Would You Desire Your End-of-Life Care Managed by a DEA Agent?

A Perspective commentary by Timothy E. Quill, M.D., and Diane E. Meier, M.D. in the January 5th 2006 issue of the New England Journal of Medicine describes the chilling effect on physicians' provision of comfort care of terminally ill patients because of the November 2001 U.S. Attorney General John Ashcroft directive which states that the prescription of Schedule 2 medications under the Oregon law violates the Controlled Substance Act since “assisting in a suicide is not a ‘legitimate medical purpose’” The commentary suggests that “If passed, this directive would allow the federal government to overrule established state law, empower the [Drug Enforcement Agency] DEA to investigate whether a violation had occurred, and potentially open to investigation every instance of prescribing of a controlled substance for a dying patient.” and not simply if administered under Oregon law.

The directive was taken to court by the state of Oregon and others with the argument that it should be the state’s responsibility to determine “legitimate medical purpose” and not the Controlled Substance Act. While the Ninth Circuit Court of Appeals supported the Oregon argument, the case was subsequently heard in the U.S. Supreme Court, which has as yet not announced a decision.

The authors conclude: “This type of DEA involvement in medical practice would adversely affect far more patients than those few who seek assistance with a hastened death in Oregon. If the government thus oversteps its legitimate role and expertise, allowing DEA agents, trained only to combat criminal substance abuse and diversion, to dictate to physicians what constitutes acceptable medical practice for seriously ill and dying persons, it will undermine palliative care and pain management for the much larger number of seriously ill patients in all states. Physicians may become hesitant to prescribe the best available medications to manage the pain, agitation, and shortness of breath that sometimes accompany the end stages of illness. As a result, they may, in essence, abandon patients and their families in their moment of the greatest need”

I have no doubt that the dire predictions of Quill and Meier will come true if the directive is sustained. We physicians will not risk jail time or heavy fines for performing humane patient comfort care. Better, society finally decides who sets the standards of practice, the States and their physicians or DEA agents And if the latter, perhaps the DEA agents would want to take over end-of-life patient management themselves. Any sarcastic comments to my sarcastic suggestion? ..Maurice.