Author Affiliations: Center for Law and Health, Indiana University School of Law-Indianapolis (Dr Orentlicher); and Center for Bioethics, University of Pennsylvania Health System, Philadelphia (Dr Caplan).
Policy Perspectives Section Editors: Robert
J. Blendon, ScD, Harvard School of Public Health, Boston, Mass; Drummond Rennie,
MD, Deputy Editor, JAMA.
Recent educational efforts in the US medical community have begun to
address the critical issue of palliative care for terminally ill patients.
However, a newly introduced bill in Congress, the Pain Relief Promotion Act
of 1999 (PRPA), could dramatically hinder these efforts if enacted. The act
criminally punishes the use of controlled substances to cause—or assist
in causing—a patient's death. The primary purposes of PRPA are to override
the physician-assisted suicide law currently in effect in Oregon and prohibit
other states from enacting similar laws. The act also includes valuable provisions
for better research and education in palliative care, but the benefits of
those provisions are outweighed by the punitive sections of the act. Under
PRPA, the quality of palliative care in the United States could be compromised
when physicians, fearing criminal prosecution, err on the side of caution
rather than risk their patients' deaths by using highly aggressive pain treatments.
Furthermore, PRPA would put Drug Enforcement Administration officials, who
have no medical expertise, in the position of regulating medical decisions.
The act also would interfere with individual states' long-standing authority
over medical practice. Finally, PRPA would discourage physicians from engaging
in experimentation and innovation in palliative care, again out of concern
for crossing the line between relief of suffering and physician-assisted suicide.
Other bills have been introduced that go much further than PRPA to encourage
palliative care, without its problematic provisions. Regardless of the controversy
surrounding physician-assisted suicide in the United States, the need for
quality end-of-life care will be far better served if Congress enacts one
of these bills rather than PRPA.
Orentlicher D, Caplan A. The Pain Relief Promotion Act of 1999: A Serious Threat to Palliative Care. JAMA. 2000;283(2):255–258. doi:10.1001/jama.283.2.255
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