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A new bill before Congress could prohibit the use of federally controlled drugs for physician-assisted suicide. But critics say the measure would restrict legitimate use of painkillers for terminally ill patients.

The Lethal Drug Abuse Prevention Act of 1998, introduced by Sen. Don Nickles (R-Okla.) and Rep. Henry Hyde (R-Ill.), declares physicians' use of prescription drugs under the Controlled Substances Act for the purpose of assisting suicide is "not a legitimate medical purpose." It also reaffirms the use of drugs for chronic pain relief.

The bill is a response to Attorney General Janet Reno's ruling in June that physician-assisted suicide falls under state jurisdiction. Her comments support Oregon voters' decision last November to legalize assisted suicide (CT, Dec. 8, 1997, p. 64).

Opponents of the measure claim doses of medicine high enough to control pain could also unintentionally cause death, making doctors reluctant to treat pain for fear of losing their federal registration, says Joseph Bailes, president-elect of the American Society of Clinical Oncology. Critics say the bill could increase requests for assisted suicide from patients with unrelieved pain.

"It's the opposite of the truth," says William Petty, a practicing oncologist in Portland, Oregon. "It not only will help prevent abuse; it will help pain control." Once he stops their pain, Petty says, his patients do not want to die: "A request for assisted suicide is really a cry for help for some other problem." Petty, a member of the Christian Medical and Dental Society, sued the state of Oregon to try to halt implementation of the Death with Dignity Act.

William Toffler, a family physician in Portland and national director of Physicians for Compassionate Care, says doctors should be concerned about managed care, not regulatory scrutiny. He is not as concerned about prescribing pain medication as he is about securing the medication from a managed-care system that claims a drug is too expensive. Oregon's managed-care system will fund patients' suicide, Toffler says, but will not pay for some medications to make their pain more manageable.

"What [assisted suicide] is really telling a person is, I don't care if you live or die," Petty says. "That's not the role of a physician." The bill is bottled up in congressional committees and will likely be bumped to the next congressional session.

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October 26 1998, Vol. 42, No. 12