Where I Stand — Mike O’Callaghan: An act to relieve pain

Thursday, May 25, 2000 | 9:52 a.m.

Mike O'Callaghan is the Las Vegas Sun executive editor.

The public clash between people who see physician-assisted suicide as an easy answer to pain and those who believe adequate pain management as the moral answer has come full circle. What they all agree upon is that much pain and suffering near the end of life is really unnecessary.

Too many elderly patients have come to believe that they must expect to suffer from diseases, like cancer, so they remain silent. Because of this silence some nursing homes have concluded that the elderly don't hurt as much as younger people. This perception has no basis in fact according to recent studies, and even more pain is often felt by elderly patients.

Two years ago the Journal of the American Medical Association in an editorial stressed that: "Undertreatment of pain is a persistent clinical problem. A leading indicator of inadequate pain management is the poor control of cancer pain, a condition for which every effort should be made to assure patient comfort. Cancer pain is feared by patients, their families, and the general public and this fear has helped to fuel the debate concerning assisted suicide."

The same editorial concluded: "Treatment of pain should be a top priority in cancer care. However, excellence in pain control and symptom management has not been adopted as a 'mission' of cancer practitioners, probably for several reasons. First, patients do not die of pain, although some evidence suggests that untreated pain begets worse pain."

In an effort to replace the Oregon practice of an "easy and final way out" of pain with legal suicide, there have been efforts to meet the challenges of pain suffered by patients. The American Nurses Association made special note that assisted suicide practices have the "potential for serious societal and professional consequences and abuses." The ANA went on to warn: "While there may be individual patient cases that are compelling, there is high potential for abuses with assisted suicide, particularly with vulnerable populations such as the elderly, poor and disabled. These conceivable abuses are even more probable in a time of declining resources. The availability of assisted suicide could foreseeably weaken the goal of providing quality care for the dying."

Last month the Senate Judiciary Committee, by a 10-7 vote, passed out the Pain Relief Promotion Act introduced by Sen. Don Nickles, R-Okla., and given strength by committee chairman Orrin Hatch, R-Utah. The act identifies that "inadequate treatment of pain, especially for chronic diseases and conditions, irreversible diseases such as cancer, and end-of-life care, is a serious public health problem affecting hundreds of thousands of patients every year; physicians should not hesitate to dispense or distribute controlled substances when medically indicated for these conditions."

In addition to recognizing the problem and the possibility of abuses, the proposed act promotes "the dispensing or distribution of certain controlled substances for the purpose of relieving pain and discomfort even if it increases the risk of death is a legitimate medical purpose and is permissible under the Controlled Substances Act."

In an effort to promote pain management and palliative care, the act will wisely provide an additional $5 million for research and education improving their use and methods.

The act is a step forward in answering needs identified but not fulfilled in recent years. Hatch said it best in his statement before the committee:

"In my judgment, terminally ill patients deserve better pain control management because their lives have the same worth and dignity as all other human beings. I am extremely troubled by laws that single out these patients as candidates for assisted suicide. By doing this, I believe society is denying the value of their lives, and thereby, showing a lack of respect for their dignity and their legitimate needs, especially their need for the best possible palliative care."

S.1272 deserves to become law as soon as possible.