Hyde bill opponents make some headway

NHO leads in opposing assisted-suicide measure

Palliative care advocates were expressing guarded optimism that their determined lobbying efforts had succeeded in slowing the juggernaut propelling H.R. 4006, the Lethal Drug Abuse Prevention Act of 1998, as this issue of Hospice Management Advisor was going to press. A floor vote in the House of Representatives had been postponed several times but was rescheduled for late September, with simultaneous mark-up of a companion bill, SB 2151, planned in the Senate Judiciary Committee. (For further discussion of the Hyde bill, see HMA, October 1998, pp. 121-122.)

September editorials in the New York Times, Washington Post, and Los Angeles Times all weighed in against what they described as misguided and heavy-handed legislation, raising hopes by opponents that they might yet mobilize sufficient opposition to derail it.

H.R. 4006 was introduced by Rep. Henry Hyde (R-IL) in response to a ruling earlier this year by Attorney General Janet Reno that the government would not use federal Drug Enforcement Administration (DEA) authority to punish physicians who participated in physician-assisted suicide. Currently, assisted suicide is legal only in the state of Oregon. Oregon’s Death with Dignity law was the primary target of the Hyde bill, which would prohibit the dispensing or distribution of controlled substances for the purpose of assisting in a suicide. The bill also creates a structure within the DEA for investigating reports of such behavior and revoking the DEA controlled substance registration and privileges of physicians or pharmacists found guilty of assisting in a suicide.

Pain management advocates, including all of the national groups representing hospice and palliative care professionals, have strenuously opposed the bill on the grounds it would chill the prescribing of controlled substances for terminally ill patients’ pain — especially given the well-documented fears already held by many physicians about regulatory second-guessing of opioid prescribing. Even groups like the Chicago-based American Medical Association, with longstanding opposition to legalizing physician-assisted suicide, have declared H.R. 4006 the wrong vehicle for enacting such opposition.

The Arlington, VA-based National Hospice Organization (NHO) has played the lead role in convening a coalition of some 50 health care organizations opposed to HR 4006, and has hosted two briefings for congressional staff, one of which was covered on the C-Span 2 cable TV network. In fact, Hyde acknowledged its effectiveness by singling out the "National Hospice Association [sic]" in a Sept. 18 Dear Colleague letter for "scaring physicians and members of Congress in believing that H.R. 4006 will prevent physicians from practicing proper pain care . . . . Don’t let the National Hospice Association spread the rumor that the DEA will be knocking on every physician’s door." Hospices should stick to making the end of life more comfortable for dying patients, Hyde stated, and stop trying to scare doctors.

Bill functions as conservative litmus test

This summer the Hyde bill was said to be on an almost unstoppable fast track through Congress. Right-to-life groups such as the Washington-based National Right-to-Life Committee had made it a litmus test for congressional social conservatives. Joanne Lynn, MD, director of the Washington-based Center to Improve Care of the Dying and another high-profile opponent of Hyde’s bill, told the Portland Oregonian newspaper in September that Hyde and others are pushing the bill for political reasons, not because it is the best way to stop assisted suicide. "From their perspective, they’re looking to deliver on some religious right agenda. And all their other bills have been bottled up."

At press time, pain advocates were saying that each day action on the bill was postponed increased their chances of mobilizing the opposition. However, John Giglio, NHO’s director of public policy and general counsel, suggested that the best chance of stopping the bill was in the Senate, not the House."I can say that the hospice community has answered the call, and Congress is starting to get the message," he told HMA. Oregon Senator Ron Wyden was said to be threatening a filibuster against the bill, if that became necessary. The Clinton administration, which also opposes legalized physician-assisted suicide, weighed in with its opposition to the bill, in a letter from Acting Assistant Attorney General L. Anthony Sufin to the chairman of the Senate Judiciary Committee, Orrin Hatch (R-UT). Congress was expected to adjourn in early October for election year campaigning.