A federal ruling announced today prohibits the use of controlled substances under the Oregon Death with Dignity Act. This ruling reinterprets existing federal law and states that controlled substances may not be used with the intent of hastening death. This new ruling may have unintended consequences resulting in the undertreatment of pain.
In a recent statewide survey, some Oregon physicians reported that physicians often underprescribe pain control medication for those who are dying. One of the reasons reported for this underprescribing is fear of investigation by the Drug Enforcement Administration. Under the new Federal ruling, the DEA is charged with investigating physicians who use controlled substances to deliberately hasten death.
Susan W. Tolle, M.D., director of the Center for Ethics in Health Care at Oregon Health & Science University, said, "I am concerned about the continued undertreatment of pain in some dying patients and about perceived threats of investigation that may increase physician fears. I encourage physicians to guard against any reduction of medication in their treatment of the suffering of those who are dying. I recommend that physicians carefully document their intent when prescribing pain control medications. When controlled substances are being prescribed for comfort, the physicians' progress notes should clearly document the symptom being treated and that the intent of the medications is to relieve suffering.
"My position, as well as that of the Center for Ethics in Health Care, remains neutral on the Oregon Death with Dignity Act, neither supporting nor opposing the option. We are united in our efforts to gather data about changes in end-of-life care in Oregon, and to promote education and policy which facilitates comfort in life's final months."