c. 1999 Religion News Service

SAN DIEGO _ The American Medical Association is asking for significant changes in a congressional bill targeting physician-assisted suicides in Oregon while affirming its general support of the legislation.

In a voice vote Wednesday (Dec. 8) subject to several interpretations, the AMA’s House of Delegates expressed apprehension about federal investigators interpreting whether deaths are physician-assisted suicides or the unintended consequence of prescribing large doses of pain relievers.

The delegates approved a resolution calling upon AMA leadership to work with other medical organizations to delete parts of proposed legislation establishing federal regulations for pain management and end-of-life care. But the resolution did not specify how a federal law could be enforced without the feds.

The AMA’s continued support of the anti-suicide bill is considered critical for it to become law. In June, the AMA’s board of trustees enthusiastically endorsed the Pain Relief Promotion Act, which was easily passed by the House of Representatives in October.

Now that the AMA House of Delegates has expressed concerns about the bill, it’s unclear how it will fare in the Senate, where the legislation is being championed by Sen. Don Nickles, R-Okla., the assistant majority leader.

Nickles’ office did not respond to requests for comment on the AMA action. But the bill’s chief opponent, Sen. Ron Wyden, D-Ore., said the AMA is sending a powerful message to Congress that it views the legislation as flawed.

“Clearly, the rank-and-file of the AMA are concerned about creating a new `physician police’ trained to second-guess doctors,” said Wyden in a prepared statement. “The AMA is essentially telling Sen. Nickles to go back to the drawing board.”

Richard Kincade, president of the Oregon Medical Association, had a different interpretation. He said the House of Delegates sent a message of concern, but he doubted it would have much practical effect since the delegates rejected a resolution saying the AMA would withdraw support of the bill if changes aren’t made.

“Because there is no teeth in this, they don’t absolutely have to do anything except to work with state associations and national speciality societies to make changes in the law,” said Kincade, who had wanted the AMA to drop all support of the congressional bill.

“My suspicion is that they’ll try to do that, and fail, but that the American Medical Association will continue to support this bill.”

The bill does not mention Oregon by name, but it would have the greatest effect in the state with the nation’s only law permitting physician-assisted suicide. The legislation does not directly overturn the Oregon law, but amends the federal Controlled Substances Act to say a long list of controlled substances such as morphine and various sedatives cannot be used to assist in suicides.

The problem for Oregon physicians is that controlled substances have been the only drugs used to quickly and effectively end the lives of terminally ill people since the law went into effect in 1997. Doctors who violate the Controlled Substances Act can lose their federal prescribing privileges and, in rare cases, be sent to prison for 20 years.

The bill says physicians who unintentionally cause death in an attempt to relieve pain cannot be punished. But someone has to decide if a death is intentional or unintentional, and physicians are leery of the federal Drug Enforcement Agency.

“They really fear the power and clout of the federal government in any sense,” said AMA President Thomas Reardon, a Portland, Ore., physician who has lobbied for the congressional legislation. “That’s understandable. You don’t want the IRS in your office or home. You don’t want the FBI in your office or home. We don’t want the DEA in our medical offices.”

Reardon said the concern does not necessarily gut the bill, and he expressed hope the AMA and Nickles could work out a solution that addresses physicians’ concerns about the Drug Enforcement Agency.

“There are different ways of doing this,” said Reardon. “It could be the state licensing board. It could be a committee from the state medical society. But we’re not going to get the DEA totally out of this.

“But what we would want is that any review of a physician would be done by his peers.”

Kincade suggested that state boards of medical examiners could take on the role of determining if a death was an assisted suicide or the unintended consequence of pain relief. That might work in some places, but it would put the board in Oregon in the awkward position of mediating a federal law discouraging assisted suicides in a state where state law permits it.

Mark Gibson, a spokesman for Oregon Gov. John Kitzhaber, said Kitzhaber would continue to oppose any federal effort to circumvent the Oregon Death With Dignity Act, “no matter what the mechanism of enforcement.”

DEA END O’KEEFE