5/28/04 A three-judge federal appeals  court panel Wednesday upheld an Oregon law allowing doctors to help terminally  ill patients commit suicide. The
decision said that Attorney General John   Ashcroft's Justice Department did not
have the authority to punish Oregon  doctors involved in assisted suicides. In its opinion, the 9th US Circuit Court  of Appeals in San Francisco had some unusually harsh words for Ashcroft, who,  the court said, overstepped his bounds by trying to block the law.

But while the decision is being cheered by  right-to-die advocates, it is also being hailed by people involved in the fight  to ensure adequate pain management for patients and protection from the drug  warriors for the doctors who prescribe for them. And some of the same people are  involved. Eli Stutsman, the Portland attorney who helped argue the case, is also  representing South
Carolina pain management physician Dr. Deborah Bordeaux  appeal the criminal conviction resulting from her pain practice, and is a major  player in the development of a legal strategy promulgated by the Pain Relief  Network (_http://www.painreliefnetwork.org_ (http://www.painreliefnetwork.org/) )  to reverse the onslaught of federal prosecutions of pain doctors  nationwide.

Though views  within the pain advocacy community on assisted suicide in principle are not  uniform, the two issues are linked functionally through the
Controlled  Substances Act (CSA), the law which enshrines criminal prohibition of drugs at  the federal level. Just as police attempts to keep opioid drugs (also known as  "narcotics") away from addicts and recreational users end up
discouraging  prescription of those drugs to patients who need them for pain control, threats  to enforce the CSA against physicians prescribing opioids (or other) drugs for  assisted suicide have had the same effect.

But there is also a more visceral link:  Threats to Oregon's assisted suicide law, now in place for seven years, appear  to be tied to reports of greater suffering by dying Oregon patients. At the end  of 1997, after the Drug Enforcement Administration (DEA) threatened to punish  Oregon doctors who helped patients commit suicide, a statewide study found a  sharp increase in the level of pain reported by terminal patients. While the  study's lead investigator, Susan Tolle, an expert in end-of-life care at Oregon  Health Sciences University, was careful in drawing conclusions, she suggested to  the Associated Press at the time that publicity over the DEA threats was the  cause in the upsurge of
suffering.

The connection between anti-assisted suicide  enforcement and under-treatment of pain has wide recognition within the medical  community. For example, in 1997, a bill entitled the "Lethal Drug Abuse  Prevention Act," sponsored by Sen. Don Nickles (R-OK) and Rep. Henry Hyde  (R-IL), would have authorized the DEA to revoke or suspend the federal  prescription license of a physician who
"intentionally dispensed or distributed  a controlled substance with a purpose of causing or assisting in causing"  suicide. The bill was defeated by a coalition of more than 50 medical and  patient groups, who successfully argued that
more DEA scrutiny and evaluation of  medical decisions would even further discourage physicians from being willing to  treat pain. Nickles and Hyde tried again in 1999, including language that would  have asserted the supremacy of the CSA over Oregon state law in a larger Pain  Relief Promotion Act of 1999.

While the introduction of that bill was initially  met with hopeful reactions by some pain patient advocates, the motives of the  Republican pair were suspect, and it died, due in some part to opposition to the  attack on Oregon's right
to choose to have physician-assisted  suicide.

Under the  Oregon law, first passed as a voter initiative in 1994 and reaffirmed in 1997,  adults whose terminal diseases are likely to kill them within si