The Pain Relief Promotion Act of 1999 - A serious threat to palliative care

Recent educational efforts in the US medical community have begun to addres s the critical issue bf palliative care for terminally ill patients. Howeve r, a newly introduced bill in; Congress, the Pain Relief Promotion Act of 1 999 (PRPA), could dramatically hinder these efforts if enacted. The act cri minally punishes the use of controlled substances to cause-or assist in cau sing-a patient's death. The primary purposes of PRPA are to override the ph ysician-assisted suicide law currently in effect in Oregon and prohibit oth er states from enacting similar laws, The act also includes valuable provis ions 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 co mpromised 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 Administratio n officials, who have no medical expertise, in the position of regulating m edical decisions. The act also would interfere with individual states' long -standing authority over medical practice. Finally, PRPA would discourage p hysicians from engaging in experimentation and innovation in palliative car e, again out of concern for crossing the line between relief of suffering a nd physician-assisted suicide. Other bills have been introduced that go much further than PRPA to encourag e palliative care, without its problematic provisions. Regardless of the co ntroversy surrounding physician-assisted suicide in the United States, the need for quality end-of-life care will be far better sewed if Congress enac ts one of these bills rather than PRPA.