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Needless to say, I
am strongly opposed to the below proposed legislation:
Pain Relief
Promotion Act of 1999 (Introduced in Senate)
106th
CONGRESS
1st Session
S. 1272
To amend the Controlled Substances Act to promote pain management and palliative
care without permitting assisted suicide and euthanasia, and for other purposes.
IN THE
SENATE OF THE UNITED STATES
June 23,
1999
Mr. NICKLES (for
himself, Mr. LIEBERMAN, Mr. LOTT, Mr. ABRAHAM, Mr. ALLARD, Mr. BROWNBACK, Mr.
COVERDELL, Mr. HAGEL, Mr. INHOFE, Mr. CRAIG, and Mr. SESSIONS) introduced the
following bill; which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
A BILL
To amend the Controlled Substances Act to promote pain management and palliative
care without permitting assisted suicide and euthanasia, and for other purposes.
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:
`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 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 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 on the date of the
enactment of this Act, whichever occurs later.
Language almost
identical to that found in the Pain Relief Promotion Act has been enacted in ten
states in recent years - and the effect of such language on the use of powerful
pain relief medication such as morphine has been dramatically positive.
There is considerable data from states passing new laws against
assisted suicide since 1992. During this period, ten states passed new laws that
ban intentionally assisting suicide (or that strengthen existing bans),
including language that affirms the use of medications to control pain even when
this may unintentionally increase the risk of death. Data on morphine use from
the Drug Enforcement Administration (DEA) show that per capita use of morphine
always increased in these states afterward, sometimes dramatically so (in Iowa,
Rhode Island and South Dakota, morphine use doubled). The average change in
morphine use in these ten states was an increase of over 50%.
During the same period, four states passed laws against assisted
suicide that did not include language affirming pain control like that found in
the federal Pain Relief Promotion Act. Even here, there is little evidence of a
significant "chilling effect" on morphine use; but per capita use of
morphine tended to stay about the same or to increase only slightly. In these
four states, where new bans on assisted suicide lacked the kind of positive
language on pain control found in the Pain Relief Promotion Act, morphine use
rose by an average of 3%. http://www.123helpme.com/assets/10171.html
Thomas E.
Radecki, M.D., J.D.
www.modern-psychiatry.com Email:
c4tf@hotmail.com |
