Testimony of Rep. Tom A. Coburn

Subcommittee on the Constitution

H.R. 4006 The Lethal Drug Abuse Prevention Act

July 14, 1998

Mr. Chairman, I wish to thank you and the members of the subcommittee for bringing forward this important legislation and for giving me this opportunity to offer testimony on it. I speak in strong support of this legislation, both as a Member of Congress and as a practicing physician.

I speak first as a legislator. The genesis of this legislation clearly lies in the unfortunate decision of a majority of the voters in last year's referendum in the State of Oregon to authorize the practice of so-called "physician-assisted suicide." In doing so, they legally extended to physicians a right to administer to certain patients lethal doses of drugs with the specific intention of ending the patient's life.

Ordinarily, I am very reluctant to contradict the expressed will of a majority of voters in any jurisdiction on any subject. Our entire system of government rests on the principle of the sovereignty of the people and on a trust that, in the long run and most of the time, the people will do the right thing. I believe that. But sometimes the voters can be wrong. And on some occasions when voters make mistakes, they jeopardize the rights of the larger community, and especially those who are most vulnerable.. This, I fear, is what the voters in Oregon did last November.

If physician-assisted suicide is unleashed in Oregon, it will become extremely dangerous for a person to become seriously ill in that state. The human person is rarely more vulnerable than when gravely ill and confronted with the likelihood of not recovering. For patients who carry that burden, the legalization of physician-assisted suicide adds a new and powerful pressure to allow themselves to be killed. We have seen how, in the Netherlands, a similar policy has led to the elimination of many medically vulnerable patients for the convenience of others.

Physician-assisted suicide is not simply a local Oregon issue. To establish, in even one state, a policy under which the medically vulnerable may be directly killed cheapens life and degrades the medical profession throughout our culture. There are some evils which, perhaps, can be tolerated as long as they are confined to certain localities, but there are others that cannot be allowed to exist at all without poisoning an entire society. Slavery was one such evil; euthanasia is another.

Indeed, the corruption of standards that inevitably accompanies the legalization of physician-assisted suicide is apparent from the chain of circumstances that led to the introduction of the legislation before us today.

On the day after the election last fall, the Drug Enforcement Administration, in response to inquiries by Representative Henry Hyde and Senator Orrin Hatch, chairmen, respectively, of the House and Senate Judiciary Committees, stated that regardless of the Oregon law, physician-assisted suicide involving lethal doses of controlled substances was a violation of the Controlled Substances Act. Under that Act doctors are licensed to prescribe for their patients drugs that are legal for medical purposes, but not generally available to the public. Those drugs are not banned because they do have great value, when used properly, in controlling or curing illnesses and restoring a patient's health. But they are controlled precisely because, if used improperly, they have the potential for harm, injuring or even, in some cases, killing those to whom they are given. It is the responsibility of physicians to see to it that these drugs are used only for the good of their patients -- for "legitimate medical purposes," as the law puts it -- but the law also, quite properly, gives doctors wide latitude in applying their own knowledge and experience in the proper use of these substances. This is not a case of the government trying to practice medicine, but rather of the government overseeing the practice of medicine in a way that proects the health and safety of the public.

Preventing the abuse of these drugs in a way that could lead to the death of a patient was very clearly part of the intent of Congress in adopting the Controlled Substances Act. Testifying on behalf of that legislation in 1984, Members of Congress noted that the abuse of legal drugs was responsible for a substantial majority of the drug-related deaths at that time, and this was precisely one of the risks against which they intended to protect the public. Congress intended to prevent the abuse of drugs not only on account of their potential "stimulant, depressant, or hallucinogenic" effects, but also, and more urgently, on account of their potential lethal effects. The DEA Administrator, therefore, was absolutely correct when he told Chairman Hyde and Senator Hatch that the practices authorized by Oregon's assisted suicide law would violate the Controlled Substances Act.

But his superior was apparently not so certain. A question arose about whether the Attorney General would enforce the federal law restricting controlled substances to "legitimate medical purposes." I joined with a number of my congressional colleagues in writing to Attorney General Reno, expressing our view that the federal law was applicable to this situation and needed to be enforced. But on June 5 of this year she announced that she did not consider the Controlled Substances Act applicable. Hence, the need for the legislation before us, to correct an error of interpretation by the Attorney General.

The Attorney General is too good a lawyer to imagine that the meaning of a federal statute can vary from state to state, or can be determined by the law of a single state that contradicts those of all the other states. She knows that the Supremacy Clause in the U. S. Constitution makes laws enacted by Congress the "supreme law of the land," outweighing any state laws that contradict them. Therefore, it must be the belief of the Attorney General that the term "legitimate medical purpose" in federal law includes the practice of administering a lethal dose to a patient. And to this point I must speak not only as a legislator, but as a doctor.

I am, as you know, a practicing physician and I believe I am competent to address the question of what constitutes a "legitimate medical purpose." And I would note, to begin with, that the practice of administering a lethal dose to a patient is explicitly repudiated by the Hippocratic Oath, the foundation of medical practice in Western civilization. I find it hard to imagine that a practice that for twenty-five centuries doctors swore they would never commit, can suddenly become a "legitimate medical purpose" in federal law because of a referendum in a single state. Since the time of the ancient Greeks, "legitimate medical purposes" have included only measures intended to save and protect life, not to cause death.

The medical profession still overwhelmingly supports the principles of good medical practice enunciated in the Hippocratic Oath. In confidential surveys, only a tiny fraction of practicing physicians say they would be willing to cooperate in taking the life of a suicidal patient. And I am very proud that the American Medical Association has not only taken a stand aghainst the practic of "assisted suicide," but has launched an extensive national campaign to educate doctors on pain management. Remarkable new advances have taken place in pain control, and it is now the case that no patient need suffer pain. Many people, including even some doctors, imagine that the only choice for the gravely ill is either to suffer excruciating pain for their remaining days or to end their lives intentionally. This is perhaps the single greatest fear people have about the end of life and it is a major argument used in support of physician assisted suicide. Yet this argument is techologically obsolete. Medical advances have made it possible for the dying to end their lives in genuine dignity, not wracked with agony but in relative comfort and with a clear mind.

I am convinced that if the voters in Oregon had known the truth about contemporary medicine, and had not been frightened by the terrible images of end-of-life pain, they would never have made the mistake of authorizing "assisted suicide." I hope that the American Medical Association's campaign to educate physicians about the new advances in pain management are successful enough to free people of the fears that led them to make such a tragic mistake.

Yet at the same time, I am mystified that this same American Medical Association that has done so much to fight against physician-assisted suicide -- a practice that will inevitably degrade the medical profession and erode the trust people feel for their doctors -- is opposing the legislation before us today. This attitude seems inexplicable. The apparent reason is that the Association seems to see some disadvantage in making doctors liable for violating their professional responsibilities. I think they fail to realize that this legislation before us does not impose new responsibilities on doctors or expose them to new liabilities. It simply reemphasizes the point that killing a patient is not a legitimate medical purpose, a point that has been taken for granted by practiciing physicians, the AMA itself, the DEA Administrator, and just about every other authority, with the regrettable exception of Attorney General Reno.

The other concern I have heard expressed about this legislation is that it might expose a doctor to the poenalty of losing his federal license to prescibe medicine when, in good faith, he or she gives a patient pain medication that has a side effect of hastening the patient's death. Yet it is very clear from the careful drafting of this bill, using language that the AMA itself recommended in another context, that this danger is purely imaginary. Easing pain is a "legitimate medical purpose," and is clearly differentiated from the direct intention of ending a patient's life. And the Oregon law itself requires a physician to declare in writing the intention to end a life. If a physician complies with the Oregon law, there is no ambiguity about his intention. He would be required to sign a document stating that he is administering a lethal dose pursuant to the patient's request. Doctors who use drugs for pain management do not fill out such a form and evince no such lethal intention.

Mr. Chairman, Members of the Subcommittee, there are only a few occasions when what we do in Congress literally has life or death consequences. This is one of those occasions. I thank you for bringing this bill forward, and I wholeheartedly support its enactment.

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