PHYSICIANS MUST BE FREE TO RELIEVE PAIN OF THE DYING

WHEN a dying patient complains of unbearable pain, the doctor needs to be
able to provide relief without fear of being sanctioned. People at the end
of life have a right to treatment of moderate pain as well, since
persistent discomfort erodes the quality of those last weeks and months.

Gradually, care for the dying has been improving. Public interest in
hospice and other alternatives to high-tech hospital death has been on the
rise. Barriers to effective pain treatment were beginning to come down.
Then last month Congress got into the act with a proposal to require the
Drug Enforcement Administration to revoke the license of any physician who
intentionally causes a patient to die.

If it becomes law, the Lethal Drug Abuse Prevention Act of 1998, introduced
by Rep. Henry Hyde, R-Ill., and Sen. Don Nickles, R-Okla., will put a
damper on progress now being made in providing pain relief to dying
patients.

If the politicians who crafted this legislation truly want to prevent
physician-assisted suicide, they're taking the wrong approach. Fear of
unrelieved pain ranks among the main reasons people give for requesting
help ending their lives. Intimidating doctors into being stingy with
painkillers is not the solution.

Granted, the proposed bill allows physicians free rein in prescribing drugs
to alleviate pain, but the amount of morphine, for example, required to
relieve the severe pain of bone cancer may also repress respiration to a
point that may be lethal. Physicians in fear of losing their licenses are
likely to err on the side of caution and underprescribe. And the message
that this bill sends to patients and their families is that pain control is
dangerous, that expecting to be comfortable near the end is unrealistic and
maybe even immoral -- that it's better for the dying to tough it out.

Last year the Supreme Court ruled that physician-assisted suicide was a
matter for the states to decide. Since then, legislatures around the
country have taken up that issue. Regardless where one stands on the
question of whether physicians should be permitted to help dying patients
voluntarily end their lives, a consensus is growing that your doctor should
be able to ease your passage. What worries people most is the prospect of
dying in misery. With good family support, good nursing care and adequate
pain control, dying in misery is not necessary.

Adequate pain control has been an option since 1989, when Texas became the
first of several states to pass an Intractable Pain Act that authorizes
physicians licensed by the Board of Medical Examiners to prescribe or
administer dangerous drugs to treat intractable pain. Not that passing a
law necessarily solves problems, but it can pave the way to a solution.

Despite recent advances, the reluctance of physicians generally to relieve
dying patients' pain is widely documented. Doctors need to be informed
about what the law says and to be confident that they will not be punished
for practicing state-of-the-art end-of-life care. State medical boards,
which are responsible for disciplining physicians who abuse prescribing
privileges, are bringing their members' knowledge of this issue up to date.

Our health-care system still has trouble treating patients once treatment
comes down to comfort, rather than cure. The art and science of palliative
care -- the comprehensive management of the physical, psychological,
social, spiritual and existential needs of patients -- finally are being
introduced into medical and nursing school curricula and continuing
education programs.

Public awareness of the need for end-of-life planning is growing. Choosing
the right course when the choice is between prolonging life and maintaining
life's quality happens one patient, one family member, one doctor at a
time. More people are realizing how important it is to talk with those
closest to them, and with their doctors, about how they want to be treated
when the end is near. The ham-fisted proposal before Congress would stymie
this hard-won progress.

When dying patients say the pain is unbearable, doctors must be free to
provide comfort. These very personal decisions should remain in the hands
of those who have the biggest stake in their outcome -- patients and their
families, and the doctors and nurses entrusted with their care.

Carson is director of the Institute for the Medical Humanities, the
University of Texas Medical Branch at Galveston.

Checked-by: Joel W. Johnson