II

106TH CONGRESS

1ST SESSION S. 1272

To amend the Controlled Substances Act to promote pain management and

palliative care without permitting assisted suicide and euthanasia, and

for other purposes.

IN THE SENATE OF THE UNITED STATES

JUNE 23, 1999

Mr. NICKLES (for himself, Mr. LIEBERMAN, Mr. LOTT, Mr. ABRAHAM, Mr.

ALLARD, Mr. BROWNBACK, Mr. COVERDELL, Mr. HAGEL, Mr. INHOFE,

Mr. CRAIG, and Mr. SESSIONS) introduced the following bill; which was

read twice and referred to the Committee on Health, Education, Labor,

and Pensions

A BILL

To amend the Controlled Substances Act to promote pain

management and palliative care without permitting assisted suicide and euthanasia, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Pain Relief Promotion

5 Act of 1999’’.
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1 TITLE I—USE OF CONTROLLED

2 SUBSTANCES CONSISTENT

3 WITH THE CONTROLLED SUB4 STANCES ACT

5 SEC. 101. REINFORCING EXISTING STANDARD FOR LEGITI6 MATE USE OF CONTROLLED SUBSTANCES.

7 Section 303 of the Controlled Substances Act (21

8 U.S.C. 823) is amended by adding at the end the fol9 lowing:

10 ‘‘(i)(1) For purposes of this Act and any regulations

11 to implement this Act, alleviating pain or discomfort in

12 the usual course of professional practice is a legitimate

13 medical purpose for the dispensing, distributing, or admin14 istering of a controlled substance that is consistent with

15 public health and safety, even if the use of such a sub16 stance may increase the risk of death. Nothing in this sec17 tion authorizes intentionally dispensing, distributing, or

18 administering a controlled substance for the purpose of

19 causing death or assisting another person in causing

20 death.

21 ‘‘(2) Notwithstanding any other provision of this Act,

22 in determining whether a registration is consistent with

23 the public interest under this Act, the Attorney General

24 shall give no force and effect to State law authorizing or

25 permitting assisted suicide or euthanasia.
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1 ‘‘(3) Paragraph (2) applies only to conduct occurring

2 after the date of enactment of this subsection.’’.

3 SEC. 102. EDUCATION AND TRAINING PROGRAMS.

4 Section 502(a) of the Controlled Substances Act (21

5 U.S.C. 872(a)) is amended—

6 (1) by striking ‘‘and’’ at the end of paragraph

7 (5);

8 (2) by striking the period at the end of para9 graph (6) and inserting ‘‘; and’’; and

10 (3) by adding at the end the following:

11 ‘‘(7) educational and training programs for

12 local, State, and Federal personnel, incorporating

13 recommendations by the Secretary of Health and

14 Human Services, on the necessary and legitimate

15 use of controlled substances in pain management

16 and palliative care, and means by which investiga17 tion and enforcement actions by law enforcement

18 personnel may accommodate such use.’’.

19 TITLE II—PROMOTING

20 PALLIATIVE CARE

21 SEC. 201. ACTIVITIES OF AGENCY FOR HEALTH CARE POL22 ICY AND RESEARCH.

23 Part A of title IX of the Public Health Service Act

24 (42 U.S.C. 299 et seq.) is amended by adding at the end

25 the following:
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1 ‘‘SEC. 906. PROGRAM FOR PALLIATIVE CARE RESEARCH

2 AND QUALITY.

3 ‘‘(a) IN GENERAL.—The Administrator shall carry

4 out a program to accomplish the following:

5 ‘‘(1) Develop and advance scientific under6 standing of palliative care.

7 ‘‘(2) Collect and disseminate protocols and evi8 dence-based practices regarding palliative care, with

9 priority given to pain management for terminally ill

10 patients, and make such information available to

11 public and private health care programs and pro12 viders, health professions schools, and hospices, and

13 to the general public.

14 ‘‘(b) DEFINITION.—For purposes of this section, the

15 term ‘palliative care’ means the active total care of pa16 tients whose prognosis is limited due to progressive, far17 advanced disease. The purpose of such care is to alleviate

18 pain and other distressing symptoms and to enhance the

19 quality of life, not to hasten or postpone death.’’.

20 SEC. 202. ACTIVITIES OF HEALTH RESOURCES AND SERV21 ICES ADMINISTRATION.

22 (a) IN GENERAL.—Part D of title VII of the Public

23 Health Service Act (42 U.S.C. 294 et seq.), as amended

24 by section 103 of Public Law 105–392 (112 Stat. 3541),

25 is amended—
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1 (1) by redesignating sections 754 through 757

2 as sections 755 through 758, respectively; and

3 (2) by inserting after section 753 the following

4 section:

5 ‘‘SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN

6 PALLIATIVE CARE.

7 ‘‘(a) IN GENERAL.—The Secretary, in consultation

8 with the Administrator for Health Care Policy and Re9 search, may make awards of grants, cooperative agree10 ments, and contracts to health professions schools, hos11 pices, and other public and private entities for the develop12 ment and implementation of programs to provide edu13 cation and training to health care professionals in pallia14 tive care.

15 ‘‘(b) PRIORITIES.—In making awards under sub16 section (a), the Secretary shall give priority to awards for

17 the implementation of programs under such subsection.

18 ‘‘(c) CERTAIN TOPICS.—An award may be made

19 under subsection (a) only if the applicant for the award

20 agrees that the program carried out with the award will

21 include information and education on—

22 ‘‘(1) means for alleviating pain and discomfort

23 of patients, especially terminally ill patients, includ24 ing the medically appropriate use of controlled sub25 stances;
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1 ‘‘(2) applicable laws on controlled substances,

2 including laws permitting health care professionals

3 to dispense or administer controlled substances as

4 needed to relieve pain even in cases where such ef5 forts may unintentionally increase the risk of death;

6 and

7 ‘‘(3) recent findings, developments, and im8 provements in the provision of palliative care.

9 ‘‘(d) PROGRAM SITES.—Education and training

10 under subsection (a) may be provided at or through health

11 professions schools, residency training programs and other

12 graduate programs in the health professions, entities that

13 provide continuing medical education, hospices, and such

14 other programs or sites as the Secretary determines to be

15 appropriate.

16 ‘‘(e) EVALUATION OF PROGRAMS.—The Secretary

17 shall (directly or through grants or contracts) provide for

18 the evaluation of programs implemented under subsection

19 (a) in order to determine the effect of such programs on

20 knowledge and practice regarding palliative care.

21 ‘‘(f) PEER REVIEW GROUPS.—In carrying out section

22 799(f) with respect to this section, the Secretary shall en23 sure that the membership of each peer review group in24 volved includes one or more individuals with expertise and

25 experience in palliative care.
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1 ‘‘(g) DEFINITION.—For purposes of this section, the

2 term ‘palliative care’ means the active total care of pa3 tients whose prognosis is limited due to progressive, far4 advanced disease. The purpose of such care is to alleviate

5 pain and other distressing symptoms and to enhance the

6 quality of life, not to hasten or postpone death.’’.

7 (b) AUTHORIZATION OF APPROPRIATIONS; ALLOCA8 TION.—

9 (1) IN GENERAL.—Section 758 of the Public

10 Health Service Act (as redesignated by subsection

11 (a)(1) of this section) is amended in subsection

12 (b)(1)(C) by striking ‘‘sections 753, 754, and 755’’

13 and inserting ‘‘section 753, 754, 755, and 756’’.

14 (2) AMOUNT.—With respect to section 758 of

15 the Public Health Service Act (as redesignated by

16 subsection (a)(1) of this section), the dollar amount

17 specified in subsection (b)(1)(C) of such section is

18 deemed to be increased by $5,000,000.

19 SEC. 203. EFFECTIVE DATE.

20 The amendments made by this title take effect Octo21 ber 1, 1999, or on the date of the enactment of this Act,

22 whichever occurs later.

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