Pubdate: Sun, 24 Mar 2002 Source: San Francisco Examiner (CA) Copyright: 2002 San Francisco Examiner Contact: http://www.examiner.com/ Details: http://www.mapinc.org/media/389 Authors: Steve Heilig and George Susens Note: Steve Heilig works for the S.F. Medical Society and co-editor of the Cambridge Quarterly of Healthcare Ethics. George Susens is past president of the S.F. Medical Society Bookmark: http://www.mapinc.org/ashcroft.htm (Ashcroft, John) Bookmark: http://www.mapinc.org/find?194 (Hutchinson, Asa) UNDER ASHCROFT'S PLAN, MORE PAIN AND NO GAIN Special To The Examiner THE U.S. CONGRESS has declared 2001-2010 the Decade of Pain Control and Research. It is a worthy and overdue focus, as pain control has been a neglected part of health care for many years. Unfortunately and paradoxically, however, another arm of our federal government is proposing to make pain relief harder to obtain. And some major medical organizations are feeling forced into taking legal action against our own attorney general. In 1997, voters in the state of Oregon legalized "physician-assisted dying." Each year since then, a couple dozen patients per year have opted to exercise this last resort. But ever since Oregon's vote, federal politicians and officials vehemently opposed to the practice have attempted to overturn that vote. First they insisted on a revote, which resulted in an even larger majority of the voters supporting assisted dying. Then, last year, they proposed the deceptively-named "Pain Relief Promotion Act" (PRPA), which would have moved the regulation of pain medications from medical boards into the purview of the Drug Enforcement Agency, an organization which admits to no medical expertise and specializes in breaking down doors and intercepting drug shipments on ships and airplanes. The act also proposed a mandatory 20-year minimum sentence for any physician who provided any patient with a lethal dose. THE PRPA was opposed by a broad coalition of medical and legal organizations and was defeated. But now the opponents of Oregon's singular law are back with similar Draconian proposals in the form of a new "directive" by Attorney General John Ashcroft. Once again, federal officials seek to usurp state control of medical practice and turn it over to the DEA, with heightened monitoring of prescriptions and severe penalties, including the revoking of the doctor's license to prescribe, for those who tread into -- or close to -- the murky waters of real or suspected "assisted dying." IT HAS BEEN SHOWN that pain is far too commonly under-treated in this nation, and that one of the reasons for this is the over-scrutiny of prescribing. The kind of regulations proposed have never been demonstrated to reduce the illegal "recreational" use of prescription medications. Recognition of these problems has finally begun to result in a trend towards trusting physicians to do the right thing when prescribing pain and other "scheduled" medications, with only five states -- including California, alas -- still retaining the archaic "triplicate" system for such medications. It may be true that the best way to truly prevent requests for "assisted dying" is to make pain medications as freely available as appropriate and possible. The directive by Ashcroft would change the entire nation's approach in this complex arena to a system that would likely do little to attain the stated goal of preventing and prosecuting "assisted dying" -- but likely would result in many thousands of patients being denied appropriate pain relief. Two well-known experts on care of the dying have recently called the Ashcroft directive "a new and dangerous precedent for all health care professionals." THAT IS WHY the hundreds of doctors who make up the governing body of the California Medical Association -- which, it should be noted, opposes legalization of assisted suicide -- have just voted to take the drastic step of suing our own Attorney General to block his new proposal. It is not a step taken lightly. But, as Oregon governor -- and physician -- John Kitzhaber, lamented, "Given everything the country is going through now, why Ashcroft picked this moment to inject this divisive issue into the public debate is just beyond me." Even those who oppose assisted suicide seem to agree: We don't need to impede pain control for uncounted numbers of suffering patients because of the ideological blinders of a powerful but shortsighted few. - --- MAP posted-by: Jackl