Don't force the serously ill to suffer more pain

Posted: Wednesday, August 23, 2000

I became an oncology nurse because I wanted to care for people during one of the most difficult and challenging times in their lives from first diagnosis to end of life support. Many times, unfortunately, patients have pain that can become so overwhelming that it consumes their every thought and prevents any quality of life for them. Every day, oncology nurses care for thousands of patients with cancer who are in severe pain due to their illness. Patients with cancer may require extremely large doses of morphine and other drugs to ease their pain. These doses would be lethal for an ordinary individual, but are necessary to alleviate many cancer patients' severe pain so they can interact with their families and are assured quality of care.

The Pain Relief Promotion Act, which Congress is scheduled to vote on in September, has dressed itself up as an aid to the medical and nursing profession, but in fact it would do just the opposite of what its name says and would hamper the ability to help patients in pain. This bill is targeted at the recent law approving physician-assisted suicide in Oregon. I am opposed to physician-assisted suicide. However, this legislation will have the unintended effect of deterring aggressive pain management and, ironically, cause more patients to suffer unrelieved pain and possibly seek suicide as their only way out from incorrectly treated pain. This cannot happen to cancer patients.

Many doctors already hesitate to dispense adequate amounts of pain medication due to lack of information or misinformation about pain relief or how to best treat it. This bill would make things worse. It would put Drug Enforcement Administration narcotics agents squarely in the middle of any doctor's decision to prescribe pain medicine. Every time a patient died, the DEA would have the authority to investigate what the physician "intended" when he or she prescribed pain medication for that patient that is, it would have to read health professionals' minds. Having the DEA looking over their shoulders will make many doctors think twice about prescribing the appropriate amount of pain medication to treat cancer pain correctly. That's because if the patient dies even from an unrelated cause or from the underlying illness the DEA can investigate the doctor, the nurse and the pharmacist who handled the drug with the threat of a 20-year minimum mandatory sentence. This will break down the collegial relationship needed for pain relief for cancer patients.

There is already misinformation or no information among health professionals regarding proper management of pain for patients with cancer. How is a federal law enforcement agent with no medical training going to distinguish what is appropriate for patients and others without interrogating doctors, nurses and grieving family members?

If Congress wants to outlaw physician-assisted suicide, it should confront that issue directly, rather than use DEA agents to pose an intimidating and significant threat to effective pain management. This bill would prevent nurses from helping patients with cancer receive appropriate pain care management. If our lawmakers want to address proper pain management, this is not the bill and it should not be supported.

Carole S. Edwards, RN, BSN, OCN


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