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APS Bulletin • Volume 8, Number 2, 1998

Pain and Public Policy

David E. Joranson, MSSW, and Michael A. Ashburn, MD MPH, Department Editors

Legislative Update: Assisted Suicide Funding Restriction Act of 1997

Perry G. Fine, MD

The June 1997 Supreme Court decision to retain state control of laws pertaining to physician-assisted suicide has generated a legislative response in the form of H.R. 1003. The Assisted Suicide Restriction Act of 1997 has been sent to the president. The purpose of H.R. 1003 is to explicitly prohibit the use of federal funds for any action or purpose connected with the suicide, euthanasia, or mercy killing of any individual. This purpose is presented as supporting current federal policy to provide payment for healthcare services and to protect the rights of individuals. Clearly, the House of Representatives, echoing the Supreme Court, does not view an individual as having the right to engage another person to purposefully end his or her life.

The language of H.R. 1003 suggests that the House foresees that assisted suicide may become lawful in certain states. It appears to be a means of imposing both financial and potential legal barriers to any loosening of assisted-suicide laws that a state might approve. For instance, I interpret the language of the act to mean that if a physician even discusses assisted suicide as an option with a patient and collects any payment for this encounter from a federal source (e.g., Medicare), it would constitute a federal crime. Therefore, it is very important for healthcare professionals to understand the extent to which these laws may affect them and their patients, regardless of their particular positions on the larger, controversial issue of complicity in dying.

Conversely, the act explicitly states that certain activities are exempt from its restriction of federal funding:

These caveats seem to support symptom management and palliative care to the fullest extent possible and to endorse the principle of double effect. This language may prove to be a strong safeguard for physicians who may hesitate to prescribe pain-relieving therapies for fear of punitive consequences. Advocates of palliative care medicine should herald this aspect of the act.

The federal funding sources covered by the act include Medicare, Medicaid, Social Security, Public Health Service, Indian Health Care, Federal Employees Health Benefits, Military Health System, Veterans Administration, Peace Corps Health Care, and Federal Prisoners Health Care.

As usual, anyone having a specific concern as to the ramifications of particular actions should consult expert legal counsel. The intent of this synopsis is to keep APS members abreast of legislative developments that may influence their individual practices and health care in general.

Perry Fine is associate medical director of the Pain Management Center at the University of Utah in Salt Lake City.

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