Intensivists get reprieve on controversial drug bill

Critical care providers are breathing easier — at least for the moment — following a decision by lawmakers to withdraw a controversial measure from the federal budget that would strip physicians of their license for using potentially lethal medications on patients for pain relief, including those who are terminally ill.

The measure, dubbed the Lethal Drug Abuse Act, was introduced recently into a package of wide-ranging legislation as part of the proposed Consolidated Omnibus Budget Reconciliation Act. If enacted, Measure S. 2151 would have required federal authorities to revoke the license of any physician who intentionally prescribes or provides medication that results in a patient’s death. The bill in its present form does not specifically affect critical care nurses.

However, the Society of Critical Care Medicine (SCCM) in Anaheim, CA, and several other health care groups opposed the measure, according to opponents of the bill, because the law would have interfered with a physician’s ability to properly manage a patient’s pain and suffering.

Physicians were especially concerned about situations involving strong pain-controlling drugs such as morphine that have a "double effect" of relieving pain but potentially causing complications in the respiratory system in extremely critically ill patients.

Bill would stunt efforts to ease suffering

The SCCM also opposed the measure on the grounds that it would allow the government to enter into "sensitive patient care issues that are most appropriately handled between the patient, the patient’s family, and their physician," according to SCCM.

Lisa Parks, an SCCM spokeswoman states, however, that her group’s opposition was not based on efforts by lawmakers to discourage illegal acts of physician assisted-suicide directly related to the actions of Michigan physician Robert Kevorkian, MD.

The bill attempts to address assisted-suicide, "but it’s more of a reaction to the recent passage of an Oregon law that legalizes assisted-suicide," Parks informed Critical Care Management.

Critics of S.2151 expressed concerns about the ability of providers to render humane medical care to patients, including terminally ill cases. They worried that the bill’s passage would undermine efforts to decrease pain and suffering of patients at the end of life.

Although its author, Sen. Don Nickles (R-OK) withdrew the bill, it is likely to be reintroduced during the current legislative session, observers say.

The issue has been at the forefront of physician ethical concerns in the wake of the enactment of the Oregon law in 1997, which legalizes physician-assisted suicides. In the law’s first year, 15 terminally ill people died after taking physician-prescribed lethal medications.

A study published in The New England Journal of Medicine found the decision by individuals to end their lives was not related to pain and suffering but in most cases involved concerns about loss of autonomy or control of bodily functions.1

Health care professionals are concerned that S. 2151 will hamper physicians’ efforts to relieve pain and suffering especially among patients who are hospitalized and under direct physician care.

Reference

    1. Chin AE, Hedberg K, Higginson GK et al., Legalized physician-assisted suicide in Oregon — the first year’s experience. NEJM 1999; 340:577-583.