NEW LAW COULD EASE PAIN-RACKED DEATHS

Doctors Are Winning Legislative Protection For Prescribing Powerful Drugs
Like Morphine For Severe Pain.

WASHINGTON- The man was dying of lung cancer.For a while, morphine
controlled his severe chest pain. But eventually, inevitably, the cancer
began literally suffocating him. His panic grew as his breathing grew labored.

More morphine could relieve that horrible feeling of smothering, but with a
risk: It also could further reduce respiration.

The doctor gave his patient enough morphine to ease his suffering. Later
that day, the man died peacefully, his family at his side.

How much pain medication to give terminally ill patients, when the
medication itself might hasten death, long has been a quandary. Many
doctors are so fearful of being accused of overprescribing narcotics or
hastening death that patients suffer. Indeed, a study last year found one
in four elderly cancer patients in nursing homes received no treatment for
daily pain.

That trend is starting to change. At least 15 states recently have passed
laws ensuring that doctors' licenses won't be revoked for prescribing
powerful controlled substances like morphine for severe pain.

The organization that accredits hospitals approved standards in August
declaring that all patients have a right to proper pain management.

And last month, Oregon's medical board became the first to ever discipline
a doctor for undertreating pain. Among the complaints was that the doctor
provided only Tylenol for a dying cancer patient's pain.

But some doctors fear that legislation pending in Congress could reverse
that progress.

The controversial legislation would formally declare prescribing controlled
substances to alleviate pain a legitimate medical decision even if those
drugs increase risk of death. Pain experts praise the protection as a
crucial step to improve patient care.

But that same bill, the Pain Relief Promotion Act, also enters a minefield,
by banning controlled substances for the purpose of physician-assited
suicide. Take strong steps to control pain, the bill says, but don't
intentionally hasten death.

Today, assisted suicide is legal in only one state, Oregon. The federal
legislation would essentially overturn Oregon's state law. Many in Oregon
say Congress should not, as Sen. Ron Wyden, D-Ore., put it, "throw the
votes of our citizens in the trash can." The bill's author, Sen. Don
Nicles, R-Okla., counters that the issue is no different from Congress
intervening if a state legalized heroin.

The average doctor might say, "I should use less controlled substances,"
worries pain expert Dr. James Rathmell of the University of Vermont."That's
not what the legislation is intended to do at all, but how do we prevent it?"

One key, Rathmell told a Senate committee this weeks is proper training and
oversight of the federal officials who would enforce the law.

Lawmakers are struggling with how to ensure that balance. The issue is "one
of the most difficult subjects this committee has ever dealt with," said
Sen. James Jeffords, R-Vt. Jeffords' Senate health committee is unlikely to
have time to vote on the issue this year.

The controversy is raising public awareness of proper pain treatment.

For the vast majority of terminally ill patients, pain can be controlled.

"I would plead for better pain control," Rathmell advised. "Focus their
physician's attention on pain being the issue, not preservation of life."

Specialists like Rathmell can advise doctors without extensive training in
pain treatment. As for that other excuse doctors sometimes use - that
narcotics are addictive - research shows that's not a big issue when
treating intractable pain especially if someone is weeks or months from death.

Rathmell recalled his lung cancer patient: "To see a peaceful death, which
is what we're all looking for - it would be a shame not to have helped with
that when we know we could.