"The Big Chill: Inserting the DEA Into End-of-Life Care"

[nosmokes]

"The Big Chill: Inserting the DEA Into End-of-Life Care"

A New England Journal of Medicine Commentary by Timothy E. Quill, MD and Diane E. Meier, MD, FACP. Online article and recorded interview is available after 5pm EST, January 4, 2006 at www.nejm.org

As the U.S. Supreme Court weighs physician-assisted dying in Gonzales v. Oregon, end-of-life specialists assess Drug Enforcement Agency involvement in care of the dying.

Increased efforts by federal authorities to restrict prescriptions for terminally-ill patients has heightened physicians' fear of Drug Enforcement Agency (DEA) investigation and prosecution and is undermining much of the progress that has been made nationally in pain and symptom management for dying patients.

Timothy E. Quill, MD, Board Member of the Death with Dignity National Center, Diane E. Meier, MD, FACP, Director of the Center to Advance Palliative Care, have written a joint commentary decrying the DEA's increasing involvement in end-of-life care in Oregon and throughout the United States. The article in its entirety and an audio interview with Quill and Meier can be found at http://content.nejm.org/.

Expanded DEA involvement in palliative and end-of-life care began under the "Ashcroft Directive," aimed at increased investigation and possible prosecution of physicians who prescribe medications to alleviate dying patients' pain and suffering. This growing federal involvement in the care of the terminally ill has culminated in the Supreme Court case of Gonzales v. Oregon, aimed at overturning the landmark Oregon Death with Dignity Act, a much scrutinized but rarely used law permitting physician-assisted dying in that state under specific conditions and guidelines.

Quill is Professor of Medicine, Psychiatry and Medical Humanities at the University of Rochester (New York) where he directs the Center for Palliative Care and Clinical Ethics. Quill is the author of several books, including: Physician Assisted Dying: The Case for Palliative Care and Patient Choice (Johns Hopkins University Press, co-edited with Margaret Battin), Caring for Patients at the End of Life: Facing an Uncertain Future Together (Oxford University Press), A Midwife Through the Dying Process, Stories of Healing and Hard Choices at the End of Life (Johns Hopkins University Press), and Death and Dignity: Making Choices and Taking Charge (W.W. Norton). He was the lead physician plaintiff in the New York State legal case Vacco v. Quill challenging the law prohibiting physician aid in dying.

Meier is Director of the Center to Advance Palliative Care and Chief of the Division of Geriatrics for the Department of Medicine, at the Mount Sinai School of Medicine (NY). Meier is recipient of a National Institute on Aging Academic Career Leadership Award focusing on palliative care of the elderly and the mentoring and support of junior faculty in palliative medicine. She is editor of the first textbook on Geriatric Palliative Care, as well as four editions of Geriatric Medicine and has appeared in numerous publications, including The New York Times, The Los Angeles Times, Newsday, and The New Yorker. She also figured prominently in Bill Moyers' PBS four-part documentary "On Our Own Terms: Dying in America."

For more information, contact the DDNC Communication and Education Office at 503-228-4415, or e-mail [e-mail].

[MountainLaurel]

1. Thank you for posting this

I remember being appalled at the idea of DEA agents hanging over dying people to make sure docs are not using dosages of painkillers beyond what the DEA will allow.

[necso]

2. Like I said,

the only inalienable right that we have is the right to die -- slowly, expensively, painfully, disrespected and dishonored -- and (very) eventually, with heartless pricks controlling the entire game -- that is, once they have their greedy hands on you.

Wild animals have it better.

Some "civilization" we have.

[rodeodance]

3. so much for the slogan -less gov (repug).

[noonwitch]

4. This type of thing is exactly what inspired Dr. Kervorkian, initially

His original stance, before getting drunken with media coverage, was that doctors were hesitant to prescribe enough medication to relieve the pain of people who were dying. They were either afraid of getting the dying person hooked on narcotics (as if it matters) or of over-eager law enforcement people accusing them of overprescribing narcotics and violating the Harrison Narcotics Act.

Origninally, his philosophy was that if the doctors were able to prescribe enough painkillers to relieve the patients' pain, not too many would be calling him to help them die. Of course, then he decided that cerebral palsy was terminal and helped a depressed woman die who should have seen a psychiatrist, not a coroner. He fired his lawyer and killed a guy on "60 Minutes", which is what got him locked up. I think he started to enjoy helping people die and it made the public very uncomfortable.

[necso]

5. I like your post.

The truth of it I do not know, but it sounds reasonable, plausible and like the way the world really works.

But I wouldn't send a dog to a psychiatrist (or a psychologist), not with their current understanding of how the mind works, their parochialism and their arrogance in thinking that they understand.

No offense meant, and none taken, I hope.

[newswolf56]

6. What we need to understand is that this is Christian theocracy in action:

forcible imposition of the core Christian principle that pain is "good" -- that suffering is punishment for sin and thus brings one closer to (the Abrahamic) god. Hence it should be no surprise that the Drug Enforcement Administration, an arm of the avowedly theocratic Bush Administration, is injecting this principle into medical care and end-of-life circumstances in general.

The method to this particular Abrahamic savagery is that, trapped in maximum suffering, the dying patient will (between screams) presumably turn to "god" in desperation. The doctrine is nothing new; what IS new -- absolutely without precedent in U.S. history in fact -- is the federal government enforcing it (or any other religious doctrine) with its secret police, in this case the DEA.

In my home state of Washington (where the DEA presence is huge because of the Canadian border) it has gotten so bad even the dentists will no longer prescribe adequate post-extraction painkillers.

Worse, the local medical profession has been intimidated to cowardly silence: last year a federal study showed that (despite the overall superb quality of locally available health care) terminally ill patients in Washington already suffer an exceptionally high percentage of unrelieved pain -- if memory swerves, the third highest such percentage in the U.S. Why? According to a story in one of the local papers (sorry; too long ago for a free link), local medical people all refused to say. Asked by the reporter if DEA interference were a factor, the medical people typically terminated the interviews.