Reality Check on the Pain Relief Promotion Act
Some have said that the proposed Pain Relief Promotion Act could actually have a "chilling effect" on pain control, by putting physicians on notice that they may be legally liable if they "intentionally" cause a patient's death. Consider the following testimonials:
- "If physicians are afraid of prosecution, they will be inhibited from providing adequate pain relief to those patients most in need."
- "It's going to have a very, very chilling effect on physicians' ability to deal with pain relief in terminally ill patients... because they're not going to want to get in a situation where they are charged with hastening a death because they've been aggressive with pain management."
- "I have been an outspoken opponent of physician assisted suicide, but I am concerned about the effects this legislation might have on the care of the terminally ill... I fear that this legislation, if it passes, will simply contribute to the fear that physicians have and will lead to a further deterioration in the symptom relief that patients receive. This could paradoxically increase the demand for physician assisted suicide."
- "This is going to have a chilling effect."
- "When what can and cannot be discussed turns not on the certain and foreseeable outcome of treatment, but on what primary intention is in the mind of the physician, and therefore unknowable, the situation will be hopelessly confused. And in a situation of confusion, we know physicians usually err on the side of avoiding risk. I fear this would have a chilling effect..."
Responsible statements about the possible impact of this misguided federal bill, right?
WRONG.
NONE of these statements was about the Pain Relief Promotion Act. They were said years ago against other state and federal bills opposing assisted suicide. And every one of those laws has demonstrably IMPROVED pain management and palliative care.
The first three statements were made in 1996 against Rhode Island's proposed criminal ban on assisted suicide; they were made, respectively, by the Rhode Island Medical Society's president, the Society's lobbyist, and the medical director of the state's largest hospice. The fourth was made against Maryland's virtually identical ban in 1999 by a doctor who belonged to the Maryland House of Delegates. And the fifth was made in 1997 by Barbara Coombs Lee of Compassion in Dying, testifying against the Assisted Suicide Funding Restriction Act of 1997.
All these laws were enacted despite these objections. (The federal bill passed the Senate 99-to-0.) And in the year following enactment: Rhode Island more than doubled its per capita use of morphine for pain control, leaping from 46th rank among states in morphine use up to 18th in one year; Maryland also increased its morphine use and made other improvements in palliative care; and hospitals covered by the federal ban, such as VA hospitals, made dramatic improvements in pain management and palliative care praised by medical and hospice groups nationwide.
The "chilling effect" argument has been used for years by assisted suicide proponents to try to kill legislation protecting the terminally ill from assisted suicide, because they know that their real arguments in support of assisted suicide will not win the debate. Those same proponents now oppose the Pain Relief Promotion Act, and have traded on physicians' fear of the federal drug laws to give this old discredited argument more impact and broader appeal.
Again, and again, and again, the "chilling effect" argument has been proved false. But that has no effect on its use, because its creators did not frame it to communicate a truth but to scare physicians and legislators away from protective legislation.
The real "chilling effect" on pain control comes from the cynical argument of assisted suicide advocates that killing pain and deliberately killing patients are essentially similar, that neither laws nor doctors can effectively distinguish them, that therefore we must allow
both if we allow either.
The wide array of medical and hospice groups supporting the Pain Relief Promotion Act know this is false. They know that the real threat to optimum pain management comes from the attitude that terminally ill patients' lives do not have the same dignity as others, that assisting their suicides is a "good enough" solution for their problems. If doctors can kill their patients when they are in pain, why bother learning good pain control?
Do not be fooled by opponents' false and cynical claim about a "chilling effect." Help provide terminally ill patients with better pain management AND respect for their inherent dignity. Support the Pain Relief Promotion Act.
References
Statement 1: Testimony to the Rhode Island Senate by Arthur A. Frazzano, M.D., President of the Rhode Island Medical Society, 1996
Statement 2: Rhode Island Medical Society lobbyist Steven DeToy, quoted by
American Medical News, August 12, 1996, page 31.
Statement 3: Letter to Rhode Island State Senators by Edward W. Martin, M.D., Medical Director of Hospice Care of Rhode Island, May 30, 1996.
Statement 4: Maryland delegate Dan Morhaim (D-Baltimore County), quoted by Associated Press, March 29, 1999
Statement 5: Testimony to the House Commerce Subcommittee on Health and Environment by Barbara Coombs Lee, Executive Director of Compassion in Dying, March 6, 1997.