Briefly reviewed the [ABCD web] site and especially liked the article by Joanne Lynn, M.D., "Complaints about Hospice: Growing Up or Going Wrong?" In several paragraphs you have synthesized my anger beautifully. I am both passionate about hospice care and currently a vocal critic.
I feel the only way to institute any change at this point is to shake people up - as [a recent] "Doonsebury" indicated - wait till the Baby Boomers start to deal with it.
I wish to praise you, Dr. Lynn, for writing this article. Acknowledging that a problem exists is the first step in addressing the problem.
Michael J. Demoratz, L.C.S.W., C.C.M.
Chilling Effects of Proposed DEA Legislation Will Touch Hundreds of Thousands Each Year
To the Editor:
What many do not understand about the proposed DEA legislation is that the chilling effect ABCD describes on physician prescribing of controlled substances will not be limited to Oregon - the adverse effect will be national. This effect will not be equally distributed - some groups of dying patients will be more adversely affected. The group at greatest risk of getting less narcotics will likely be the group who need them most. It will be those with the greatest suffering who will suffer most from the chilling effects of this Bill.
My guess is that if only small amounts of controlled substances are needed to control symptoms - that these patients will in most cases still get narcotics and sedatives at about the same level they are now (which many studies have previously proven not to be enough). My projection is that those who need dosages in the top 10% or so will be the most adversely affected. These "eyebrow raising cases" will be more likely to have the prescribing doctor's intent questioned.
More than 2 million Americans die each year - if I am right, then 230,000 will die in more distress. Please remind others that only 30,000 people die in Oregon each year and only 5 are known to have used Oregon’s Death with Dignity Act.
Whatever one's stand on assisted suicide (and I and the Center for Ethics in Health Care at the Oregon Health Sciences University remain neutral on the moral issue) this is a bad bill! If Congress wishes to repeal the Oregon Death With Dignity Act, they should do so more directly. Congress should not take the risk that ABCD and so many others working in end-of-life care are right and that many dying persons will be hurt by this Bill, including many who have no interest in physician-assisted suicide and whose only wish is to have their pain controlled.
Susan W. Tolle, M.D.
Director, Center for Ethics in Health Care
Oregon Health Sciences University
e-mail: tolles@ohsu.edu
phone: 503.494.4466