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President's Page
March 2006
Supreme Court Ruling
on Assisted Suicide
2006 DCMS PresidentOn Jan 17, the Supreme Court made a very important decision for medicine. This column is not about physician-assisted suicide, but rather about the right of physicians to practice medicine without federal intervention. Justice Anthony Kennedy wrote that the Controlled Substance Act of 1970 was silent on the practice of medicine in general and on its recognition of state regulation of the medical profession. It is difficult to defend former Attorney General John Ashcroft’s declaration that the statute implicitly criminalizes physician-assisted suicide.
The court said Mr Ashcroft was claiming extraordinary authority to impose his own view on what is proper medical care for those who are near death. Citing a federal law against drug trafficking, the attorney general said Oregon’s physicians who persisted in the face of his edict would lose the right to prescribe medication. Judge Kennedy said the law referred only to conventional drug dealing and did not imply that the attorney general could tell physicians how to use legal medication.
If left unfettered, before this decision there was the risk the Drug Enforcement Agency could have been empowered to evaluate the end-of-life practices of physicians whose patients die while receiving opiates or barbiturates. This would have a chilling effect on physician willingness to treat patients’ terminal symptoms.
Uncontrolled pain and other distressing symptoms are patients’ primary concerns and greatest fears. More than 90 percent of the pain associated with severe illness can be relieved if physicians adhere to well-established guidelines and seek help from experts in pain management or palliative care. In this situation, addiction to the medication is not as serious a problem as is the undertreatment of pain, with its resultant discomfort to the patient and extreme emotional distress to the family.
Two California cases highlight the legal ramifications of under treatment.
(1) In 2001, Bergman vs Chin convicted the treating physician under the state’s elder abuse statute, awarding the family $1.5 million for undertreatment of the patient’s pain.(2) In 2003, Tomlinson vs Bayberry Care Center saw charges of inadequate pain management successfully brought against the physician and the patient’s nursing home.
The DEA has set the tone and it drives physician perception about the legal risk associated with prescribing Schedule 2 drugs. If the government oversteps its legitimate role and expertise, allowing DEA agents who are trained to combat criminal substance abuse to dictate what constitutes acceptable medical practice for seriously ill patients, it will undermine palliative care and pain management. If physicians become hesitant in prescribing for these patients the best available medication, they actually may be abandoning the patient and their families at the time of greatest need.
These are difficult decisions. I certainly am against the prescription of any medication that is not indicated. However, if I or one of my loved ones have a medical condition requiring potentially addictive medication, I hope my physician has the courage to prescribe the correct medications without fear of reprisal.
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