Legislation and End-of-Life Care

To the Editor: Drs Orentlicher and Caplan¹ described the Pain Relief Promotion Act of 1999 (PRPA) as a " . . . serious threat to palliative care." They were concerned about interference by the federal government with state authority and speculated that such legislation would inhibit good palliative care and pain relief.

I would like to share a different perspective from a hospice physician who has been active in pain promotion in Maryland where the state has passed (despite similar misleading arguments as those of Orentlicher and Caplan) legislation banning physician-assisted suicide with wording to promote good pain management,¹ similar to that seen in the bill recently passed by the US House of Representatives.¹ The reason that the Maryland version became law with bipartisan support (despite the fact that Maryland is arguably the most liberal state in the Union²) had to do with specific wording that provided protection for clinicians who prescribe medication for pain relief, even if such prescribing increases the risk of death or potentially hastens death. As is true with the proposed federal legislation, such prescribing would only be illegal if the physician intended to kill a patient. Even a novice prosecutor recognizes how daunting it is to prove intent.