c. 1999 Religion News Service

WASHINGTON _ Key members of Congress are preparing to renew their attacks on Oregon’s physician-assisted-suicide law with legislation to be introduced as soon as this week.

They have already picked up the support of the National Hospice Organization, one of the groups that led the successful fight against their proposals last session.

Like the bills that stalled in the House and Senate last year, the new legislation would outlaw the use of controlled substances for assisted suicide while permitting the aggressive use of pain medication, even when it inadvertently hastens death.

The staff of Sen. Don Nickles, R-Okla., said his upcoming legislation succeeded in striking that balance.

“This is a completely new piece of legislation,” said Nickles’ spokesman, Brook Simmons. “It’s a comprehensive look at long-term palliative care and how we address those issues and how we promote relief.”

The new legislation adds provisions for research and training in end-of-life care, according to a summary of a bill proposal by Nickles, the assistant Senate majority leader.

Oregon voters approved physician-assisted suicide in 1994 and reaffirmed the law in 1997. In 1998, 15 patients died through use of the law, the only one of its kind in the United States.

The Nickles proposal has picked up important support from the National Hospice Organization. The organization was a leader among more than 35 medical and patient advocacy groups that attacked similar legislation proposed last year by Nickles and Rep. Henry Hyde, R-Ill., who is chairman of the House Judiciary Committee.

Last year, the hospice organization and the other groups said they were concerned the bills would discourage doctors from aggressively treating their patients’ suffering out of fear they could inadvertently cause a patient’s death with high doses of medication and spark a federal criminal inquiry.

But the organization has decided to support Nickles’ new bill, based on a draft provided to the organization.

“In our estimation, it is a positive bill in helping hospices treat terminally ill patients and address their families’ concerns,” said Jon Keyserling, director of public policy for the organization.

Other medical groups, including the American Medical Association, are waiting to see the final bill before deciding whether to support it.

Dr. Thomas Reardon, a Portland, Ore., physician and president-elect of the AMA, said his organization’s concerns had not changed from last session.

“We support aggressive use of pain management, but the intent is to treat and not to kill,” Reardon said. “The issue is, where is that line and do you have the Justice Department looking over your shoulder and accusing physicians of assisted suicide when it wasn’t.”

Oregon health leaders and public officials share some of Reardon’s concerns.

“I cannot imagine a system that could target only those involved in assisted suicide and have no impact on prescribing practices” for other dying patients, said Dr. Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health Sciences University.

Tolle and others expressed concern that the bill, which would affect federal drug enforcement only in Oregon, singles out the state.

The bill would also provide $5 million in grants for end-of-life care training to medical schools, hospices and other programs that will not espouse assisted suicide in that training.

“This clarifies existing law to retain a uniform national standard over controlled substances,” said Simmons, Nickles’ spokesman. “In those states that do not legalize assisted suicide, the application of the Controlled Substances Act is not changed whatsoever.”

Ann Jackson, director of the Oregon Hospice Association, said, “It’s really very scary. Oregon is going to be hung out to dry.”

Despite her national organization’s support for the bill, Jackson worries about its impact on all dying Oregonians.

Gov. John Kitzhaber, who testified against last year’s legislation before a congressional panel, is equally concerned, said Mark Gibson, the governor’s health policy adviser.

“I think Oregon will be in an uphill struggle once again to prevent the federal government from eroding authority that the state has traditionally had to make decisions about the practice of medicine within its own borders,” Gibson said.

Whether the proposed bill would stop assisted suicide under Oregon’s law is also being debated, particularly by those eager to avoid a battle over states’ rights.

Some say doctors could give a patient federally controlled drugs such as morphine or sedatives to make the patient comfortable. Then the patient could self-administer an infusion of a non-federally controlled drug such as potassium chloride to stop the heart, similar to Dr. Jack Kevorkian’s tactics. But whether the Oregon law would allow such an infusion has never been tested, and the willingness of doctors and patients to try such a route is unknown.

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Nickles is expected to introduce his legislation this month. Simmons, Nickles’ spokesman, said the senator had been working very closely with Hyde on the assisted suicide legislation.

Sens. Gordon Smith, R-Ore., and Ron Wyden, D-Ore., have not taken positions on the Nickles proposal. But Wyden’s chief of staff, Josh Kardon, expressed skepticism about its aim, even though it includes a focus on palliative care.

“This appears to be nothing more than a stalking horse to undermine the will of Oregon’s voters,” Kardon said.

DEA END HOGAN