While others are comforted that a medical advisory board is not included in the proposed 1999 legislation, we are still alarmed. We believe that this year s provision for the education and training of state, local and federal law enforcement personnel in the appropriate use of controlled substances is an even more hazardous substitute. It is unrealistic to think the Secretary of Health and Human Services will be more successful at effectively training law enforcement officials than medical schools or Boards of Medical Examiners have been at training physicians. If this bill is passed, the standard of care for any community will be determined by the investigative judgement or whim of its local law enforcement personnel. While we applaud efforts to establish that controlled substances should be used for pain control, even if the use of such substances may increase the likelihood of death, the bill s definition of palliative care negates that provision when it codifies into law ambiguous goals.
Palliative care seeks to neither hasten nor postpone death.
But it would be inhumane to not palliate inevitable pain and other symptoms of a patient who has asked to be removed from a ventilator, when her intent is to hasten her death. It would be inhumane to deny a patient interventions that may postpone his death just long enough to reach an important milestone, such as the wedding of a cherished daughter. Hastening or postponing the dying process, while not usual, does happen under good palliative care. While palliative care is an evolving specialty, it is so narrowly defined in this bill that the effect will be to put its practitioners into a too rigid box. A goal of the Pain Relief Promotion Act is to make a clear distinction between an appropriate use of controlled substances to manage pain, even if death is hastened inadvertently, and an inappropriate use of controlled substances to assist in a suicide.