NCPA - National Center for Policy Analysis

Palliative Care And The Pain Reduction Promotion Act Of 1999

May 19, 2000

Many terminally ill patients are under-treated for pain, according to research studies, and the fear of intolerable suffering is a major reason for public support of assisted suicide. Unfortunately, the Pain Reduction Promotion Act of 1999 (PRPA) would deal a severe blow for pain treatment of chronically ill and dying patients, known as palliative care, some physicians argue.

The primary purpose of PRPA, say critics, is to override the Oregon physician-assisted suicide law and prevent other states from adopting such laws. However, they concede the bill sponsored by Rep. Henry Hyde (R-Ill.) and Sen. Don Nickles (R-Okla.) contains valuable provisions for education and research in palliative care.

How would the PRPA, which would amend the Controlled Substances Act, inhibit palliative care?

  • The Act would criminally punish a physician who uses controlled substances -- which include powerful opiates -- to cause or contribute to the death of a patient.
  • Experts are concerned that threat will force physicians to err on the side of under-treating patients' pain rather than risking aggressive treatment that may cause death.
  • Drug Enforcement Agency (DEA) officials with no medical expertise will be in charge of regulating and investigating physicians' medical decisions and their intent.
  • The states' authority over medical practice will be infringed.
  • And physicians will be discouraged from experimentation and innovation in pain management because of fear of prosecution.

However, the current state of affairs is not favorable either:

  • In the past decade physicians have become more likely to face civil lawsuits and criminal prosecutions for overly aggressive pain management.
  • The DEA already has the authority under the Controlled Substances Act to investigate physicians for overly aggressive palliative care.
  • The states' authority over medical practice is already limited with regard to approval and use of pharmaceuticals.

The PRPA was passed by the House on October 27, 1999, by a vote of 271-156. The Senate Judiciary Committee held hearings on April 27, 2000, and has returned the bill to the full Senate for further consideration.

Source: David Orentlicher and Arthur Caplan, "The Pain Relief Promotion Act of 1999: A Serious Threat to Palliative Care," Journal of the American Medical Association, January 12, 2000.


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