Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor
To the Editor: Drs Orentlicher and Caplan1 described the Pain Relief Promotion Act of 1999
(PRPA) as a " . . . serious threat to palliative care." They were concerned
about interference by the federal government with state authority and speculated
that such legislation would inhibit good palliative care and pain relief.
I would like to share a different perspective from a hospice physician
who has been active in pain promotion in Maryland where the state has passed
(despite similar misleading arguments as those of Orentlicher and Caplan)
legislation banning physician-assisted suicide with wording to promote good
pain management,1 similar to that seen in
the bill recently passed by the US House of Representatives.1
The reason that the Maryland version became law with bipartisan support (despite
the fact that Maryland is arguably the most liberal state in the Union2) had to do with specific wording that provided
protection for clinicians who prescribe medication for pain relief, even if
such prescribing increases the risk of death or potentially hastens death.
As is true with the proposed federal legislation, such prescribing would only
be illegal if the physician intended to kill a patient. Even a novice prosecutor
recognizes how daunting it is to prove intent.
Gloth III FM. Legislation and End-of-Life Care. JAMA. 2000;283(22):2933. doi:10.1001/jama.283.22.2931