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.
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MAP posted-by: Jackl