Pubdate: Mon, 18 Oct 1999 Source: Orange County Register (CA) Copyright: 1999 The Orange County Register Contact: http://www.ocregister.com/ Section: News,page 12 Author: LAURAN NEERGAARD, The Associated Press NEW LAW COULD EASE PAIN-RACKED DEATHS Doctors Are Winning Legislative Protection For Prescribing Powerful Drugs Like Morphine For Severe Pain. WASHINGTON- The man was dying of lung cancer.For a while, morphine controlled his severe chest pain. But eventually, inevitably, the cancer began literally suffocating him. His panic grew as his breathing grew labored. More morphine could relieve that horrible feeling of smothering, but with a risk: It also could further reduce respiration. The doctor gave his patient enough morphine to ease his suffering. Later that day, the man died peacefully, his family at his side. How much pain medication to give terminally ill patients, when the medication itself might hasten death, long has been a quandary. Many doctors are so fearful of being accused of overprescribing narcotics or hastening death that patients suffer. Indeed, a study last year found one in four elderly cancer patients in nursing homes received no treatment for daily pain. That trend is starting to change. At least 15 states recently have passed laws ensuring that doctors' licenses won't be revoked for prescribing powerful controlled substances like morphine for severe pain. The organization that accredits hospitals approved standards in August declaring that all patients have a right to proper pain management. And last month, Oregon's medical board became the first to ever discipline a doctor for undertreating pain. Among the complaints was that the doctor provided only Tylenol for a dying cancer patient's pain. But some doctors fear that legislation pending in Congress could reverse that progress. The controversial legislation would formally declare prescribing controlled substances to alleviate pain a legitimate medical decision even if those drugs increase risk of death. Pain experts praise the protection as a crucial step to improve patient care. But that same bill, the Pain Relief Promotion Act, also enters a minefield, by banning controlled substances for the purpose of physician-assited suicide. Take strong steps to control pain, the bill says, but don't intentionally hasten death. Today, assisted suicide is legal in only one state, Oregon. The federal legislation would essentially overturn Oregon's state law. Many in Oregon say Congress should not, as Sen. Ron Wyden, D-Ore., put it, "throw the votes of our citizens in the trash can." The bill's author, Sen. Don Nicles, R-Okla., counters that the issue is no different from Congress intervening if a state legalized heroin. The average doctor might say, "I should use less controlled substances," worries pain expert Dr. James Rathmell of the University of Vermont."That's not what the legislation is intended to do at all, but how do we prevent it?" One key, Rathmell told a Senate committee this weeks is proper training and oversight of the federal officials who would enforce the law. Lawmakers are struggling with how to ensure that balance. The issue is "one of the most difficult subjects this committee has ever dealt with," said Sen. James Jeffords, R-Vt. Jeffords' Senate health committee is unlikely to have time to vote on the issue this year. The controversy is raising public awareness of proper pain treatment. For the vast majority of terminally ill patients, pain can be controlled. "I would plead for better pain control," Rathmell advised. "Focus their physician's attention on pain being the issue, not preservation of life." Specialists like Rathmell can advise doctors without extensive training in pain treatment. As for that other excuse doctors sometimes use - that narcotics are addictive - research shows that's not a big issue when treating intractable pain especially if someone is weeks or months from death. Rathmell recalled his lung cancer patient: "To see a peaceful death, which is what we're all looking for - it would be a shame not to have helped with that when we know we could. - --- MAP posted-by: Keith Brilhart