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HOSPICES, OTHERS SUPPORT ANTI-EUTHANASIA BILL AT JUNE 24 HEARING.

Strong support for the positive alternatives to euthanasia fostered by the Pain Relief Promotion Act, together with dire warnings of the consequences of legalized euthanasia, dominated a June 24 hearing on the bill held by the House Judiciary Committee's Subcommittee on the Constitution. H.R. 2260 is sponsored by Judiciary Committee Chairman Henry Hyde (R-Il) and Representative Bart Stupak (D-Mi). The bill, which had 130 other co-sponsors as of July 2, would reverse a ruling by Attorney General Janet Reno that permits the use of federally controlled drugs to assist suicide in any state, such as Oregon, that has legalizes the practice as a matter of state law.

The National Hospice Organization's past chairperson, Samira Beckwith, expressed the NHO's support of the bill which, she said, "affirms the appropriate use of controlled substances to alleviate pain and symptoms [; ...] provides for education of health care professionals and research that will increase the competencies of those providing care [; and ...] will help to break down the barriers that keep people from being able to access hospice care."

"During a recent conversation," Beckwith testified, "a woman talked with me about her mother who lives in our community. Her mother wanted a stash of pills to keep `just in case." She feared the agony she anticipated having to suffer in the final stage of her Parkinson's. After visiting our Hospice House, she told her daughter that she would not need the `stash' after all. She felt safe knowing that she would have the care she needed when her time came."

Beckwith also told the story of a teacher who "was curled in a fetal position when the nurse and social worker went to his home to admit him to hospice service. He talked about his pain and asked for help to end his life. Within hours, his pain was controlled. He spent his final months visiting with friends and family. Good pain control is not difficult. What is difficult is to correct the misunderstandings that exist and make it available to those in

Another leader in the hospice movement, Dr. Walter R. Hunter, associate national medical director of VistaCare Hospice, warned that assisting suicide "cannot and will not be contained to a very small group of `terminally ill' patients as proponents have us believe. The 'safeguards' touted in all debates are paper tigers which have no real meaning in the real world of clinical practice. Additionally, I am of the firm belief that legalization of physician assisted suicide and euthanasia will radically change the nature of the medical profession itself."

He asked, "Would our seeming rush to embrace assisted suicide all but vanish if our citizens truly knew what a comprehensive hospice and palliative plan of care entailed and had it as available as any commonly utilized medical procedure in their communities?"

Dr. Gregory Hamilton, of the Oregon-based Physicians for Compassionate Care, testified that "Assisted suicide and euthanasia inevitably interfere with pain management and palliative care. In Oregon, its rationed health plan for the poor denies payment for 171 needed services while it fully funds assisted suicide."

He added, "Over 38% of Oregon Health Plan members report barriers to obtaining mental health services, yet assisted suicide costs the state as low as $45, according to its own estimates. Oregon insurance companies and health maintenance organizations (HMOs) generally limit two key elements of palliative care -- mental health and hospice care benefits. One Oregon HMO (Qual Med) caps in home palliative care (hospice) at $1,000 while fully funding assisted suicide."

Dr. Hamilton warned that nonvoluntary direct killing is coming to the state. He told the subcommittee of the "Gallant case, in which a Corvallis doctor was found by the Oregon Board of Medical Examiners clearly to have ordered a lethal injection for an elderly woman who did not even request it. Nevertheless, the Eugene district attorney declined to prosecute him, because he did not think he could get a conviction in this state with its official sanctioning of assisted suicide."

Thomas J. Marzen, general counsel of the National Legal Center for the Medically Dependent and Disabled, warned that expansion of such nonvoluntary killing is likely. "[I]f there is no distinction between the use of active means to cause death and forgoing lifesaving treatment, then assisted suicide would be made available not only for competent adults, but also for mentally incapacitated adults and children, he said. "At least thirty-eight states and the District of Columbia impute the authority to order the withholding or withdrawing of life-sustaining medical treatment to surrogates to exercise on behalf of patients unable to make their own treatment decisions."

Marzen noted that, "In state after state, it has been ruled, as did the Washington State Supreme Court, that `[a]n incompetent's right to refuse treatment should be equal to a competent's right to do so." If the right to forgo treatment necessary to sustain life is to be equated with a right to seek a lethal prescription, it follows that lethal drugs may be provided to mentally disabled adults and to children whenever surrogates may refuse lifesaving treatment for them."

He concluded, "Under the same circumstances in which a public guardian or family member might reject use of a respirator or chemotherapy for adults with Alzheimer disease or for children with disabilities, they would also have the authority to order lethal drugs be given to them."

Three witnesses attacked the legislation.

Ann Jackson is executive director of the Oregon Hospice Association and member of a task force that prepared a guidebook to help health providers implement Oregon's law legalizing assisting suicide. She argued that despite the bill's endorsement by groups such as the American Academy of Pain Management, the American Society of Anesthesiologists, the American Medical Association and the National Hospice Organization, the Pain Relief Promotion Act of 1999 "will have a negative impact on pain and symptom management." She particularly objected to the bill's definition of "palliative care" as not including the purpose "to hasten ... death."

Jackson said, "Hastening... the dying process, while not usual, does happen under good palliative care. While palliative care is an evolving specialty, it is so narrowly defined in this bill that the effect will be to put its practitioners into a too rigid box."

David Orentlicher, M.D., J.D., Professor at the Indiana University School of Law-Indianapolis Center for Law and Health and an advocate of legalizing assisting suicide, testified, "This Act most obviously frustrates state experimentation and innovation by overriding Oregon's Death with Dignity Act." He argued that on "complicated matters of social policy" such as euthanasia, "[w]ith local variations, the country can discover the best course of action."

(However, Orentlicher did not comment on the unsuccessful attempt by euthanasia advocates to override the laws of most states so as to impose nationwide legalization of assisting suicide in 1997, by seeking to have it declared a federal constitutional right by the U.S. Supreme Court.)

The "states rights" theme was also sounded by David E. Joranson; director of the Pain & Policy Studies Group at the University of Wisconsin-Madison. Comprehensive Cancer Center. "I think it is extraordinary," he said, "to single out states with controversial policies on important societal issues, issues which are nevertheless within their authority, and then, because there is an (albeit tenuous) relation to the use of controlled substances, amend the [Controlled Substances Act] to contravene the policy of that State."

In contrast, Richard Doerflinger, associate director for policy development at the National Conference of Catholic Bishops Secretariat for Pro-Life Activities, testified, "Nothing in that act indicates that an individual state, by dropping its own state penalties for a form of manslaughter, can convert such killing into a `legitimate medical purpose' for the use of federally controlled drugs within the meaning of the federal Act. Indeed, any 'states' rights' argument on this issue is contradicted by the plain language and intent of the CSA."

Doerflinger added, "Provisions to ensure that narcotics and other dangerous drugs are used solely for a `legitimate medical purpose', and are never used to endanger `public health and safety', have been included in this act and its implementing regulations precisely to establish a uniform federal standard that would not rely on the vagaries of individual state laws."

The Constitution Subcommittee is scheduled to vote on the Pain Relief Promotion Act on July 14, and a vote in the full Judiciary Committee is expected thereafter. The bill will also have to be considered by the Commerce Committee before reaching the House floor. (See Action Alert, page 8.)
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Title Annotation:Pain Relief Promotion Act
Author:Beckwith, Samira
Publication:National Right to Life News
Geographic Code:1USA
Date:Jul 6, 1999
Words:1420
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