1. Do not give patients medicine to ease their pain.

2. If they are in great pain and near death, do not let them put an end to their misery.

The
Republicans have been so determined to become the Pain Party that
they’ve brushed aside their traditional belief in states’ rights. The
Bush administration wants lawyers in Washington and federal prosecutors
with no medical training to tell doctors how to treat patients.

As
attorney general, John Ashcroft decided that Oregon’s law allowing
physician-assisted suicide violated the federal Controlled Substances
Act because he didn’t consider this use of drugs to be a "legitimate
medical purpose." Karen Tandy, the head of the Drug Enforcement
Administration, has been using this same legal theory to decree how
doctors should medicate patients with pain, and those who disagree with
her medical judgment can be sent to prison.

You know Republicans
have lost their bearings when they need a lesson in states’ rights from
Janet Reno, who considered the Oregon law when she was attorney
general. For the federal government to decide what constituted
legitimate medicine, she wrote, would wrongly "displace the states as
the primary regulators of the medical profession."

The Supreme
Court agreed with her in its decision this week upholding the Oregon
law. In the majority decision, Justice Anthony Kennedy ruled that the
federal drug law did not empower the attorney general "to define
general standards of medical practice." It merely "bars doctors from
using their prescription-writing powers as a means to engage in illicit
drug dealing and trafficking as conventionally understood."

That’s
news to the D.E.A. and the federal prosecutors, who have gone way
beyond any "conventionally understood" idea of drug trafficking.
They’ve been prosecuting doctors for prescribing painkillers like
OxyContin, even where there’s no evidence of any of the drugs being
resold on the streets. It doesn’t matter that the doctor genuinely
believed that the patient needed the drugs and was not abusing them. It
doesn’t matter that the patient was in pain.

No, doctors are now
going to prison merely for prescribing more pain pills than the D.E.A.
and prosecutors deem a "legitimate medical purpose." These drug
warriors are not troubled by the enormous range in the level of pain
medication that different patients need.

They don’t even seem to
worry much about the potency of the pills, just the number. They want
enough pills of any dosage to make a good photo, like the bag of pills
that Tandy held up at a press conference celebrating one doctor’s
conviction.

Tandy likes to claim that only a few corrupt doctors
have anything to fear. She responded to a column of mine last year by
saying that her agency had investigated only 0.1 percent of the 600,000
doctors in America. But she was far too modest. Most doctors, after
all, write few if any prescriptions for opioid painkillers.

The
doctors who matter are the small number of specialists in pain
treatment who prescribe opioids. Ronald Libby, a professor of political
science at the University of North Florida, estimates that 17 percent
of those doctors were investigated during one year by the D.E.A., and
an even greater number of others were investigated by local and state
authorities, typically in concert with the drug agency. That means a
pain specialist might have a one-in-three chance of being investigated
for prescribing opioids.

Faced with those odds, doctors are
understandably afraid. As noted in The New England Journal of Medicine
this month, the D.E.A. has made doctors reluctant to give opioids to
desperately ill patients, even when these drugs are the most effective
pain treatment. The article warned that a victory for the Bush
administration in the Oregon case, besides affecting terminally ill
patients in Oregon, could cause doctors across the country to "abandon
patients and their families in their moment of greatest need."