Thomas Coburn

Mr. COBURN

Mr. COBURN. Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks on H.R. 2260, and to insert extraneous material on the bill.

Mr. COBURN

Mr. COBURN. Mr. Speaker, this is a difficult issue. End of life issues always are. What the people of Oregon have done, they have every right to do as long as they follow the laws of the United States that do not supersede that. The fact is, this bill will not keep Oregon from having physician- assisted suicide. What it says is they just cannot use federally controlled drugs to do that. Now, how did we get where we are? The Attorney General of the United States decided that physician assisted-suicide as far as Oregon's law is concerned is a legitimate practice of medicine. I am here to tell my colleagues that that is not a legitimate practice of medicine. Matter of fact, even Oregon put great safeguards into their bills to make sure that mistakes were not made. Let me read to my colleagues what happened with one of the first cases. The first publicly reported case of assisted suicide in Oregon involved an out-of-state woman who was found to be clinically depressed by her doctor. Within 3 weeks of contacting the Compassion in Dying and moving to Oregon, she was dead by lethal overdose. Significantly, two other doctors had rendered opinions against the assisted suicide, including a physician who believed the woman was suffering from a clinical depression. These opinions were not included in the Oregon Health Division report in the law's first year. The fact is with this motion to recommit what we will be saying, if we follow it in its essence, is that it is okay for a doctor in Oregon to use federally controlled substances to kill a patient, but it is not okay to harm them. So what we will see is, if they harm someone, they are going to be held liable; but if they kill somebody, they will not. I would put forth to the body of the House that we have a wonderful example of what happens when a group of people follow this logic, and all we have to do is look at Holland. Last year in Holland, a very small country, 80 babies were euthanized by their gynecologists. Now, I know Oregon does not allow euthanasia of babies, but neither did Holland when they first started. The vast majority of people, well over 2,000 people in Holland, were euthanized against their choice. What is in the testimony is the fact that they are incapable in Holland of knowing how many people were euthanized against their will. I would ask the Members of this body to throw off the false argument that we are having the DEA look over the shoulder of doctors. In fact, the opposite is true. We have created a safe harbor for doctors that says if their intent is to eliminate pain, then they are held without liability. We also had charts presented and facts presented that showed that in every State that had put in a common-sense approach like this, the use of pain controlled medicines, morphine, has dramatically risen in helping those who are in the pains of dying with manageable pain. And, in fact, we are now moving as a Nation to manage that pain. I reject this motion to recommit, and I ask the House to support that position. Mr. Speaker, I yield back the balance of my time.

Mr. COBURN. Mr. Speaker, I rise in opposition to the motion to recommit.

Mr. COBURN. Mr. Chairman, I yield myself the balance of my time. I think three points need to be made. There is well-intended thought in the substitute but there are a couple of factual errors. Number one, we would not be here if the Attorney General had not said that physician-assisted suicide is the legitimate practice of medicine. It is not. That is number one. Number two is the rules and regulations that the Oregon law put up were good. They are intended to make sure the wrong things do not happen, to make sure that if in fact somebody helps somebody die, that they did that when they are not depressed, when they are not coerced, when they are not in a position. But we already have this experiment that has been carried out for us in Holland. They have the exact same rules. I want to quote to Members the testimony before the Committee on Commerce. There is a substantial practice of euthanasia now, primarily voluntarily, but definitely also not voluntarily. Even 5 years after the regulations were established, the majority of cases of euthanasia and physician-assisted suicide and almost all cases of nonvoluntary euthanasia are not reported, making effective control by the legal authorities impossible in Holland. In fact, the first publicly reported case of assisted suicide in the State of Oregon involved an out-of-State woman who was found to be depressed by one doctor that she consulted. Within 3 weeks of contacting Compassion in Dying and moving to Oregon, she was dead by lethal overdose. Significantly, while two doctors rendered opinions against the assisted suicide, including a physician who believed the woman was suffering from clinical depression, these opinions were not included in the Oregon Health Division Report of the law's first year after enactment. So we can be well-intentioned. We can try to design it, but the fact is there are holes. And the very first case in Oregon slipped through the cracks. Let me read to Members about what we are going to see in the future, and I am not saying this is happening in Oregon today but this is where we are going: ``Thanks to another `prosecution' of a doctor who euthanized an infant, euthanasia, already practiced on adults in the Netherlands, will soon openly enter the pediatric ward. Dr. Henk Prins killed a 3- day-old girl who was born with spina bifida, leg deformities and hydrocephaly, which all babies who have spina bifida have. The doctor, a gynecologist, not a pediatrician or medical expert in such cases, although experts were consulted, was defended. He testified in the trial court that he killed the child with her parents' permission because of the infant's poor prognosis.'' I am not saying that is going on right now. And I understand and believe the people in opposition to this base bill that they do not believe in physician-assisted suicide. But I beg you to open your eyes to see where we are going. When abortion was first made legal in this country, it was to prevent back alley abortions. The number one reason for abortion today is birth control. That was not the intended purpose when we said we should allow medical abortions. But where are we? Just 50 million babies that are not here for birth control. The lazy birth control. Have an abortion. So think about what can come out of this. There are legitimate options in the substitute as far as enhancing the treatment of pain control. There is no question. But the fact is this bill will protect physicians. My own experience tells me that. My own gut tells me that. But most importantly we will not violate the State right of Oregon. If Oregon wants to kill somebody not using a Federally controlled drug, they have every right to do it. But what we are saying is, if you are going to use a Federally controlled product, you do not have that right.

Mr. COBURN. Mr. Chairman, I yield myself 15 seconds, and I want to quote Herbert Hinden, Professor of Psychiatry at New York Medical College. ``The proposed law provides protection for physicians who prescribe medication with the intention of relieving pain, even if that medication has the secondary effect of causing death.'' Mr. Chairman, I yield 2\1/2\ minutes to the gentleman from Alabama (Mr. Bachus).

Mr. COBURN. Mr. Chairman, I yield 1 minute to the gentleman from Florida (Mr. Weldon).

Mr. COBURN. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Iowa (Mr. Ganske).

Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, we have heard a lot of debate already on the rule. We have heard a debate about the intent of our Forefathers. I would counter what the gentleman from Massachusetts (Mr. Frank) said during the debate on the rule that, in fact, that every law that we pass has a moral consequence; and that, in fact, if we read the writings of our Founders, they did not see that questions such as this would come up. The real thing that we are going to be debating is about life. As the freest Nation in the world, are we going to abandon the principle that life has value? I have come to recognize with all my own deficiencies, and especially how they have been exemplified my last 5 years in Congress, that we are all handicapped in one way or another. Some of us, we can see the external handicap. It is very plain and visible. Others, we hide our handicaps. But the fact is, all of us, handicapped as we are, have value, whether I agree with the philosophical point of view or not of that other individual, is that all of God's creation, all life has value. What we are really debating is whether or not the State of Oregon can ignore a law that is 28 years old and decide that, in this country, the freest country of the world, that they will allow other people to decide whether life has value. We are on a terrible slippery slope. The committee of which I am a member had testimonies about what has happened in Holland. In fact, when euthanasia and assisted suicide started in Holland, it was a very small number. It has grown progressively each year. But most importantly, because of the number of people who have been euthanized against their will, people now carry a card in Holland in their billfolds to say do not euthanize me. They have had to do that because they are worried that, if they get in a precarious life-threatening situation, somebody might make the decision about their life. Our country cannot go that direction. We must demand and stand for the fact that all life has value. Whether it is the unborn child just conceived, whether it is the child with multiple anomalies, it all has value. If it has no value, there is no real meaning to life in the beginning or in the end. I throw that off as a Member of this body, somebody who represents the great State of Oklahoma, who was brought up in a tradition that this is the freest country in the land, but it is only free if we preserve the principles of life. Mr. Chairman, I reserve the balance of my time.

Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume. I quote, and this testimony was also given before the constitutional subcommittee in the House. I want to give my colleagues the quote of a physician: ``What is the sense of having that woman here? It makes no difference whether she dies today or after 2 weeks. We need the bed for another case.'' This is a recounting of a Catholic nun who did not want to be euthanized but was euthanized anyway in Holland because they needed the bed. Mr. Chairman, psychiatrists are in lawsuits every day in this country because they give antidepressants that have a lethal dose of 50 and they give too much medicine. One of the things you are taught in medical school is to not give too much medicine, enough medicine that someone could take their life. So we understand that issue and those arguments are fallacious. The fact remains that if we are going to encourage a doctor-patient relationship, I will encourage that all the way up to the point we decide that the doctor has the right to take the patient's life. That is no longer a relationship. That is not a relationship when I as a physician decide I am going to be the giver or taker of life for my patient. And if that is the foundational construct under how we are going to run doctor-patient relationships, we need start completely over. Psychotropic drugs are controlled in this country and for good reason. That is called mescaline, LSD. We use very few. We use antipsychotic drugs and we use narcotics and we use barbiturates. But most psychotropic drugs we do not even allow doctors to write a prescription for because they are significantly mind- altering drugs. The doctor-patient relationship does need to be preserved. This law does nothing to disturb a proper doctor-patient relationship in Oregon. But as soon as a doctor has made the decision that they are the giver or taker of life, they no longer are a physician. They may be called doctor by our society but they no longer are a physician. They no longer have the ethical right to care for that patient. Mr. Chairman, I reserve the balance of my time.

Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, I would like to just go through and rhetorically ask some questions and answer them so we can really talk about what this bill does. Because we have heard everything except the essence, other than what the gentleman from Michigan (Mr. Stupak) just outlined, as the truth about what this bill does. Is it the intent of this bill to undermine States' ability to help patients access appropriate palliative care? No, it is not the intent whatsoever. Is it the intent of this bill to create a fear on the part of physicians so they will not do the proper thing when it comes to caring for end-of-life, pain-enduring patients? No, that is not the intent. And that is not the consequence, regardless of what has been said on the floor. What we actually do is define better so that we do not put physicians at risk and give them a safe harbor. Are we trying to go around guidelines for end-of-life issues in the State? No, we are not trying to do that at all. What we are trying to say is have whatever guidelines they want, but as far as the use of narcotics, we do not think that those narcotics ought to be used to intentionally take a life. Some have said we are going to allow the DEA agents to make a decision over what the intent was of the doctor. Well, that is simple. I am for that. I do not have any problem. Because do my colleagues know what? They make that decision about me right now. Whatever my intent is, whether I write a narcotic prescription to alleviate pain associated with a fracture or if I write morphine suppositories for a patient dying of metastatic cancer, they still get a look at it; and they are making a decision right now. And do my colleagues know what? All they want is to make sure that we are not violating the law. And every physician is trained in that. Now, what is the real question? The real question is will physicians in this country stand up and put their patients first? That is the real question, will they really go out and help their patient? As the gentleman from Florida (Mr. Weldon) so eloquently said, we can help patients. We do it all the time. The question is we have to be trained in it, we have to want to do it, and we have to make sure that the extenders of the physicians in this country will in fact carry out our order. There is no question, the American Medical Association said 2 years ago we have not done a good job in this country in training physicians in end-of-life pain control management. They have redoubled their efforts not only at the American Medical Association but in every medical school in this country. So what we have heard about the untoward events that will come out of this bill is poppycock; it is not based in fact. The fact is, if they are going to assume everybody is going to do everything wrong, they might be able to do that. Somehow we changed in this country. We used to assume that people would do things right, that they were honorable, that they had integrity. And then, as we start undermining the values and foundational principles of our country, we have to assume that everybody is going to do everything wrong. What this bill does is say, if their intent is right, they are safe- harbored and they are protected. The fact is that every day good physicians are out there making great decisions about pain control for their patients. This bill will enhance their ability to do that, not take away from that. Mr. Chairman, I reserve the balance of my time.

Mr. COBURN. Mr. Chairman, I yield 1 minute to the gentleman from Florida (Mr. Weldon).

Mr. COBURN. Mr. Chairman, I yield myself 15 seconds for just a response. If a doctor writes a prescription that he knows is going to be used to take someone's life, that is doctor-assisted suicide, period, end of sentence. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Ohio (Mr. Chabot).

Mr. COBURN. Mr. Chairman, I ask unanimous consent to yield the balance of my time for purposes of control to the gentleman from Florida (Mr. Canady).

Mr. COBURN. Mr. Chairman, I rise in opposition to the amendment.

Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, what this amendment does is gut the portion of the DEA enforcement that we presently have and is presently law. The real issue we are talking about is how do you defend taking somebody else's life and doing it under the Oregon statute? How do you defend that? How do you say it is okay for me as a physician to take your loved one out? What, under our Constitution, what would ever give me that right, whether I am in Oregon or Oklahoma? The fact is that Oregon gets the right to pass their laws. As the chairman of the Committee on the Judiciary said, they can still take that; they just cannot do it using the Federal Controlled Substances Act. There is very good reason that we have that act. What the gentleman wishes to do is to make it not apply in this instance. What about the child that is born, that is severely handicapped and the parents say, ``Oh, no, we can't. You know, we just cannot take care of this child. It is too big of a burden. Will you not please, Mr. Pediatrician, Dr. Obstetrician, won't you relieve our suffering? Please give an injection of respiratory depressant or of a high dose of narcotics so we don't have to handle this burden. Oh, take care of our problem.'' What about the value of that life? It does not have any value, according to the people of Oregon, because only in the context of the people making the decision will it have value. Only in the context of an elderly person that has severe Alzheimer's, is uncontrollable, only if that family desires, and if it is registered to be done, can they do it. That life has no value? There is no value? In terms of inaccurate statements, the fact is the DEA law is not changed, just clarified, which will make no major change. We could give a safe harbor for physicians. As a practicing physician who gives palliative care for dying cancer patients and others, I welcome this change in the law, because it does clarify, and it does offer safe harbor. Mr. Chairman, I reserve the balance of my time.

Mr. COBURN. Mr. Chairman, I yield 1 minute to the gentleman from Florida (Mr. Canady).

Mr. COBURN. Mr. Chairman, I yield myself 1\1/2\ minutes, the balance of the time. Mr. Chairman, this House twice, 2 years in a row, has said we do not think the FDA ought to be in the business of approving drugs that kill babies; we do not find a role for it, that, in fact, we should not spend Federal dollars to figure out the best ways to kill somebody. If my colleagues want to talk about a slippery slope, pretty soon we are going to figure out the best way to take a senior out, the most comfortable way, the least expensive way, the most efficacious way to end life. Pretty soon, we are going to figure out what is the easiest way to terminate a pregnancy, to eliminate the consequences of a mistake in judgment or a crime. We are going to spend Federal dollars on how to eliminate those segments of our society that are most dependent on us. I am not a partisan up here. But on this issue, I say that if my colleagues really care about those who cannot care for themselves, they cannot be for anybody in our society to make the final decision about whether they live or not, whether it is me making a decision about my child or us making a decision as a group about a family member or me as a physician making a decision about my patient. What we are saying was said in Holland 10 years ago. The same statements were said, and it was ignored. Today, they have active euthanasia of newborn babies growing at 20 percent per year. They have active euthanasia of those that are handicapped growing at 20 percent a year. It will happen here, folks.

Mr. COBURN. Mr. Chairman, I rise in opposition to the amendment in the nature of a substitute.

Mr. COBURN. Mr. Chairman, I yield myself 15 seconds so that I might respond. The gentlewoman from Connecticut (Mrs. Johnson) might not recognize that every narcotic prescription that I write today, when it is reviewed and surveyed and sampled, a DEA agent makes a decision whether or not my judgment was appropriate in that. If there is any question, they are in my office looking at my medical records. So the statement to say we do not allow them judgment today is wrong. Mr. Chairman, I yield 8 minutes to the gentleman from Kansas (Mr. Tiahrt).

Mr. COBURN. Mr. Chairman, I yield 2\1/2\ minutes to the gentlewoman from New Jersey (Mrs. Roukema).

Mr. COBURN

Mr. COBURN. As my colleagues know, I thank the gentleman for his words. I actually take that a completely different way. One does have the right to be secure, which means nobody has the right to take their life, nobody; and I would put forth to this body that if our Founding Fathers thought we killed 3 to 5 million unborn babies a year in this country, they would be sickened of heart at how we have not held on to the very principles of life, liberty and the pursuit of the qualities that go along with life and liberty. There is not a stronger States' rights person here than me, but with the tenth amendment gives no right to take someone's life. We do have a Constitution of the United States; and if it was my own State, Oklahoma, had passed the Oregon law, I would be here fighting them because not only are they wrong constitutionally, they are wrong morally; and our founders founded this country on the basis of moral beliefs and the beliefs of a higher being that endowed us with inalienable rights, but one of those rights was not the right to take someone's life.

Mr. COBURN. Mr. Speaker, what the gentleman fails to state is that the DEA already has that power. Yes, there is no more important thing than intent. Every doctor, when they graduate from medical school, their goal is to preserve life, not take it. There are lots of times in my life that have been low, I would have loved to have been out of here. But I am glad somebody did not help me leave. Because there is always another day. For those of my colleagues who have not treated dying patients with metastatic bone cancers, first of all, we do not use barbiturates. We use narcotics. Barbiturates are not used for pain relief. They are used to accentuate pain relief. But narcotics are used for pain relief. There is no new law. The DEA, if I misuse a drug today, a controlled substance, can in fact harm me, take away my license to dispense drugs, and incarcerate me. And rightly so. We do not in this country, under our Constitution or our Declaration of Independence, have the right to die. That is not one of the guaranteed freedoms in this country. We do not have the right to die. As a matter of fact, it is against the law to commit suicide in many States. So what we are really saying is the motivation of the people from Oregon is a good motivation. People are in pain. How do we fix that? Well, the professionals have already said we need to do a better job of training doctors and we need to make sure doctors do not feel afraid to go up with the intention of alleviating pain and worry about the unintended consequence it might suppress somebody's respiration and they die. This bill truly addresses that because it does not give the free will for a physician to say, we are going to take their life. Most people who want their life taken have a clinical depression, a clinical depression. They have another illness besides the illness that is in front of everybody, and it is that, that we need to recognize.

Mr. COBURN. Mr. Speaker, this is the bill. What the gentleman from New Jersey (Mr. Rothman) just said is false. There is no penalty in here. Every doctor in this country today, every controlled substance is available for review by the DEA. There is no change in that. The gentleman knows that. There is no penalty, new penalty in this bill for anybody. What this bill is about is saying that Federal law, as far as narcotics control, cannot be preempted by a State in the use of those narcotics. That is what it is about. The gentleman has not ever given pain medicine to somebody who is dying. I have. I have intentionally medicated somebody to help them with their pain. Unfortunately, as a consequence of that, some have died. There is nothing that keeps us from doing that today except our fear of rhetoric that is untrue. That is untrue, absolutely blatantly false that there is criminal penalties in this bill for any doctor who does the right thing. This is about not allowing the State to stick their nose out at a Federal law that we all know is important, and that is controlling dangerous substances. Now, the gentleman's desire is an honorable desire that, in fact, we should help doctors alleviate pain; and we can do that. There is no question that I have seen in my 18 years of practice of medicine that we, in fact, do not do as good a job as we should at that issue. But to take and create that as a reason to allow any State to use narcotics to kill a patient is wrong. That is what is going to happen. We have great testimony. We have the great experience of the Dutch. We had 2,100 people in 1995 in Holland who were euthanized against their will. They did not want to die. But a doctor decided they should not live anymore. The slippery slope that the gentleman from Texas (Mr. Paul) talked about and his understanding of this bill I believe is wrong. There is a slippery slope. But it is not the slope of allowing the Federal Government to continue to enforce the laws of this land and to have a Federal standard on narcotics. That is not the slippery slope. The slippery slope is to create an environment where any State, regardless of their own desires, can ignore Federal law today; every doctor who writes a prescription for a controlled substance can be reviewed; every prescription can be looked at by the DEA. There is no new authority for the DEA in this. What this bill says, and it is only this few pages, is that the law applies to every State equally, and that just because Oregon decides that they want to take someone's life, that they should not be able to say that Federal law does not apply. The fact is all life has value. As we have determined in this country, we have said the unborn does not have value. Now Oregon says the dying do not have value, and that in the future, those that are not dying have no value. There were just 1,100 babies that were born last year and the year before in the whole land that the doctor decided should not live. So what did they do? They gave them paregoric, they paralyzed the respiration, and they died. Do we want doctors deciding who lives and who dies? No, we do not want that. This is a slope, a real slope where we are going to become God. We do not have that power. The Declaration of Independence says that we should have the right to pursue life, liberty, and the pursuit of happiness. Nothing in it says we have the right to pursue death, nothing.

Mr. COBURN

Mr. COBURN. Mr. Speaker, I object to the vote on the ground that a quorum is not present and make the point of order that a quorum is not present.

Mr. COBURN. Mr. Speaker, I offer a motion to instruct.