ABCD Exchange : January 1999 : On the Hill - EOL Issues

Upfront - Complementary Therapies
President's Letter - Change
QuickScan - News in Brief
Conference Notes - EOL Jails and Prisons
Research - Practice Guidelines
Research - Oregon's Physician Orders for Life-Sustaining Treatment Document
Lunch Bunch - Second Meeting
Arts - Healing by Killing

What's on the Congressional Horizon
by Janet Heald Forlini, J.D.

There is no question that end-of-life care has become a "hot" topic on Capitol Hill. After last session’s "Lethal Drug Abuse Prevention Act (HR 4006, SB 2151)," policymakers from ABCD and other groups have been working to educate legislative staff before Congress reconvenes. Bills 4006/2151 were introduced with the primary intention of putting an end to the practice of physician-assisted suicide (currently legal in Oregon). The bill’s sponsors argued that its passage would also have promoted appropriate pain management; the bill included a section that attempted to legitimize the issue of "double effect," a widely accepted concept. ABCD pointed out the pitfalls of the Lethal Drug Abuse Prevention Act—a sentiment echoed by over 50 other organizations involved in the Coalition to Improve Pain Management. The bills eventually died in both the House and the Senate, leaving many of us energized to come up with a better alternative this coming session.

In November, Senator Ron Wyden (D-OR) convened a hearing on pain management (See December 1998 Exchange) in which experts offered insights on what is needed to improve pain management from clinical, regulatory, personal, and systematic perspectives. Wyden initiated another commendable endeavor when he appointed a task force on end-of-life care last summer. Such proactive efforts can turn the debate in a direction guided by data and measurement rather than one clouded with angry emotions and fears about what the system presently lacks as well as what some see as a necessary option—the right to legalized physician-assisted suicide.

Legislators are likely to turn to the Drug Enforcement Administration to clarify what constitute the present duties of agents are, and where the Department of Justice stands on these controversial questions. Last session’s hearings pointed to the role of state boards in providing oversight of physician practices; this topic deserves more discussion. Legislators may consider strategies to change practices while avoiding significant financial burdens to the system, especially when one considers HCFA’s already strained budget. Legislation that can direct change without calling for significant appropriations to do so will have the greatest appeal for policymakers.

As mentioned in this column in past months, ABCD has a firm position against the legalization of physician-assisted suicide. We will be fighting to introduce well-crafted legislation that builds on the findings of SUPPORT and other studies, as well as the experience of providers and patients, to improve the health care system at large. Let’s work together to make fear of physical pain and debilitation at the end-of-life very rare. Let’s support legislation that would improve provider education, relieve burdens on caregivers and create incentives for federal insurance programs so to encourage comfort care and continuity.

Let’s work hard to ensure that the Congress passes legislation that can make all of us breathe a little easier about facing the ends of our lives!

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This content is provided by Americans for Better Care of the Dying. For more information, visit www.abcd-caring.org.