The NEJM has an article and an interview about the Oregon assisted suicide ruling that is coming up before the Supreme Court. Because theocratic fascist John Ashcroft was unable to overturn the will of the Oregon voters legally he tried to get around it by using the controlled substance act. If the Supreme Court rules in the Administration’s favor, it has very serious consequences for palliative care. Basically doctors will be even more in fear than they are now of prescribing opiates, and patients will suffer.
The interview is pretty interesting. Despite both wanting the Supremes to rule against Ashcroft, one of the authors is in favor of the assisted suicide law, one against it. Diane Meier opposes it because she feels (rightly) that the average physician doesn’t have the training or the time to properly evaluate requests for assisted suicide. Funnily enough America’s leading and crazed advocate of assisted suicide agreed with her, which is why Kevorkian advocated creating a medical specialty for helping patients who wanted it. The other author, Timothy Quill does approve of the Oregon law, citing that as an experiment it gives data showing that the law is working and that patients and their families are using it as the entrance to a discussion about what they actually need. And of course palliative care with opiates is one type of help those critically ill patients, who are often in tremendous pain, need. And of course the authors are terrified that the DEA will not understand that the line between proper palliative care and going slightly over that line to hasten a coming death is very fuzzy and one that often cannot be identified.
But in dealing with this issue, there are two massive problems faced by rational people in the US. First, the opponents of this type of care — including leading bloggers — are happy to start labeling any doctor thinking about this as a genocidal Nazi. Secondly, the DEA is already intervening with no regard to patient care in its insane prosecutions of doctors who are treating patients according to acceptable guidelines. Meier can claim that the DEA is good at intercepting illegal diversion of prescriptions, but it’s clear that the DEA couldn’t give a rats arse about diversions, they’re just out to impose themselves on anyone they don’t like. Consequently patients all over America are suffering already. The imposition of the DEA into end of life care won’t make much difference, other than the pain of those at the end of life will last less time than those living with chronic pain who can’t get the care they need because of the DEA’s appalling behavior. If you don’t believe me, read the comments on my last post on this subject.
I sincerely hope that the AMA looks past its nose and gets involved in this travesty of a public policy. Maybe this article is a start, but it may well be too late. The only hope is that this case will be decided by O’Connor, before the theocratic fascist that Alito appears to be gets on the court.