, however, is by no means the best way to 
     supervise and discipline doctors who stray from their proper 
     role as healers.
       The bill has gained broad support in the House largely 
     because of misleading arguments being made by its proponents. 
     Hyde titles his bill. ``The Pain Relief Promotion Act'' and 
     the author of its Senate counterpart, Sen. Don Nickles (R-
     Oklahoma), insists that ``there's no going after doctors in 
     this.''
       In fact, Hyde's legislation imposes civil penalties and a 
     20-year mandatory prison sentence on doctors who knowingly 
     hasten a terminally ill patient's death. The California 
     Medical Assn., along with physician groups representing a 
     dozen other states, persuasively argue that the harsh 
     sanctions would lead doctors to under-medicate patients to 
     avoid prosecution--thus inhibiting the effective pain 
     management the bill purports to promote.
       Some Hyde staffers have said they would consider reducing 
     the bill's penalties if that would persuade President Clinton 
     to sign it. But even if the sanctions were reduced, the bill 
     remains marred by its requirement that the Drug Enforcement 
     Administration define legitimate medical uses of pain 
     medications, then regulate and enforce those subjective 
     determinations. The DEA, basically a policing agency, by its 
     own admission has neither the expertise nor the resources to 
     play doctor.
       The best way to prevent medical abuses that drift toward 
     euthanasia is through vigilance by state medical authorities 
     and legislators, not by passing a federal bill with a 
     misleading title and unenforceable aims.
                                  ____



                                     American Pain Foundation,

                                                    Baltimore, MD.

Opposition to ``Pain Relief Promotion Act'' (H.R. 2260) as Reported by 
                               Committees

       H.R. 2260 is well-intended and an improvement over last 
     year's bill, but it is seriously flawed. Please vote against 
     H.R. 2260 in its present form.
       Many doctors and other health care practitioners think H.R. 
     2260 will have a chilling effect on pain management. Others 
     disagree. It's not worth Congress' taking the risk that 
     people in pain will suffer more under H.R. 2260.
       Current law and Drug Enforcement Administration (DEA) 
     regulations protect doctors who aggressively treat pain with 
     morphine and other oploids. Doctors don't need a new law, 
     they need better implementation of existing law.
       DEA will investigate physicians' subjective ``intent'' in 
     palliative care with the threat of criminal penalties. 
     Practitioners will incur costs and burden of justifying their 
     medical care to federal authorities. Result: undertreatment 
     of pain.
       Assisted suicide should be dealt with in a separate law, 
     not linked to the medical practice of pain management.
       Correct H.R. 2260 with floor amendments:
       Strike Title I to remove provisions that turn the DEA into 
     a medical oversight body investigating ``intent'' and 
     ``purpose'' in a physician's care for a patient.
       Substitute the provisions of the Conquering Pain Act--an 
     effective approach to stopping suicides, assisted and 
     otherwise, by relieving unnecessary pain.
       Many patients, physicians, nurses, pharmacists and cancer 
     specialists oppose H.R. 2260:
       Patient and Health Care Groups Opposed (partial list): 
     American Academy of Family Physicians, American Alliance of 
     Cancer Pain Initiatives, American Nurses Association, 
     American Pain Foundation, American Pharmaceutical 
     Association, American Society for Action on Pain, American 
     Society of Health-System Pharmacists, American Society of 
     Pain Management Nurses, Hospice and Palliative Nurses 
     Association, National Association of Orthopaedic Nurses, 
     National Foundation for the Treatment of Pain, Oncology 
     Nursing Society, and Society of Critical Care Medicine.
       State Medical Societies Already Opposed or Having Serious 
     Reservations (10/19/99): Arizona Medical Association, 
     Arkansas Medical Society, California Medical Association, 
     Louisiana State Medical Society, Massachusetts Medical 
     Society, Oregon Medical Association, Rhode Island Medical 
     Society, Texas Medical Association, Vermont Medical Society, 
     Washington State Medical Association, and State Medical 
     Society of Wisconsin.
                                  ____

                                            Department of Justice,


                                Office of Legislative Affairs,

                                 Washington, DC, October 19, 1999.
     Hon. John D. Dingell,
     Ranking Minority Member, Committee on Commerce, House of 
         Representatives, Washington, DC.
       Dear Congressman Dingell: This letter presents the views of 
     the Department of Justice on H.R. 2260, the ``Pain Relief 
     Promotion Act of 1999.''
       H.R. 2260 makes two changes to federal drug law as it 
     relates to the use of controlled substances by terminally ill 
     patients. First, the bill clarifies that controlled 
     substances may be used to alleviate pain in the course of 
     providing palliative care to terminally ill patients. The 
     bill also funds research and education on the appropriate use 
     of controlled substances for this purpose. The Department 
     strongly supports these provisions of H.R. 2260.
       Second, H.R. 2260 states that the use of controlled 
     substances to assist a terminally ill person in committing 
     suicide is not authorized by federal law. The Department 
     opposes physician-assisted suicide, but is concerned about 
     the propriety of a federal law that would unquestionably make 
     physician-assisted suicide a federal crime with harsh 
     mandatory penalties. Imposing such penalties would also 
     effectively block State policy making on this issue at a time 
     when, as the Supreme Court recently noted in Washington v. 
     Glucksberg, 117 S. Ct. 2258, 2275 (1997), the States are 
     still ``engaged in an earnest and profound debate about the 
     morality, legality, and practicality of physician-assisted 
     suicide.''


                            palliative care

       Section 101 of H.R. 2260 amends section 303 of the 
     Controlled Substances Act (``CSA''), 21 U.S.C. Sec. 823, to 
     specify that the use of controlled substances to 
     ``alleviat[e] pain or discomfort in the usual course of 
     professional practice'' is a ``legitimate medical purpose'' 
     under the CSA, 21 U.S.C. Sec. 841, ``even if the use of such 
     a substance may increase the risk of death.'' Because a 
     physician who acts with a ``legitimate medical purpose'' is 
     acting in compliance with the Act,\1\ H.R. 2260 creates a 
     ``safe harbor'' against administrative and criminal sanctions 
     when controlled substances are used for palliative care. 
     Sections 102, 201 and 202 amend the CSA and the Public Health 
     Service Act (42 U.S.C. Sec. 299) to authorize the Attorney 
     General, the Administrator of the Agency for Health Care 
     Policy and Research, and the Secretary of the Health and 
     Human Services Department to conduct research on palliative 
     care, to collect and distribute guidelines for the 
     administration of palliative care, and to award grants, 
     cooperative agreements, and contracts to health schools and 
     other institutions to provide education and training on 
     palliative care.
---------------------------------------------------------------------------
     Footnotes at end of letter.
---------------------------------------------------------------------------
       The Department fully supports these measures. H.R. 2260 
     would eliminate any ambiguity about the legality of using 
     controlled substances to alleviate the pain and suffering of 
     the terminally ill by reducing any perceived threat of 
     administrative and criminal sanctions in this context. The 
     Department accordingly supports those portions of H.R. 2260 
     addressing palliative care.


                       physician assisted suicide

       H.R. 2260 would amend section 303 (21 U.S.C. Sec. 823) of 
     the CSA to provide that ``[n]othing in this section 
     authorizes intentionally dispensing, distributing, or 
     administering a controlled substance for the purpose of 
     causing death or assisting another person in causing death.'' 
     By denying authorization under the CSA, H.R. 2260 would make 
     it a federal crime for a physician to dispense a controlled 
     substance to aid a suicide.\2\ A physician who prescribes the 
     controlled substances most commonly used to aid a suicide 
     would, because he or she necessarily intends death to result, 
     face a 20-year mandatory minimum sentence in federal prison 
     (as well as civil and administrative sanctions under the 
     Act).\3\
       The Administration strongly opposes the practice of 
     physician-assisted suicide and would not support the practice 
     as a matter of federal policy. H.R. 2260 side-steps the 
     federal policy question, however, and operates instead by 
     blocking State policy making on an issue that many, including 
     the Supreme Court, think is appropriately left to the States 
     to decide as each chooses.\4\
       Moreover, H.R. 2260 would affirmatively interferes with 
     State policy making in a particularly heavy handed way by 
     using 20-year

[[Page 27083]]

     mandatory prison sentences (as well as civil and 
     administrative sanctions) to effectively preclude States from 
     adopting any policy that would authorize physician-assisted 
     suicide, even if that authorization contains carefully 
     drafted provisions designed to protect the terminally ill.
       For these reasons, H.R. 2260 is particularly intrusive to 
     State policy making, and the Department accordingly opposes 
     this portion of the bill.\5\ The Department would, however, 
     be willing to work with you in formulating a legislative or 
     regulatory solution that obviates the concerns identified in 
     this letter.\6\
       Thank you for this opportunity to present our views. The 
     Office of Management and Budget has advised that there is no 
     objection from the standpoint of the Administration's program 
     to the presentation of this letter. Please do not hesitate to 
     call upon us if we may be of further assistance in connection 
     with this or any other matter.
           Sincerely,
                                                     Robert Raben,
                                       Assistant Attorney General.

                               Footnotes

     \1\ See e.g. 21 C.F.R. Sec. 1306.04(a) (authorizing 
     prescriptions only for ``legitimate medical purposes'').
     \2\ The criminal provisions of the CSA are triggered by the 
     absence of proper authorization. See 21 U.S.C. Sec. 841(a) 
     (``Except as authorized by this subchapter, it shall be 
     unlawful . . .'') (emphasis added).
     \3\ See 21 U.S.C. Sec. 841(b)(1)(C) (setting 20 year 
     mandatory minimum sentence when death results from the 
     distribution of a Schedule II substance); 21 C.F.R. 
     Sec. 1308.12(a)-(c) (defining Schedule II substances). 
     Schedule III drugs, which are sometimes used, do not carry 
     any mandatory minimum sentence. See 21 U.S.C. 
     Sec. 841(b)(1)(D).
     \4\ Glucksburg, 117 S. Ct. 2258, 2274 (noting that debate 
     over physician-assisted suicide is underway in the States, 
     ``as it should in a democratic society''); id at 2303 
     (O'Connor, I., concurring) (endorsing majority's result, 
     which left ``the . . . challenging task of drafting 
     appropriate procedures for safeguarding . . . liberty 
     interests . . . to the `laboratory' of the States''); id. at 
     2293 (Souter, I., concurring) (emphasizing that, in light of 
     current state experimentation, ``[t]he Court should stay its 
     hand to allow reasonable legislative consideration [of this 
     difficult issue]'').
     \5\ This approach to physician-assisted suicide is consistent 
     with the Department's approach to ``medical marijuana.'' The 
     legality of the latter turns on factual, not ethical, 
     questions. That is, the scheduling of controlled substances 
     is based on scientific testing to determine, among other 
     things, whether they have any ``currently accepted medical 
     use for treatment in the United States,'' a ``high potential 
     for abuse,'' and ``a lack of accepted safety for use . . . 
     under medical supervision.'' 21 U.S.C. Sec. 812(b)(1) and 
     Schedule I(c)(10). As a result, the CSA appropriately creates 
     a uniform national system of drug scheduling. Where an issue 
     turns solely on ethics, not science, it is reasonable to 
     allow individual states to reach their own conclusions, 
     rather than impose a uniform national standard through 
     implied preemption of state medical standards.
     \6\ Any solution should also be careful not to make state-
     authorized assisted suicides more painful, as H.R. 2260 
     appears to do. H.R. 2260's prohibitions would only reach 
     controlled substances, which are most often used as sedatives 
     and not as the actual agents of death. As a result, H.R. 2260 
     might well result in physician-assisted suicides that do not 
     use sedatives and pain-controlling substances that are 
     accordingly more painful.

  Mr. COBURN. Mr. Chairman, I yield 1 minute to the gentleman from 
Florida (Mr. Weldon).
  Mr. WELDON of Florida. Mr. Chairman, I would like to address two of 
the criticisms of the bill that have been brought up. Number one, 
somebody rose and said there is nothing in this bill that will help 
people with pain. There are two titles in this act. The second title 
which encompasses most of the bill deals with extensive training so 
that physicians will get better training on how to manage pain. That is 
really the problem. That is why people suffer. There are a lot of 
doctors who are not well trained in how to manage these cases.
  Now, the issue that has been brought up as well by the last two 
speakers, that there will be this gray zone and you will give a few 
pills and the DEA will start scrutinizing you, in practical effect that 
never happens. Indeed, under the Oregon statute, which is essentially 
the focus of all this discussion, you have to register with the State 
that you are going to execute somebody. It is quite clear what the 
intent is there. There is not a gray zone at all involved.
  I believe if Members take the time to read it as the gentleman from 
Iowa (Mr. Ganske) said, this is an excellent bill, an extremely well 
crafted bill, one of the best ones I have ever seen.
  Mr. ROTHMAN. Mr. Chairman, the Oncology Nursing Society and American 
Nurses Association support the Johnson substitute.
  Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Oregon 
(Mr. DeFazio).
  Mr. DeFAZIO. Mr. Chairman, I thank the gentleman for yielding me this 
time.
  We have heard some extraordinary things from the other side. The 
people who are one day for States' rights today want to preempt it. The 
people who are for individual decisions want to preempt them. The 
people who want to sanctify the physician-patient relationship want to 
put a Drug Enforcement Administration agent in the room with the 
physician and the patient while they are making these critical 
decisions. They have talked about the word execute, euthanasia.
  Look at the Oregon law. It is something where a physician can only 
prescribe after there are two diagnoses, a psychological consultation, 
the person willingly asks, they have acceded in writing, they have 
informed their next of kin, there has been a waiting period and the 
person must self-administer. That is the key. It is not euthanasia. It 
is not physician-assisted suicide. They write a humane prescription for 
a person who is dying a horrible, horrible death and who might want 
relief.
  What has happened in Oregon? Fewer people have taken their lives with 
guns and other things because they just knew it was there if they 
needed it. They want to turn back the clock to the bad old days when my 
father is dying and I said, can he not have more pain medication, the 
doctor said, no, it might depress his breathing. In one line in the 
bill, they give the doctor that authority. But they take it away five 
lines later where they say if the doctor intentionally depresses that 
person's breathing.

                              {time}  1245

  Who knows? How are we going to determine intent? Are the drug 
enforcement administration the best people to determine one's 
physician's intent and chill their desire to give relief from 
intractable pain? I would say no, and I do not think on any other day 
of the week the Republican party would advocate having the Drug 
Enforcement Administration involved in our personal legal lives.
  Mr. COBURN. Mr. Chairman, I yield myself 15 seconds for just a 
response.
  If a doctor writes a prescription that he knows is going to be used 
to take someone's life, that is doctor-assisted suicide, period, end of 
sentence.
  Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Ohio (Mr. 
Chabot).
  Mr. CHABOT. Mr. Chairman, I rise in strong support of H.R. 2260, the 
Pain Relief Promotion Act, 1999. Like many of my colleagues on both 
sides of the aisle who have spoken here, I have a very profound respect 
for the sanctity of human life. I also believe that every individual 
has the right to live and ultimately die with dignity. The Pain Relief 
Promotion Act goes a long way to ensure that terminally-ill patients 
receive the palliative care necessary to alleviate chronic pain. In 
doing so it allows these individuals to die with dignity. This bill 
prohibits the use of CSA-controlled drugs for assisted suicide and 
euthanasia, but it gives doctors greater leeway to aggressively treat 
pain.
  In 1997 Congress passed the Assisted Suicide Funding Restriction Act 
with the support of the current administration. The act forbids the use 
of Federal funds for assisted suicide whether or not States legalize 
the practice. The vote in the House on that bill was 398 to 16, and it 
was unanimous in the Senate. However, since that time we have been 
confronted with a tragic ruling by the Attorney General, that 
physician-assisted suicide does not fall under the jurisdiction of the 
Controlled Substances Act. We, as a body, must now take this 
opportunity to further clarify our message, and that message is: 
Congress does not sanction assisted suicide, and federally controlled 
substances cannot be prescribed for that purpose.
  Sadly, we will probably all at one time or another be confronted with 
a tragedy of personal illness or suffering, and this bill is a good 
bill, and I would urge its passage.
  Mr. STUPAK. Mr. Chairman, I yield our remaining minute to the 
gentleman from Arkansas (Mr. Berry).
  Mr. BERRY. Mr. Chairman, I rise today in support of the Pain Relief 
Promotion Act. As a cosponsor of this bill, I know that the Pain Relief 
Promotion Act would not keep physicians, nurses, or health care workers 
from providing appropriate pain and symptom control to sick patients. 
The

[[Page 27084]]

measure simply clarifies what is already established as case law and 
common practice. The use of drugs outside of established professional 
and legal parameters is forbidden, and this bill is very similar to a 
law already in place in my home State of Arkansas, a law that has 
proved to be effective and enforceable.
  Mr. Chairman, this legislation has been endorsed by a broad spectrum 
of organizations such as the National Hospice Organization, the 
American Medical Association, the former Surgeon General, C. Everett 
Koop. Let us pass this legislation and show that we know the value of 
human life.
  Mr. COBURN. Mr. Chairman, I ask unanimous consent to yield the 
balance of my time for purposes of control to the gentleman from 
Florida (Mr. Canady).
  The CHAIRMAN pro tempore (Mr. Hastings of Washington). Is there 
objection to the request of the gentleman from Oklahoma?
  There was no objection.
  The CHAIRMAN pro tempore. Without objection, 15 seconds is yielded to 
the gentleman from Florida (Mr. Canady).
  There was no objection.
  Mr. ROTHMAN. Mr. Chairman, I yield myself the balance of the time.
  The CHAIRMAN pro tempore. The gentleman from New Jersey (Mr. Rothman) 
is recognized for 1\1/2\ minutes.
  Mr. ROTHMAN. Here are the facts, Mr. Chairman.
  There is an undertreatment of pain in the United States of America 
because doctors feel inhibited they will be sued civilly in the medical 
malpractice suit.
  What does the underlying bill do? It adds additional fear to doctors 
that they will be sent to jail and lose their license. How do we know 
they are fearful of this? Half of the doctors groups have said they do 
not support this bill. Most of the nurses organizations do not support 
this bill. Instead, they support the Johnson-Rothman substitute.
  So we know doctors and nurses are being chilled now. They are telling 
us do not pass that underlying bill. If my colleagues do not like 
physician-assisted suicide, which I do not, which most Members of 
Congress do not, and they do not like the Oregon physician-assisted 
suicide bill, go to the Supreme Court and get it thrown out.
  But do not chill doctors giving of pain medication to the tens of 
millions of children, boys and girls, men and women in America and the 
other 49 states because of not liking Oregon's law. Let us deal with 
pain for the millions of Americans in pain. Deal with the Oregon 
constitutional situation in the Supreme Court. They are trying to make 
this a physician-assisted suicide sanctity-of-life issue. We all 
believe in the sanctity of life. Address that separately before the 
Supreme Court. Let us give people in agonizing terminal pain the 
ability not to kill themselves, but to get the pain medicine they are 
asking and begging for.
  Mr. Chairman, I yield back the balance of my time.
  Mr. CANADY of Florida. Mr. Chairman, I yield the balance of my time 
to the gentleman from Illinois (Mr. Hyde), chairman of the House 
Committee on the Judiciary.
  The CHAIRMAN pro tempore. The gentleman from Illinois (Mr. Hyde) is 
recognized for 10\1/4\ minutes.
  Mr. HYDE. Mr. Chairman, let us not make any mistake. The real danger, 
the real danger if we go down this road, if we leap off the cliff into 
the abyss is in 10 years, once we make assisted suicide permissible, 
once we make it possible, once doctors lose the healing, diminish their 
healing faculty and become an assistant to the hangmen, we put and 
jeopardize the unwanted people, and we are diminishing the value of 
human life.
  We were told, we pro-lifers, that we do not care about people after 
they are born; our only concern is when they are born. No, but some of 
us said, You're starting down a slippery slope; you're devaluing human 
life, and that is what we see here today. But we are just beginning. 
The unwanted, the uninsured, the poor, the elderly, the frail, the 
diseased, the profoundly handicapped, they are at risk. They are 
watching this today, if only they could, to see if they are going to be 
put at risk.
  They talk about expanding the authority of the DEA. The DEA has this 
authority already. We are trying to reinstate it in the one State where 
it has been removed, and that is Oregon. We are not providing any more 
authority to any law enforcement that they do not have now, and the 
doctor, the gentleman from Washington (Mr. McDermott), talked about 
these tough decisions. Well, if they are so tough, how is a U.S. 
Attorney going to prove beyond all reasonable doubt that the doctor had 
a criminal intent? Not so.
  This is an important bill because it assures the uniform application 
of Federal law, and I really ought to thank the gentleman from Florida 
(Mr. Canady), Senator Nickles, the gentleman from Michigan (Mr. 
Stupak), and the gentleman from Oklahoma (Mr. Coburn), and the 
gentleman from Florida (Mr. Weldon), and so many and all in the hospice 
and medical communities who have worked so diligently to produce a bill 
that offers our citizens greater access to palliative care to the 
management and alleviation of pain and maintains medicine as a healer, 
a healing force, an alleviator of pain.
  The bill has 165 cosponsors in the House and in the Senate. The 
companion bill cosponsored by Senator Lieberman and sponsored by 
Senator Nickles has 31 cosponsors, so there is bipartisan support in 
the House and in the Senate.
  Now we know the Controlled Substances Act was passed in 1970 to 
establish uniform Federal laws on a uniquely Federal subject, the 
control, the regulation of controlled substances. Those are drugs that 
are potentially dangerous. We have got a DEA, we have got a drug car, 
and we have a national drug problem. The agency's task is to ensure 
that these potentially dangerous drugs are administered for legitimate 
medical purposes.
  Now it happens that Oregon decided to change the traditional time-
honored professional purpose of medicine and give Oregon doctors the 
option no longer to serve as healing forces but as social engineers, 
messengers of death. So Oregon has passed a State law that gives 
doctors the right to assist in the intentional killing of patients, 
patients who may want to die, families who want their older relatives 
to die, and so doctors are authorized now by Oregon law to put down 
their stethoscope and pick up the poison pill and proceed to assist in 
the execution of their patient.
  Very simple. It comes down to this. Do we want to empower our doctors 
to intentionally kill a patient even if that is the desire of the 
patient or the family? Do we want to add executions to the list of 
healing services they provide? Should Oregon law trump the Federal law?
  Now some Oregonians resent this Federal intrusion in response to 
their decision to let doctors do away with the weak, the weary, the 
fearful of being a burden to their families. Suicide is the ultimate 
act of despair, and facilitating the intentional killing of a human 
life is the opposite of healing. The opposite of alleviating pain, it 
is a surrender to hopelessness when there are other options that reject 
the culture of death.
  Physicians have not been taught what medications to prescribe for a 
suicide. There is no research or case series in medical literature to 
which doctors of death can refer to find prescribing information and 
directions. It is doubtful that one standard will fit all. There is no 
documented scientific literature or guide book on how to kill one's 
patient.
  The medical profession is concerned about palliative care, and the 
debate about assisted suicide which takes place now must be at the 
forefront of our concerns because to focus on the management of pain in 
the last months, the last days, the last hours of life, hospice doctors 
and others in the medical profession study and practice medicine with a 
clear purpose of making their patients more comfortable even while 
mindful that administering palliative care sometimes can have the 
unintended side effect of hastening death.
  These are difficult decisions faced every day. This bill can help end 
those decisions by providing what is not

[[Page 27085]]

there now, a safe harbor, one that is absent in the current law. That 
safe harbor in this bill protects doctors even if the administration of 
pain medications result in unintended death.
  This bill does something more. It provides money and guidance for 
training and safeguards now absent in current law to educate doctors, 
caregivers, medical students, health professions, nurses, State, local 
and Federal law enforcement officials on the practice of palliative 
medicine. That is why this is an important bill. It deals with the very 
nature of man, the value of every life, the definition of a physician. 
It emphasizes the alleviation and management of pain, not reversing the 
role of doctor from healer to hangman.
  Some of us here today cry Federal preemption of a State law when 
really what we are dealing with is State preemption of a Federal law. 
We can advocate the Federal Government look the other way on this 
issue, play Pontius Pilate, wash our hands, but we have to think about 
it because there is a sanctity of life that must be respected and 
defended.
  As my colleagues know, there is an insidiousness about the notion of 
assisted suicide. We make it permissible, then we make it acceptable, 
and finally it becomes an act of nobility. We plant the idea with the 
elderly, it is their duty to die, get out of the way. Is that not what 
the governor of Colorado said a few years ago? The elderly have a duty 
to die and get out of the way, not to be a burden on the children.
  Many times the anguishing words ``I want to die'' really mean I do 
not want to be a burden on my family. We insist that more be done at 
the Federal level to promote palliative end-of-life care. There are 
very effective ways to control pain, and I am confident that doctors 
will not shy from their duty to alleviate pain, and this bill 
encourages palliative care. It provides that safe harbor for the 
physician should the palliative care inadvertently lead to the death of 
a patient. It provides money for training in pain management and 
requires caregivers adhere to our national policy of administering 
controlled substances for legitimate medical purposes, not taking a 
life.

                              {time}  1300

  A doctor should not be asked to play the role of hired gun. His art 
and science are in the service of life. In this bill, we expressly 
permit and encourage the use of controlled substances for pain 
management, even when it might unintentionally hasten death. We supply 
money and training.
  To those who assert we are preempting the laws of Oregon, this bill 
does not preempt the Oregon law legalizing assisted suicide in 
specified circumstances. The legal effect of this bill is to forbid the 
use of certain controlled substances which are federally controlled for 
the intentional purpose of killing the patient. If you want to use non-
controlled substances or some other method to assist the passage of the 
patient, you can still do so under Oregon law, unfortunately.
  The single ethic that has provided the moral backbone for Western 
civilization is one that insists that every member of the human family 
has equal inherent moral worth. It is called the Sanctity of Life 
ethic. That is the core of our belief, that the poor and the powerless 
deserve equal rights and equal protection.
  One of the frequent criticisms of certain acts or omissions by the 
government is that it will have a chilling effect on some people. How 
often we hear that phrase. Well, physician assisted suicide has a 
chilling effect on handicapped people, elderly people, sick people and 
the unwanted, because it is an aspect of a philosophy from another time 
and another place that said it was appropriate to get rid of the 
useless eaters. It starts us down a real slippery slope, where some of 
us who do not measure up to someone else's standards become vulnerable, 
expendable and discardable.
  Mr. LEVIN. Mr. Chairman, I oppose assisted suicide. I voted against a 
recent Michigan ballot initiative which would have legalized it in my 
State. I did so because I believe that it is increasingly evident that 
with modern pain management techniques doctors can make comfortable 
patients who are critically ill.
  The primary responsibility to handle this issue has traditionally 
been with the States, which almost universally prohibit assisted 
suicide. Under current law, assisted suicide is not explicitly listed 
as a Federal crime. The DEA has never prosecuted a physician for 
assisted suicide under the Controlled Substances Act (CSA). Instead, 
the responsibility for enforcing medical standards has historically 
been a State responsibility.
  The effect of H.R. 2260 would be to add assisted suicide to the list 
of Federal crimes under the CSA which carry a mandatory 20-year jail 
sentence. For the first time, the Justice Department and the DEA would 
be required to become involved in determining the intent of doctors 
when they prescribed pain medication to patients. Associations 
representing about half of our doctors and almost all of our nurses 
have said that they believe the fear of being investigated by the DEA 
would lead many doctors to prescribe less medication for pain.
  I support the other sections of H.R. 2260, which would support 
efforts to educate health professionals about effective pain 
management. I have long supported pain management education for health 
professionals and a comprehensive approach to end-of-life care. I first 
introduced legislation in this area in 1990. That legislation became 
law. The most recent version of the legislation would improve upon our 
earlier efforts by taking steps to provide patients and their families 
with the information and support they need during the difficult time at 
the end of life. This legislation would also improve Medicare's 
coverage of self-administered drugs for pain. All of these issues--pain 
management, support and information, and the payment policies of 
Medicare and other insurance payors--should be part of our efforts to 
prevent suicide and assisted suicide.
  Ms. KILPATRICK. Mr. Chairman, today I rise in strong opposition to 
H.R. 2260, A bill which claims to promote pain relief but actually will 
increase the pain of many of this Nation's citizens that suffer from 
debilitating and incurable diseases.
  My opposition to this legislation is based on the premise that 
Federal legislators, most of whom are not doctors, should not delve, 
dig or pry into the intense and personal decisions made between a 
doctor and his or her patient. Once again, this Congress is attempting 
to legislate our lives most private and intimate decisions (the right 
to die with dignity). It is my belief that the decision to recommend 
this or any other medical procedure depends on expert medical judgement 
and therapeutic assessment. Such decisions--much like a women's 
decision regarding her own reproductive rights--are a physicians 
responsibility, within the privacy and confidentiality of the doctor-
patient relationship.
  Like most Members of Congress, I live my life to the fullest. I never 
take a single moment for granted. For Members of Congress to imply or 
imagine collectively we know what is best for a family tortured with 
the final decision of life is pure folly. Again, we need to let doctors 
in consultation with the patients and the patients family decide what 
is best in each individual, unique situation.
  I am also alarmed by the very reason that we are considering this 
bill. We are considering this bill to topple the will of the people of 
the State of Oregon who approved, on two occasions, a measure that 
would legalize assisted suicide under strict and well deliberated 
mandates and guidelines. How ironic it is that the Congress, which 
claims it is the Congress of State rights, is the primary promoter of 
this legislation?
  Congress needs to state focusing on the issues that are most 
important to the American people. The American people continue to cry 
out for legislation to address education and health care. How long will 
the Republicans continue to ignore the citizens call for campaign 
finance and gun control reforms? We are simply wasting time and energy 
on a matter that is a decision that will eventually be determined by 
the Supreme Court, and an issue the States are already effectively 
addressing.
  In this crucial time, when the federal budget is in limbo, it is 
important that we address the real challenges and problems that need to 
be, and should be addressed. I am asking that we say ``no'' to the 
further intrusion on the work of trained, skilled professionals and let 
doctors, families and patients make the very difficult and hard life 
and death decisions in private and without the intervention of the 
Federal Government.
  Mr. BURTON of Indiana. Mr. Chairman, as an original cosponsor of H.R. 
2260, the Pain Relief Promotion Act of 1999, I think it is important to 
reiterate the importance of this bill. On October 19, the Committee for 
Government Reform conducted a hearing entitled,

[[Page 27086]]

``Improving Care at the End of Life with Complementary Medicine.'' Pain 
management is one of the top concerns of palliative care, including 
those patients who are dying. The need to properly recognize and treat 
pain is why the Veterans Health Administration added monitoring pain as 
the fifth vital sign. It is a sad day in this country when some 
individuals in the medical establishment have determined that one of 
the options for alleviating pain will be for a doctor to hasten the 
death. And a sadder day indeed when that option gains so much 
credibility that the U.S. Congress has to debate a bill clarifying that 
physician-assisted suicide or the polite term ``euthanasia'' is not an 
option for pain management.
  As we look to provide care for our veterans, including the 32,000 
World War II veterans that die each month, we must insure that pain is 
properly treated. We must also assure that the option to hasten death 
is not what we look to as a resolution for taking care of veterans and 
all Americans.
  At our October 19, hearing we heard from Dr. Ira Byock, a renowned 
expert in palliative care. Dr. Byock clarified some of the 
misconceptions of this bill, including that physicians who use drugs 
such as morphine to treat pain are already monitored by the Drug 
Enforcement Administration (DEA) and that this bill will not prevent 
the prescribing of strong and effective pain drugs. This bill clarifies 
the importance of pain management and palliative care and asks for 
further research and the development of practice guidelines for pain 
management.
  We heard from Dr. Byock, who also conducts research in improving care 
at the end of life, as well as Dannion Brinkley, the chairman of 
Compassion in Action, an organization that trains hospice volunteers 
and provides professional and community education, that pain management 
has to be addressed and that there are other options available to 
individuals including non-pharmacologic efforts. These treatment 
options include music therapy, acupuncture, and guided imagery. We 
heard from Dr. Patricia Grady, Director of the National Institute of 
Nursing Research that there is research to indicate that these 
therapies especially when used in conjunction with pain medication 
allowed patients to have less pain, to rest better, and to go longer 
between the need for medication.
  Dr. Byock also stated something that my colleague from Florida, 
Congressman Weldon (MD) has reiterated--a doctor knows whether he or 
she is prescribing a drug to treat pain or to cause death and that pain 
can be properly treated. Educating health care professionals in pain 
management and treatment options is vital and this bill will move this 
forward.
  I stand in support of this bill and also suggest that we look at 
solving the problems of pain in this country by looking to non-
controlled substances and complementary therapies as options to treat 
pain.
  Mr. BARCIA. Mr. Chairman, I rise today in support of H.R. 2260, the 
Pain Relief Promotion Act. I have repeatedly heard today that this bill 
overturns Oregon's assisted suicide law. This is simply not true. The 
bill does not prevent anyone in Oregon from assisting in a suicide, nor 
does the bill establish any new authority to penalize assisted suicide. 
The bill simply clarifies that assisted suicide may not take place with 
federally controlled substances. This bill continues to allow States to 
pass their own laws while clarifying the boundaries of Federal 
involvement regarding assisted suicide. As Federal legislators, this is 
our duty. We are in the business of clarifying Federal involvement. 
Oregon's current experiment in democracy is perfectly within its right, 
but this does not mean that one State has the right to tell the Federal 
Government how federally controlled substances should be used.
  The essence of H.R. 2660 is that it clarifies the extent to which 
federally controlled substances can be used in order to relieve the 
patient's pain. Additionally, by clarifying that drugs under the 
Controlled Substances Act can be used to relieve pain, even if those 
drugs hasten death, this bill protects health care providers while 
allowing them to use the strongest drugs necessary for pain relief.
  Mr. Chairman, to the dying we owe our compassion. We have the ability 
to alleviate the pain of the dying. We must comfort the dying with 
compassion by voting for H.R. 2260.
  Mr. NUSSLE. Mr. Chairman, I rise today in strong support of H.R. 
2260. This legislation takes a much needed step toward the Federal 
protection of all human life. This bill will provide doctors in Iowa's 
second district and throughout the country the ability to aggressively 
provide their patients with pain relief while prohibiting the use of 
federally controlled substances in assisting suicide.
  The purpose of this legislation is to encourage the alleviation of 
pain suffered by patients with advanced disease and chronic illness and 
pain associated with conditions that do not respond to treatment. H.R. 
2260 also encourages the promotion of life of such patients and would 
prohibit States from enacting laws that permit physician-assisted 
suicide.
  Much of the debate surrounding H.R. 2260 focuses on the affect it 
will have on those who have severe pain. The opponents to H.R. 2260 
worry that this legislation would hinder a doctors willingness to 
prescribe pain medication to the seriously ill. My home State of Iowa 
adopted an almost identical provision to H.R. 2260 in 1996, and the 
statistics show that the use of pain control drugs have almost doubled. 
Obviously, the Iowa law did not deter doctors from administering pain 
relief to the seriously ill, neither would H.R. 2260.
  H.R. 2260, for the first time, writes into the Controlled Substance 
Act protection for physicians who prescribe large doses of drugs 
sometimes necessary to manage intractable pain, even if this may 
increase the risk of death, so long as the drugs are not prescribed 
intentionally for the purpose of assisting suicide or euthanasia. Under 
this bill, a doctor who intentionally dispenses or distributes a 
controlled substance with the purpose of causing the suicide or 
euthanasia of any individual may have his license suspended or revoked.
  In summary, Mr. Chairman, I hope that my colleagues will join me in 
supporting H.R. 2260. This legislation provides doctors the ability to 
use federally regulated drugs for the pain management of the seriously 
ill.
  Mrs. MINK of Hawaii. Mr. Chairman, I rise to express my concerns 
about H.R. 2260, the Pain Relief Promotion Act.
  Although this bill is being represented as if it would improve 
physicians' abilities to provide pain relief and palliative care, the 
bill's primary purpose is to criminalize physician assisted suicide 
utilizing controlled substances. And although I do not condone assisted 
suicide, exposing doctors to additional criminal and civil liabilities 
for using controlled substances will curtail the pain relief options 
available to patients.
  H.R. 2260 authorizes the Drug Enforcement Agency to investigate and 
second-guess the intent of a physician when a death, possibly 
attributable to a controlled substance, occurs. Such investigations 
would effectively discourage doctors from dispensing such substances 
even in the most severe cases. Patients would be left to suffer even 
more painful and agonizing deaths.
  Physicians should not have to fear losing their medical licenses for 
prescribing pain relief to terminally ill patients. Their 
responsibilities are complex enough without the additional threat of 
DEA investigations and criminal and civil law suits questioning their 
intent. Physicians should have all inventions, treatments and 
substances, at their disposal to provide care for their patients and to 
make the last days of a terminally ill patient's life as comfortable as 
possible.
  The DEA should be focusing its efforts on fighting illegal drug 
activities that are a menace to our society, not on doctors prescribing 
pain relief for terminally ill patients. And Congress should be 
focusing its efforts on the issue of what is proper pain management and 
what are the best ways to treat pain. Accordingly, I support the 
provisions in the bill that would establish a program within the 
Department of Health and Human Services to study pain management and 
distribute pain management information. I also support the grants 
provided by the bill to train health professionals in the care of 
patients with advanced illnesses. Still we should not bind the hands of 
physicians treating terminally ill patients.
  I support improving pain management for the terminally ill but I 
oppose limiting physicians' abilities to practice medicine. I urge a 
``nay'' vote on H.R. 2260 as it is currently drafted.
  Mr. SMITH of New Jersey. Mr. Chairman, I rise in support of H.R. 2260 
because the bill encourages sound medical practice in the relief of 
pain and suffering of the chronically and terminally ill patients.
  This bill would add a provision to the Controlled Substances Act, 
acknowledging the legitimate use of narcotics for the management of 
serious pain and discomfort, even if their use increases the risk of 
death for the patient.
  In the Hyde-Stupak bill, the goal is to make the patient as 
comfortable as possible during that person's terminal or chronic 
illness. Relief of pain is the contemplated result.
  This is not physician-assisted suicide or euthanasia, either in 
substance or intent. Physicians are not actively and intentionally 
seeking to end the life of the patient.
  But powerful drugs that relieve pain have serious secondary effects. 
They can cause loss of cognition, depressed respiration, retained 
secretions, and increased dehydration by depressing voluntary 
nutrition. The secondary, or unintended effect, may therefore

[[Page 27087]]

hasten death, through death is not a directly intended purpose.
  Organized medicine has recognized the principle of this ``double 
effect'' as the potential consequence of the legitimate and necessary 
use of controlled substances for pain management. The AMA calls this 
principle ``a vital element in creating a legal environment in which 
physicians may administer appropriate pain care for patients and we 
appreciate its inclusion.''
  The AMA further expands its position as follows. ``Physicians have an 
obligation to relieve pain and suffering and to promote the dignity and 
autonomy of dying patients in their care. This includes providing 
effective palliative treatment, even though it may foreseeably hasten 
death.''
  The bill will promote the training of health professionals to use 
these drugs appropriately while providing palliative care. This will 
dovetail with the newly inaugurated AMA program--``Education for 
Physicians on End of Life Care.'' This program is designed to educate 
physicians more fully in pain management and to deal more holistically 
with the patient.
  I oppose the Johnson-Rothman-Hooley substitute because it does 
nothing to prevent or restrict assisted suicide and it does nothing to 
train physicians and nurses in pain management, which the Hyde bill 
accomplishes.
  Johnson-Rothman-Hooley continues to authorize the use of federally 
regulated drugs to assist suicides whenever a state law permits this 
deadly practice. Finally, the substitute never clearly distinguishes 
pain control from deliberate killing or assisted suicide.
  There appears to be much confusion in the debate as to the scope of 
this proposal and how it might affect individual states. Supervision of 
controlled substances is a federal prerogative--it always has been. 
There are no new penalties suggested. Nothing is new. Rather, Hyde-
Stupak heightens and reinforces current federal policy.
  While the bill will not technically ``overturn'' current Oregon law 
in this general matter, it will abrogate its use. Since physicians will 
be unable to legally prescribe intentionally lethal doses of federally 
controlled substances, the doctors will be encouraged to offer better 
pain control and not offer death to the seriously ill patient.
  Relief of pain with moderate or even substantial doses of drugs is 
good medical practice. Purposely and intentionally ending human life is 
inappropriate and antithetical to the role of the physician as healer.
  H.R. 2260 clarifies and enables physicians to pursue their legitimate 
role as healers. Easing pain at the time of the patient's final passage 
is one of medicine's most noble callings. I urge your support for this 
important bill.
  Mr. HALL of Texas. Mr. Chairman, two years ago I was privileged to be 
the sponsor of the Assisted Suicide Funding Restriction Act, which 
passed the House floor by a vote of 398 to 16 before being signed into 
law by President Clinton.
  The Assisted Suicide Funding Restriction Act said that we don't want 
federal tax dollars going to pay for euthanasia, and we don't want 
euthanasia going on in federally controlled facilities such as 
Veterans' Hospitals and Public Health Service facilities. The Pain 
Relief Promotion Act says we don't want federally controlled drugs 
being used for euthanasia.
  That is a popular position with the American people. In a nationwide 
poll in June, 64% answered ``no'' when asked whether federal law should 
allow the use of federally controlled drugs for the purpose of assisted 
suicide and euthanasia. Only 31% said ``yes.'' That's better than 2 to 
1. We are trying to help people live!
  One of the parts of the Assisted Suicide Funding Restriction Act that 
was very important was a rule of construction that made clear that 
funding and facilities could be provided ``for the purpose of 
alleviating pain or discomfort, even if such use may increase the risk 
of death, so long as ``the purpose was not ``of causing, or * * * 
assisting in causing, death * * *.'' The American Medical Association 
wrote, ``This provision assures patients and physicians alike that 
legislation opposing assisted suicide will not chill appropriate 
palliative and end-of-life-care.''
  I am glad to see that very similar language is included in the Pain 
Relief Promotion Act, along with important positive programs to 
increase the knowledge of health care personnel at the clinical level 
to be able to control pain.
  I am sure that is a large part of why this bill is endorsed by so 
many medical and end-of-life care groups, including the American 
Academy of Pain Management, the American Society of Anesthesiologists, 
the AMA, the National Hospice Organization, the Hospice Association of 
America, and Aging with Dignity.
  Even the Hemlock Society, which works to legalize assisting suicide 
and of course therefore opposes this bill, concedes that ``the bill 
encourages aggressive pain relief for the terminally ill.'' Our 
distinguished colleague, Mr. Nadler from New York, voted against the 
bill in the Judiciary Committee because he thinks controlled substances 
should be available for assisted suicide in states that legalize it. 
But at the Judiciary Committee markup, Mr. Nadler said, ``[M]ost of the 
secondary reasons for opposing it, the pain issue and so forth, I 
really don't think are very valid and I think the bill has really been 
cleaned up in that respect.''
  Some of the groups that still oppose the bill, it's important to 
understand, don't oppose assisting suicide. The American Pharmaceutical 
Association, for example, has a formal policy that ``opposes laws and 
regulations that * * * prohibit the participation of pharmacists in 
physician-assisted suicide.'' Mr. Skip Baker, the head of the Society 
for Action on Pain, has called the ``Oregon suicide law a much needed 
law.''
  But suicide is not the solution. You don't really solve problems by 
getting rid of the person to whom the problems happen. Once we accept 
death as a solution, we begin to lose the incentive and the drive to 
work on positive alternatives. We can do better than that in America.
  This bill is a good start. It will help us end the patient's pain, 
not the patient's life. Please support it.
  Mr. GARY MILLER of California. Mr. Chairman, I believe the Pain 
Relief Promotion Act is one of the most compassionate and life-
affirming bills to come before us this year.
  Two years ago, a gentleman came to see me regarding laws on pain 
relief. At the time, I was working on a ``Pain Patients Bill of 
Rights'' for Californians who suffer from extreme pain.
  The gentleman who visited me is a police officer who had broken his 
back in the line of duty during an incident with a suspect. As a result 
of his injury he was in constant, untreatable pain. He had to endure 
numerous invasive surgeries, that were not successful. It seemed that 
he had no choice but to endure chronic pain that most of us cannot even 
imagine.
  He shared with me that because the pain was so unendurable, and 
because it seemed there was no treatment to stop the pain, he arrived 
at a point where he wanted to end his life. Pain made life so 
unbearable, that this protector of the people did not think his life 
was worth living anymore.
  After seeing many different doctors, this police officer finally was 
referred to a specialist in pain treatment. The doctor was able to 
prescribe high levels of pain medication, which made the pain 
manageable, and as a result made this police officer feel that his life 
was worth living.
  Unfortunately, most doctors are afraid to prescribe high levels of 
pain medication because they do not know if the Drug Enforcement Agency 
will come after them for diverting drugs or prescribing too much. 
Doctors are not going to act if they are not sure whether or not they 
are breaking the law.
  Doctors know how to treat their patients, and we need to make sure 
they have the freedom to prescribe the treatment that will make their 
patients comfortable. This compassionate piece of legislation will give 
doctors the legal protection to take care of patients who are 
experiencing terrible, debilitating pain.
  I can testify that the police officer who came to talk with me now 
has a happy life, and his pain is manageable. He walks with a cane and 
a limp, but his quality of life is high and he has a passion for life.
  For everyone in this room who values life, this is a ``yes'' vote.
  Mr. LUCAS of Kentucky. Mr. Chairman, I support the Pain Relief 
Promotion Act. The Pain Relief Promotion Act will make important 
strides in giving health care providers around the country better 
access to the most advanced ways of dealing with patients' pain. It 
will assure physicians who prescribe federally controlled substances 
that they can safely authorize adequate amounts to manage pain without 
jeopardizing their Drug Enforcement Administration registration.
  It will also ensure a uniform national application of the existing 
principle that federally controlled and regulated drugs should not be 
used to assist suicide or for euthanasia, even if a particular state 
legalizes the practice as a matter of state law.
  This is a good complement to the Assisted Suicide Funding Restriction 
Act that passed by an overwhelming margin two years ago. That Act said 
that euthanasia shouldn't be carried out in federal facilities, such as 
Veteran's Hospitals, and that federal tax dollars shouldn't fund it. 
This bill says that those narcotics and other dangerous drugs that have 
long been regulated by the federal government under the

[[Page 27088]]

Controlled Substances Act should not be used to kill patients.
  Congress must not blur the distinction between pain relief and 
assisted suicide. In order to protect the vulnerable in our society, it 
is critically important that we maintain the difference recognized by 
the medical profession and the Supreme Court between treating patients 
appropriately even if it means risking increasing the likelihood of 
death and giving patients the means to intentionally kill themselves.
  We in Congress must not facilitate turning doctors into killers by 
giving permission to use federally controlled drugs for assisted 
suicide and euthanasia. We must enact H.R. 2260, the Pain Relief 
Promotion Act.
  Mr. RAHALL. Mr. Chairman, I support H.R. 2260, a bill to promote pain 
relief in lieu of promoting assisted suicide for men, women and 
children suffering from unremitting pain of grievous injury and 
terminal disease.
  The American people oppose euthanasia as a solution to the problem of 
pain and suffering. They know that is not the humane, decent choice.
  I believe that saying yes to people who talk about, threaten or ask 
for assisted suicide is not respecting that person's choice.
  The threat of or request for assisted suicide is a cry for help--not 
a real request to die.
  The yearning for, the love of life, the desire to live, is a part of 
each and every one of us. When a person--a loved one perhaps--believe 
they want to die because their pain cannot be or is not being 
controlled adequately, it is not for us to answer them by allowing 
controlled substances to be used to bring about their death.
  It is our duty and responsibility to let them know we care and that 
we will do something for them--not to bring about death--but to bring 
about relief from the pain that causes them to think they would rather 
die.
  It should not be--should not be--the response of the Federal 
Government to legalize assisted suicide.
  Our response should be that we have the medical technology that makes 
the administration of pain-relieving drugs sufficient to control pain. 
Our response must be to improve our medical delivery system so that 
what we know about the cutting edge of medicine becomes a reality at 
every bedside--and that doctors, nurses and family members are assured 
that the safe prescription of drugs for pain control is possible 
without fear that they will be charged with a crime.
  Our response must be that we will ensure through authorized federal 
programs the dissemination of state-of-the-art information to doctors 
or care-givers in medical settings, about how to control pain. Our 
response should be to give all care givers the information that our 
best pain specialists know. Our response is to ensure that this 
information go out to every general practitioner in every clinical 
setting--so that no one needs to be put to death--but are made 
comfortable so that even their final hours are spent in the most pain-
free state medically possible.
  The Pain Relief Promotion Act before the House today takes those 
steps--strong steps--in that direction.
  Rather than starting down the slippery, dangerous slope of assisted 
suicide, let us take a higher ground--to a place that tells us it is 
reasonable--not extraordinary--to expect not to have to kill our loved 
ones in order to put them out of their misery.
  We have the medical technology. We have pain control and management 
specialists who are ready and willing to impart their knowledge to 
medical practitioners so it can be used for humane--and safe--purposes.
  The relief from pain for those who are suffering from grievous injury 
or terminal illness is within our capability now--and it can be 
administered without killing them. No one has a duty to die because 
they may be a burden to care givers, or a drain on a family's financial 
resources.
  If we do nothing else, we must stop going down that path where we put 
pressure on those who are vulnerable, who are poor and sick and 
disabled--that they have a duty to die because they are a burden. To do 
otherwise is to set a dangerous, inhumane precedent.
  I urge my colleagues to vote for alternatives to suicide--not 
assisted suicide. Vote for the Pain Relief Promotion Act.
  Mr. WU. Mr. Chairman, death with dignity is a right which all 
Americans should have. Currently, only Oregonians have this right. 
Today, we debate whether Congress will deprive Oregonians of their most 
fundamental human rights--the right to choose one's destiny.
  May God guide this House in its deliberations.
  The bill before us today is misnamed the ``Pain Relief Promotion 
Act,'' a crafty piece of legislation that hides its real intent. 
Organizations that have taken the time to study the bill, including the 
state chapters of the American Medical Association, have expressed 
their opposition. Every day, opposition is growing to this bill because 
it subjects thousands of doctors across the country to second-guessing 
by the DEA.
  In order to hide the real motive of the legislation, H.R. 2260 alters 
the Controlled Substances Act--a law intended to deal with drug 
trafficking and diversion--in an attempt to regulate state medical 
practice. Frankly, H.R. 2260 amounts to little more than one section 
that contains non-controversial palliative care measures, and one 
section that is a thinly veiled attempt to overturn Oregon's Death with 
Dignity Act.
  Terminal illness has nothing to do with drug trafficking or forgery 
or all the other things that are traditionally the purview of the 
Office of Diversion Control within the DEA. H.R. 2260 would have this 
unknown law enforcement agency make determinations regarding a new 
offense that is inherently intent based, yet without allowing a 
physician to avoid legal responsibility by establishing that they 
merely intended to relieve pain, even where death inadvertently 
results.
  The Controlled Substances Act is written as a strictly liability law 
for both criminal and civil purposes and contains no intent 
requirement. Sadly, the Judiciary Committee voted down an amendment 
that would have required the government to prove the doctor's intent, 
and another which would have allowed health care providers to make an 
affirmative defense that they had no such intent.
  How will the DEA enforce this legislation? The DEA never testified 
before Congress on either H.R. 2260 or its predecessor in the last 
Congress, H.R. 4006.
  The gymnastics that are required to make this legislation work are 
mind-boggling.
  I am very concerned that there will be vast amounts of new paperwork 
requirements. Health care workers will be required to report on each 
other.
  Will family members who are sad to see a loved one pass away report 
the physician?
  This bill is fundamentally destructive of patient rights, the 
physician-patient relationship, and the independent practice of 
medicine.
  Testimony before the Committee indicated that ``this Act subjects 
physicians who care for dying patients to the oversight of police with 
no expertise in the provision of medical care.'' I am disappointed that 
the Committee chose to ignore these words.
  While members were not permitted to testify this year in the 
Judiciary Committee, my state medical association, the Oregon Medical 
Association, did testify. They said ``Physicians already undermedicate 
patients for fear of being sanctioned under the current law.''
  H.R. 2260 will only exacerbate the current situation, and leave 
thousands more needlessly suffering. All it will take is one case, in 
any town in the United States, where the DEA investigates a physician 
on this issue, and I guarantee that an instant freeze on prescriptions 
for analgesics across that state will result.
  H.R. 2260 will trigger a federal enforcement process that would ruin 
the careers of physicians and throw them in jail. Physicians, already 
beset by controversy in local state laws, will be reluctant to 
prescribe the large doses of pharmaceuticals that are often required to 
treat incapacitating levels of pain.
  The Rules Committee has allowed a substitute by Mrs. Johnson, Mr. 
Rothman, and Ms. Hooley, my colleague from Oregon, to be considered on 
the floor. This substitute will enhance all the non-controversial 
provisions in H.R. 2260 regarding the need to boost palliative care, 
but leave out the provisions that have led the American Nurses 
Association, and American Pharmaceutical Association, the American 
Academy of Family Physicians, the Association of Health System 
Pharmacists, the American Pain Foundation, and many other organizations 
to oppose this bill.
  I hope my colleagues will consider the fact that the Johnson-Rothman-
Hooley substitute puts Congress on record as opposing assisted suicide, 
but does not threaten treatment of chronic pain.
  There have been instances in our nation's history where it is 
appropriate for federal law to supercede state law in order to fulfill 
national imperatives, but this is not one of those occasions.
  With this bill today, Congress misses the opportunity to engage in a 
real debate about end-of-life care, and what our choices should be as 
individuals in a free society. Today does not represent the kind of 
open, courageous, and enlightening discussion that Congress is capable 
of having. Instead, this bill aptly demonstrates what Congress can do 
in a backhanded way.
  I urge my colleagues to oppose H.R. 2260, support the DeFazio-Scott 
amendment, and support the Johnson-Rothman-Hooley substitute.

[[Page 27089]]

  The CHAIRMAN pro tempore (Mr. Hastings of Washington). All time for 
general debate has expired.
  Pursuant to the rule, an amendment in the nature of a substitute 
consisting of the bill, modified by the amendments recommended by the 
Committee on Commerce, is considered as an original bill for the 
purpose of amendment and is considered read.
  The text of the committee amendment in the nature of a substitute, as 
modified, is as follows:

                               H.R. 2260

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Pain Relief Promotion Act of 
     1999''.

 TITLE I--USE OF CONTROLLED SUBSTANCES CONSISTENT WITH THE CONTROLLED 
                             SUBSTANCES ACT

     SEC. 101. REINFORCING EXISTING STANDARD FOR LEGITIMATE USE OF 
                   CONTROLLED SUBSTANCES.

       Section 303 of the Controlled Substances Act (21 U.S.C. 
     823) is amended by adding at the end the following:
       ``(i)(1) For purposes of this Act and any regulations to 
     implement this Act, alleviating pain or discomfort in the 
     usual course of professional practice is a legitimate medical 
     purpose for the dispensing, distributing, or administering of 
     a controlled substance that is consistent with public health 
     and safety, even if the use of such a substance may increase 
     the risk of death. Nothing in this section authorizes 
     intentionally dispensing, distributing, or administering a 
     controlled substance for the purpose of causing death or 
     assisting another person in causing death.
       ``(2) Notwithstanding any other provision of this Act, in 
     determining whether a registration is consistent with the 
     public interest under this Act, the Attorney General shall 
     give no force and effect to State law authorizing or 
     permitting assisted suicide or euthanasia.
       ``(3) Paragraph (2) applies only to conduct occurring after 
     the date of enactment of this subsection.''.

     SEC. 102. EDUCATION AND TRAINING PROGRAMS.

       Section 502(a) of the Controlled Substances Act (21 U.S.C. 
     872(a)) is amended--
       (1) by striking ``and'' at the end of paragraph (5);
       (2) by striking the period at the end of paragraph (6) and 
     inserting ``; and''; and
       (3) by adding at the end the following:
       ``(7) educational and training programs for local, State, 
     and Federal personnel, incorporating recommendations by the 
     Secretary of Health and Human Services, on the necessary and 
     legitimate use of controlled substances in pain management 
     and palliative care, and means by which investigation and 
     enforcement actions by law enforcement personnel may 
     accommodate such use.''.

                  TITLE II--PROMOTING PALLIATIVE CARE

     SEC. 201. ACTIVITIES OF AGENCY FOR HEALTH CARE POLICY AND 
                   RESEARCH.

       Part A of title IX of the Public Health Service Act (42 
     U.S.C. 299 et seq.) is amended by adding at the end the 
     following section:

     ``SEC. 906. PROGRAM FOR PALLIATIVE CARE RESEARCH AND QUALITY.

       ``(a) In General.--The Administrator shall carry out a 
     program to accomplish the following:
       ``(1) Develop and advance scientific understanding of 
     palliative care.
       ``(2) Collect and disseminate protocols and evidence-based 
     practices regarding palliative care, with priority given to 
     pain management for terminally ill patients, and make such 
     information available to public and private health care 
     programs and providers, health professions schools, and 
     hospices, and to the general public.
       ``(b) Definition.--For purposes of this section, the term 
     `palliative care' means the active, total care of patients 
     whose disease or medical condition is not responsive to 
     curative treatment or whose prognosis is limited due to 
     progressive, far-advanced disease. The purpose of such care 
     is to alleviate pain and other distressing symptoms and to 
     enhance the quality of life, not to hasten or postpone 
     death.''.

     SEC. 202. ACTIVITIES OF HEALTH RESOURCES AND SERVICES 
                   ADMINISTRATION.

       (a) In General.--Part D of title VII of the Public Health 
     Service Act (42 U.S.C. 294 et seq.), as amended by section 
     103 of Public Law 105-392 (112 Stat. 3541), is amended--
       (1) by redesignating sections 754 through 757 as sections 
     755 through 758, respectively; and
       (2) by inserting after section 753 the following section:

     ``SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN PALLIATIVE 
                   CARE.

       ``(a) In General.--The Secretary, in consultation with the 
     Administrator for Health Care Policy and Research, may make 
     awards of grants, cooperative agreements, and contracts to 
     health professions schools, hospices, and other public and 
     private entities for the development and implementation of 
     programs to provide education and training to health care 
     professionals in palliative care.
       ``(b) Priorities.--In making awards under subsection (a), 
     the Secretary shall give priority to awards for the 
     implementation of programs under such subsection.
       ``(c) Certain Topics.--An award may be made under 
     subsection (a) only if the applicant for the award agrees 
     that the program carried out with the award will include 
     information and education on--
       ``(1) means for alleviating pain and discomfort of 
     patients, especially terminally ill patients, including the 
     medically appropriate use of controlled substances;
       ``(2) applicable laws on controlled substances, including 
     laws permitting health care professionals to dispense or 
     administer controlled substances as needed to relieve pain 
     even in cases where such efforts may unintentionally increase 
     the risk of death; and
       ``(3) recent findings, developments, and improvements in 
     the provision of palliative care.
       ``(d) Program Sites.--Education and training under 
     subsection (a) may be provided at or through health 
     professions schools, residency training programs and other 
     graduate programs in the health professions, entities that 
     provide continuing medical education, hospices, and such 
     other programs or sites as the Secretary determines to be 
     appropriate.
       ``(e) Evaluation of Programs.--The Secretary shall 
     (directly or through grants or contracts) provide for the 
     evaluation of programs implemented under subsection (a) in 
     order to determine the effect of such programs on knowledge 
     and practice regarding palliative care.
       ``(f) Peer Review Groups.--In carrying out section 799(f) 
     with respect to this section, the Secretary shall ensure that 
     the membership of each peer review group involved includes 
     one or more individuals with expertise and experience in 
     palliative care.
       ``(g) Definition.--For purposes of this section, the term 
     `palliative care' means the active, total care of patients 
     whose disease or medical condition is not responsive to 
     curative treatment or whose prognosis is limited due to 
     progressive, far-advanced disease. The purpose of such care 
     is to alleviate pain and other distressing symptoms and to 
     enhance the quality of life, not to hasten or postpone 
     death.''.
       (b) Authorization of Appropriations; Allocation.--
       (1) In general.--Section 758 of the Public Health Service 
     Act (as redesignated by subsection (a)(1) of this section) is 
     amended in subsection (b)(1)(C) by striking ``sections 753, 
     754, and 755'' and inserting ``section 753, 754, 755, and 
     756''.
       (2) Amount.--With respect to section 758 of the Public 
     Health Service Act (as redesignated by subsection (a)(1) of 
     this section), the dollar amount specified in subsection 
     (b)(1)(C) of such section is deemed to be increased by 
     $5,000,000.

     SEC. 203. EFFECTIVE DATE.

       The amendments made by this title take effect October 1, 
     1999, or upon the date of the enactment of this Act, 
     whichever occurs later.

  The CHAIRMAN pro tempore. No amendment to that amendment shall be in 
order except those printed in House Report 106-409. Each amendment may 
be offered only in the order printed in the report, may be offered only 
by a Member designated in the report, shall be considered read, 
debatable for the time specified in the report, equally divided and 
controlled by a proponent and an opponent, and shall not be subject to 
amendment.
  The Chairman of the Committee of the Whole may postpone a request for 
a recorded vote on any amendment and may reduce to a minimum of 5 
minutes the time for voting on any postponed question that immediately 
follows another vote, provided that the time for voting on the first 
question shall be a minimum of 15 minutes.
  It is now in order to consider Amendment No. 1 printed in House 
Report No. 106-409.


                  Amendment No. 1 Offered by Mr. Scott

  Mr. SCOTT. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 1 offered by Mr. Scott:
       In title I, strike section 101 and redesignate succeeding 
     sections and all cross references accordingly.

  The CHAIRMAN pro tempore. Pursuant to House Resolution 339, the 
gentleman from Virginia (Mr. Scott) and a Member opposed will each 
control 5 minutes.
  The Chair recognizes the gentleman from Virginia (Mr. Scott)
  Mr. SCOTT. Mr. Chairman, I yield myself 2 minutes.
  Mr. Chairman, this amendment strikes section 101 from the bill. That

[[Page 27090]]

is the part that overturns the Oregon referendum and also exposes 
doctors to criminal and civil liability.
  This bill states that alleviating pain in the usual course of 
professional practice is legitimate, even if the use of controlled 
substances may increase the risk of death. However, then it turns 
around and specifically prohibits the intentional use of such 
substances for causing death.
  Now, the part about alleviating pain being a legitimate practice 
under the law is legally meaningless because it does not create a legal 
safe harbor. It does not create an affirmative defense. It does not say 
if you are consistent with the medical protocol that you can use that 
as a defense against a charge of intention.
  The problem we have is that the case will only arise when you have a 
terminally ill patient who has died and is full of drugs. DEA comes in 
and says, well, you killed him intentionally. The DEA has expertise in 
prohibiting the possession of certain drugs that are totally 
prohibited, but they have no expertise to know how to prescribe drugs 
and when too many or not enough drugs have been prescribed.
  Now, a doctor may be subject to scrutiny by the state medical board 
if they inappropriately prescribe drugs, but a law enforcement agency, 
without any expertise, is inappropriate. Even if the DEA decides not to 
prosecute a doctor, the fact that this bill is on the books will create 
civil liability, so that anybody can come in and sue the doctor, 
contrary to the stated purpose of the bill. Then section 101's 
expansion of DEA authority, potential civil and criminal liability, 
will likely increase the doctor's reluctance to prescribe sufficient 
drugs to relieve pain. This is particularly harmful, because physicians 
already undermedicate under current law for fear of violating laws, 
and, if we truly want to encourage aggressive pain relief, we should 
not expose doctors to additional civil and criminal penalties if they 
do exactly what we want them to do.
  Mr. COBURN. Mr. Chairman, I rise in opposition to the amendment.
  The CHAIRMAN pro tempore. The gentleman from Oklahoma is recognized 
for 5 minutes.
  Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, what this amendment does is gut the portion of the DEA 
enforcement that we presently have and is presently law. The real issue 
we are talking about is how do you defend taking somebody else's life 
and doing it under the Oregon statute? How do you defend that? How do 
you say it is okay for me as a physician to take your loved one out?
  What, under our Constitution, what would ever give me that right, 
whether I am in Oregon or Oklahoma? The fact is that Oregon gets the 
right to pass their laws. As the chairman of the Committee on the 
Judiciary said, they can still take that; they just cannot do it using 
the Federal Controlled Substances Act. There is very good reason that 
we have that act. What the gentleman wishes to do is to make it not 
apply in this instance.
  What about the child that is born, that is severely handicapped and 
the parents say, ``Oh, no, we can't. You know, we just cannot take care 
of this child. It is too big of a burden. Will you not please, Mr. 
Pediatrician, Dr. Obstetrician, won't you relieve our suffering? Please 
give an injection of respiratory depressant or of a high dose of 
narcotics so we don't have to handle this burden. Oh, take care of our 
problem.''
  What about the value of that life? It does not have any value, 
according to the people of Oregon, because only in the context of the 
people making the decision will it have value. Only in the context of 
an elderly person that has severe Alzheimer's, is uncontrollable, only 
if that family desires, and if it is registered to be done, can they do 
it. That life has no value? There is no value?
  In terms of inaccurate statements, the fact is the DEA law is not 
changed, just clarified, which will make no major change. We could give 
a safe harbor for physicians. As a practicing physician who gives 
palliative care for dying cancer patients and others, I welcome this 
change in the law, because it does clarify, and it does offer safe 
harbor.
  Mr. Chairman, I reserve the balance of my time.
  Mr. SCOTT. Mr. Chairman, I yield 2 minutes to the gentleman from 
Oregon (Mr. DeFazio)
  Mr. DeFAZIO. Mr. Chairman, if you are for States rights, you will 
support this amendment. But even if you are not for States rights and 
you are not supportive of what Oregon has done, twice, the people of 
Oregon by initiative, if you do not want the Drug Enforcement 
Administration second guessing the intent of every physician providing 
end-of-life pain care to every American and chilling and destroying 
that relationship and the capability of people to get relief from pain, 
you will support this amendment.
  The other side is trying to scare people with all sorts of inaccurate 
statements. Taking someone else's life? The person has to be competent, 
judged by two doctors, a psychiatrist, and they can only do it by their 
own hand with a prescription. ``Hangman,'' we heard from the chairman 
of the committee. ``Euthanasia,'' we heard. Incredibly irresponsible 
statements by the other side, denigrating the people of Oregon, the 60 
percent who supported this, and the people who are suffering horribly 
at the end of life.
  And, finally, the hypocrisy. The chairman of the committee proposed 
in the last Congress a bill, H.R. 1252, and what he said there is no 
single Federal judge should be able to overturn a state law adopted by 
referendum, and that they cannot grant any relief or anticipatory 
relief on the ground the a state law is repugnant of the Constitution, 
which they do not say here. It is repugnant to them and their moral 
structure. Treatises or laws of the United States, unless the 
application for anticipatory relief is heard and determined by a court 
of three judges. So he feels so strongly about state referenda that he 
wants to say a single Federal judge cannot find a violation of the 
Constitution.
  But, in this case, he feels so little about the will of the people of 
a state and for States rights and for individuals suffering horribly, 
horribly, at the end of life, that he would overturn it here in a 
curtailed debate in the House of Representatives, where we get 5 
minutes on our side, where the proponents were given three-quarters of 
the time during the debate. It is a stacked deck. It is not fair.
  If you want to preempt the Oregon law, do it straight and honest and 
straight up and preempt the Oregon law on the floor, and see what the 
Supreme Court says about that.
  Mr. COBURN. Mr. Chairman, I yield 1 minute to the gentleman from 
Florida (Mr. Canady).
  Mr. CANADY of Florida. Mr. Chairman, I thank the gentleman for 
yielding me time.
  Mr. Chairman, I just want to point out that the whole argument being 
made by the opponents of this bill is really an argument against the 
Controlled Substances Act. If you do not like the Controlled Substances 
Act, that is a position you can take. But this argument that somehow in 
this particular context we should not be allowed to apply the 
Controlled Substances Act is based on an argument that undermines the 
whole regulatory and statutory scheme under the Controlled Substances 
Act.
  It is important for the Members of the House to understand that the 
question before us is whether we will say that the Federal Government 
will support and encourage assisted suicide. Now, if you believe that 
we should support and encourage assisted suicide, you should vote for 
this amendment and vote against the bill. The question is that, 
however, and we need to focus on that question: Will we authorize the 
use of controlled substances for the purpose of killing human beings? 
If you believe that we should do that, vote for the amendment. If you 
think that is something we should not do, I suggest you vote against 
the amendment. That is what is at stake before the House, and Members 
need to focus on what is really at stake and put aside the scare 
tactics.
  Mr. SCOTT. Mr. Chairman, I yield myself the balance of my time.

[[Page 27091]]

  The CHAIRMAN. The gentleman is recognized for 1 minute.
  Mr. SCOTT. Mr. Chairman, first of all, if a physician intentionally 
kills someone, they will be subject to all of the state laws, criminal 
laws. But the point here is that if you have a terminally ill patient 
who has died and is full of drugs, this bill will allow the DEA to come 
in to determine what the intent of the physician was. Not medical 
enforcement, not the medical society full of doctors determining 
whether the appropriate protocol was followed, but a law enforcement 
officer. The DEA knows which drugs can be possessed and which drugs 
cannot be possessed. They know nothing about over-prescribing or under-
prescribing drugs.
  We need to encourage pain relief for patients. We ought not be 
subjecting the physicians to additional civil and criminal penalties if 
they do just that.
  Now, if this bill passes, we will be subjecting them not only to 
additional criminal laws, but also the fact that you violated a law 
makes you exposed to more civil litigation. So even if the DEA has the 
common sense not to prosecute, anybody else can come in and sue. That 
is not what we need, and that is why we need the amendment.

                              {time}  1315

  Mr. COBURN. Mr. Chairman, I yield myself 1\1/2\ minutes, the balance 
of the time.
  Mr. Chairman, this House twice, 2 years in a row, has said we do not 
think the FDA ought to be in the business of approving drugs that kill 
babies; we do not find a role for it, that, in fact, we should not 
spend Federal dollars to figure out the best ways to kill somebody.
  If my colleagues want to talk about a slippery slope, pretty soon we 
are going to figure out the best way to take a senior out, the most 
comfortable way, the least expensive way, the most efficacious way to 
end life. Pretty soon, we are going to figure out what is the easiest 
way to terminate a pregnancy, to eliminate the consequences of a 
mistake in judgment or a crime. We are going to spend Federal dollars 
on how to eliminate those segments of our society that are most 
dependent on us.
  I am not a partisan up here. But on this issue, I say that if my 
colleagues really care about those who cannot care for themselves, they 
cannot be for anybody in our society to make the final decision about 
whether they live or not, whether it is me making a decision about my 
child or us making a decision as a group about a family member or me as 
a physician making a decision about my patient.
  What we are saying was said in Holland 10 years ago. The same 
statements were said, and it was ignored. Today, they have active 
euthanasia of newborn babies growing at 20 percent per year. They have 
active euthanasia of those that are handicapped growing at 20 percent a 
year. It will happen here, folks.
  The CHAIRMAN pro tempore (Mr. Hastings of Washington). All time has 
expired.
  The question is on the amendment offered by the gentleman from 
Virginia (Mr. Scott).
  The question was taken; and the Chairman pro tempore announced that 
the noes appeared to have it.
  Mr. DeFAZIO. Mr. Chairman, I demand a recorded vote, and pending 
that, I make the point of order that a quorum is not present.
  The CHAIRMAN pro tempore. Pursuant to House Resolution 339, further 
proceedings on the amendment offered by the gentleman from Virginia 
(Mr. Scott) will be postponed.
  The point of no quorum is considered withdrawn.
  It is now in order to consider amendment No. 2 printed in House 
Report 106-409.


Amendment No. 2 in the Nature of a Substituted Offered by Mrs. Johnson 
                             of Connecticut

  Mrs. JOHNSON of Connecticut. Mr. Chairman, I offer an amendment in 
the nature of a substitute.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment in 
the nature of a substitute.
  The text of the amendment in the nature of a substitute is as 
follows:

       Amendment No. 2 in the nature of a substitute offered by 
     Mrs. Johnson of Connecticut:
       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Conquering 
     Pain Act of 1999''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title.
Sec. 2. Findings and purpose.
Sec. 3. Definitions.

    TITLE I--EMERGENCY RESPONSE TO THE PUBLIC HEALTH CRISIS OF PAIN

Sec. 101. Guidelines for the treatment of pain.
Sec. 102. Quality improvement projects.
Sec. 103. Surgeon General's report.

                TITLE II--DEVELOPING COMMUNITY RESOURCES

Sec. 201. Family support networks in pain and symptom management.

                   TITLE III--REIMBURSEMENT BARRIERS

Sec. 301. Insurance coverage of pain and symptom management.

   TITLE IV--IMPROVING FEDERAL COORDINATION OF POLICY, RESEARCH, AND 
                              INFORMATION

Sec. 401. Advisory Committee on Pain and Symptom Management.
Sec. 402. Institutes of Medicine report on controlled substance 
              regulation and the use of pain medications.
Sec. 403. Conference on pain research and care.

                    TITLE V--DEMONSTRATION PROJECTS

Sec. 501. Provider performance standards for improvement in pain and 
              symptom management.

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress finds that--
       (1) pain is often left untreated or under-treated 
     especially among older patients, African Americans, and 
     children;
       (2) chronic pain is a public health problem affecting at 
     least 50,000,000 Americans through some form of persisting or 
     recurring symptom;
       (3) 40 to 50 percent of patients experience moderate to 
     severe pain at least half the time in their last days of 
     life;
       (4) 70 to 80 percent of cancer patients experience 
     significant pain during their illness;
       (5) despite the best intentions of physicians, nurses, 
     pharmacists, and other health care professionals, pain is 
     often under-treated because of the inadequate training of 
     physicians in pain management;
       (6) despite the best intentions of physicians, nurses, 
     pharmacists, and other health care professionals, pain and 
     symptom management is often suboptimal because the health 
     care system has focused on cure of disease rather than the 
     management of a patient's pain and other symptoms;
       (7) the technology and scientific basis to adequately 
     manage most pain is known;
       (8) pain should be considered the fifth vital sign; and
       (9) coordination of Federal efforts is needed to improve 
     access to high quality effective pain and symptom management 
     in order to assure the needs of chronic pain patients and 
     those who are terminally ill are met.
       (b) Purpose.--The purpose of this Act is to enhance 
     professional education in palliative care and reduce 
     excessive regulatory scrutiny in order to mitigate the 
     suffering, pain, and desperation many sick and dying people 
     face at the end of their lives in order to carry out the 
     clear opposition of the Congress to physician-assisted 
     suicide.

     SEC. 3. DEFINITIONS.

       In this Act:
       (1) Chronic pain.--The term ``chronic pain'' means a pain 
     state that is persistent and in which the cause of the pain 
     cannot be removed or otherwise treated. Such term includes 
     pain that may be associated with long-term incurable or 
     intractable medical conditions or disease.
       (2) Drug therapy management services.--The term ``drug 
     therapy management services'' means consultations with a 
     physician concerning a patient which results in the 
     physician--
       (A) changing the drug regimen of the patient to avoid an 
     adverse drug interaction with another drug or disease state;
       (B) changing an inappropriate drug dosage or dosage form 
     with respect to the patient;
       (C) discontinuing an unnecessary or harmful medication with 
     respect to the patient;
       (D) initiating drug therapy for a medical condition of the 
     patient; or
       (E) consulting with the patient or a caregiver in a manner 
     that esults in a significant improvement in drug regimen 
     compliance.

     Such term includes services provided by a physician, 
     pharmacist, or other health care professional who is legally 
     authorized to furnish such services under the law of the 
     State in which such services are furnished.
       (3) End of life care.--The term ``end of life care'' means 
     a range of services, including hospice care, provided to a 
     patient, in the final stages of his or her life, who is 
     suffering from 1 or more conditions for which treatment 
     toward a cure or reasonable improvement is not possible, and 
     whose focus of care is palliative rather than curative.

[[Page 27092]]

       (4) Family support network.--The term ``family support 
     network'' means an association of 2 or more individuals or 
     entities in a collaborative effort to develop multi-
     disciplinary integrated patient care approaches that involve 
     medical staff and ancillary services to provide support to 
     chronic pain patients and patients at the end of life and 
     their caregivers across a broad range of settings in which 
     pain management might be delivered.
       (5) Hospice.--The term ``hospice care'' has the meaning 
     given such term in section 1861(dd)(1) of the Social Security 
     Act (42 U.S.C. 1395x(dd)(1)).
       (6) Pain and symptom management.--The term ``pain and 
     symptom management'' means services provided to relieve 
     physical or psychological pain or suffering, including any 1 
     or more of the following physical complaints--
       (A) weakness and fatigue;
       (B) shortness of breath;
       (C) nausea and vomiting;
       (D) diminished appetite;
       (E) wasting of muscle mass;
       (F) difficulty in swallowing;
       (G) bowel problems;
       (H) dry mouth;
       (I) failure of lymph drainage resulting in tissue swelling;
       (J) confusion;
       (K) dementia;
       (L) anxiety; and
       (M) depression.
       (7) Palliative care.--The term ``palliative care'' means 
     the total care of patients whose disease is not responsive to 
     curative treatment, the goal of which is to provide the best 
     quality of life for such patients and their families. Such 
     care--
       (A) may include the control of pain and of other symptoms, 
     including psychological, social and spiritual problems;
       (B) affirms life and regards dying as a normal process;
       (C) provides relief from pain and other distressing 
     symptoms;
       (D) integrates the psychological and spiritual aspects of 
     patient care;
       (E) offers a support system to help patients live as 
     actively as possible until death; and
       (F) offers a support system to help the family cope during 
     the patient's illness and in their own bereavement.
       (8) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
    TITLE I--EMERGENCY RESPONSE TO THE PUBLIC HEALTH CRISIS OF PAIN

     SEC. 101. GUIDELINES FOR THE TREATMENT OF PAIN.

       (a) Development of Website.--Not later than 2 months after 
     the date of enactment of this Act, the Secretary, acting 
     through the Agency for Health Care Policy Research, shall 
     develop and maintain an Internet website to provide 
     information to individuals, health care practitioners, and 
     health facilities concerning evidence-based practice 
     guidelines developed for the treatment of pain.
       (b) Requirements.--The website established under subsection 
     (a) shall--
       (1) be designed to be quickly referenced by health care 
     practitioners; and
       (2) provide for the updating of guidelines as scientific 
     data warrants.
       (c) Provider Access to Guidelines.--
       (1) In general.--In establishing the website under 
     subsection (a), the Secretary shall ensure that health care 
     facilities have made the website known to health care 
     practitioners and that the website is easily available to all 
     health care personnel providing care or services at a health 
     care facility.
       (2) Use of certain equipment.--In making the information 
     described in paragraph (1) available to health care 
     personnel, the facility involved shall ensure that such 
     personnel have access to the website through the computer 
     equipment of the facility and shall carry out efforts to 
     inform personnel at the facility of the location of such 
     equipment.
       (3) Rural areas.--
       (A) In general.--A health care facility, particularly a 
     facility located in a rural or underserved area, without 
     access to the Internet shall provide an alternative means of 
     providing practice guideline information to health care 
     personnel.
       (B) Alternative means.--The Secretary shall determine 
     appropriate alternative means by which a health care facility 
     may make available practice guideline information on a 24-
     hour basis, 7 days a week if the facility does not have 
     Internet access. The criteria for adopting such alternative 
     means should be clear in permitting facilities to develop 
     alternative means without placing a significant financial 
     burden on the facility and in permitting flexibility for 
     facilities to develop alternative means of making guidelines 
     available. Such criteria shall be published in the Federal 
     Register.

     SEC. 102. QUALITY IMPROVEMENT EDUCATION PROJECTS.

       The Secretary shall provide funds for the implementation of 
     special education projects, in as many States as is 
     practicable, to be carried out by peer review organizations 
     of the type described in section 1152 of the Social Security 
     Act (42 U.S.C. 1320c-1) to improve the quality of pain and 
     symptom management. Such projects shall place an emphasis on 
     improving pain and symptom management at the end of life, and 
     may also include efforts to increase the quality of services 
     delivered to chronic pain patients.

     SEC. 103. SURGEON GENERAL'S REPORT.

       Not later than October 1, 2000, the Surgeon General shall 
     prepare and submit to the appropriate committees of Congress 
     and the public, a report concerning the state of pain and 
     symptom management in the United States. The report shall 
     include--
       (1) a description of the legal and regulatory barriers that 
     may exist at the Federal and State levels to providing 
     adequate pain and symptom management;
       (2) an evaluation of provider competency in providing pain 
     and symptom management;
       (3) an identification of vulnerable populations, including 
     children, advanced elderly, non-English speakers, and 
     minorities, who may be likely to be underserved or may face 
     barriers to access to pain management and recommendations to 
     improve access to pain management for these populations;
       (4) an identification of barriers that may exist in 
     providing pain and symptom management in health care 
     settings, including assisted living facilities;
       (5) and identification of patient and family attitudes that 
     may exist which pose barriers in accessing pain and symptom 
     management or in the proper use of pain medications;
       (6) an evaluation of medical school training and residency 
     training for pain and symptom management; and
       (7) a review of continuing medical education programs in 
     pain and symptom management.
                TITLE II--DEVELOPING COMMUNITY RESOURCES

     SEC. 201. FAMILY SUPPORT NETWORKS IN PAIN AND SYMPTOM 
                   MANAGEMENT.

       (a) Establishment.--The Secretary, acting through the 
     Public Health Service, shall award grants for the 
     establishment of 6 National Family Support Networks in Pain 
     and Symptom Management (in this section referred to as the 
     ``Networks'') to serve as national models for improving the 
     access and quality of pain and symptom management to chronic 
     pain patients and those individuals in need of pain and 
     symptom management at the end of life and to provide 
     assistance to family members and caregivers.
       (b) Eligibility and Distribution.--
       (1) Eligibility.--To be eligible to receive a grant under 
     subsection (a), an entity shall--
       (A) be an academic facility or other entity that has 
     demonstrated an effective approach to training health care 
     providers concerning pain and symptom management and 
     palliative care services; and
       (B) prepare and submit to the Secretary an application (to 
     be peer reviewed by a committee established by the 
     Secretary), at such time, in such manner, and containing such 
     information as the Secretary may require.
       (2) Distribution.--In providing for the establishment of 
     Networks under subsection (a), the Secretary shall ensure 
     that--
       (A) the geographic distribution of such Networks reflects a 
     balance between rural and urban needs; and
       (B) at least 3 Networks are established at academic 
     facilities.
       (c) Activities of Networks.--A Network that is established 
     under this section shall--
       (1) provide for an integrated interdisciplinary approach to 
     the delivery of pain and symptom management;
       (2) provide community leadership in establishing and 
     expanding public access to appropriate pain care, including 
     pain care at the end of life;
       (3) provide assistance through caregiver and bereavement 
     supportive services;
       (4) develop a research agenda to promote effective pain and 
     symptom management for the broad spectrum of patients in need 
     of access to such care that can be implemented by the 
     Network;
       (5) provide for coordination and linkages between clinical 
     services in academic centers and surrounding communities to 
     assist in the widespread dissemination of provider and 
     patient information concerning how to access options for pain 
     management;
       (6) establish telemedicine links to provide education and 
     for the delivery of services in pain and symptom management; 
     and
       (7) develop effective means of providing assistance to 
     providers and families for the management of a patient's pain 
     24 hours a day, 7 days a week.
       (d) Provider Pain and Symptom Management Communications 
     Projects.--
       (1) In general.--Each Network shall establish a process to 
     provide health care personnel with information 24 hours a 
     day, 7 days a week, concerning pain and symptom management. 
     Such process shall be designed to test the effectiveness of 
     specific forms of communications with health care personnel 
     so that such personnel may obtain information to ensure that 
     all appropriate patients are provided with pain and symptom 
     management.
       (2) Termination.--The requirement of paragraph (1) shall 
     terminate with respect to a Network on the day that is 2 
     years after the date on which the Network has established the 
     communications method.
       (3) Evaluation.--Not later than 60 days after the 
     expiration of the 2-year period referred to in paragraph (2), 
     a Network shall conduct an evaluation and prepare and submit 
     to the Secretary a report concerning the costs of operation 
     and whether the form of

[[Page 27093]]

     communication can be shown to have had a positive impact on 
     the care of patients in chronic pain or on patients with pain 
     at the end of life.
       (4) Rule of construction.--Nothing in this subsection shall 
     be construed as limiting a Network from developing other ways 
     in which to provide support to families and providers, 24 
     hours a day, 7 days a week.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $18,000,000 for 
     fiscal years 2000 through 2002.
                   TITLE III--REIMBURSEMENT BARRIERS

     SEC. 301. INSURANCE COVERAGE OF PAIN AND SYMPTOM MANAGEMENT.

       (a) In General.--The General Accounting Office shall 
     conduct a survey of public and private health insurance 
     providers, including managed care entities, to determine 
     whether the reimbursement policies of such insurers inhibit 
     the access of chronic pain patients to pain and symptom 
     management and pain and symptom management for those in need 
     of end-of-life care. The survey shall include a review of 
     formularies for pain medication and the effect of such 
     formularies on pain and symptom management.
       (b) Report.--Not later than 1 year after the date of 
     enactment of this Act, the General Accounting Office shall 
     prepare and submit to the appropriate committees of Congress 
     a report concerning the survey conducted under subsection 
     (a).
   TITLE IV--IMPROVING FEDERAL COORDINATION OF POLICY, RESEARCH, AND 
                              INFORMATION

     SEC. 401. ADVISORY COMMITTEE ON PAIN AND SYMPTOM MANAGEMENT.

       (a) Establishment.--The Secretary shall establish an 
     advisory committee, to be known as the Advisory Committee on 
     Pain and Symptom Management, to make recommendations to the 
     Secretary concerning a coordinated Federal agenda on pain and 
     symptom management.
       (b) Membership.--The Advisory Committee established under 
     subsection (a) shall be comprised of 11 individuals to be 
     appointed by the Secretary, of which at least 1 member shall 
     be a representative of--
       (1) physicians (medical doctors or doctors of osteopathy) 
     who treat chronic pain patients or the terminally ill;
       (2) nurses who treat chronic pain patients or the 
     terminally ill;
       (3) pharmacists who treat chronic pain patients or the 
     terminally ill;
       (4) hospice;
       (5) pain researchers;
       (6) patient advocates;
       (7) caregivers; and
       (8) health insurance issuers (as such term is defined in 
     section 2791(b) of the Public Health Service Act (42 U.S.C. 
     300gg-91(b))).
     The members of the Committee shall designate 1 member to 
     serve as the chairperson of the Committee.
       (c) Meetings.--The Advisory Committee shall meet at the 
     call of the chairperson of the Committee.
       (d) Agenda.--The agenda of the Advisory Committee 
     established under subsection (a) shall include--
       (1) the development of recommendations to create a 
     coordinated Federal agenda on pain and symptom management;
       (2) the development of proposals to ensure that pain is 
     considered as the fifth vital sign for all patients;
       (3) the identification of research needs in pain and 
     symptom management, including gaps in pain and symptom 
     management guidelines;
       (4) the identification and dissemination of pain and 
     symptom management practice guidelines, research information, 
     and best practices;
       (5) proposals for patient education concerning how to 
     access pain and symptom management across health care 
     settings;
       (6) the manner in which to measure improvement in access to 
     pain and symptom management and improvement in the delivery 
     of care; and
       (7) the development of an ongoing mechanism to identify 
     barriers or potential barriers to pain and symptom management 
     created by Federal policies.
       (e) Recommendation.--Not later than 2 years after the date 
     of enactment of this Act, the Advisory Committee established 
     under subsection (a) shall prepare and submit to the 
     Secretary recommendations concerning a prioritization of the 
     need for a Federal agenda on pain, and ways in which to 
     better coordinate the activities of entities within the 
     Department of Health and Human Services, and other Federal 
     entities charged with the responsibility for the delivery of 
     health care services or research on pain, with respect to 
     pain management.
       (f) Consultation.--In carrying out this section, the 
     Advisory Committee shall consult with all Federal agencies 
     that are responsible for providing health care services or 
     access to health services to determine the best means to 
     ensure that all Federal activities are coordinated with 
     respect to research and access to pain and symptom 
     management.
       (g) Administrative Support; Terms of Service; Other 
     Provisions.--The following shall apply with respect to the 
     Advisory Committee:
       (1) The Committee shall receive necessary and appropriate 
     administrative support, including appropriate funding, from 
     the Department of Health and Human Services.
       (2) The Committee shall hold open meetings and meet not 
     less than 4 times per year.
       (3) Members of the Committee shall not receive additional 
     compensation for their service. Such members may receive 
     reimbursement for appropriate and additional expenses that 
     are incurred through service on the Committee which would not 
     have incurred had they not been a member of the Committee.
       (4) The requirements of appendix 2 of title 5, United 
     States Code.

     SEC. 402. INSTITUTES OF MEDICINE REPORT ON CONTROLLED 
                   SUBSTANCE REGULATION AND THE USE OF PAIN 
                   MEDICATIONS.

       (a) In General.--The Secretary, acting through a contract 
     entered into with the Institute of Medicine, shall review 
     findings that have been developed through research conducted 
     concerning--
       (1) the effects of controlled substance regulation on 
     patient access to effective care;
       (2) factors, if any, that may contribute to the underuse of 
     pain medications, including opioids; and
       (3) the identification of State legal and regulatory 
     barriers, if any, that may impact patient access to 
     medications used for pain and symptom management.
       (b) Report.--Not later than 18 months after the date of 
     enactment of this Act, the Secretary shall prepare and submit 
     to the appropriate committees of Congress a report concerning 
     the findings described in subsection (a).

     SEC. 403. CONFERENCE ON PAIN RESEARCH AND CARE.

       Not later than December 31, 2003, the Secretary, acting 
     through the National Institutes of Health, shall convene a 
     national conference to discuss the translation of pain 
     research into the delivery of health services to chronic pain 
     patients and those needing end-of-life care. The Secretary 
     shall use unobligated amounts appropriated for the Department 
     of Health and Human Services to carry out this section.
                    TITLE V--DEMONSTRATION PROJECTS

     SEC. 501. PROVIDER PERFORMANCE STANDARDS FOR IMPROVEMENT IN 
                   PAIN AND SYMPTOM MANAGEMENT.

       (a) In General.--The Secretary, acting through the Public 
     Health Service, shall award grants for the establishment of 
     not less than 5 demonstration projects to determine effective 
     methods to measure improvement in the skills and knowledge of 
     health care personnel in pain and symptom management as such 
     skill and knowledge applies to providing services to chronic 
     pain patients and those patients requiring pain and symptom 
     management at the end of life.
       (b) Evaluation.--Projects established under subsection (a) 
     shall be evaluated to determine patient and caregiver 
     knowledge and attitudes toward pain and symptom management.
       (c) Application.--To be eligible to receive a grant under 
     subsection (a), an entity shall prepare and submit to the 
     Secretary an application at such time, in such manner and 
     containing such information as the Secretary may require.
       (d) Termination.--A project established under subsection 
     (a) shall terminate after the expiration of the 2-year period 
     beginning on the date on which such project was established.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section.

  The CHAIRMAN pro tempore. Pursuant to House Resolution 339, the 
gentlewoman from Connecticut (Mrs. Johnson) and a Member opposed will 
each control 20 minutes.
  The Chair recognizes the gentlewoman from Connecticut (Mrs. Johnson).
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I rise to speak in strong 
support of aggressive pain management and palliative care. We need the 
opportunity to oppose physician-assisted suicide and advance the cause 
of pain management without having to support an aggressive new Federal 
role in the practice of medicine.
  In the next several years, we will see tremendous growth of the 
elderly population. As we advance medical science to prolong life, we 
must also do all we can to make people's final months and days pain 
free. Too many patients with terminal illness and chronic conditions 
suffer extreme pain without receiving adequate treatment or even 
knowing the treatment options. Because acute prolonged pain is a 
significant cause of people seeking to end their lives, the substitute 
strikes at a major cause of suicide in an effective and progressive 
way.
  Our substitute amendment clearly opposes physician-assisted suicide. 
But it would also eliminate the need for such extreme measures by 
advancing

[[Page 27094]]

the science of pain management and making it more available to 
patients.
  Our substitute would help broaden access to palliative care through 
the creation of family support networks and outreach programs. It would 
also help disseminate information to patients, their families, and 
physicians through a centralized health and human services Web site 
specific to pain management and far more accessible information than 
the existing Web site.
  It would also help develop the science of pain management and advance 
the state of medical practice at the patient's bed side. It would train 
and educate physicians at the local level through the use of peer 
review organizations and direct the National Institutes of Health to 
convene a conference to put new developments in pain research into 
practice and the health care system.
  It would create an 11-member advisory committee to coordinate efforts 
within the Federal Government to make recommendations about additional 
research needs, practice guidelines, and other areas of pain management 
practice.
  Finally, the amendment would instruct the Surgeon General to issue a 
report on the legal and regulatory barriers to pain management, the 
level of competence in treating pain by physicians around the country, 
the amount and quality of training received by medical students and 
residents, and other issues relating to pain management.
  I deeply respect the opposition to physician-assisted suicide of the 
gentleman from Illinois (Chairman Hyde). Congress has already stated 
its opposition when it overwhelmingly passed legislation to ban Federal 
funds and Federal health programs from funding assisted suicide.
  Most States, including my home State of Connecticut, ban assisted 
suicide, prohibit it as a matter of State law and as a matter of 
medical practice.
  Our substitute reflects the will of Congress in its clear language 
opposing assisted suicide, but it goes beyond that to strike at one of 
the most significant reasons people feel that suicide is the only 
answer: the sheer desperation and hopelessness that severe pain causes.
  Our amendment would address this desperation by promoting the 
development of pain management, advancing physician knowledge, and 
increasing patient expectations that their pain should be properly 
managed.
  In contrast, the underlying bill would discourage physicians from 
prescribing appropriate pain medications. I have a long list of quotes 
from physicians that demonstrates what a chilling effect this bill 
would have on current practice.
  This is why I have been trying to intervene when my colleagues were 
saying we do not change the law, because we do change the law, it will 
have a chilling effect on the willingness of physicians to deliver pain 
relief care. For the first time, under the Hyde language, DEA agents 
would be required to judge retroactively the intent of a prescribing 
physician. With little or no medical training, agents would have to 
judge if a physician intended to relieve pain even at the risk of death 
or intended to ``hasten death.''
  Now, remember, Mr. Chairman, there is always a risk of death when 
prescribing controlled substances for extreme pain suffered by very ill 
patients. Patients build up resistance to medications and require 
stronger doses for relief. As a result, there is nearly always a risk 
of death to the patient.
  How is a DEA agent to judge whether the stronger dose was 
appropriate, though it risked death, which is legal under the Hyde 
language, or it was not appropriate because it hastened death? Does 
this House want to delegate to nonmedical professionals that kind of 
authority? Do we want the Federal Government writing regulations to 
implement this section of law?
  Pain management is a developing science and each terminal case has 
its own tragic reality. Under current practice, the DEA already has 
clear regulatory authority over physicians who are illegally 
trafficking drugs and misused controlled substances.
  On matters involving questions of medical judgment, however, the DEA 
defers to the State health agencies and State medical boards which have 
historically governed the scope and standards of medical practice.
  Why would we want to change this? Why would we ask DEA agents to 
judge the intention of physicians managing extreme pain in very sick 
patients?
  Ironically, a few weeks ago, this body passed legislation to prevent 
insurance companies from the second guessing of physicians. We should 
not now require DEA agents to second-guess physicians.
  I urge my colleagues to support the substitute amendment that 
addresses the desperation and hopelessness of suffering severe pain by 
developing the science of pain management, advancing physician 
knowledge, and increasing patient expectation and access to proper pain 
management. I urge support of my amendment.
  Mr. Chairman, I reserve the balance of my time.
  The CHAIRMAN pro tempore. For what purpose does the gentleman from 
Oklahoma (Mr. Coburn) rise?
  Mr. COBURN. Mr. Chairman, I rise in opposition to the amendment in 
the nature of a substitute.
  The CHAIRMAN pro tempore. The gentleman from Oklahoma (Mr. Coburn) is 
recognized for 20 minutes.
  Mr. COBURN. Mr. Chairman, I yield myself 15 seconds so that I might 
respond.
  The gentlewoman from Connecticut (Mrs. Johnson) might not recognize 
that every narcotic prescription that I write today, when it is 
reviewed and surveyed and sampled, a DEA agent makes a decision whether 
or not my judgment was appropriate in that. If there is any question, 
they are in my office looking at my medical records. So the statement 
to say we do not allow them judgment today is wrong.
  Mr. Chairman, I yield 8 minutes to the gentleman from Kansas (Mr. 
Tiahrt).
  Mr. TIAHRT. Mr. Chairman, I thank the gentleman from Oklahoma for 
yielding me this time.
  Mr. Chairman, much of the debate surrounding the Pain Relief 
Promotion Act focuses on whether it is more likely to have a positive 
or a negative impact on those who suffer from severe and continuing 
pain. I believe the experience in my own State of Kansas can shed 
important light on this question.
  Major medical organizations, including the American Academy of Pain 
Management, the American Society of Anesthesiologists, and the American 
Medical Association say the bill will live up to its title. They 
emphasize that, for the first time, the bill writes into the Controlled 
Substances Act protection for physicians who prescribe the large doses 
of drugs sometimes necessary to manage intractable pain, even when it 
may increase the risk of death, so long as the drugs are not prescribed 
intentionally for the purpose of assisting suicide or euthanasia.
  However, a dissident group of State medical societies and some other 
medical organizations predict that this very provision will lead some 
physicians to hesitate to prescribe needed drugs, fearing that their 
intentions may be subject to question by the Drug Enforcement Agency, 
or the DEA.
  Fortunately, there is evidence from a number of States against which 
we can test these competing predictions. In the period from 1993 
through 1998, Kansas and four other States enacted new laws similar in 
effect to the disputed provision in the Pain Relief Promotion Act.
  Like H.R. 2260, these State laws have combined a provision 
specifically protecting doctors who prescribe medications for pain 
relief with provisions preventing their use for purpose of assisting 
suicide or euthanasia. Let us look at what happened at the drug 
prescriptions following enactment of these laws.
  Let us begin with my own State of Kansas. The bill preventing 
assisted suicide was enacted in our State legislature in 1993 while I 
served in the State Senate. Did that cause doctors to be less likely to 
prescribe high doses? Look at the chart here. Per capita

[[Page 27095]]

morphine usage increased a little bit for a couple of years, then in 
1996, began to rise dramatically. In 1998, the law on assisting suicide 
was strengthened. At the same time, language specifically protecting 
prescriptions for pain relief was added.
  It read: ``A licensed health care professional who administers, 
prescribes, or dispenses medications or procedures to relieve another 
person's pain or discomfort, even if the medication or procedure may 
hasten or increase the risk of death, does not violate this law unless 
the medications or procedures are knowingly administered, prescribed, 
or dispensed with the intent to cause death.'' That is very close, 
indeed, to the language of the Pain Relief Promotion Act.
  What happened to the prescriptions for pain killing drugs? Based on 
the figures for the first half of 1999, per capita use of morphine rose 
22 percent in Kansas. The experience has been replicated in State after 
State after State.
  Let us look at a chart for Kentucky. In June of 1994, Kentucky passed 
a law banning assisted suicide, but specifically allowing pain control 
that may unintentionally risk death. That year, per capita use of 
morphine increased. While there was a little dip in 1995, usage was 
still higher than either of the 2 years before the law passed. Since 
then, morphine usage per capita has increased over 2,200 grams for 
every 100,000 people in 1997 and 1998, and projected from half-year 
figures in 1999.
  Next is Iowa. In 1996, Iowa enacted legislation against assisted 
suicide. The law included language to protect prescriptions for pain 
relief very similar to that of Kansas and the Pain Relief Promotion 
Act.
  What happened? Again, let us look at the chart. Before the bill, 
prescriptions of morphine per 100,000 people were almost flat, ranging 
from 935 to 1,100 grams. With the bill's enactment, the amount of 
morphine used in prescription soared. By 1997, it had almost doubled.
  Next a chart for Louisiana. In 1995, Louisiana passed a law 
preventing assisted suicide which stated that it did not apply to 
prescribing medication if the intent is to relieve the patient's pain 
or suffering and not to cause death. As the chart dramatically shows, 
in the 4 years preceding the law's effective date, the use of morphine 
was below 1,000 grams per 100,000 people. In the 4 years since, it has 
soared. So that, in the first half of this year, it has stood at 3,659 
grams per 100,000 people.
  Michigan, the home of Jack Kevorkian is next. That chart shows a 
checkered history of the laws on assisted suicide in their State 
compared with morphine usage per capita. As my colleagues can see, 
there is certainly no downward effect on morphine usage associated with 
the periods the ban was in effect.

                              {time}  1330

  Since a permanent statutory ban, which includes language like that in 
H.R. 2260 promoting pain relief, went into effect in 1998, the trend of 
morphine usage has been steadily upward.
  Rhode Island. Now we will look at this particularly interesting case 
because the Rhode Island Medical Society is opposing the Pain Relief 
Promotion Act, saying that preventing the use of drugs to assist 
suicide will chill prescriptions for pain control.
  In 1996, the organization made the same argument against an assisted-
suicide bill in the State legislature that passed despite its 
opposition. That Rhode Island law included the following language: ``A 
licensed health care professional who administers, prescribes, or 
dispenses medications or procedures to relieve another person's pain or 
discomfort, even if the medication or procedure may hasten or increase 
the risk of death, does not violate the provisions of this chapter, 
unless the medications or procedures are knowingly administered, 
prescribed, or dispensed to cause death.''
  Again, this is quite similar to the language of the Pain Relief 
Promotion Act.
  What happened? As my colleagues can see from the chart, per capita 
prescriptions of morphine shot up to almost double the highest pre-law 
rate. Since then they have dropped off a little bit, but remaining far 
above the pre-law rate.
  Next is Tennessee. In July, 1993, a law with language very much like 
the Pain Relief Promotion Act was enacted. Morphine usage that year and 
the next year was up from the year before. In 1995, there was a dip, 
but morphine usage per capita was still greater than that of the year 
before the law. Since then it has continued up.
  Virginia. Briefly let us look at Virginia. In the spring of 1997, the 
Virginia legislature passed a measure to prevent assisting suicide, 
which went into effect after reaffirming the vote in the spring of 
1998. That law contained language differentiating between the intent to 
relieve pain, even with the risk of death, and the intent to cause 
death, just like the Pain Relief Promotion Act.
  The result is clear on the chart. Per capita use of morphine has not 
been deterred. In fact, it went up.
  Finally, some of my friends from Oregon make the argument that 
passing the law legalizing assisted suicide in some cases has freed 
doctors to provide needed higher doses to accomplish pain relief. But 
let us look at the Oregon chart.
  True, morphine use per capita has increased in Oregon, but virtually 
all of that increased while the suicide law was not yet in effect, 
because it had been enjoined by a court order. That means the increase 
occurred while physicians remained subject to investigation and 
revocation of their DEA registration if they used federally controlled 
drugs to assist any suicide. Clearly, that did not deter Oregon doctors 
from significantly increasing their prescriptions for the pain killing 
morphine.
  Remember, other than Oregon, all of these States' new laws 
distinguish between the intent to alleviate pain and cause death. 
Because of experiences in Kansas and other States, we can be confident 
that a vote for H.R. 2260 will promote and not threaten improved pain 
relief. I urge a vote of passage and opposition to any substitute or 
amendments.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, may I inquire as to how 
much time I have remaining?
  The CHAIRMAN pro tempore (Mr. HASTINGS of Washington). The 
gentlewoman from New Jersey (Mrs. Johnson) has 13 minutes remaining, 
and the gentleman from Oklahoma (Mr. Coburn) has 11\3/4\ minutes 
remaining.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 3 minutes to the 
gentleman from Oregon (Mr. Walden).
  Mr. WALDEN. Mr. Chairman, I rise today in opposition to the Pain 
Relief Promotion Act and in support of the Johnson-DeFazio amendments.
  I share many of my colleagues' discomfort with the issue of assisted 
suicide, and I certainly respect the desire of the gentleman from 
Illinois (Mr. Hyde) to improve palliative care and to ensure that the 
seriously ill receive safe, quality, and effective pain management.
  However, I also support States rights. The people of Oregon, not once 
but twice, through long and through thoroughly debated ballot measure 
campaigns, affirmed their desire to allow terminally ill people to seek 
help from their physicians in ending their lives. For most Oregonians, 
deciding on how to vote on this issue was a deeply personal and moral 
process. I know, because I too agonized over how to vote on this 
measure.
  I agonized as a father, who watched the life drain from a young son, 
and who watched as cancer worked its wicked will on a mother. I voted 
against assisted suicide when it was on the ballot because I personally 
have serious moral misgivings for it. But I also have a deep respect 
for the underpinnings of our democracy in our State and our country, 
and I respect the right of the initiative and the referendum process.
  Oregon voters are probably the only ones that have voted both through 
the initiative and the referendum process to stand up for what they 
felt was right for their loved ones and for their lives. Now, more than 
2500 miles away, a Congress, foreign to many in my State, wants to 
overturn their will, wants to make that very personal decision for 
them.

[[Page 27096]]

  I have to tell my colleagues that in the year that I was out 
campaigning for this very office there were many times people came up 
to me and said, ``Are you going to go back there and undo what we 
did?'' Not on this issue, but on others. Do my colleagues realize how 
cynical people are about how they act at the ballot box, only to have 
some level of government higher or the Judiciary overturn what they 
seek to do?
  So, Mr. Chairman, I stand here today in support of this amendment and 
of the DeFazio amendment. And I want to close with a quote from Time 
magazine from a cancer specialist, Dr. Nancy Crumpacker, who said, ``If 
this bill is passed, doctors will never again be able to treat 
suffering people without the fear of punishment.''
  I do not want them to have to operate under the fear of that kind of 
punishment. I want this decision, a very personal decision, to remain 
the way it has been crafted very carefully, not only by Oregon voters 
but by their legislature as well, so that it is between the terminally 
ill person, witnessed in that person's physician. So I support the 
amendments to this legislation.
  Mr. COBURN. Mr. Chairman, I yield myself 15 seconds, and I want to 
quote Herbert Hinden, Professor of Psychiatry at New York Medical 
College.
  ``The proposed law provides protection for physicians who prescribe 
medication with the intention of relieving pain, even if that 
medication has the secondary effect of causing death.''
  Mr. Chairman, I yield 2\1/2\ minutes to the gentleman from Alabama 
(Mr. Bachus).
  Mr. BACHUS. Mr. Chairman, what we are talking about here is the 
relationship between a doctor and a patient. Most of these patients are 
dying patients, at least that is what we assume.
  These people are at their weakest, they are at their most vulnerable, 
their complete trust, in fact, their life is in the hands of their 
doctor. They have every right to expect that their doctor is going to 
be a healer and not a killer; that their doctor is not going to seek a 
quick fix. Doctors have the right to prescribe very useful, very 
strong, very powerful drugs to alleviate pain. But to alleviate pain, 
not to eliminate patients. It is to eliminate pain.
  We, in this country, believe in the sanctity of human life. I can 
remember my grandmother, very ill in the hospital. I can remember the 
doctor telling us she would not live through the night. She did live 
through the night. She came home and she spent 3 more years with my 
grandfather, and they were productive years. She was not confined to a 
wheelchair, she was not confined to a bed.
  Now, this bill has been misrepresented. I want to commend the 
gentleman from Illinois (Mr. Hyde) and I want commend the gentleman 
from Florida (Mr. Canady) for bringing this bill.
  Once again let me repeat what this bill does allow doctors to do. And 
let me say this, doctors support this bill. The American Medical 
Association has endorsed this bill. The organization that cares for 
these dying patients and knows more about them, the American Hospice 
Organization, has endorsed this bill. Americans support this bill by 
more than two to one.
  This bill allows physicians to do their job effectively and 
compassionately. Those with terminal illnesses often find themselves in 
terrible pain, and under current laws many doctors do not have the 
ability to help those sickest patients. Under this legislation, and it 
clearly states this, that alleviating pain or discomfort is a 
legitimate medical purpose consistent with public health and safety, 
even if the use of such substance may increase the risk of death.''
  This bill allows doctors to effectively prescribe medication to 
control pain of patients and to improve their last few days of life, 
but at the same time ensures to all of us that they will be healers and 
that they will conform to their ethical code never to kill, only to 
cure.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 1 minute to the 
gentleman from Maryland (Mr. Hoyer).
  Mr. HOYER. Mr. Chairman, I thank the gentlewoman for yielding me this 
time. I want to associate myself with the remarks of the gentleman from 
Oregon (Mr. Walden).
  Like the gentleman from Oregon, I too have watched a loved one die of 
cancer. I did not want her to commit suicide nor be put to death. I 
wanted her to be healed, as the previous speaker has said, and I 
believe all the doctors that dealt with her wanted to do that. But 
anybody who has gone through that experience, I think, is convicted of 
the fact that they want the doctor to have the latitude to use such 
means and devices as in the doctor's judgment is best to relieve that 
patient from the agony of death.
  I will vote for this substitute and urge the adoption of this 
substitute because I believe it gives that latitude. It states as a 
policy that we are against assisted suicide, but it also goes on to 
train and to offer counseling and education in this very difficult time 
for families and individuals.
  Mr. Chairman, I rise today in support of the Rothman-Johnson-Maloney-
Hooley ``Conquering Pain Substitute'' to H.R. 2260--``The Pain Relief 
Promotion Act.''
  Assisted suicide remains a divisive issue around the nation. For 
young and old alike who suffer from terminal illness, finding a way to 
ease excruciating pain is a complex and difficult task.
  The ``Conquering Pain Substitute'' provides a viable alternative to 
the ```Pain Relief Promotion Act.''
  Not only does it express this body's opposition to assisted suicide, 
but it implements a variety of programs to provide information on pain 
management and learn more about the importance of controlled substances 
in treating the seriously and terminally ill.
  The ``Conquering Pain Substitute'' puts more emphasis into research 
and insuring that health professions have the information they need in 
making pain management decisions.
  The substitute expands access to pain management by establishing 
family support networks, a pain guidelines web-site, and insures that 
all Medicare recipients are informed of their insurance coverage of 
pain treatment.
  The bill also calls for a report by the Surgeon General on legal and 
regulatory barriers to pain management as well as establishing an 
advisory committee on pain to coordinate efforts to the Federal 
Government.
  This substitute provides a sensible approach to a difficult and 
emotional issue and I hope my fellow colleagues will join me in 
supporting it.
  From time to time a few egregious cases, like assisted suicide, lead 
us to adopt legislation with broad implications and possible unintended 
consequences.
  However, if the substitute fails, I will vote for final passage of 
H.R. 2260.
  Representatives Hyde and Stupak have made a concerted effort to win 
wide-spread support of their bill including support by the American 
Medical Association, and the National Hospice Association. This bill is 
far superior to the Lethal Drug Abuse Prevention Act that was 
introduced in the 105th Congress.
  Once again I urge my colleagues to support the ``Conquering Pain 
Substitute''
  Mr. COBURN. Mr. Chairman, I yield 2\1/2\ minutes to the gentlewoman 
from New Jersey (Mrs. Roukema).
  Mrs. ROUKEMA. Mr. Chairman, I thank the gentleman for yielding me 
this time, and I rise here today in the first place because I have been 
wrongly identified as a supporter of the substitute, and secondly I 
rise in support of the base bill.
  But I also wanted to tell my colleagues, that I, too, like the 
gentleman from Maryland (Mr. Hoyer), have had to care for terminally 
ill members of my family as both a daughter and a mother. I cared for 
my father at my home during his last weeks as a prostate cancer patient 
and for my own son, Todd whom I lost to leukemia, and I cared for him. 
Sincerely and seriously, I address this issue from the memories of the 
trauma--physical and mental that my loved ones endured.
  I have to tell my colleagues that originally I was too focused on 
only the palliative care questions because the issues had been 
misrepresented to me. And as I investigated, both with the Justice 
Department and with the AMA as to their reasons for supporting these 
portions of the bill, I learned that absolutely this does not interfere 
with the doctor-patient relationship.
  I want to read from the October 19 letter that the Justice Department 
wrote to the gentleman from Illinois (Mr. Hyde), and I want to be 
specific

[[Page 27097]]

about this because there is a lot of rhetoric around here and we are 
talking about legal questions. The Department of Justice fully supports 
these measures. ``H.R. 2260 would eliminate any ambiguity about the 
legality of using controlled substances to alleviate the pain and 
suffering of the terminally ill,'' and I want to emphasize this, 
because they go on to say, ``by reducing any perceived threat of 
administrative and criminal sanctions in this context.'' That gives me 
the assurance that I believe I need.
  Further on, they go on to other questions. But, clearly, the 
palliative care and the protection of the physician's professional 
actions are there.

                              {time}  1345

  But, in addition, I questioned at length, the AMA. At first I called 
the AMA with deep concern about their support for the bill. And then 
after discussing with the AMA, they sent me documentation as to their 
reasons for support.
  Because I am the wife of a doctor and I have had all kinds of 
contacts with medical provisions, and they specifically explicitly 
state in black and white that the addition of language explicitly 
acknowledging the medical legitimacy of the double effect in the CSA 
provides a new and important statutory protection for the physicians 
prescribing controlled substances for pain, particularly for patients 
at the end of life.
  It is unambiguous and the AMA supports this because their previous 
concerns have been addressed quite correctly by the gentleman from 
Illinois (Chairman Hyde) and the committee.
  I strongly support the bill; and oppose the substitute as ambiguous 
and inadequate.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield myself 10 seconds.
  Mr. Chairman, the gentlewoman from New Jersey (Mrs. Roukema) 
described herself as wrongly identified. I would like the Record to 
note that she asked to be a cosponsor of the amendment, voluntarily 
signed ``dear colleagues,'' and was part of a letter to the leadership; 
and while she may have changed her mind, things were not misrepresented 
and she was not wrongly identified. She has merely changed her 
position. And I certainly accept and respect that.
  Mr. Chairman, I yield 1 minute to my colleague, the gentleman from 
Texas (Mr. Green).
  Mr. GREEN of Texas. Mr. Chairman, I oppose assisted suicide. If I had 
the opportunity either as a Member of Congress or in a referendum, I 
would vote to make that illegal. However, I am concerned about the 
unintended consequences that this bill would place on providers and 
patients at risk, as well as preempt State laws that have already 
addressed this issue.
  All of us have had experience with very dear and close family members 
who have died and had to have hospice treatment. In my State of Texas, 
where a physician-assisted suicide is not legal, the definition of 
``intractable pain'' and the rules that govern its treatment are 
carefully worked out and negotiated.
  Over the past years, the Texas Board of State Medical Examiners has 
modified their rules to fine tune them so that they will provide for 
best care for patients without undue interference. Our pain act was 
passed to reassure physicians that they would not have enforcement 
action taken against them if they prescribed a prescription for a 
controlled substance.
  Now I see we have a difference between the AMA and Texas Medical 
Association. Because before this act was passed by the legislature, 
many physicians were consciously undertreating patients because of the 
fear of State disciplinary action. I worried this would happen. That is 
why I stand in support of the Johnson-Rothman-Hooley substitute.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 1\1/2\ minutes to 
my colleague, the gentleman from Texas (Mr. Paul).
  Mr. PAUL. Mr. Chairman, I thank the gentlewoman for yielding me the 
time.
  Mr. Chairman, I rise in support of this amendment. This will improve 
the bill. I am very concerned, as a physician, that this bill will do 
great harm to the practice of medicine. This is micromanaging the 
palliative care of the dying.
  So I strongly support this amendment because it will remove the 
severe penalties and the threats. Physicians are accustomed to 
practicing with lawyers over their shoulders. Now we are going to add 
another DEA agent over our shoulders to watch what we do.
  It is said, well, there is not going to be any change in law. Well, 
if there is not, why the bill? Certainly there is a change in law. This 
bill does not state that it is dealing with euthanasis. It says it is a 
pain relief promotion act.
  Generally speaking, I look at the names of bills and sometimes 
intentionally and sometimes just out of the way things happen here, 
almost always the opposite happens from the bill that we raise up. So I 
would call this the pain promotion act. I really sincerely believe, as 
a physician, that this will not help.
  Too often physicians are intimidated and frightened about giving the 
adequate pain medication that is necessary to relieve pain. This 
amendment will be helpful. This is what we should do. We should not 
intimidate. The idea of dealing with the issue of euthanasis, 
euthanasia is killing. It is murder.
  I am pro-life. I am against abortion. I am absolutely opposed to 
euthanasis. But euthanasis is killing. Under our Constitution, that is 
a State issue, not a congressional issue.
  I strongly urge the passage of this amendment.
  Mr. Chairman, today Congress will take a legislative step which is as 
potentially dangerous to protecting the sanctity of life as was the 
Court's ill-advised Roe versus Wade decision.
  The Pain Relief Promotion Act of 1999, H.R. 2260, would amend Title 
21, United States Code, for the laudable goal of protecting palliative 
care patients from the scourge of ``assisted'' suicide. However, by 
preempting what is the province of States--most of which have already 
enacted laws prohibiting ``assisted suicide''--and expanding its use of 
the Controlled Substances Act to further define what constitutes proper 
medical protocol, the federal government moves yet another step closer 
to both a federal medical bureau and a national police state.
  Our federal government is, constitutionally, a government of limited 
powers. Article one, section eight, enumerates the legislative areas 
for which the U.S. Congress is allowed enact legislation. For every 
other issue, the federal government lacks any authority or consent of 
the governed and only the state governments, their designees, or the 
people in their private market actions enjoy such rights to governance. 
The tenth amendment is brutally clear in stating ``The powers not 
delegated to the United States by the Constitution, nor prohibited by 
it to the States, are reserved to the States respectively, or to the 
people.'' Our nation's history makes clear that the U.S. Constitution 
is a document intended to limit the power of central government. No 
serious reading of historical events surrounding the creation of the 
Constitution could reasonably portray it differently.
  In his first formal complaint to Congress on behalf of the federal 
Judiciary, Chief Justice William H. Rehnquist said ``the trend to 
federalize crimes that have traditionally been handled in state courts 
. . . threatens to change entirely the nature of our federal system.'' 
Rehnquist further criticized Congress for yielding to the political 
pressure to ``appear responsive to every highly publicized societal ill 
or sensational crime.''
  However, Congress does significantly more damage than simply 
threatening physicians with penalties for improper prescription of 
certain drugs--it establishes (albeit illegitimately) the authority to 
dictate the terms of medical practice and, hence, the legality of 
assisted suicide nationwide. Even though the motivation of this 
legislation is clearly to pre-empt the Oregon Statute and may be 
protective of life in this instance, we mustn't forget that the saw (or 
scalpel) cuts both ways. The Roe versus Wade decision--the Court's 
intrusion into rights of states and their previous attempts to protect 
by criminal statute the unborn's right not to be aggressed against--was 
quite clearly less protective of life than the Texas statute it 
obliterated. By assuming the authority to decide for the whole nation 
issues relating to medical practice, palliative care, and assisted 
suicide, the foundation is established for a national assisted suicide 
standard which may not be protective of life when the political winds

[[Page 27098]]

shift and the Medicare system is on the verge of fiscal collapse. Then, 
of course, it will be the federal government's role to make the tough 
choices of medical procedure rationing and for whom the cost of medical 
care doesn't justify life extension. Current law already prohibits 
private physicians from seeing privately funded patients if they've 
treated a Medicaid patient within two years.
  Additionally, this bill empowers the Attorney General to train 
federal, state, and local law enforcement personnel to discern the 
difference between palliative care and euthanasia. Most recently, 
though, it was the Attorney General who specifically exempted the 
physicians of Oregon from certain provisions of Title 21, the very 
Title this legislation intends to augment. Under the tutelage of the 
Attorney General, it would thus become the federal police officer's 
role to determine at which point deaths from pain medication constitute 
assisted suicide.
  To help the health care professionals become familiar with what will 
become the new federal medical standard, the bill also authorizes $24 
million dollars over the next five years for grant programs to health 
education institutions. This is yet another federal action to be found 
nowhere amongst the enumerated powers.
  Like the unborn, protection of the lives of palliative care patients 
is of vital importance. So vitally important, in fact, it must be left 
to the states' criminal justice systems and state medical licensing 
boards. We have seen what a mess results from attempts to federalize 
such an issue. Numerous states have adequately protected both the 
unborn and palliative care patients against assault and murder and done 
so prior to the federal government's unconstitutional sanctioning of 
violence in the Roe versus Wade decision. Unfortunately, H.R. 2260 
ignores the danger of further federalizing that which is properly 
reserved to state governments and, in so doing, ignores the 
Constitution, the bill of rights, and the insights of Chief Justice 
Rehnquist. For these reasons, I must oppose H.R. 2260, The Pain Relief 
Promotion Act of 1999.


                Preferential Motion Offered by Mr. Obey

  Mr. OBEY. Mr. Chairman, I offer a preferential motion.
  The CHAIRMAN pro tempore (Mr. Hastings of Washington). The Clerk will 
report the motion.
  The Clerk read as follows:

       Mr. Obey moves that the Committee do now rise and report 
     the bill back to the House with a recommendation that the 
     enacting clause be stricken out.

  Mr. OBEY. Mr. Chairman, many of us are against assisted suicide. But, 
in my view, in an attempt to get at that problem, this bill is a 
blunder and it pushes us away from added protection for patients.
  I am for the amendment that is being considered. Because what this 
bill does is to say that, when a doctor prescribes pain killing agents, 
the Drug Enforcement Agency could look over the doctor's shoulder and 
threaten that doctor with 20 years in jail.
  That is an outrageous Big Brother intrusion in the doctor-patient 
relationship. Nobody, not government, not religion, not politicians 
have the right to tell any individual how much pain they have to endure 
and how it has to be managed. That is my business and my doctor's 
business. It is not yours or yours or yours or anybody else's.
  Does anybody really believe that today there is too much bias in 
medicine toward relieving pain? If they think that is the case, they 
have not been in many hospital rooms lately.
  The fact is that today incentives are in the opposite direction to 
make doctors so careful that they often will err on the side of not 
enough pain relief. This bill would make that problem worse. That is 
why I am opposed to it, and that is why I support the amendment.
  Mr. COBURN. Mr. Chairman, I seek time in opposition, and I yield to 
the gentleman from Florida (Mr. Canady).
  Mr. CANADY of Florida. Mr. Chairman, I thank the gentleman for 
yielding.
  Mr. Chairman, I want to bring to the attention of the House why we 
are here today, and that is because the Attorney General of the United 
States has made a determination as the Attorney General that physician-
assisted suicide is legitimate medical practice. That is what she 
decided.
  Now, that was a break with tradition. That was a break with the 
policy of the Federal Government. She decided that. And we are here 
today, as the Congress, to express our view legislatively on whether 
she was right or wrong. I submit to the House that she was wrong and 
this House should not endorse the position of the Attorney General that 
physician-assisted suicide is legitimate medical practice.
  That is the real issue before us here today. There has been a lot of 
things talked about, but I want to thank the gentlewoman from New 
Jersey (Mrs. Roukema) for bringing out the fact that the Department of 
Justice has endorsed the provisions of this bill that deal with 
palliative care.
  There have been many things said about those provisions, criticizing 
them and saying they are going to create additional problems. But the 
Department of Justice has written in a letter of October 19 that H.R. 
2260 would eliminate any ambiguity about the legality of using 
controlled substances to alleviate the pain and suffering of the 
terminally ill by reducing any perceived threat of administrative and 
criminal sanctions in this context. The Department, accordingly, 
supports these portions of H.R. 2260 addressing palliative care.
  This is a very important statement coming from the Department of 
Justice, and I think the Members should evaluate some of the attacks 
that have been made on this bill and look at what the Department of 
Justice, which does not support the overall bill, I hasten to add, they 
do not support provisions with respect to the effect on Oregon. That is 
very clear, as well. But palliative care they support.
  I suggest that the Members ask themselves as they consider how they 
are going to vote on this whether we wanted to say that the Federal 
Government will support and encourage assisted suicide or are we going 
to authorize the use of controlled substances for the purpose of 
killing human beings?
  It is the Federal Government that authorizes the use of controlled 
substances. We have a general prohibition on them. But we allow them to 
be utilized in certain circumstances. Is it going to be the position of 
this Federal Government that we will authorize them for the purpose of 
killing human beings? That is the issue that is before us here today, 
will we allow this well-established regulatory scheme governing 
controlled substances to be undermined in that way. It is my view that 
to allow it to be used in that way would be to undermine it.
  Now remember, when a physician authorizes the use of a controlled 
substance, he has to take out a special prescription pad is my 
understanding, a prescription pad that is authorized by the DEA; and on 
that special controlled substance prescription pad, he is going to 
write out a prescription to kill somebody.
  Now, do we want to put in place a mechanism where that sort of thing 
takes place? I do not think so. But we have got to decide today, are we 
going to go on record supporting the decision of the Attorney General 
that this is a legitimate medical practice, or are we going to say no?
  Now, it is very interesting that each of the proponents of the bill 
say they are against physician-assisted suicide. Well, if they are 
against physician-assisted suicide, why do they want to allow a Federal 
regulatory scheme to be utilized in a way that supports and encourages 
it? Why do we want to authorize the use of federally controlled drugs 
for physician-assisted suicide if we are opposed to physician-assisted 
suicide? I think there is a fatal contradiction.
  Mr. HYDE. Mr. Chairman, will the gentleman yield?
  Mr. CANADY of Florida. I yield to the gentleman from Illinois.
  Mr. HYDE. Mr. Chairman, I would like to ask the gentleman from 
Oklahoma (Mr. Coburn) a question.
  Whenever he prescribes a controlled substance, does not the DEA 
review that prescription?
  Mr. COBURN. Mr. Chairman, reclaiming my time, absolutely.
  Mr. HYDE. Mr. Chairman, if the gentleman will continue to yield, now 
did my colleagues hear that? Every time he writes a prescription for a 
controlled substance, the DEA, that horrible gestapo, reviews the 
prescription and the purpose for it.

[[Page 27099]]

  Now, therefore, the DEA has a role to play today as we speak in the 
existing law, and this bill does not change it. It just says to Oregon 
that they are back in with the rest of the 50 States now.
  We do not create a gestapo. We simply say that what exists now will 
continue to exist, but they cannot use controlled substances to execute 
people, however directly or indirectly.
  Mr. CANADY of Florida. Mr. Chairman, the gentleman from Illinois (Mr. 
Hyde) is absolutely correct.
  The CHAIRMAN pro tempore. The question is on the motion offered by 
the gentleman from Wisconsin (Mr. Obey).
  The motion was rejected.
  The CHAIRMAN pro tempore. The Chair would advise that both Members 
have 6\1/2\ minutes remaining in the debate.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 1 minute to the 
gentlewoman from the Virgin Islands (Mrs. Christensen).
  Mrs. CHRISTENSEN. Mr. Chairman, I thank my colleague for yielding.
  Mr. Chairman, we should not support H.R. 2260 in its present form. As 
a physician, I rise in support of the substitute amendment offered by 
my colleagues, the gentlewoman from Connecticut (Mrs. Johnson), the 
gentleman from New Jersey (Mr. Rothman), the gentlewoman from New York 
(Mrs. Maloney), and the gentlewoman from Oregon (Ms. Hooley), which 
tries to lessen the damage that would be done by the underlying bill.
  Mr. Chairman, one would believe that the proponents of this bill 
never have had someone close to them terminally ill, their body taken 
over by cancer and racked with pain. The only thing that families ask 
for at times like these is that the last days of their loved ones be as 
comfortable as possible. And the only thing that we as physicians can 
offer is palliative treatment or pain relief.
  This is not assisted suicide. It is good and caring medical practice. 
What we need to be doing as a Congress, instead of preventing 
physicians from providing the care that a person needs, is to do 
precisely what the amendment asks us to do, allow us to practice our 
healing arts with compassion and also provide for research and training 
to expand our options for palliative care so that our loved ones can 
transition with dignity.
  Mr. Chairman, this bill is misguided and it is one more attempt to 
interfere with the practice of good medicine. Let us pass this 
amendment. I would want my doctor to be able to provide needed pain 
relief if I were terminally ill, and so would my colleagues.

                              {time}  1400

  Mr. COBURN. Mr. Chairman, I yield 1 minute to the gentleman from 
Florida (Mr. Weldon).
  Mr. WELDON of Florida. Mr. Chairman, I rise in opposition to the 
substitute. I would like to make it quite clear to all of my colleagues 
what the substitute does. Both bills have funding and authorization for 
more education for physicians so that they will more aggressively treat 
patients with pain. I think the gentlewoman from Connecticut one-ups 
the authors of the original bill. She has got $19 million in there and 
a website, et cetera. But she very strategically does not have the 
language that addresses what is going on in the State of Oregon, and I 
will again reiterate what I said earlier. When you hold out suicide as 
an option, it is a fraud. You can take care of these patients.
  I practiced treating these people. I took care of them. In proper 
hands you can manage their pain. You can treat their depression. And to 
say that in some cases we cannot handle those things and therefore you 
have to allow them to commit suicide to me is a hoax.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 1 minute to the 
gentleman from Oregon (Mr. Wu).
  Mr. WU. I thank the gentlewoman from Connecticut for yielding me this 
time.
  Mr. Chairman, so much has been said in this debate already. I seek 
not to restate any of that. I ask my fellow Members of the House to do 
one thing and one thing only, and, that is, to read the Oregon statute 
before they vote. Please read the Oregon statute before you vote. There 
are dozens of protections in the statute. They should be fully informed 
about what they vote on today, because this body is about to substitute 
its judgment for the judgment of individuals in small rooms in my home 
State. Please read the statute before you vote.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 1 minute to the 
gentlewoman from New York (Mrs. Maloney).
  Mrs. MALONEY of New York. Mr. Chairman, I rise in support of the 
bipartisan Johnson amendment. This debate today is not about squashing 
the Oregon law 3,000 miles away. It is about whether or not people can 
get appropriate pain relief in our own neighborhoods at home, our 
parents, our friends.
  One of my constituents writes, ``After 5 years and one suicide 
attempt and my doctor saying he could not legally go any higher on my 
pain relief medication, I do not want to live anymore. I want to be 
productive and see my young girl grow up but I really feel I have been 
sentenced to death.''
  I ask my colleagues to consider the lives of people who depend on 
appropriate pain medication to live. It is not our place or 
government's place to come between doctors and their patients and 
potentially criminalize their efforts to ease the suffering of those 
who need help, who need pain relief.
  I urge all of my colleagues to vote for the Johnson substitute and 
against the base bill.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 2 minutes to the 
gentleman from New Jersey (Mr. Rothman).
  Mr. ROTHMAN. Mr. Chairman, first let me correct my colleague and 
friend from New Jersey. On page 3 of the Justice Department's letter to 
the gentleman from Illinois (Mr. Hyde), they say specifically they 
oppose the portion of the bill with regards to the Oregon law. They are 
in favor of the palliative portion but oppose the Oregon portion. That 
is clear.
  Now, let me read from the substitute: ``The purpose of the act is to 
enhance professional education in palliative care and reduce excessive 
regulatory scrutiny in order to mitigate the suffering, pain and 
desperation many sick and dying people face at the end of their lives 
in order to carry out the clear opposition of the Congress to 
physician-assisted suicide.''
  That is the substitute. We are against physician-assisted suicide but 
we want to foster palliative care to the tens of millions of Americans 
suffering chronic, debilitating, horrible pain. Now, the doctors in 
this Chamber, Democrats and Republicans, are on both sides of this 
question. The doctors in the major organizations in the United States 
are on both sides of this question. Most of the nursing organizations 
are for the substitute. Why? Because they know that there is a chilling 
effect, a real one, on doctors in prescribing pain medication if the 
underlying bill is passed and we reject the substitute. If you are 
against the Oregon law, go to the Supreme Court and throw it out. But 
do not affect the ability of tens of millions of Americans to get the 
pain relief that they need. Vote for the substitute that says we are 
against physician-assisted suicide but we want doctors to be able to 
prescribe pain medicine to relieve the pain of people suffering 
horrible, debilitating pain in their last weeks and days of life.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield myself the balance 
of my time. I rise in strong support of my amendment and urge my 
colleagues to support it as well.
  It is far more aggressive in developing the science of pain 
management and advancing physician knowledge of pain management and 
increasing patient expectation of pain management. That is why the 
National Foundation for the Treatment of Pain, the American Pain 
Foundation and many other organizations, including the American Academy 
of Family Physicians, the Society of Critical Care Medicine, the 
Emergency Room Physicians, the Hospice and Palliative Nurses 
Association

[[Page 27100]]

and many others support my amendment. It is also why many State medical 
societies support this in spite of the AMA's stand.
  Furthermore, it is very clear, according to the former counsel of the 
DEA office of the chief counsel, that under current DEA law and policy, 
physicians can prescribe controlled substances for pain management, but 
it is also true that this new bill contradicts the Department of 
Justice's and DEA's findings that the agency should defer to the 
medical community on appropriate standards for providing palliative 
care and that the PRPA would for the first time establish Federal 
criteria in statute to define ``legitimate medical purposes''. This is 
a departure from current law that would prevent deferring to State and 
medical standards and create a conflict with State medical guidelines 
as to the appropriate standard of medical care. It would create 
conflict with State law, conflict with State guidelines, conflict with 
the State agencies that have traditionally implemented this part of the 
DEA statute. It is a significant change in Federal statute, because for 
the first time it requires federal criteria as to what is ``legitimate 
medical purpose'' and requires DEA agents to judge the intent of a 
physician as he administers to a patient suffering acute pain during 
the concluding days of serious illness.
  I urge support of the amendment.
  Mr. COBURN. Mr. Chairman, I yield myself the balance of my time.
  I think three points need to be made. There is well-intended thought 
in the substitute but there are a couple of factual errors. Number one, 
we would not be here if the Attorney General had not said that 
physician-assisted suicide is the legitimate practice of medicine. It 
is not. That is number one.
  Number two is the rules and regulations that the Oregon law put up 
were good. They are intended to make sure the wrong things do not 
happen, to make sure that if in fact somebody helps somebody die, that 
they did that when they are not depressed, when they are not coerced, 
when they are not in a position. But we already have this experiment 
that has been carried out for us in Holland. They have the exact same 
rules.
  I want to quote to Members the testimony before the Committee on 
Commerce. There is a substantial practice of euthanasia now, primarily 
voluntarily, but definitely also not voluntarily. Even 5 years after 
the regulations were established, the majority of cases of euthanasia 
and physician-assisted suicide and almost all cases of nonvoluntary 
euthanasia are not reported, making effective control by the legal 
authorities impossible in Holland.
  In fact, the first publicly reported case of assisted suicide in the 
State of Oregon involved an out-of-State woman who was found to be 
depressed by one doctor that she consulted. Within 3 weeks of 
contacting Compassion in Dying and moving to Oregon, she was dead by 
lethal overdose. Significantly, while two doctors rendered opinions 
against the assisted suicide, including a physician who believed the 
woman was suffering from clinical depression, these opinions were not 
included in the Oregon Health Division Report of the law's first year 
after enactment.
  So we can be well-intentioned. We can try to design it, but the fact 
is there are holes. And the very first case in Oregon slipped through 
the cracks.
  Let me read to Members about what we are going to see in the future, 
and I am not saying this is happening in Oregon today but this is where 
we are going:
  ``Thanks to another `prosecution' of a doctor who euthanized an 
infant, euthanasia, already practiced on adults in the Netherlands, 
will soon openly enter the pediatric ward. Dr. Henk Prins killed a 3-
day-old girl who was born with spina bifida, leg deformities and 
hydrocephaly, which all babies who have spina bifida have. The doctor, 
a gynecologist, not a pediatrician or medical expert in such cases, 
although experts were consulted, was defended. He testified in the 
trial court that he killed the child with her parents' permission 
because of the infant's poor prognosis.''
  I am not saying that is going on right now. And I understand and 
believe the people in opposition to this base bill that they do not 
believe in physician-assisted suicide. But I beg you to open your eyes 
to see where we are going. When abortion was first made legal in this 
country, it was to prevent back alley abortions. The number one reason 
for abortion today is birth control. That was not the intended purpose 
when we said we should allow medical abortions. But where are we? Just 
50 million babies that are not here for birth control. The lazy birth 
control. Have an abortion.
  So think about what can come out of this. There are legitimate 
options in the substitute as far as enhancing the treatment of pain 
control. There is no question. But the fact is this bill will protect 
physicians. My own experience tells me that. My own gut tells me that. 
But most importantly we will not violate the State right of Oregon. If 
Oregon wants to kill somebody not using a Federally controlled drug, 
they have every right to do it. But what we are saying is, if you are 
going to use a Federally controlled product, you do not have that 
right.
  The CHAIRMAN pro tempore (Mr. Ney). The question is on the amendment 
in the nature of a substitute offered by the gentlewoman from 
Connecticut (Mrs. Johnson).
  The question was taken; and the Chairman pro tempore announced that 
the noes appeared to have it.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I demand a recorded vote.
  The CHAIRMAN pro tempore. Pursuant to House Resolution 339, further 
proceedings on the amendment in the nature of a substitute offered by 
the gentlewoman from Connecticut (Mrs. Johnson) will be postponed.


          Sequential Votes Postponed in Committee of the Whole

  The CHAIRMAN pro tempore. Pursuant to House Resolution 339, 
proceedings will now resume on those amendments on which further 
proceedings were postponed in the following order: amendment No. 1 
offered by the gentleman from Virginia (Mr. Scott); amendment No. 2 in 
the nature of a substitute offered by the gentlewoman from Connecticut 
(Mrs. Johnson).
  The Chair will reduce to 5 minutes the time for any electronic vote 
after the first vote in this series.


                  Amendment No. 1 Offered by Mr. Scott

  The CHAIRMAN pro tempore. The pending business is the demand for a 
recorded vote on the amendment offered by the gentleman from Virginia 
(Mr. Scott) on which further proceedings were postponed and on which 
the noes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The CHAIRMAN pro tempore. A recorded vote has been demanded.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 160, 
noes 268, not voting 5, as follows:

                             [Roll No. 542]

                               AYES--160

     Abercrombie
     Ackerman
     Allen
     Andrews
     Baird
     Baldacci
     Baldwin
     Barrett (WI)
     Becerra
     Berkley
     Berman
     Bishop
     Blagojevich
     Blumenauer
     Bonior
     Boucher
     Boyd
     Brady (PA)
     Brown (FL)
     Brown (OH)
     Campbell
     Capps
     Capuano
     Cardin
     Carson
     Castle
     Chenoweth-Hage
     Clay
     Clayton
     Clyburn
     Conyers
     Coyne
     Crowley
     Cummings
     Davis (IL)
     DeFazio
     DeGette
     DeLauro
     Deutsch
     Dicks
     Dixon
     Doggett
     Dooley
     Engel
     Eshoo
     Evans
     Farr
     Fattah
     Filner
     Ford
     Frank (MA)
     Frost
     Gejdenson
     Gephardt
     Gilman
     Gonzalez
     Greenwood
     Gutierrez
     Hastings (FL)
     Hilliard
     Hinchey
     Holt
     Hooley
     Horn
     Hoyer
     Inslee
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson (CT)
     Johnson, E.B.
     Jones (OH)
     Kaptur
     Kennedy
     Kilpatrick
     Kind (WI)
     Kolbe
     Lampson
     Lantos
     Larson
     Lee
     Levin
     Lewis (GA)
     Lofgren
     Lowey
     Luther
     Maloney (NY)
     Markey
     Matsui
     McCarthy (MO)
     McDermott
     McGovern
     McKinney
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Metcalf
     Millender-McDonald
     Miller, George
     Minge
     Mink
     Moore
     Moran (VA)
     Morella
     Nadler

[[Page 27101]]


     Napolitano
     Obey
     Olver
     Owens
     Pallone
     Pastor
     Paul
     Payne
     Pelosi
     Pickett
     Porter
     Rangel
     Reyes
     Rivers
     Rodriguez
     Rohrabacher
     Rothman
     Roybal-Allard
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Scott
     Serrano
     Shays
     Sherman
     Slaughter
     Smith (WA)
     Snyder
     Stabenow
     Stark
     Tanner
     Tauscher
     Thompson (CA)
     Thompson (MS)
     Thurman
     Tierney
     Towns
     Udall (CO)
     Udall (NM)
     Velazquez
     Vento
     Visclosky
     Walden
     Waters
     Watt (NC)
     Waxman
     Weiner
     Wexler
     Wise
     Woolsey
     Wu
     Wynn

                               NOES--268

     Aderholt
     Archer
     Armey
     Bachus
     Baker
     Ballenger
     Barcia
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bass
     Bateman
     Bentsen
     Bereuter
     Berry
     Biggert
     Bilbray
     Bilirakis
     Bliley
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bono
     Borski
     Boswell
     Brady (TX)
     Bryant
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Canady
     Cannon
     Chabot
     Chambliss
     Clement
     Coble
     Coburn
     Collins
     Combest
     Condit
     Cook
     Cooksey
     Costello
     Cox
     Cramer
     Crane
     Cubin
     Cunningham
     Danner
     Davis (FL)
     Davis (VA)
     Deal
     DeLay
     DeMint
     Diaz-Balart
     Dickey
     Dingell
     Doolittle
     Doyle
     Dreier
     Duncan
     Dunn
     Edwards
     Ehlers
     Ehrlich
     Emerson
     English
     Etheridge
     Everett
     Ewing
     Fletcher
     Foley
     Forbes
     Fossella
     Fowler
     Franks (NJ)
     Frelinghuysen
     Gallegly
     Ganske
     Gekas
     Gibbons
     Gilchrest
     Gillmor
     Goode
     Goodlatte
     Goodling
     Gordon
     Goss
     Graham
     Granger
     Green (TX)
     Green (WI)
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hansen
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Herger
     Hill (IN)
     Hill (MT)
     Hilleary
     Hobson
     Hoeffel
     Hoekstra
     Holden
     Hostettler
     Houghton
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Isakson
     Istook
     Jenkins
     John
     Johnson, Sam
     Jones (NC)
     Kanjorski
     Kasich
     Kelly
     Kildee
     King (NY)
     Kingston
     Kleczka
     Klink
     Knollenberg
     Kucinich
     Kuykendall
     LaFalce
     LaHood
     Largent
     Latham
     LaTourette
     Lazio
     Leach
     Lewis (CA)
     Lewis (KY)
     Linder
     Lipinski
     LoBiondo
     Lucas (KY)
     Lucas (OK)
     Maloney (CT)
     Manzullo
     Martinez
     McCarthy (NY)
     McCollum
     McCrery
     McHugh
     McInnis
     McIntosh
     McIntyre
     McKeon
     McNulty
     Mica
     Miller (FL)
     Miller, Gary
     Moakley
     Mollohan
     Moran (KS)
     Murtha
     Myrick
     Neal
     Nethercutt
     Ney
     Northup
     Norwood
     Nussle
     Oberstar
     Ortiz
     Ose
     Oxley
     Packard
     Pascrell
     Pease
     Peterson (MN)
     Peterson (PA)
     Petri
     Phelps
     Pickering
     Pitts
     Pombo
     Pomeroy
     Portman
     Price (NC)
     Pryce (OH)
     Quinn
     Radanovich
     Rahall
     Ramstad
     Regula
     Reynolds
     Riley
     Roemer
     Rogan
     Rogers
     Ros-Lehtinen
     Roukema
     Royce
     Ryan (WI)
     Ryun (KS)
     Salmon
     Sanford
     Saxton
     Schaffer
     Schakowsky
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Sherwood
     Shimkus
     Shows
     Shuster
     Simpson
     Sisisky
     Skeen
     Skelton
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Souder
     Spence
     Spratt
     Stearns
     Stenholm
     Strickland
     Stump
     Stupak
     Sununu
     Sweeney
     Talent
     Tancredo
     Tauzin
     Taylor (MS)
     Taylor (NC)
     Terry
     Thomas
     Thornberry
     Thune
     Tiahrt
     Toomey
     Traficant
     Turner
     Upton
     Vitter
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Weldon (PA)
     Weller
     Weygand
     Whitfield
     Wicker
     Wilson
     Wolf
     Young (AK)
     Young (FL)

                             NOT VOTING--5

     Delahunt
     Hinojosa
     Mascara
     Rush
     Scarborough

                              {time}  1437

  Messrs. TANCREDO, PASCRELL, MARTINEZ, BENTSEN, HALL of Texas, 
BILBRAY, OBERSTAR and Ms. PRYCE of Ohio changed their vote from ``aye'' 
to ``no.''
  Mr. WISE, Mr. BOYD, Ms. JACKSON-LEE of Texas and Ms. SLAUGHTER 
changed their vote from ``no'' to ``aye.''
  So the amendment was rejected.
  The result of the vote was announced as above recorded.


                Announcement by the Chairman Pro Tempore

  The CHAIRMAN pro tempore (Mr. Ney). Pursuant to House Resolution 339, 
the Chair announces that he will reduce to a minimum of 5 minutes the 
period of time within which a vote by electronic device will be taken 
on the additional amendment on which the Chair has postponed further 
proceedings.


 Amendment No. 2 in the Nature of a Substitute Offered by Mrs. Johnson 
                             of connecticut

  The CHAIRMAN pro tempore. The pending business is the demand for a 
recorded vote on Amendment No. 2 in the nature of a substitute offered 
by the gentlewoman from Connecticut (Mrs. Johnson) on which further 
proceedings were postponed and on which the noes prevailed by voice 
vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The CHAIRMAN pro tempore. A recorded vote has been demanded.
  A recorded vote was ordered.
  The CHAIRMAN pro tempore. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 188, 
noes 239, not voting 6, as follows:

                             [Roll No. 543]

                               AYES--188

     Abercrombie
     Ackerman
     Allen
     Andrews
     Baird
     Baldacci
     Baldwin
     Barrett (WI)
     Bass
     Becerra
     Bentsen
     Berkley
     Berman
     Biggert
     Bishop
     Blagojevich
     Blumenauer
     Boehlert
     Bonior
     Boucher
     Boyd
     Brady (PA)
     Brown (FL)
     Brown (OH)
     Campbell
     Capps
     Capuano
     Cardin
     Carson
     Castle
     Clay
     Clayton
     Clyburn
     Condit
     Conyers
     Cooksey
     Coyne
     Cramer
     Crowley
     Cummings
     Davis (IL)
     Davis (VA)
     DeFazio
     DeGette
     DeLauro
     Deutsch
     Dicks
     Dixon
     Doggett
     Dooley
     Edwards
     Ehrlich
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Filner
     Ford
     Frank (MA)
     Frelinghuysen
     Frost
     Gejdenson
     Gephardt
     Gilchrest
     Gilman
     Gonzalez
     Gordon
     Green (TX)
     Greenwood
     Gutierrez
     Hastings (FL)
     Hilliard
     Hinchey
     Holt
     Hooley
     Horn
     Houghton
     Hoyer
     Inslee
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson (CT)
     Johnson, E. B.
     Jones (OH)
     Kaptur
     Kennedy
     Kilpatrick
     Kind (WI)
     Kolbe
     Kuykendall
     Lampson
     Lantos
     Larson
     Lee
     Levin
     Lewis (GA)
     Lofgren
     Lowey
     Luther
     Maloney (CT)
     Maloney (NY)
     Markey
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McDermott
     McGovern
     McKinney
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Metcalf
     Millender-McDonald
     Miller, George
     Minge
     Mink
     Moakley
     Moore
     Moran (VA)
     Morella
     Nadler
     Napolitano
     Neal
     Obey
     Olver
     Owens
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pelosi
     Porter
     Price (NC)
     Rangel
     Reyes
     Rivers
     Rodriguez
     Rohrabacher
     Rothman
     Roybal-Allard
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sanford
     Sawyer
     Scott
     Serrano
     Shaw
     Shays
     Sherman
     Shuster
     Sisisky
     Slaughter
     Smith (WA)
     Snyder
     Spratt
     Stabenow
     Stark
     Strickland
     Tanner
     Tauscher
     Thomas
     Thompson (CA)
     Thompson (MS)
     Thurman
     Tierney
     Towns
     Udall (CO)
     Udall (NM)
     Velazquez
     Vento
     Visclosky
     Walden
     Waters
     Watt (NC)
     Waxman
     Weiner
     Wexler
     Wise
     Woolsey
     Wu
     Wynn

                               NOES--239

     Aderholt
     Archer
     Armey
     Bachus
     Baker
     Ballenger
     Barcia
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bateman
     Bereuter
     Berry
     Bilbray
     Bilirakis
     Bliley
     Blunt
     Boehner
     Bonilla
     Bono
     Borski
     Boswell
     Brady (TX)
     Bryant
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Canady
     Cannon
     Chabot
     Chambliss
     Chenoweth-Hage
     Clement
     Coble
     Coburn
     Collins
     Combest
     Cook
     Costello
     Cox
     Crane
     Cubin
     Cunningham
     Danner
     Davis (FL)
     Deal
     DeLay
     DeMint
     Diaz-Balart
     Dickey
     Dingell
     Doolittle
     Doyle
     Dreier
     Duncan
     Dunn
     Ehlers
     Emerson
     English
     Everett
     Ewing
     Fletcher
     Foley
     Forbes
     Fossella
     Fowler
     Franks (NJ)
     Gallegly
     Ganske
     Gekas
     Gibbons
     Gillmor
     Goode
     Goodlatte
     Goodling
     Goss
     Graham
     Granger
     Green (WI)
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hansen
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Herger
     Hill (IN)
     Hill (MT)
     Hilleary
     Hobson
     Hoeffel
     Hoekstra
     Holden
     Hostettler
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Isakson
     Istook
     Jenkins
     John
     Johnson, Sam
     Jones (NC)
     Kanjorski
     Kasich
     Kelly
     Kildee
     King (NY)
     Kingston
     Kleczka
     Klink
     Knollenberg
     Kucinich

[[Page 27102]]


     LaFalce
     LaHood
     Largent
     Latham
     LaTourette
     Lazio
     Leach
     Lewis (CA)
     Lewis (KY)
     Linder
     Lipinski
     LoBiondo
     Lucas (KY)
     Lucas (OK)
     Manzullo
     Martinez
     McCollum
     McCrery
     McHugh
     McInnis
     McIntosh
     McIntyre
     McKeon
     McNulty
     Mica
     Miller (FL)
     Miller, Gary
     Mollohan
     Moran (KS)
     Murtha
     Myrick
     Nethercutt
     Ney
     Northup
     Norwood
     Nussle
     Oberstar
     Ortiz
     Ose
     Oxley
     Packard
     Pease
     Peterson (MN)
     Peterson (PA)
     Petri
     Phelps
     Pickett
     Pitts
     Pombo
     Pomeroy
     Portman
     Pryce (OH)
     Quinn
     Radanovich
     Rahall
     Ramstad
     Regula
     Reynolds
     Riley
     Roemer
     Rogan
     Rogers
     Ros-Lehtinen
     Roukema
     Royce
     Ryan (WI)
     Ryun (KS)
     Salmon
     Saxton
     Schaffer
     Schakowsky
     Sensenbrenner
     Sessions
     Shadegg
     Sherwood
     Shimkus
     Shows
     Simpson
     Skeen
     Skelton
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Souder
     Spence
     Stearns
     Stenholm
     Stump
     Stupak
     Sununu
     Sweeney
     Talent
     Tancredo
     Tauzin
     Taylor (MS)
     Taylor (NC)
     Terry
     Thornberry
     Thune
     Tiahrt
     Toomey
     Traficant
     Turner
     Upton
     Vitter
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Weldon (PA)
     Weller
     Weygand
     Whitfield
     Wicker
     Wilson
     Wolf
     Young (AK)
     Young (FL)

                             NOT VOTING--6

     Delahunt
     Hinojosa
     Mascara
     Pickering
     Rush
     Scarborough

                              {time}  1449

  Mr. HAYWORTH changed his vote from ``aye'' to ``no.''
  So the amendment in the nature of a substitute was rejected.
  The result of the vote is announced as above recorded.
  Stated against:
  Mr. PICKERING. Mr. Chairman, on rollcall No. 543, I was unavoidably 
detained. Had I been present, I would have voted ``No.''
  The CHAIRMAN pro tempore (Mr. Ney). The question is on the committee 
amendment in the nature of a substitute.
  The committee amendment in the nature of a substitute was agreed to.
  The CHAIRMAN pro tempore. Under the rule, the Committee rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Hobson) having assumed the chair, Mr. Ney, Chairman pro tempore of the 
Committee of the Whole House on the State of the Union, reported that 
that Committee, having had under consideration the bill (H.R. 2260) to 
amend the Controlled Substances Act to promote pain management and 
palliative care without permitting assisted suicide and euthanasia, and 
for other purposes, pursuant to House Resolution 339, he reported the 
bill back to the House with an amendment adopted by the Committee of 
the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  The question is on the committee amendment in the nature of a 
substitute.
  The committee amendment in the nature of a substitute was agreed to.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time and was 
read the third time.


              Motion to Recommit Offered By Mr. Blumenauer

  Mr. BLUMENAUER. Mr. Speaker, I offer a motion to recommit.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. BLUMENAUER. In its present form, Mr. Speaker, I am.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Mr. Blumenauer moves to recommit the bill H.R. 2260 to the 
     Committee on Commerce with instructions to report the same 
     back to the House forthwith with the following amendment:
       Page 3, line 25, before the period insert ``, except a law 
     adopted or confirmed through a State citizen initiative or 
     referendum''.
       Add at the end of title I the following:

     SEC. 103. EXCLUSION OF CRIMINAL LIABILITY.

       No person shall be held criminally liable for any violation 
     of law based on the effect of the amendments made by section 
     101.

  Mr. BLUMENAUER. Mr. Speaker, this motion to recommit is offered on 
behalf of myself, the gentleman from Oregon (Mr. Wu), the gentleman 
from Oregon (Mr. DeFazio), and the gentlewoman from Oregon (Ms. 
Hooley).
  The supporters of this legislation have every right to attempt to ban 
assisted suicide or to promote the pain management in this country. 
Unfortunately, the legislation that we have been offered today is the 
worst of both worlds. It does not just trample on States rights, but it 
most assuredly does so, effectively overturning legislation that has 
been approved, not just once, but twice by the citizens of Oregon.
  In addition, the physicians that I represent in Oregon tell me that, 
regardless of their position on physician-assisted suicide, it will 
make it much, much harder to manage pain, allowing additional second-
guessing of their professional judgments as they seek to meet the needs 
of their patients.
  I sincerely believe that virtually nobody outside this Beltway wants 
to criminalize doctor-patient decisions of this most sensitive manner. 
Tough decisions are made every day in hospitals all across the country, 
withdrawing life support, and sometimes, in instances, withdrawing 
drugs that can, in fact, hasten death.
  There are some tragic cases that involve actual suicide. Outside of 
Oregon, people are often driven to desperate acts alone, seeking to 
insulate their families from the trauma.
  We have heard repeatedly in the course of this discussion that pain 
management is a serious problem around the country. But most often in 
this country, as these decisions are made in quiet, most of America 
looks the other way and ignores the difficulty and the trauma. The 
citizens of Oregon have taken a difficult decision to help deal with 
these end-of-life questions, providing the only framework in the United 
States.
  Those of us who listened to the debate on the floor of this assembly 
heard very eloquent statements by my colleagues about how they arrived 
as individual citizens in making the decision to vote on that measure 
themselves, the eloquence of the gentleman from Oregon (Mr. Walden) 
from Hood River talking about very personal instances that affected his 
family.
  Twice Oregonians have decided this is the way they want to go. 
Despite all the rhetoric about opening the flood gates for physician-
assisted suicide, such has not been the case. There are only 15 cases 
last year in Oregon, and in fact the research suggests and common sense 
would reinforce that when we give people, their families, and their 
physicians control over the situation, they are less likely to take 
desperate and unfortunate action.
  The ironic approach that is taken by the supporters of this 
legislation may actually lead to an increase, if they are successful, 
in suicide in my State but without the framework.
  Mr. Speaker, I strongly urge that Members of this assembly move this 
bill back to committee to strip away the provisions that would 
criminalize the decisions that are made by physicians exercising their 
professional judgment on how best to meet the needs and wishes of their 
patients and the patients' families, and that we would exempt States 
which have, by a vote of their citizens, squarely addressed this issue.
  Mr. Speaker, I yield the balance of my time to the gentlewoman from 
Oregon (Ms. Hooley).
  Ms. HOOLEY of Oregon. Mr. Speaker, I ask for my colleagues' 
recommittal of this bill. What I have heard around this place today are 
a lot of people talking about this group supports it, that group does 
not support it. What we are talking about are real people in every one 
of our districts.
  If that doctor feels a threat of law enforcement, the DEA looking 
over their shoulder, will they give one's friend, one's neighbor, one's 
son or daughter, one's wife, one's husband, will they give them 
adequate pain medication? That is what it is about. It is about whether 
or not we are going to let people that we care about suffer. Please 
recommit.
  The SPEAKER pro tempore. For what purpose does the gentleman from 
Oklahoma (Mr. Coburn) rise?
  Mr. COBURN. Mr. Speaker, I rise in opposition to the motion to 
recommit.
  The SPEAKER pro tempore. The gentleman from Oklahoma (Mr. Coburn) is 
recognized for 5 minutes.

[[Page 27103]]


  Mr. COBURN. Mr. Speaker, this is a difficult issue. End of life 
issues always are. What the people of Oregon have done, they have every 
right to do as long as they follow the laws of the United States that 
do not supersede that.
  The fact is, this bill will not keep Oregon from having physician-
assisted suicide. What it says is they just cannot use federally 
controlled drugs to do that.
  Now, how did we get where we are? The Attorney General of the United 
States decided that physician assisted-suicide as far as Oregon's law 
is concerned is a legitimate practice of medicine.

                              {time}  1500

  I am here to tell my colleagues that that is not a legitimate 
practice of medicine. Matter of fact, even Oregon put great safeguards 
into their bills to make sure that mistakes were not made. Let me read 
to my colleagues what happened with one of the first cases.
  The first publicly reported case of assisted suicide in Oregon 
involved an out-of-state woman who was found to be clinically depressed 
by her doctor. Within 3 weeks of contacting the Compassion in Dying and 
moving to Oregon, she was dead by lethal overdose. Significantly, two 
other doctors had rendered opinions against the assisted suicide, 
including a physician who believed the woman was suffering from a 
clinical depression. These opinions were not included in the Oregon 
Health Division report in the law's first year.
  The fact is with this motion to recommit what we will be saying, if 
we follow it in its essence, is that it is okay for a doctor in Oregon 
to use federally controlled substances to kill a patient, but it is not 
okay to harm them. So what we will see is, if they harm someone, they 
are going to be held liable; but if they kill somebody, they will not.
  I would put forth to the body of the House that we have a wonderful 
example of what happens when a group of people follow this logic, and 
all we have to do is look at Holland. Last year in Holland, a very 
small country, 80 babies were euthanized by their gynecologists. Now, I 
know Oregon does not allow euthanasia of babies, but neither did 
Holland when they first started. The vast majority of people, well over 
2,000 people in Holland, were euthanized against their choice. What is 
in the testimony is the fact that they are incapable in Holland of 
knowing how many people were euthanized against their will.
  I would ask the Members of this body to throw off the false argument 
that we are having the DEA look over the shoulder of doctors. In fact, 
the opposite is true. We have created a safe harbor for doctors that 
says if their intent is to eliminate pain, then they are held without 
liability. We also had charts presented and facts presented that showed 
that in every State that had put in a common-sense approach like this, 
the use of pain controlled medicines, morphine, has dramatically risen 
in helping those who are in the pains of dying with manageable pain. 
And, in fact, we are now moving as a Nation to manage that pain.
  I reject this motion to recommit, and I ask the House to support that 
position.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Hobson). Without objection, the previous 
question is ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The motion to recommit was rejected.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.


                             Recorded Vote

  Mr. CANADY of Florida. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 271, 
noes 156, not voting 6, as follows:

                             [Roll No. 544]

                               AYES--271

     Aderholt
     Andrews
     Archer
     Armey
     Bachus
     Baker
     Baldacci
     Ballenger
     Barcia
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bateman
     Bereuter
     Berry
     Bilbray
     Bilirakis
     Bishop
     Bliley
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bono
     Borski
     Boswell
     Brady (PA)
     Brady (TX)
     Bryant
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Canady
     Cannon
     Chabot
     Chambliss
     Chenoweth-Hage
     Clement
     Coble
     Coburn
     Collins
     Combest
     Cook
     Costello
     Cox
     Cramer
     Crane
     Crowley
     Cubin
     Cunningham
     Danner
     Davis (FL)
     Davis (VA)
     Deal
     DeLay
     DeMint
     Diaz-Balart
     Dickey
     Doolittle
     Doyle
     Dreier
     Duncan
     Dunn
     Ehlers
     Emerson
     English
     Etheridge
     Everett
     Ewing
     Fletcher
     Foley
     Forbes
     Fossella
     Fowler
     Franks (NJ)
     Frelinghuysen
     Gallegly
     Ganske
     Gekas
     Gibbons
     Gillmor
     Gilman
     Goode
     Goodlatte
     Goodling
     Gordon
     Goss
     Graham
     Granger
     Green (TX)
     Green (WI)
     Greenwood
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hansen
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Herger
     Hill (IN)
     Hill (MT)
     Hilleary
     Hobson
     Hoeffel
     Hoekstra
     Holden
     Hostettler
     Houghton
     Hoyer
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Isakson
     Istook
     Jefferson
     Jenkins
     John
     Johnson, Sam
     Jones (NC)
     Kanjorski
     Kasich
     Kelly
     Kildee
     King (NY)
     Kingston
     Kleczka
     Klink
     Knollenberg
     Kucinich
     Kuykendall
     LaFalce
     LaHood
     Lampson
     Largent
     Latham
     LaTourette
     Lazio
     Leach
     Lewis (CA)
     Lewis (KY)
     Linder
     Lipinski
     LoBiondo
     Lucas (KY)
     Lucas (OK)
     Maloney (CT)
     Manzullo
     Martinez
     McCarthy (NY)
     McCollum
     McCrery
     McHugh
     McInnis
     McIntosh
     McIntyre
     McKeon
     McNulty
     Mica
     Miller (FL)
     Miller, Gary
     Moakley
     Mollohan
     Moore
     Moran (KS)
     Murtha
     Myrick
     Neal
     Nethercutt
     Ney
     Northup
     Norwood
     Nussle
     Oberstar
     Ortiz
     Ose
     Oxley
     Packard
     Pascrell
     Pease
     Peterson (MN)
     Peterson (PA)
     Petri
     Phelps
     Pickering
     Pitts
     Pombo
     Pomeroy
     Portman
     Pryce (OH)
     Quinn
     Radanovich
     Rahall
     Ramstad
     Regula
     Reyes
     Reynolds
     Riley
     Roemer
     Rogan
     Rogers
     Ros-Lehtinen
     Roukema
     Royce
     Ryan (WI)
     Ryun (KS)
     Salmon
     Saxton
     Schaffer
     Schakowsky
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Sherwood
     Shimkus
     Shows
     Simpson
     Sisisky
     Skeen
     Skelton
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Souder
     Spence
     Spratt
     Stearns
     Stenholm
     Strickland
     Stupak
     Sununu
     Sweeney
     Talent
     Tancredo
     Tauzin
     Taylor (MS)
     Taylor (NC)
     Terry
     Thomas
     Thornberry
     Thune
     Tiahrt
     Toomey
     Traficant
     Turner
     Upton
     Visclosky
     Vitter
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Weldon (PA)
     Weller
     Weygand
     Whitfield
     Wicker
     Wilson
     Wise
     Wolf
     Wynn
     Young (AK)
     Young (FL)

                               NOES--156

     Abercrombie
     Ackerman
     Allen
     Baird
     Baldwin
     Barrett (WI)
     Bass
     Becerra
     Bentsen
     Berkley
     Berman
     Biggert
     Blagojevich
     Blumenauer
     Bonior
     Boucher
     Boyd
     Brown (FL)
     Brown (OH)
     Campbell
     Capps
     Capuano
     Cardin
     Carson
     Castle
     Clay
     Clayton
     Clyburn
     Condit
     Conyers
     Cooksey
     Coyne
     Cummings
     Davis (IL)
     DeFazio
     DeGette
     DeLauro
     Deutsch
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Edwards
     Ehrlich
     Engel
     Eshoo
     Evans
     Farr
     Fattah
     Filner
     Ford
     Frank (MA)
     Frost
     Gejdenson
     Gephardt
     Gilchrest
     Gonzalez
     Gutierrez
     Hastings (FL)
     Hilliard
     Hinchey
     Holt
     Hooley
     Horn
     Inslee
     Jackson (IL)
     Jackson-Lee (TX)
     Johnson (CT)
     Johnson, E. B.
     Jones (OH)
     Kaptur
     Kilpatrick
     Kind (WI)
     Kolbe
     Lantos
     Larson
     Lee
     Levin
     Lewis (GA)
     Lofgren
     Lowey
     Luther
     Maloney (NY)
     Markey
     Matsui
     McCarthy (MO)
     McDermott
     McGovern
     McKinney
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Metcalf
     Millender-McDonald
     Miller, George
     Minge
     Mink
     Moran (VA)
     Morella
     Nadler
     Napolitano
     Obey
     Olver
     Owens
     Pallone
     Pastor
     Paul
     Payne
     Pelosi
     Pickett
     Porter
     Price (NC)
     Rangel
     Rivers
     Rodriguez
     Rohrabacher
     Rothman
     Roybal-Allard
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sanford
     Sawyer
     Scott
     Serrano
     Shays
     Sherman
     Shuster
     Slaughter
     Smith (WA)
     Snyder
     Stabenow
     Stark

[[Page 27104]]


     Stump
     Tanner
     Tauscher
     Thompson (CA)
     Thompson (MS)
     Thurman
     Tierney
     Towns
     Udall (CO)
     Udall (NM)
     Velazquez
     Vento
     Walden
     Waters
     Watt (NC)
     Waxman
     Weiner
     Wexler
     Woolsey
     Wu

                             NOT VOTING--6

     Delahunt
     Hinojosa
     Kennedy
     Mascara
     Rush
     Scarborough

                              {time}  1519

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________