THE INVISIBLE EPIDEMIC OF PAIN

THERE ARE many reasons why doctors under-treat pain. As Dr. Eric Chevlen,
director of palliative care at St. Elizabeth Hospital in Youngstown, Ohio,
explained: ``They're treating a symptom which is invisible, and so it's
easy to dismiss. They say, `Oh, she's exaggerating.' A person's not going
to die of pain. There's not a big downside for doctors who are doing a bad
job; it's a minority of their practice. It's easy for them to blow it off.''

A recent survey found that four in 10 dying patients were in severe pain
most of the time. A New York study found that 71 percent of doctors said
they had under-medicated for pain for fear of running afoul of the
authorities. As Chevlen noted, ``If pain were uncontrollable, it would be a
tragedy; that it is controllable makes it not a tragedy, but a scandal.''

Rep. Henry Hyde, R-Ill., and Sen. Don Nickles, R-Okla., have introduced
legislation that should result in improved pain control. Say, ``Amen.''
Last year the House passed the Pain Relief Promotion Act by a 271-156 vote.
Soon the Senate is expected to vote on the measure, which recognizes that
``the dispensing or distribution of certain controlled substances for the
purpose of relieving pain and discomfort even if it increases the risk of
death is a legitimate medical purpose and is permissible under the Control
Substances Act.''

When necessary pain control can hasten death, that's known as the ``double
effect.'' In recognizing the legitimacy of drugging patients

- --not to hasten death, but to relieve suffering -- the measure would give
doctors added legal protections. That's why the American Medical
Association supports the bill.

If the Pain Relief Promotion Act doesn't become law, it will be because it
also prohibits the use of controlled substances in assisted suicides, which
Oregon voters legalized when they passed a 1994 initiative. Critics say
that it steps on Oregon state law. Being a believer in states' rights, I
should be thrilled to see Democrats clamoring for state self-determination.

Except when Attorney General Janet Reno ruled in 1998 that the Oregon law
does not violate federal drug laws, she contradicted herself. Earlier, she
had ruled that California's Medical Marijuana Act is invalid because a
``state initiative cannot supplant the will of the people of the United
States.'' So which is it? How can Uncle Sam see states' rights in Oregon,
but federal supremacy over California law?

Also, the Hyde-Nickles bill need not hinder Oregon doctors -- those who
choose to help kill their patients instead of treat their pain -- because
they could prescribe lethal drugs that do not fall under the Controlled
Substance Act. The measure only deals with drugs covered under the
Controlled Substance Act.

Besides, states do not have a right to pass laws that essentially
countenance the killing of sick people. Killing the sick and disabled is
not right, it's not constitutional and it's not compassionate.

Of course, assisted suicide advocates like to pose as if they are the
compassionate ones and opponents are mean-spirited people who have no
problem with sick people living in pain. To the contrary, their rhetoric on
this bill shows who cares and who will say anything to make a point.
Unwilling to stick to the arguments, Pain Relief Promotion Act opponents
have begun a scare campaign that warns that if the bill passes it will have
a ``chilling effect'' on pain control management. That is, in order to
defeat the bill, they're telling doctors that the bill should or could
cause them to under-prescribe needed pain medication.

Bunk. As the AMA noted: ``We see the bill as providing a new statutory
protection for physicians who aggressively prescribe controlled substances
to help patients in pain at the end of life. We never had that before.''
Says something doesn't it? If they can't use the drugs to kill people, they
are ready to reduce the chances that the drugs will be used to kill other
people's pain.