Faculty Bibliography

The hoopla surrounding the human genome was followed by a fair amount of hand-wringing about the dangers that genetic knowledge poses to our privacy and to our economic security. It is as likely that your boss and insurance agent will be as interested in your genetic test results as your doctor. But in truth, no one will be uninsured next week because of the announcement. Like the medical progress that genetic knowledge brings, its dangers and harms will be slow to unfold as well. It will take years to figure out what the genetic correlations are for the many diseases and ailments that plague us

CRAIG VENTER, the chief executive scientific majordomo of Celera Genomics, a private company based in Maryland, has said he and his colleagues have finished analyzing all the component pieces that make up human DNA. That same basic result has also been achieved by the Human Genome Project, the publicly funded consortium that includes Washington University, which is also working to decipher the human genetic code

Recent educational efforts in the US medical community have begun to address the critical issue of palliative care for terminally ill patients. However, a newly introduced bill in Congress, the Pain Relief Promotion Act of 1999 (PRPA), could dramatically hinder these efforts if enacted. The act criminally punishes the use of controlled substances to cause-or assist in causing-a patient's death. The primary purposes of PRPA are to override the physician-assisted suicide law currently in effect in Oregon and prohibit other states from enacting similar laws. The act also includes valuable provisions for better research and education in palliative care, but the benefits of those provisions are outweighed by the punitive sections of the act. Under PRPA, the quality of palliative care in the United States could be compromised when physicians, fearing criminal prosecution, err on the side of caution rather than risk their patients' deaths by using highly aggressive pain treatments. Furthermore, PRPA would put Drug Enforcement Administration officials, who have no medical expertise, in the position of regulating medical decisions. The act also would interfere with individual states' long-standing authority over medical practice. Finally, PRPA would discourage physicians from engaging in experimentation and innovation in palliative care, again out of concern for crossing the line between relief of suffering and physician-assisted suicide. Other bills have been introduced that go much further than PRPA to encourage palliative care, without its problematic provisions. Regardless of the controversy surrounding physician-assisted suicide in the United States, the need for quality end-of-life care will be far better served if Congress enacts one of these bills rather than PRPA.