Senator Connie Mack (R-FL) spoke of the contrast between the way his brother, Michael died, and the way his father died twenty years later. Mack told the panel that when his brother died in the late seventies, he was often in severe pain in his final days. But doctors told Mack and his family that they could not provide certain types of pain medication because they feared creating an addiction in the brother, heaping liability concerns on the doctors. In contrast, Mack described his father’s death in 1997, which was in a hospice where he received ‘state-of-the-art pain management treatment.” Mack used the contrast to illustrate that provider education and training can make a significant difference in patients’ comfort at the end of life.
Senators Don Nickles (R-OK) and Ron Wyden (D-OR) also spoke on the panel. Each described the legislation he had recently introduced - Nickles’ Pain Relief Promotion Act and Wyden’s Conquering Pain Act - and why it would help to ensure better relief of pain and other symptoms at the end of life (for details on both bills, see the August/September 1999 issue of Exchange). (The Hyde-Nickles Bill recently passed in the House and, at this writing, is in the Senate.) Each Senator discussed his opinion on physician-assisted suicide and how the two respective bills could play a role in curbing requests for assisted suicide. Finally, Senator Lieberman (D-CT) spoke, echoing Mack’s personal stories of family members in pain at the end of life. Lieberman detailed the data from Oregon after the state’s first year of legalized physician-assisted suicide. Lieberman, in explaining his strong stance against assisted suicide and rationale for supporting the Hyde-Nickles bill, told the panel that analysis of Oregon’s first year of data indicates that several of the individuals who sought assistance may have been driven in part by loneliness and fear of loss of control. Lieberman stated that these conclusions should be viewed as “tears in society” and that legalized assisted suicide was not the answer to this problem. (Of note, however, is a report from the Oregon group, Compassion in Dying, led by Barbara Coombs-Lee, that found that many of the patients who requested physician-assisted suicide were actually in hospice. - Ed)
In addition to the Senate panelists, a second panel of experts and representatives from various organizations also testified. Physicians from the National Hospice Organization and the American Medical Association - the two organizations most vocal about their support of the Pain Relief Promotion Act - testified. An anesthesiologist from Vermont specializing in chronic/cancer pain and the Director of the University of Wisconsin Pain and Policy Studies Group balanced the panel.
When asked what they considered to be the most important issues that Congress could address, all the panelists indicated that health care provider education and training were critical.
The hearing was one step in demonstrating that Congress sees the questions surrounding comfort care for dying Americans as both important and appropriate for federal action. Though the hearing was weighted heavily in its emphasis on the question of physician-assisted suicide - an issue that most members of Congress and organizational representatives would prefer to set aside - the hearing was at least a start. This Congress will soon adjourn; perhaps next year, Congress will allow for a much fuller debate on efforts needed to improve end-of-life care for all Americans.
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