Don Nickles

Mr. NICKLES

Mr. NICKLES. Mr. President, end-of-life issues are some of the most complicated our society wrestles with today, as medical technology dramatically advances and life expectancies continue to increase. Many of us have relatives, or know someone, who has grappled with grave and terminal illnesses. Doctors, caregivers, and family members work together in such situations, not just in an effort to save a loved one's life, but to give them the comfort and palliative care they deserve. However, love and concern can often come up against a confusing and complicated set of Federal and state laws which govern and influence care and treatment decisions in such situations. Today I, along with Senators Lieberman, Lott, Abraham, Allard, Brownback, Coverdell, Enzi, Hagel, Helms, Inhofe, and Craig, introduce the Pain Relief Promotion Act of 1999. This comprehensive legislation will restore the uniform national standard of the Controlled Substances Act (CSA) to all 50 states. The Pain Relief Promotion Act will: Affirm and support aggressive pain management as a ``legitimate medical purpose'' for the use of federally-controlled substances--even in cases where such use may unintentionally hasten death as a side- effect (``principle of double effect''). Encourage practitioners to dispense and distribute federally- controlled substances as medically appropriate to relieve pain and other distressing symptoms, by clarifying that such conduct is consistent with the Controlled Substances Act. Provide that a state law authorizing or permitting assisted suicide or euthanasia does not change the federal government's responsibility to prevent misuse of federally-controlled, potentially dangerous, drugs. The Federal government's responsibility to prevent such misuse in states which have not legalized assisted suicide is already conceded by the Attorney General and would not change. Provide education and training to law enforcement officials and health professionals on medically accepted means for alleviating pain and other distressing symptoms for patients with advanced chronic disease or terminal illness, including the legitimate use of federally- controlled substances. Establish a ``Program for Palliative Care Research and Quality'' within the Agency for Health Care Policy and Research (AHCPR) to develop and advance scientific understanding of palliative care, and collect, disseminate and make available information on pain management, especially for the terminally ill health professionals and the general public. Authorize $5 million for a grant program within the Health Resources and Services Administration (HRSA) to make grants and contracts for the development and implementation of programs to provide education and training in palliative care. It states that physicians entrusted by the federal government with the authority to prescribe and dispense federally-controlled substances may not abuse that authority by using them for assisted suicide; however, it strongly affirms that it is a ``legitimate medical purpose'' to use these federally-controlled substances to treat patient's pain and end- of-life symptoms, even in light of the unfortunate and unintended side effect of possibly hastening a patient's death. Recognize that this policy promoting pain control does not authorize the use of federally-controlled substances for intentional assistance in suicide or euthanasia. Restore the uniform national standard that federally-controlled substances can not be used for the purpose of assisted suicide by applying the current law in 49 states to all 50 states. This bill does not create any new regulatory authority for the DEA. This is a straight-forward, very positive bill that would merely apply what is current law in 49 states to all 50 states, without increasing the federal regulatory authority of the Drug Enforcement Administration (DEA). The bill has been endorsed by organizations including the National Hospice Organization, American Society of Anesthesiologists, American Academy of Pain Management, and former Surgeon General Dr. C. Everett Koop. And, today I was informed that the House of Delegates of the American Medical Association voted to support the bill. A variety of provisions in this legislation is in direct response to the June 5, 1998, letter by the Attorney General, allowing Oregon to use federally-controlled substances for assisted suicide, a decision that was in direct opposition to an earlier policy determination by her own Drug Enforcement Administration. It is significant to remember that in 1984 Congress passed amendments to strengthen the Controlled Substances Act, due to specific concerns regarding the use of prescription drugs in lethal overdoses. Congress's view was that while the states are the first line of defense against misuse of prescription drugs, the federal government must enforce its own objective standard as to what constitutes such misuse--and it must have the authority to enforce that standard when a state cannot or will not do so. Again, Congress clearly spoke on the issue of assisted suicide when it passed the Assisted Suicide Federal Funding Restriction Act of 1997 by a nearly unanimous vote. Signing the bill President Clinton said it ``will allow the Federal Government to speak with a clear voice in opposing these practices,'' and warned that ``to endorse assisted suicide would set us on a disturbing and perhaps dangerous path.'' It is time for Congress to speak again. Federal law is clearly intended to prevent use of these drugs for lethal overdoses, and contains no exception for deliberate overdoses approved by a physician. The DEA currently pursues cases where a physician's negligent use of controlled substances has led to the death of a patient, it was inappropriate for the Attorney General to allow for the intentional use of controlled substances to cause the death of a patient. The Pain Relief Promotion Act will clarify federal law, to affirm use of controlled substances to control pain and reject their deliberate use to kill patients. This legislation is overdue. Already physicians have used these federally controlled substances to cause the death of their patients. There is no role for the Federal government in providing assisted suicide. I urge my colleagues to support and enact this urgently needed bipartisan legislation. Mr. President, I ask unanimous consent that the text of the bill and letters, of support be printed in the Record.

Mr. NICKLES

Mr. NICKLES. Mr. President, end-of-life issues are some of the most complicated our society wrestles with today, as medical technology dramatically advances and life expectancies continue to increase. Many of us have relatives, or know someone, who has grappled with grave and terminal illnesses. Doctors, caregivers, and family members work together in such situations, not just in an effort to save a loved one's life, but to give them the comfort and palliative care they deserve. However, love and concern can often come up against a confusing and complicated set of Federal and state laws which govern and influence care and treatment decisions in such situations. Today I, along with Senators Lieberman, Lott, Abraham, Allard, Brownback, Coverdell, Enzi, Hagel, Helms, Inhofe, and Craig, introduce the Pain Relief Promotion Act of 1999. This comprehensive legislation will restore the uniform national standard of the Controlled Substances Act (CSA) to all 50 states. The Pain Relief Promotion Act will: Affirm and support aggressive pain management as a ``legitimate medical purpose'' for the use of federally-controlled substances--even in cases where such use may unintentionally hasten death as a side- effect (``principle of double effect''). Encourage practitioners to dispense and distribute federally- controlled substances as medically appropriate to relieve pain and other distressing symptoms, by clarifying that such conduct is consistent with the Controlled Substances Act. Provide that a state law authorizing or permitting assisted suicide or euthanasia does not change the federal government's responsibility to prevent misuse of federally-controlled, potentially dangerous, drugs. The Federal government's responsibility to prevent such misuse in states which have not legalized assisted suicide is already conceded by the Attorney General and would not change. Provide education and training to law enforcement officials and health professionals on medically accepted means for alleviating pain and other distressing symptoms for patients with advanced chronic disease or terminal illness, including the legitimate use of federally- controlled substances. Establish a ``Program for Palliative Care Research and Quality'' within the Agency for Health Care Policy and Research (AHCPR) to develop and advance scientific understanding of palliative care, and collect, disseminate and make available information on pain management, especially for the terminally ill health professionals and the general public. Authorize $5 million for a grant program within the Health Resources and Services Administration (HRSA) to make grants and contracts for the development and implementation of programs to provide education and training in palliative care. It states that physicians entrusted by the federal government with the authority to prescribe and dispense federally-controlled substances may not abuse that authority by using them for assisted suicide; however, it strongly affirms that it is a ``legitimate medical purpose'' to use these federally-controlled substances to treat patient's pain and end- of-life symptoms, even in light of the unfortunate and unintended side effect of possibly hastening a patient's death. Recognize that this policy promoting pain control does not authorize the use of federally-controlled substances for intentional assistance in suicide or euthanasia. Restore the uniform national standard that federally-controlled substances can not be used for the purpose of assisted suicide by applying the current law in 49 states to all 50 states. This bill does not create any new regulatory authority for the DEA. This is a straight-forward, very positive bill that would merely apply what is current law in 49 states to all 50 states, without increasing the federal regulatory authority of the Drug Enforcement Administration (DEA). The bill has been endorsed by organizations including the National Hospice Organization, American Society of Anesthesiologists, American Academy of Pain Management, and former Surgeon General Dr. C. Everett Koop. And, today I was informed that the House of Delegates of the American Medical Association voted to support the bill. A variety of provisions in this legislation is in direct response to the June 5, 1998, letter by the Attorney General, allowing Oregon to use federally-controlled substances for assisted suicide, a decision that was in direct opposition to an earlier policy determination by her own Drug Enforcement Administration. It is significant to remember that in 1984 Congress passed amendments to strengthen the Controlled Substances Act, due to specific concerns regarding the use of prescription drugs in lethal overdoses. Congress's view was that while the states are the first line of defense against misuse of prescription drugs, the federal government must enforce its own objective standard as to what constitutes such misuse--and it must have the authority to enforce that standard when a state cannot or will not do so. Again, Congress clearly spoke on the issue of assisted suicide when it passed the Assisted Suicide Federal Funding Restriction Act of 1997 by a nearly unanimous vote. Signing the bill President Clinton said it ``will allow the Federal Government to speak with a clear voice in opposing these practices,'' and warned that ``to endorse assisted suicide would set us on a disturbing and perhaps dangerous path.'' It is time for Congress to speak again. Federal law is clearly intended to prevent use of these drugs for lethal overdoses, and contains no exception for deliberate overdoses approved by a physician. The DEA currently pursues cases where a physician's negligent use of controlled substances has led to the death of a patient, it was inappropriate for the Attorney General to allow for the intentional use of controlled substances to cause the death of a patient. The Pain Relief Promotion Act will clarify federal law, to affirm use of controlled substances to control pain and reject their deliberate use to kill patients. This legislation is overdue. Already physicians have used these federally controlled substances to cause the death of their patients. There is no role for the Federal government in providing assisted suicide. I urge my colleagues to support and enact this urgently needed bipartisan legislation. Mr. President, I ask unanimous consent that the text of the bill and letters, of support be printed in the Record.

Mr. NICKLES

Mr. NICKLES. Mr. President, I suggest the absence of a quorum.

Mr. NICKLES. Mr. President, for the information of all of our colleagues, we have been negotiating with the minority leader. I say ``we.'' Senator Lott, I, others, and Senator Kennedy have been negotiating, trying to come up with some type of time agreement on the so-called Patients' Bill of Rights. As I stated yesterday, it doesn't belong on the agriculture bill. We are working, and I think we are making good progress. Hopefully, we will have an agreement in the not too distant future as far as the timing to take up the bill. With that in mind, I ask unanimous consent that the Senate continue in morning business until the hour of 1 o'clock with the time to be equally divided.

Mr. NICKLES

Mr. NICKLES. I ask unanimous consent that each side have 20 minutes of additional time for morning business.

Mr. NICKLES

Mr. NICKLES. If I might just interrupt. I apologize. I was not on the floor earlier.

Mr. NICKLES

Mr. NICKLES. Mr. President, I ask unanimous consent to extend morning business until 3 o'clock, with the time equally divided.

Mr. NICKLES

Mr. NICKLES. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. NICKLES

Mr. NICKLES. Mr. President, I am afraid my colleague from Massachusetts didn't hear my colleague from Tennessee state that we do have internal appeals that are decided by physicians. We also have external appeals that are decided by experts in the medical community. So if his statement is correct, he should vote for our proposal. I encourage him to do so. Mr. LOTT addressed the Chair.

Mr. NICKLES. I will reserve 12 seconds. In a moment there will be a motion to table the Republican substitute. I hope our colleagues will vote against that motion to table and then, hopefully, after that is not tabled, I will move to table the Kennedy amendment. Mr. President, I will do so for a couple of reasons. One, it doesn't belong on the agriculture bill. I told my colleagues we are willing to come up with a reasonable time agreement and a limited number of amendments to debate this issue. It doesn't belong on the agriculture appropriations bill. There are other reasons to table the underlying Kennedy amendment. If you want to increase health care costs, that is what this bill does. It will increase health care costs 5 percent, in addition to the 6, 7, 8, 9 percent of health care inflation. You are going to have a 13 or 14- percent increase in health care costs, which is going to increase the number of uninsured probably by 1.5 million, maybe more. We should not be passing legislation to put 1.5 million people into the uninsured category. That would be a serious mistake.

Mr. NICKLES. Mr. President, how much time remains?

Mr. NICKLES. Mr. President, I yield 3 minutes to the Senator from Maine.

Mr. NICKLES. Mr. President, how much time remains?

Mr. NICKLES. On the other side?

Mr. NICKLES. Mr. President, how much time remains?

Mr. NICKLES. I yield my colleague from Tennessee 8 minutes.

Mr. NICKLES. Mr. President, how much time remains to both sides?

Mr. NICKLES. I yield myself a couple of minutes, and then I will yield to my colleague from Maine. Our colleague from Massachusetts said there was a unanimous consent request last year; we were talking about doing this last June and July. That is correct. We offered several unanimous consent requests, from June 18, July 15, and July 25, to bring this bill up to allow both sides to have a chance to vote on their proposals. We offered a number of amendments before the August break. Those were not agreed upon. Everyone has had a chance to offer their bill and to have it voted on. We would have a package, we would have a bill, before the Senate that possibly could pass. That was not agreed upon last year. I don't know if it will be agreed upon this year. I told the Democratic sponsors we are willing to come to some time agreement, some limit on amendments, but we are not just going to have the bill on the floor for an unlimited number of amendments with unlimited debate. Somebody asked, Why haven't we done this? The Kennedy bill increased health care costs a lot. It is estimated that health care costs will increase 4.8 percent in addition to whatever health care increases are already scheduled. Increases are scheduled to be 7 to 9 percent. Take the average of that, 8 percent, and add 4.8 percent. That is a 13-percent increase in health care costs. That will increase the number of uninsured by at least 1.5 million. I am going to work energetically to see we don't pass any bill that increases people's health care costs by 13 percent in 1 year. Certainly, I will work energetically to see we don't pass a health care bill that increases the number of uninsured by 1.5 million. That would be a serious mistake. Whatever the Senate does, it should do no harm. If we increase health care costs in double digits and increase the number of uninsured by over a million, we have done a lot of harm. Some Members will not do that. We should make some needed reforms. One of my colleagues worked energetically to put together a good package that makes needed reforms. I yield 7 minutes to our colleague from Maine, Senator Collins.

Mr. NICKLES. I yield the Senator from Pennsylvania 5 minutes.

Mr. NICKLES. Mr. President, I appreciate the accommodation and cooperation by my friend and colleague, Senator Durbin from Illinois. There are several on this side who wish to speak on this issue as well. We have been wanting to speak for about the last hour. I yield to the Senator from Vermont for 10 minutes.

Mr. NICKLES

Mr. NICKLES. I announce that the Senator from Arizona (Mr. McCain) is necessarily absent.

Mr. NICKLES

Mr. NICKLES. I announce that the Senator from Arizona (Mr. McCain) is necessarily absent.

Mr. NICKLES. Mr. President, I will read a couple of lines from his article. He says: No one has more to lose from quotas than America's farmers who grow more and export more than any farmers in the world. He also says: The quota bill is not in our Nation's economic interest, and it is not even in the interest of our steel industry and its workers. He is exactly right. This bill would be a serious mistake. The Commerce Department has already taken action against Russia, against Brazil, and against Japan. They can impose tariffs up to 28 percent on Japan for dumping, up to 86 percent on Brazil for dumping, and up to 200 percent on Russia for dumping. Already there are remedies. Incidentally, I might mention that the problem is not near as grave as some people have indicated. Steel imports have gone down 72 percent from last November, which was an all-time high. Again, I don't think the facts warrant passage of this bill. I clearly think if people look at the long-term ramifications of passing it, agriculture will lose, the American economy will lose, and I really think, frankly, the steel industry will lose as well.

Mr. NICKLES. Mr. President, I urge my colleagues to vote no on the so-called steel quota bill. I think it would be a mistake. I think the bill would do more harm than good; I mean more harm than good to our entire economy, and I believe also to the steel industry and to the steelworkers. I think it would be a serious mistake. One would have to figure what happens if we enacted these arbitrary quota restraints. Senator Moynihan just mentioned it would be a violation of our trading laws. If we do that, that will hurt the steel industry indirectly, because we export a lot of steel products. We export a lot of tractors, we export a lot of heavy equipment, and we export a lot of cars, all of which use steel. If we establish arbitrary quotas on what we are going to import, many other countries are going to retaliate, and they have the right to do so under the WTO. We are going to be violating the trade laws that we have agreed to, and there is going to be a response. Senator Grassley just mentioned that the biggest response is going to be against agriculture. It is kind of the easiest thing to hit. Agriculture is very competitive in the export market. Farmers all across the country are going to be faced with a loss of exports, and they are going to say: Wait a minute. Congress just imposed a restriction on steel imports, and, therefore, they are going to put restrictions on the amount of wheat, or the amount of grain they will import. It would be a serious mistake. Mr. President, I ask unanimous consent to have printed in the Record an article in today's Washington Times by William Daley, Secretary of Commerce.

Mr. NICKLES. Mr. President, I now ask the manager of the bill for 3 minutes to speak on the steel quota bill.