A debate has begun on the application of federal drug laws to assisted suicide — a debate which may result in a new federal law to counter Oregon’s experiment in doctor-assisted death. Last November the Drug Enforcement Administration (DEA) concluded that assisting a suicide is not a “legitimate medical purpose” for the use of federally regulated drugs, and that using such drugs to assist a suicide could cost a physician the federal DEA registration authorizing him or her to prescribe controlled substances.
But on June 5, U. S. attorney general Janet Reno reversed the DEA policy, ruling that the Controlled Substances Act “does not authorize the DEA to prosecute, or to revoke the DEA registration of, a physician who has assisted in a suicide in compliance with Oregon law” [page 4]. The attorney general added that the DEA could act against physicians in states that have not legalized assisted suicide, and even in Oregon when “a physician fails to comply with state procedures in doing so.
By ruling that the DEA would actively help Oregon enforce its policy of authorizing some assisted suicides while forbidding others, Ms. Reno made a congressional response inevitable. On the day of the attorney general’s ruling, Representatives Henry Hyde (R-IL) and James Oberstar (D-MN) introduced H. R. 4006, the Lethal Drug Abuse Prevention Act of 1998. Senator Don Nickles (R-OK), the Assistant Majority Leader of the Senate, introduced a Senate version (S. 2151) four days later.
Both bills would clarify the Controlled Substances Act by stating that a medical practitioner who misuses controlled substances to assist suicides may lose his or her DEA registration. The bills distinguish assisted suicide from legitimate use of drugs for pain management, using language endorsed by the American Medical Association (AMA) last year as part of the Assisted Suicide Funding Restriction Act. A physician investigated by the DEA may demand a hearing before an advisory panel of medical experts, who can advise the DEA on whether his or her actions are consistent with the legitimate purpose of controlling pain.
Despite the sponsors’ commitment to encouraging legitimate use of drugs for pain control, the AMA and some other medical groups oppose the legislation. While reaffirming that assisted suicide is “incompatible with the physician’s role as healer,” the AMA has somewhat confusingly attacked the legislation as a “federal intrusion” into “the practice of medicine. ” It adds that the legislation will have a “chilling effect” on the use of drugs for pain control. The bills have nonetheless moved forward rather quickly.
The House bill has acquired 44 co-sponsors, and the Senate version has 23. On July 14 the House Judiciary Subcommittee on the Constitution held a hearing on the bill; on July 22 it approved amendments to give further protection to legitimate pain control efforts, then approved the bill on a party-line vote of 6-to-5. As of this writing, a markup in full House Judiciary Committee and a hearing in the Senate Judiciary Committee were scheduled to take place before Congress leaves for its August recess.
At the July 14 hearing, several physicians disagreed with the AMA and endorsed H. R. 4006, saying it will prevent misuse of federally regulated drugs to kill patients without infringing on legitimate medical practice. Even Dr. Thomas Reardon of Oregon, testifying for the AMA as its president-elect, conceded that his own “personal view” is the one he expressed last November, when he publicly welcomed the DEA’s policy. Governor Kitzhaber of Oregon urged Congress to allow his state’s carefully crafted law to function — but when asked what the penalties are for violating Oregon’s careful “safeguards” against abuse, he said he was “not aware” of any such penalties.