Tight regulations have long discouraged doctors from prescribing narcotics to control severe pain, even though they're often the only effective measure. (See "No Relief in Sight," January 1997.) The result has been needless suffering. In October, by a vote of 271 to 156, the House of Representatives tried to address this problem by passing the Pain Relief Promotion Act of 1999, a bill that could instead make things worse.
The legislation would amend the Controlled Substances Act to say that "alleviating pain or discomfort in the usual course of professional practice" is a legitimate reason to prescribe a controlled substance, even if the drug "may increase the risk of death." But in response to an Oregon law that authorizes physician-assisted suicide, the bill would also ban the use of controlled substances "for the purpose of causing death."
As David Orentlicher, a physician and professor of law at Indiana University, observed in his testimony against the act, "the line between acceptable palliative care and unacceptable assisted suicide rests solely on the physician's intent. When intent is the critical issue, physicians must–and will–worry that law enforcement officers will see a criminal intent even when none existed."
Since a physician accused of having the wrong intent could not only lose his federal prescription license but also end up in prison, the bill may well make doctors less inclined to treat pain aggressively in patients who are near death–the very opposite of the intended result.