Pain Relief Promotion Act Hearing Committee on the Judiciary United States Senate
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S. HRG. 106–1005 PAIN RELIEF PROMOTION ACT HEARING BEFORE THE COMMITTEE ON THE JUDICIARY UNITED STATES SENATE ONE HUNDRED SIXTH CONGRESS SECOND SESSION ON H.R. 2260 APRIL 25, 2000 Serial No. J–106–77 Printed for the use of the Committee on the Judiciary ( U.S. GOVERNMENT PRINTING OFFICE 72–844 WASHINGTON : 2001 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: (202) 512–1800 Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001 VerDate 11-MAY-2000 05:54 Sep 19, 2001 Jkt 072844 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 E:\HR\OC\A844.XXX pfrm11 PsN: A844 COMMITTEE ON THE JUDICIARY ORRIN G. HATCH, Utah, Chairman STROM THURMOND, South Carolina PATRICK J. LEAHY, Vermont CHARLES E. GRASSLEY, Iowa EDWARD M. KENNEDY, Massachusetts ARLEN SPECTER, Pennsylvania JOSEPH R. BIDEN, JR., Delaware JON KYL, Arizona HERBERT KOHL, Wisconsin MIKE DEWINE, Ohio DIANNE FEINSTEIN, California JOHN ASHCROFT, Missouri RUSSELL D. FEINGOLD, Wisconsin SPENCER ABRAHAM, Michigan ROBERT G. TORRICELLI, New Jersey JEFF SESSIONS, Alabama CHARLES E. SCHUMER, New York BOB SMITH, New Hampshire MANUS COONEY, Chief Counsel and Staff Director BRUCE A. COHEN, Minority Chief Counsel (II) VerDate 11-MAY-2000 05:54 Sep 19, 2001 Jkt 072844 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 E:\HR\OC\A844.XXX pfrm11 PsN: A844 C O N T E N T S STATEMENT OF COMMITTEE MEMBER Page Hatch, Hon. Orrin G., a U.S. Senator from the State of Utah ............................ 1 WITNESSES Bleich, Rabbi J. David, on behalf of the Union of Orthodox Jewish Congrega- tions of America ................................................................................................... 59 Caplan, Arthur L., Director, Center for Bioethics, and Trustee Professor, University of Pennsylvania ................................................................................. 57 Chevlen, Eric, M.D., Director of Palliative Care, Cancer Care Center, St. Elizabeth Hospital ................................................................................................ 42 Foley, Kathleen, M.D., Attending Neurologist, Memorial Sloan-Kettering Can- cer Center ............................................................................................................. 63 Hunter, Walter R. M.D., Associate National Medical Director, Vista Care Hospice .................................................................................................................. 69 Nickles, Hon. Don, a U.S. Senator from the State of Oklahoma ......................... 4 Smith, Hon. Gordon, a U.S. Senator from the State of Oregon ........................... 37 Wyden, Hon. Ron, a U.S. Senator from the State of Oregon ............................... 21 APPENDIX PROPOSED LEGISLATION Bill H.R. 2260 ........................................................................................................... 83 ADDITIONAL SUBMISSIONS FOR THE RECORD American Nurses Association, prepared statement .............................................. 97 Campbell, James N. M.D., Johns Hopkins Medicine, Department of Neuro- surgery, letter ....................................................................................................... 95 Fins, Joseph J., M.D., F.A.C.P., Associate Professor of Medicine, Weill Medical College of Cornell and Director of Medical Ethics, New York Presbyterian hospital, prepared statement .............................................................................. 101 Fishman, Scott M., M.D., Chief, Division of Pain Median and Associate Pro- fessor of Anesthesiology, University of California, Davis School of Medicine, prepared statement .............................................................................................. 104 Gilbert, John A. Jr., Hyman, Phelps & McNamara, PC, letter ........................... 91 Guest, James A., Executive Director, American Pain Foundation, prepared statement .............................................................................................................. 98 Joranson, David E., Senior Scientist, Director of the Pain & Policy Studies Group, University of Wisconsin Comprehensive Cancer Center, prepared statement .............................................................................................................. 105 Miech, Ralph P., M.D., Ph.D., Brown University School of Medicine, Dept. of Molecular Pharmacology, Physiology & Biotechnology, letter ..................... 96 National Association of Pro-Life Nurses, prepared statement ............................. 107 National Conference of Catholic Bishops, prepared statement ........................... 109 National Right to Life Committee, prepared statement ....................................... 118 Oncology Nursing Society, prepared statement .................................................... 118 Pain Care Coalition, prepared statement .............................................................. 119 Physicians for Compassionate Care, prepared statement .................................... 121 Rose, Harvey L., M.D., Board Certified Family Practitioner, prepared state- ment ...................................................................................................................... 126 Sparks, Robert M., letter ......................................................................................... 97 The Pain Relief Promotion Act ............................................................................... 3 Vorenberg, James, Harvard Law School, letter .................................................... 94 (III) VerDate 11-MAY-2000 05:54 Sep 19, 2001 Jkt 072844 PO 00000 Frm 00003 Fmt 5904 Sfmt 5904 E:\HR\OC\A844.XXX pfrm11 PsN: A844 VerDate 11-MAY-2000 05:54 Sep 19, 2001 Jkt 072844 PO 00000 Frm 00004 Fmt 5904 Sfmt 5904 E:\HR\OC\A844.XXX pfrm11 PsN: A844 PAIN RELIEF PROMOTION ACT TUESDAY, APRIL 25, 2000 U.S. SENATE, COMMITTEE ON THE JUDICIARY, Washington, DC. The committee met, pursuant to notice, at 9:39 a.m., in room SD–226, Dirksen Senate Office Building, Hon. Orrin G. Hatch (chairman of the committee) presiding. Also present: Senators Sessions and Grassley. OPENING STATEMENT OF HON. ORRIN G. HATCH, A U.S. SENATOR FROM THE STATE OF UTAH The CHAIRMAN. Today, the Judiciary Committee is holding a hearing on H.R. 2260, the Pain Relief Promotion Act. The Senate companion, S. 1272, was introduced by Senator Nickles of Okla- homa. We are happy to have Senator Nickles, Senator Wyden, and Senator Smith here, as well. Similar legislation has been considered by this committee in the past. During the 105th Congress, the Senate Judiciary Committee held a hearing on S. 2151 and reported it to the Senate on Sep- tember 24, 1998. In this Congress, the Pain Relief Promotion Act was passed by the House of Representatives on October 27, 1999, by a substantial 271 to 156 vote. In addition, the Senate HELP Committee held a hearing on this legislation late last year. The Pain Relief Promotion Act has two main purposes. First, it encourages practitioners to prescribe and administer controlled substances to relieve pain and discomfort. Practitioners should be encouraged to treat pain aggressively even when the treatment may increase the risk of death. Almost every member of the com- mittee has known someone who has confronted unbearable pain in the end-of-life situation, and we all understand that the medical community must be able to exercise certain discretion in minis- tering to those patients in these situations. Title I of the bill instructs HHS through the Agency for Healthcare Research and Quality to undertake activities that will promote and advance scientific understanding of pain management and palliative care. This legislation states that alleviating pain with controlled substances in the usual course of medical practice is a legitimate medical purpose. Because pain treatment and pallia- tive care are protected by a safe harbor is one reason why there is substantial support for this legislation from health care pro- viders. The second purpose of this legislation is to prevent the dis- pensing of controlled substances for causing death or assisting (1) VerDate 11-MAY-2000 05:54 Sep 19, 2001 Jkt 072844 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 E:\HR\OC\A844.XXX pfrm11 PsN: A844 2 someone in causing his or her death. This includes the practice of physician assisted suicide. I believe that this practice is abhorrent. The question of how people should conduct their lives when con- fronted by a terminal disease involves intensely personal moral and religious issues. The old and wise principle of, ‘‘first, do no harm,’’ is irreconcilable with assisted suicide. I think the majority of the members of this committee agree with me. In other words, aggressive pain management should be encour- aged and assisted suicide using federally controlled substances should not be permitted under any circumstances. I do not think reasonable people have any difficulty discerning the difference. Let us not forget why we are here. This bill simply tries to cor- rect an erroneous, soft-headed interpretation of title 21 of the Con- trolled Substances Act. Attorney General Reno, with her eye on the Oregon law, reinterpreted an existing Federal statute in a fashion contrary to DEA Administrator Constantine, our nation’s chief drug enforcement officer. Administrator Constantine had taken the tra- ditional and legitimate view that the CSA does not permit con- trolled substances to be used to bring about assisted suicide or eu- thanasia. Unfortunately, the Attorney General