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New US act overturns legality of doctor assisted suicide in Oregon

BMJ 1999; 319 doi: (Published 13 November 1999) Cite this as: BMJ 1999;319:1312
  1. Fred Charatan
  1. Florida

    Last month the US House of Representatives passed the Pain Relief Promotion Act, which effectively supersedes the state of Oregon's 1997 Death with Dignity Act. The Senate version, introduced by Senator Don Nickles and 31 cosponsors, seems also likely to pass.

    Oregon is the only US state where doctor assisted suicide is legal. It allows voluntary self administration of lethal drugs expressly prescribed by a doctor for that purpose. It prohibits euthanasia—whereby a doctor directly administers a drug to end another person's life.

    The new federal law's main provisions were to endorse the “legitimate medical purpose” of doctors prescribing drugs listed in the 1970 Controlled Substances Act to relieve pain; and to recognise the so called “double effect,” where the use of a narcotic may hasten death.

    A doctor who prescribes drugs “for the purpose of causing death” would be subject to criminal penalties—20 years in prison for prescribing the drugs used to aid a suicide. Education, research, and training are included in the new law

    A key part of the new law is that a state law allowing doctor assisted suicide does not change the federal responsibility to prevent misuse of federally controlled and potentially dangerous drugs.

    By applying the current law in 49 states to all 50 states, the law restores the uniform national standard whereby federally controlled substances cannot be used for the purpose of assisted suicide.

    The new law therefore bars the use of drugs like morphine and other narcotics, stimulants, and depressants listed in the Controlled Substances Act, in doctor assisted suicide.

    The American Medical Association, supporting the law, said that the law did not expand the authority of the Drug Enforcement Administration concerning jurisdiction, investigations, or enforcement regarding the Controlled Substances Act

    The National Hospice Association, the American Society of Anesthesiologists, the American Academy of Pain Management, and former US surgeon general C Everett Koop also supported the law.

    Opposed were the Hemlock Society, the Oregon Medical Association, and 10 state medical societies, which said that the new law would do “significant harm” to doctors' abilityto manage their patients' pain.

    “The ‘death with dignity’ law has made Oregon the nation's leader in end of life care,” said Hannah Davidson, director of the Oregon Death with Dignity Legal Defence and Education Center. “This new federal law would undermine all the advances we've made.”

    The United States Supreme Court ruled in 1997 that an individual does not have the right to commit doctor assisted suicide. However, Oregon's governor, Democrat John Kitzhaber, himself a doctor, might consider challenging in the Supreme Court the new law, on thegrounds of states' rights.

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