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105th Congress                                             Rept. 105-46
                        HOUSE OF REPRESENTATIVES

 1st Session                                                     Part 1
_______________________________________________________________________


 
            ASSISTED SUICIDE FUNDING RESTRICTION ACT OF 1997

                                _______
                                

 April 8, 1997.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

_______________________________________________________________________


  Mr. Bliley, from the Committee on Commerce, submitted the following

                              R E P O R T

                             together with

                    ADDITIONAL AND DISSENTING VIEWS

                        [To accompany H.R. 1003]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Commerce, to whom was referred the bill 
(H.R. 1003) to clarify Federal law with respect to restricting 
the use of Federal funds in support of assisted suicide, having 
considered the same, report favorably thereon with amendments 
and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     4
Hearings.........................................................     5
Committee Consideration..........................................     6
Rollcall Votes...................................................     6
Committee Oversight Findings.....................................    10
Committee on Government Reform and Oversight.....................    10
New Budget Authority and Tax Expenditures........................    10
Committee Cost Estimate..........................................    10
Congressional Budget Office Estimate.............................    10
Federal Mandates Statement.......................................    11
Advisory Committee Statement.....................................    11
Constitutional Authority Statement...............................    11
Applicability to Legislative Branch..............................    11
Section-by-Section Analysis of the Legislation...................    11
Committee Correspondence.........................................    23
Changes in Existing Law Made by the Bill, as Reported............    24
Additional Views.................................................    35
Dissenting Views.................................................    37

  The amendments (stated in terms of the page and line numbers 
of the introduced bill) are as follows:
  Page 2, after the item in the table of contents relating to 
section 11, insert the following:

Sec. 12. Suicide prevention (including assisted suicide).

  Page 4, line 20, strike ``create'' and insert ``apply to or 
to affect''.
  Page 21, after line 2, insert the following new section:

SEC. 12. SUICIDE PREVENTION (INCLUDING ASSISTED SUICIDE).

  (a) Purpose.--The purpose of this section is to reduce the 
rate of suicide (including assisted suicide) among persons with 
disabilities or terminal or chronic illness by furthering 
knowledge and practice of pain management, depression 
identification and treatment, and issues related to palliative 
care and suicide prevention.
  (b) Research and Demonstration Projects.--Section 781 of the 
Public Health Service Act (42 U.S.C. 295) is amended--
          (1) by redesignating subsection (e) as subsection 
        (f); and
          (2) by inserting after subsection (d) the following 
        new subsection:
  ``(e) Research and Demonstration Projects on Suicide 
Prevention (Including Assisted Suicide).--
          ``(1) Research.--The Secretary may make grants to and 
        enter into contracts with public and private entities 
        for conducting research intended to reduce the rate of 
        suicide (including assisted suicide) among persons with 
        disabilities or terminal or chronic illness. The 
        Secretary shall give preference to research that aims--
                  ``(A) to assess the quality of care received 
                by patients with disabilities or terminal or 
                chronic illness by measuring and reporting 
                specific outcomes;
                  ``(B) to compare coordinated health care 
                (which may include coordinated rehabilitation 
                services, symptom control, psychological 
                support, and community-based support services) 
                to traditional health care delivery systems; or
                  ``(C) to advance biomedical knowledge of pain 
                management.
          ``(2) Training.--The Secretary may make grants and 
        enter into contracts to assist public and private 
        entities, schools, academic health science centers, and 
        hospitals in meeting the costs of projects intended to 
        reduce the rate of suicide (including assisted suicide) 
        among persons with disabilities or terminal or chronic 
        illness. The Secretary shall give preference to 
        qualified projects that will--
                  ``(A) train health care practitioners in pain 
                management, depression identification and 
                treatment, and issues related to palliative 
                care and suicide prevention;
                  ``(B) train the faculty of health professions 
                schools in pain management, depression 
                identification and treatment, and issues 
                related to palliative care and suicide 
                prevention; or
                  ``(C) develop and implement curricula 
                regarding disability issues, including living 
                with disabilities, living with chronic or 
                terminal illness, attendant and personal care, 
                assistive technology, and social support 
                services.
          ``(3) Demonstration projects.--The Secretary may make 
        grants to and enter into contracts with public and 
        nonprofit private entities for the purpose of 
        conducting demonstration projects that will--
                  ``(A) reduce restrictions on access to 
                hospice programs; or
                  ``(B) fund home health care services, 
                community living arrangements, and attendant 
                care services.
          ``(4) Palliative medicine.--The Secretary shall 
        emphasize palliative medicine among its funding and 
        research priorities.''.
  (c) Report by General Accounting Office.--Not later than 1 
year after the date of enactment of this Act, the Comptroller 
General of the United States shall submit to the Congress a 
report providing an assessment of programs under subsection (e) 
of section 781 of the Public Health Service Act (as added by 
subsection (b) of this section) to conduct research, provide 
training, and develop curricula and of the curricula offered 
and used by schools of medicine and osteopathic medicine in 
pain management, depression identification and treatment, and 
issues related to palliative care and suicide prevention. The 
purpose of the assessment shall be to determine the extent to 
which such programs have furthered knowledge and practice of 
pain management, depression identification and treatment, and 
issues related to palliative care and suicide prevention.

                          Purpose and Summary

    The principal purpose of H.R. 1003, the Assisted Suicide 
Funding Restriction Act of 1997, is to maintain current Federal 
policy by explicitly providing that Federal funds may not be 
used to pay for items and services the purpose of which is to 
cause or assist in causing the suicide, euthanasia, or mercy 
killing of a person. The prohibition on Federal funding 
provided by H.R. 1003 applies to all Federal financial 
assistance, including the direct purchase of assisted suicide 
services and the involvement of Federal personnel or Federal 
facilities in the provision of such services. H.R. 1003 also 
prohibits the use of Federal funds for advocacy and legal 
activities that would assist in or support assisted suicide, 
euthanasia, or mercy killing.
    H.R. 1003 establishes that the Act's prohibitions do not 
pertain to the withholding or withdrawing of medical treatment 
or care, nutrition, or hydration, or to the provision of such 
end-of-life care as pain alleviation. Withholding or 
withdrawing treatment or nourishment is generally not 
considered an act of assisted suicide, nor is treatment aimed 
solely at the alleviation of suffering that may nonetheless 
shorten life, unless such measures are undertaken with the 
specific purpose of causing death.

                  Background and Need for Legislation

    Almost all States ban assisted suicide either by statute or 
court decision. However, four State statutory bans are 
currently involved in litigation challenging such prohibitions. 
Among these legal actions are two cases currently before the 
U.S. Supreme Court, one before the Ninth Circuit Court of 
Appeals, and one before the Supreme Court of the State of 
Florida.
    These cases have raised questions concerning the potential 
use of Federal funds to cover the cost of assisted suicide in 
those States where it is or may be determined, legislatively or 
judicially, to be legal. This question was first raised in 1994 
when the then-director of Oregon's Medicaid program expressed 
the expectation that Medicaid funds would likely be used to 
fund assisted suicide once the Oregon referendum measure 
legalizing assisted suicide was implemented. (Although that 
referendum passed, it has not yet been implemented pending 
legal action.) There is concern that a judicial finding that 
strikes existing State bans on assisted suicide or that 
affirmatively permits assisted suicide could result in the use 
of Federal funding to pay the costs of assisted suicide.
    Under current Federal law, policy, and practice, no Federal 
funds are used to provide or pay for assisted suicide. Among 
programs in the jurisdiction of this Committee that provide 
direct health care to patients, for example, the National 
Institutes of Health and the Indian Health Service do not 
permit their health care providers to assist suicide or 
``hasten the moment of death.'' Nor does either the Medicare or 
the Medicaid program pay for physician-assisted suicide. In a 
May 1, 1996 letter provided to the Committee, the Health Care 
Financing Administration stated that neither the statutory 
criteria of the Medicare program nor the President's FY 1998 
budget proposal provide for Federal funding of assisted 
suicide.
    In the event that ongoing legal actions could result in the 
legalization of assisted suicide in various States, H.R. 1003 
reinforces current policy and clarifies Federal law by 
establishing current practice in Federal statute. Specifically, 
the provisions of H.R. 1003 preserve the current interpretation 
of Federal law that Federal funding may not be used to pay for 
items and services intended to cause or assist in causing the 
suicide, euthanasia, or mercy killing of a person. The Act does 
not, however, limit the availability or use of Federal funding 
relating to such practices of end-of-life care as the 
withholding or withdrawal of medical treatment, nutrition, or 
hydration. The Act also does not limit funding to the provision 
of pain management services that may increase the risk of 
death, so long as such practices do not have the purpose of 
causing or assisting in causing death.
    In addition, H.R. 1003 would prohibit the use of Federal 
funds for advocacy to assist in or support assisted suicide, 
euthanasia, or mercy killing, or to bring suit or provide any 
form of legal assistance for assisted suicide, euthanasia, or 
mercy killing. The Act also specifies that Medicare and 
Medicaid rules pertaining to advance directives would not 
require a provider or organization to inform or counsel any 
individual about assisted suicide, euthanasia, or mercy 
killing. It would also clarify that Federal law does not 
require providers or organizations to follow the provisions of 
an advance directive that directs the purposeful causing of 
death.
    The provisions of H.R. 1003 prohibiting the use of Federal 
funding for purposes related to assisted suicide extend to 
numerous Federal health programs and facilities, including but 
not limited to the following: the Medicare program, the 
Medicaid program, the Social Services Block Grant, the Maternal 
and Child Health Block Grant, the Public Health Service Act, 
the Indian Health Care Improvement Act, the Federal Employees 
Health Benefits Program, the military health care system 
(including the TRICARE and CHAMPUS programs), veterans' medical 
care, health services for Peace Corps volunteers, medical 
services for Federal prisoners, the Developmental Disabilities 
and Bill of Rights Act, the Protection and Advocacy for 
Mentally Ill Individuals Act, protection and advocacy systems 
under the Rehabilitation Act, the Older Americans Act, and the 
Legal Services Program.
    H.R. 1003 would become effective upon the date of enactment 
and would apply to payments made on or after enactment. The 
provisions of the Act also would apply to contracts entered 
into or renewed after enactment as well as to contracts entered 
into before the date of enactment to the extent permitted under 
such contracts.

                                Hearings

    The Subcommittee on Health and Environment held a hearing 
on assisted suicide on March 6, 1997. The Subcommittee received 
testimony from: Cardinal Bernard Law, Archbishop of Boston; 
Rabbi A. James Rudin, Director of Interfaith Relations, 
American Jewish Committee; Reverend David L. Adams, Executive 
Director, Office of Government Information, The Lutheran 
Church-Missouri Synod; Reverend Dr. Stanley Harakas on behalf 
of the Greek Orthodox Church Archdiocese of America; Dr. N. 
Gregory Hamilton, Co-founder, Physicians for Compassionate 
Care; Dr. Lonnie Bristow, Immediate Past President, American 
Medical Association; Ms. Felicia Cohn, Center to Improve Care 
of the Dying, George Washington University Medical Center; Dr. 
Nancy J. Osgood, Virginia Commonwealth University, Medical 
College of Virginia; Dr. Ira R. Byock, The Palliative Care 
Service; Mr. Cornelius Baker, Executive Director, National 
Association of People with AIDS; Mr. Mark Shaffer on behalf of 
The Consortium for Citizens with Disabilities, Rights Task 
Force; Mr. Justin Dart, private citizen; Ms. Barbara Coombs 
Lee, Executive Director, Compassion in Dying; Dr. Daniel P. 
Sulmasy, Center for Clinical Bioethics, Georgetown University; 
Mr. Robert J. Castagna, Oregon Catholic Conference; and Dr. 
Henk Jochemsen, G.A. Lindeboom Institute Center for Medical 
Ethics, The Netherlands.

                        Committee Consideration

    On Thursday, March 13, 1997, the Subcommittee on Health and 
Environment met in open markup session and approved H.R. 1003 
for Full Committee consideration, amended, by a voice vote. On 
Thursday, March 20, 1997, the Full Committee met in open markup 
session and ordered H.R. 1003 reported to the House, as 
amended, by a roll call vote of 45 yeas to 2 nays.

                             Rollcall Votes

    Clause 2(l)(2)(B) of rule XI of the Rules of the House 
requires the Committee to list the recorded votes on the motion 
to report legislation and amendments thereto. The following are 
the recorded votes on the motion to report H.R. 1003 and on 
amendments offered to the measure, including the names of those 
Members voting for and against.


                      Committee Oversight Findings

    Pursuant to clause 2(l)(3)(A) of rule XI of the Rules of 
the House of Representatives, the Committee held a hearing and 
made findings that are reflected in this report.

              Committee on Government Reform and Oversight

    Pursuant to clause 2(l)(3)(D) of rule XI of the Rules of 
the House of Representatives, no oversight findings have been 
submitted to the Committee by the Committee on Government 
Reform and Oversight.

               New Budget Authority and Tax Expenditures

    In compliance with clause 2(l)(3)(B) of rule XI of the 
Rules of the House of Representatives, the Committee finds that 
H.R 1003 would result in no new or increased budget authority 
or tax expenditures or revenues.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 403 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 2(l)(3)(C) of rule XI of the Rules of 
the House of Representatives, the following is the cost 
estimate provided by the Congressional Budget Office pursuant 
to section 403 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, April 4, 1997.
Hon. Tom Bliley,
Chairman, Committee on Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1003, a bill to 
clarify federal law with respect to restricting the use of 
federal funds in support of assisted suicide.
    If you wish for further details on this estimate, we will 
be pleased to provide them. The CBO staff contact is Jeff 
Lemieux.
            Sincerely,
                                         June E. O'Neill, Director.
    Enclosure.

H.R. 1003--A bill to clarify Federal law with respect to restricting 
        the use of Federal funds in support of assisted suicide

    CBO estimates that enactment of this bill would have no 
budgetary impact.
    The bill would ensure that federal funds were not used to 
purchase or provide health care items or services for the 
purpose of causing or assisting the death of any individual, 
such as by assisted suicide, euthanasia, or mercy killing. 
Because no federal funds appropriated for health care 
providers, facilities, insurance programs, or other programs 
would be used for those purposes under current law, the bill 
would not affect the federal budget.
    This bill contains an intergovernmental mandate as defined 
in the Unfunded Mandates Reform Act of 1995 (UMRA) because it 
would prohibit funds, employees, and facilities of the District 
of Columbia from being involved in the suicide, euthanasia, or 
mercy killing of an individual, including assistance and 
advocacy. This mandate would impose no costs on the District of 
Columbia because such activities are currently illegal in that 
jurisdiction. Furthermore, because euthanasia is currently 
illegal in every state except Oregon (where a ballot measure 
allowing euthanasia is held up by a court injunction), this 
bill's provisions limiting the use of federal government funds 
would not result in costs for other state, local, or tribal 
governments. H.R. 1003 does not include any private sector 
mandates as defined in the Unfunded Mandates Reform Act.
    The CBO staff contact for the estimate is Jeff Lemieux. 
This estimate was approved by Paul N. Van de Water, Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                   Constitutional Authority Statement

    Pursuant to clause 2(l)(4) of rule XI of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
Article I, section 8, clause 3, which grants Congress the power 
to regulate commerce with foreign nations, among the several 
States, and with the Indian tribes.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation

               Section 1. Short title; table of contents

Current law

    No provision.

Explanation of provision

    This section states that the Act may be cited as the 
``Assisted Suicide Funding Restriction Act of 1997'' and sets 
forth the table of contents.

                    Section 2. Findings and purpose

Current law

    No provision.

Explanation of provision

    This section contains a description of the findings of the 
bill, including the finding that Congress is not currently 
providing Federal financial assistance in support of assisted 
suicide, euthanasia, or mercy killing and intends that Federal 
funds not be used to promote such activities.
    This section also states that the principal purpose of the 
bill is to continue current Federal policy by providing 
explicitly that Federal funds may not be used to pay for items 
and services the purpose of which is to cause or assist in 
causing the suicide, euthanasia, or mercy killing of any 
individual.
    Webster's Third New International Dictionary Unabridged 
(Merriam-Webster, 1986) defines ``suicide'' in relevant part as 
``the act or an instance of taking one's own life voluntarily 
and intentionally; self-destruction.'' It defines 
``euthanasia'' in relevant part as ``the act or practice of 
painlessly putting to death persons suffering from incurable 
conditions or diseases.'' By ``assisted suicide,'' the bill 
describes provision of any means (including, but not limited 
to, a lethal drug overdose) to another person with the intent 
of enabling or assisting that person to kill himself or herself 
(as by ingesting the lethal overdose). By ``euthanasia'' and 
``mercy killing,'' the bill more generally describes the use of 
active means by one person to cause the death of another person 
(as by lethal injection) because, as a result of illness, 
injury, or disability, either the person is deemed to be dying 
or suffering or the person is considered to be a ``burden'' on 
family, community or society. It should be emphasized that 
euthanasia or mercy killing can occur whether or not the person 
who is killed consents to be killed.

   Section 3. Restriction on use of Federal funds under health care 
                                programs

Current law

    There is neither an explicit statutory provision 
restricting the use of Federal funds for items and services the 
purpose of which is to cause or assist in causing the suicide, 
euthanasia, or mercy killing of any individual, nor any 
provision providing Federal funds for such items and services.

Explanation of provision

    Subsection (a) generally would prohibit funds appropriated 
by Congress for the purpose of paying for health care services 
to be used: (1) to provide any health care item or service 
furnished for the purpose of causing or assisting in causing 
the death of any individual, such as by assisted suicide, 
euthanasia, or mercy killing; (2) to pay for an item or service 
furnished for the purpose of causing or assisting in causing 
the death of any individual, such as by assisted suicide, 
euthanasia, or mercy killing, either directly, through Federal 
financial participation or other matching payments, or 
otherwise; or (3) to pay in whole or in part for health benefit 
coverage that includes any coverage of an item or service 
furnished for the purpose of causing or assisting in causing 
the death of any individual, such as by assisted suicide, 
euthanasia, or mercy killing, or of any expenses relating to 
such an item or service.
    As stated above, the purpose of H.R. 1003 is to explicitly 
provide that Federal funds may not be used to pay for items and 
services for the purpose of causing or assisting in causing the 
suicide, euthanasia, or mercy killing of any individual. 
Section 3 places no restrictions on State-financed or privately 
financed assisted suicide, however, and is not intended to 
penalize an entire program through loss of Federal funds if 
some component of the program exclusively uses private or State 
funds for items and services for the purpose of causing or 
assisting in causing the suicide, euthanasia, or mercy killing 
of any individual. Because the bill provides only that no 
Federal funds may be used in any way for such activities, a 
program would lose its Federal funding if it could not be 
demonstrated that the funds used for items and services for the 
purpose of causing or assisting in causing the suicide, 
euthanasia, or mercy killing of any individual were State or 
private funds used exclusive of Federal funds.
    In this section, the term ``health care item or service'' 
is used in order to include any lethal agent and the 
prescribing of such an agent; therefore, the provisions 
prohibit reimbursement for the cost of such an agent and the 
cost of prescribing such agent to a person for the purpose of 
causing or effecting death. In addition, use of the term 
``expenses relating to such an item or service'' is intended to 
preclude reimbursement for a process that may be required 
before such an agent is delivered. Thus, for example, neither a 
``prescription for medication'' provided to a patient (such as 
pursuant to the Oregon Death with Dignity Act legalizing 
assisted suicide; See Or. Rev. Stat. Sec. Sec. 127.805, 
127.815(7), and 127.840) in order that a patient might commit 
suicide nor the cost of the medication provided would be 
reimbursable.
    Payment for related services and activities is also 
prohibited. For example, Oregon law also requires the 
``attending physician'' (Id. Sec. 127.800(2)) and ``consulting 
physician'' (Id. Sec. 127.800(3)) to follow certain procedures 
before a ``prescription for medication'' may be provided (e.g., 
determining whether the patient has a terminal disease, is 
capable of making decisions, and has made a request for suicide 
assistance voluntarily; providing information necessary to 
informed consent; referral to a consulting physician; possible 
referral for psychological evaluation; request that the patient 
notify next of kin; and other formalities necessary for 
compliance with the Oregon Act). Id. Sec. 127.815. Since these 
services are provided in contemplation of and in preparation 
for issuing a ``prescription for medication'' to assist 
suicide, they would not be reimbursable. Section 3(a) of H.R. 
1003 would preclude reimbursement both for providing the means 
to secure a lethal agent with which to commit suicide (or to 
perform euthanasia or mercy killing) and for services of a 
physician or other health care provider in connection with such 
acts.
    As used in this section, the term ``to pay (in whole or in 
part) for health benefit coverage'' is intended to prevent the 
disbursement of Federal funds for payment of assisted suicide, 
euthanasia, or mercy killing. With respect to health coverage 
of Federal employees, this section prohibits the use of any 
Federal funds for any health benefits package or health 
coverage that includes assisted suicide, euthanasia, or mercy 
killing, or for the administration of such health coverage. 
Therefore, Federal employees who seek coverage for assisted 
suicide, euthanasia, or mercy killing may choose to use their 
own private funds to pay for such a procedure or purchase 
separate coverage for it. The same principle applies to 
patients whose health care is provided by the Federally funded 
Medicare program.
    The term ``to pay (in whole or in part) for health benefit 
coverage'' also applies to cases in which a State may seek 
Federal reimbursement for the capitation fees needed to provide 
membership in managed care plans for its Medicaid population: 
Federal funds could not be used to pay part of these fees if 
they are used to purchase a health coverage which provides 
assisted suicide, euthanasia, or mercy killing, or are used to 
pay for any part of the administration of such health coverage. 
To be eligible for such Federal funds, a State could contract 
solely with managed care plans that do not cover assisted 
suicide, euthanasia, or mercy killing, or work out an 
arrangement by which they are subsidized from a segregated fund 
containing only State or private funds.
    Subsection (b) provides that nothing in the Act shall be 
construed as creating any limitation relating to (1) the 
withholding or withdrawing of medical treatment or medical 
care; (2) the withholding or withdrawing of nutrition or 
hydration; (3) abortion; or (4) the use of items, goods, 
benefits, or services furnished for purposes relating to the 
alleviation of pain or discomfort even if they may increase the 
risk of death, so long as they are not furnished for the 
purpose of causing or assisting in causing death.
    This subsection clarifies the limitations on the scope of 
the bill--that is, what procedures and services are not 
intended to fall within the prohibitions on the use of Federal 
funds. Thus, for example, the withholding or withdrawing of any 
form of medical treatment or care, as well as the withholding 
or withdrawing of nutrition or hydration, are specifically 
excluded from the scope of the prohibitions on Federal funding 
in the bill. The bill is intended only to encompass the use of 
active means of causing death such as by lethal injection or 
the provision of a lethal oral drug overdose. It is not 
intended to encompass decisions not to provide or to continue 
to provide treatment or care even if, in some circumstances, 
some might deem such decisions as a form of passive euthanasia 
or mercy killing.
    The limitation provided by section 3(b)(4) of the bill is 
intended to assure that methods ``furnished for the purpose of 
alleviating pain or discomfort'' are not encompassed within the 
funding restrictions of the bill even if their use might as an 
unintended effect ``increase the risk of death.'' Thus, for 
example, the administration of morphine for the purpose of 
alleviating pain may continue to be paid for by Federal funds 
even if its use might risk causing death or risk shortening 
life because it might also have the side effect of suppressing 
respiratory functions. Nevertheless, section 3(b)(4) would not 
permit Federal funding of methods to cause death used on the 
pretext of pain relief. Thus, it states that pain relief 
methods may be funded ``so long as'' the methods are ``not also 
furnished for the purpose of causing, or the purpose of 
assisting in causing death, for any reason.'' Methods that are 
used both to alleviate pain or discomfort and ``also'' 
purposefully to cause death would not be funded under the Act. 
In addition, methods that purposefully cause death in order to 
alleviate pain or discomfort would not be funded under the Act.
    Subsection (c) provides that no health care item or service 
furnished by or in a health care facility owned or operated by 
the Federal government or by any physician or other individual 
employed by the Federal government to provide health care 
services may be furnished for the purpose of causing or 
assisting in causing the death of any individual, such as by 
assisted suicide, euthanasia, or mercy killing.
    Subsection (d) lists programs within the jurisdiction of 
the Committee on Commerce and of other Committees of the House 
to which these restrictions apply, including but not limited 
to: the Medicare program, the Medicaid program, the Social 
Services Block Grant, the Maternal and Child Health Block 
Grant, the Public Health Service Act, the Indian Health Care 
Improvement Act, the Federal Employees Health Benefits Program, 
the military health care system (including the TRICARE and 
CHAMPUS programs), veterans' medical care, health services for 
Peace Corps volunteers, medical services for Federal prisoners, 
the Developmental Disabilities and Bill of Rights Act, the 
Protection and Advocacy for Mentally Ill Individuals Act, 
protection and advocacy systems under the Rehabilitation Act, 
the Older Americans Act, and the Legal Services Program.

Reasons for change

    To this point, Federal law has not been interpreted to 
allow Federal funding for assisted suicide, euthanasia, and 
mercy killing. However, these activities may soon become legal 
in one or more States. This could result in the courts being 
asked to reinterpret current Federal policy regarding payment 
for assisted suicide or other related activities. In the 
absence of statutory clarification, this could result in court 
decisions that overturn the current Medicare policy which does 
not consider assisted suicide as medically necessary, and so 
does not pay for services that would be related to such an 
activity.
    There are two cases before the Supreme Court in which 
plaintiffs are contending they have a constitutional right to 
physician assisted suicide. Both the 2nd Circuit and the 9th 
Circuit have struck down State laws that outlawed assisted 
suicide in the States of New York and Washington on the grounds 
that these State laws violate the Due Process Clause or the 
Equal Protection Clause of the U.S. Constitution. Washington v. 
Glucksberg, No. 96-110; Vacco v. Quill, No. 95-185 8 (U.S.; 
oral argument heard January 8, 1997). If these Circuit Court 
decisions are upheld, there could be a nationwide 
Constitutional right to assisted suicide, euthanasia, and 
mercy-killing and Federal funding--under Medicare, Medicaid, 
Title XX, and other programs--for such actions would be at 
issue.
    In addition, Oregon has passed the Oregon Death with 
Dignity Act, Or. Rev. Stat. Sec. Sec. 127.800 through 127.995 
(1995), which legalizes assisted suicide in certain 
circumstances. Oregon's Medicaid director and its Health 
Services Commission chair both have said recently that once 
assisted suicide is legal it will be covered by the State's 
Medicaid plan.
    In May, the Florida Supreme Court will hear oral arguments 
on an appeal from a lower court ruling that, if upheld, would 
legalize assisting suicide in that State. Krischer v. McIver, 
No. 89,837 (Fl. Appeal granted Feb. 17, 1997). If upheld by the 
State Supreme Court, this decision will raise the question of 
State and Federal funding in matching programs such as 
Medicaid, and raise questions about the permissibility of 
assisted suicide in Federally-owned health care institutions in 
that State.
    Despite the fact that Federal health programs do not 
currently fund assisted suicide, most Federal programs have no 
written policy on assisted suicide because such restrictions 
were unnecessary when such activities were illegal in every 
State. Those Federal policies which do exist generally are 
stated through internal program guidelines or interpretive 
memoranda that are inherently changeable and may lack the force 
of law.
    Section 1862(a)(1)(A) of the Social Security Act states 
that payment may be made under Part A or Part B of the Medicare 
program for expenses incurred for items or services which are: 
``reasonable and necessary for the diagnosis or treatment of 
illness or injury or to improve the functioning of a malformed 
body member. * * *''
    Further, Section 1862(a)(1)(C) states that payment may be 
made under Part A or Part B for expenses incurred for items or 
services which in the case of hospice care are: ``reasonable 
and necessary for the palliation or management of terminal 
illness. * * *''
    The Health Care Financing Administration (HCFA) has taken 
the position that:

          [T]he Medicare statute limits Medicare coverage to 
        items and services that ``are reasonable and necessary 
        for the diagnosis or treatment of illness or injury or 
        to improve the functioning of a malformed body 
        member.'' Physician assisted suicide, even if allowed 
        under State law, does not meet these statutory 
        criteria. As such, the program is prohibited from 
        making payment for it. (May 1, 1996, Letter of Debbie 
        Chang, Director, Office of Legislative and 
        Intergovernmental Affairs, Health Care Financing 
        Administration.)

    The Committee agrees that HCFA's views are consistent with 
the intent of Congress that assisted suicide, euthanasia, and 
mercy killing are not appropriately regarded as medical 
treatments for illness or injury or as palliation or management 
of terminal illness and thus that payment is precluded for them 
under Medicare and other Federal programs. However, the 
Committee believes that, because the Medicare statute and other 
Federal laws do not explicitly prohibit the use of Federal 
funds for the funding or advocacy of assisted suicide, lawsuits 
still may be brought by beneficiaries or physicians in States 
where assisted suicide is legal, to compel funding based on the 
claim that assisted suicide is indeed ``reasonable and 
necessary for the * * * treatment of illness or injury'' or 
that such actions are ``reasonable and necessary for the 
palliation or management of terminal illness.''
    It is the intent of the Committee to preclude such claims 
by providing a clarification of existing Federal law and to 
make explicit that Federal funds may not be used for assisted 
suicide, euthanasia, or mercy killing.
    Section 3(a)(1) prevents the use of funds to provide health 
care items or services ``furnished for the purpose of causing * 
* * the death of any individual, such as by assisted suicide, 
euthanasia, or mercy killing.'' This broader language is used 
in this section of the bill, as in sections 4 and 7 of the 
bill, primarily because proponents of assisted suicide, mercy 
killing, and euthanasia often use other terms to describe these 
activities, such as ``physician-aid-in-dying.'' In fact, the 
Oregon Death with Dignity Act, which legalizes these actions 
under certain circumstances, specifically provides that 
``[a]ctions taken in accordance with [this law] shall not, for 
any purpose, constitute assisted suicide, mercy killing, or 
homicide under the law.'' Or. Rev. Stat. Sec. 127.880 (1995).
    This broad language is used with regard to the general 
prohibition on health care funding (section 3) and the 
prohibition on the use of funds under the Developmental 
Disabilities Assistance Act (section 4) and the Patient Self-
Determination Act (section 7) to ensure that the activities and 
actions intended to be prohibited by the legislation are in 
fact prohibited. This broad language is necessary because 
euthanasia, mercy killing, and assisted suicide are often 
described by other terms or other State-law definitions. The 
Committee does not believe that this language will have 
unintended consequences because the programs covered in these 
instances are clearly and narrowly defined.
    The narrow language specifically prohibiting the use of 
Federal funds for ``assisted suicide, euthanasia, or mercy 
killing'' found in the bill's ``findings and purposes'' 
provisions (section 2), restrictions on advocacy programs 
(section 5), and restrictions on funding for mercy killing, 
euthanasia, and assisted suicide in other Federal programs 
(section 6) is used because the Committee believes the broad 
language, if applied to these programs, could have unintended 
consequences. For example, if the broad language were used with 
respect to military operations, it might have the effect of 
prohibiting legitimate national defense activities. If the 
broad language were used with respect to criminal justice 
enforcement, it might have the effect of prohibiting capital 
punishment.
    The Committee emphasizes that the use of narrow rather than 
broad language is strictly to avoid unintended consequences, 
not to authorize the use of Congressionally appropriated funds 
for what might be termed ``physician aid-in-dying,'' ``self-
deliverance,'' or any other practice that has traditionally 
been deemed assisted suicide, euthanasia, or mercy killing, 
even if such an alternative name is specifically intended to 
evade limitations on what is generally understood to be 
encompassed by the terms ``assisted suicide,'' ``euthanasia,'' 
or ``mercy killing.''

  Section 4. Restriction on use of Federal funds under certain grant 
 programs under the Developmental Disabilities Assistance and Bill of 
                               Rights Act

Current law

    Part B of the Developmental Disabilities Assistance and 
Bill of Rights Act guarantees Federal assistance to State 
Developmental Disabilities Councils; Part D of that Act 
provides for grants to university affiliated programs to 
promote independence, productivity, and integration of 
individuals with developmental disabilities; and Part E of that 
Act provides for grants and contracts for projects of national 
significance to promote these purposes.

Explanation of provision

    Section 4 of H.R. 1003 would prohibit funds appropriated to 
carry out Parts B, D, or E of the Developmental Disabilities 
Assistance and Bill of Rights Act to support or fund any 
program or service which has a purpose of assisting in 
procuring any item, benefit, or service for the purpose of 
causing or assisting in causing the death of any individual, 
such as by assisted suicide, euthanasia, or mercy killing.
    In the absence of Section 4, it is possible that some might 
attempt to use Federal funds under these programs for such 
purposes as training individuals to assist suicide, advocating 
the legalization of assisted suicide, or researching methods of 
assisting suicide. It is the opinion of the Committee that such 
purposes are not consistent with Congressional intent in 
enacting the Developmental Disabilities Assistance and Bill of 
Rights Act.
    The funding restrictions of Section 4 are intended to 
require that programs receiving Federal funds maintain 
objective integrity and independence from other programs that 
include the prohibited activities, through the use of separate 
facilities, personnel, and accounting records. Employees of the 
entity conducting the program are free to advocate and 
encourage the activities at issue at any time, except when they 
are acting within the scope of employment in programs receiving 
Federal funds.

  Section 5. Restriction on use of Federal funds by advocacy programs

Current law

    There are a variety of Federal laws providing funds to 
assist individuals in obtaining health care and other services.

Explanation of provision

    The explicitly stated purpose of this section is to 
prohibit the use of any congressionally appropriated funds for 
legal or other assistance ``for the purpose of * * * (1) 
securing or funding * * * (2) compelling any person, 
institution, [or] governmental entity * * * or (3) asserting or 
advocating a legal right'' in the relevant context. An advocacy 
program could provide factual answers to a client's questions 
about a State law on assisting suicide, since that alone would 
not be providing assistance for such purposes. Similarly, these 
provisions do not prohibit such programs from counseling 
clients about alternatives to assisted suicide, such as pain 
management, mental health care, and community-based services 
for people with disabilities. Advocacy programs could not, 
however, use congressionally appropriated funds to write 
letters, make telephone calls, or file suit to facilitate 
obtaining assisted suicide, euthanasia, or mercy killing; to 
compel an entity to provide or fund any item or service to be 
used for assisted suicide, euthanasia, or mercy killing; or to 
refer a client to some other person or entity for such purpose.
    Subsection (a) would prohibit the use of funds appropriated 
by Congress to assist in, support, or fund any activity or 
service which has a purpose of assisting in or providing any 
form of legal assistance for the purpose of (1) securing or 
funding items, benefits, programs or services furnished for the 
purpose of causing the suicide, euthanasia, or mercy killing of 
any individual; (2) compelling any person, institution, or 
government entity to provide or fund any item, benefit, program 
or service furnished for the purpose of causing the suicide, 
euthanasia, or mercy killing of any individual; or (3) 
advocating a legal right to cause or assist in causing the 
suicide, euthanasia, or mercy killing of any individual.
    The prohibition in paragraph (1) of subsection (a) 
encompasses, for example, the provision of any assistance to 
obtain the means of death (such as lethal drugs), the aid of a 
person or institution (such as a physician or hospital), or the 
means to finance such a practice. It likewise prohibits the use 
of Federal funds, for example, to assist in the execution of an 
advance directive to secure death by assisted suicide, 
euthanasia, or mercy killing. It should be noted, however, by 
virtue of Section 3(b) of the Act (Construction and Treatment 
of Certain Services), the bill would not foreclose the use of 
Federal funds to assist in the execution of an advance 
directive to withhold or withdraw medical treatment or care. 
The prohibition in paragraph (2) means, for example, that legal 
assistance could not be provided to an individual for the 
purpose of suing a public or private hospital to permit the 
individual to receive assistance in committing suicide in its 
facilities. The prohibition in paragraph (3) means, for 
example, that legal assistance could not be provided to argue 
that a law or regulation prohibiting or regulating assisted 
suicide, euthanasia, or mercy killing was unconstitutional or 
otherwise in violation of the law.
    Subsection (b) includes an illustrative list of programs to 
which these restrictions apply, including protection and 
advocacy programs, legal services, and ombudsman programs 
funded by the Developmental Disabilities Assistance and Bill of 
Rights Act, Advocacy for Mentally Ill Individuals Act, 
Rehabilitation Act of 1973, Older Americans Act, and Legal 
Assistance Corporation Act. However, the listed programs are 
not exclusive.

Reasons for change

    This section of the bill is intended to prohibit the use of 
Federal funds to promote and facilitate assisted suicide. It 
places no restrictions on State-financed or privately financed 
advocacy. Moreover, Section 5 is not intended to have the 
effect of de-funding an entire program, such as a Legal 
Services program or other legal or advocacy program, simply 
because some State or privately funded portion of that program 
may advocate for or file suit to compel funding or services for 
assisted suicide. This section is intended only to restrict 
Federal funds from being used for such activities.

          Section 6. Restriction on use of other Federal funds

Current law

    No provision.

Explanation of provision

    This section would provide that certain other Federal funds 
may not be used to provide, procure, furnish, or fund items, 
goods, benefits, activities, or services furnished or performed 
for the purpose of causing or assisting in causing suicide, 
euthanasia, or mercy killing. Among other areas, this provision 
would apply (instead of restrictions in previous sections) to 
Department of Defense activities (other than military health) 
and criminal justice activities (other than prison health).

      section 7. clarification with respect to advance directives

Current law

    Under the Medicare and Medicaid programs, hospitals, 
skilled nursing facilities, home health agencies, hospice 
programs, and prepaid health plans are required to provide 
written information to all adults receiving medical care 
through the provider or organization about the rights of such 
adults under State law to make decisions concerning the 
acceptance or refusal of medical treatment and to prepare 
advance directives, such as so-called ``living wills,'' 
concerning the acceptance or refusal of medical treatment; to 
describe the provider's or organization's policies towards 
implementing advance directives; to document in the medical 
record whether there is an advance directive; not to 
discriminate against patients based on expectation of an 
advance directive; to ensure compliance with State laws on 
advance directives; and to provide education concerning advance 
directives. It has been contended that, in a State in which 
assisted suicide has been legalized, these existing provisions 
of Federal law would require medical care facilities to advise 
patients of their right to assisted suicide, euthanasia, and 
mercy killing, and to appoint a witness to witness written 
requests for such services.

Explanation of provision

    This section would clarify that the advance directive 
provisions of the Medicare and Medicaid laws, sections 1866(f) 
and 1902(w) of the Social Security Act, shall not be construed 
(1) to require any provider or organization, or employee of 
such provider or organization, to inform or counsel any 
individual about any right to obtain an item or services 
furnished for the purpose of causing or assisting in causing 
the death of an individual, such as by assisted suicide, 
euthanasia, or mercy killing; or (2) to require providers or 
organizations to follow a portion of an advance directive that 
directs the purposeful causing, or assisting in causing, the 
death of any individual, such as by assisted suicide, 
euthanasia, or mercy killing.

Reasons for change

    Section 7 of the bill is intended to specify that the 
advance directive provisions of Medicare and Medicaid law 
(Sections 1866(f) and 1902(w) of the Social Security Act, 
respectively) shall not be construed to require providers or 
organizations to counsel an individual about a right to 
assisted suicide. This section of the bill goes further to 
release providers or organizations from any Federal obligation 
to follow portions of advance directives that direct assisted 
suicide, euthanasia, or mercy killing.
    However, it is not the Committee's intent to prohibit 
providers, organizations, or their employees acting under State 
law from counseling about assisted suicide or following advance 
directives that direct assisted suicide. Nor is this section of 
the bill intended to restrict the scope of any State law on 
assisted suicide or the content of advance directives. Under 
Section 7, health care facilities, organizations, and their 
employees will remain free, if they choose, to provide 
information about assisting suicide or euthanasia to patients. 
States will be free to mandate that health care facilities in 
the State provide such information. Section 7 simply clarifies 
that there is no Federal requirement to do so.
    It is the view of the Committee that the Federal government 
should not promote assisting suicide by requiring that every 
patient seen by a health care provider who receives Medicare or 
Medicaid reimbursement be told that assisted suicide is one of 
his or her options simply because State law may make it legal. 
Many hospitals and other health care providers consider 
assisting suicide fundamentally unethical. They should not be 
compelled to violate their consciences by being forced to 
publicize the availability of assisted suicide.

             Section 8. Application to District of Columbia

Current law

    The annual Federal payment to the District of Columbia is 
authorized under Title V of the District of Columbia Self-
Government and Governmental Reorganization Act.

Explanation of provision

    For the purposes of the Act, this section would treat funds 
appropriated to the District of Columbia as Federally 
appropriated funds and make District employees and facilities 
subject to the same restrictions as employees and facilities of 
the Federal Government.

                    Section 9. Conforming amendments

Current law

    No provision.

Explanation of provision

    This provision contains conforming amendments to various 
Federal laws and programs, including the Medicare program, the 
Medicaid program, the Maternal and Child Health Block Grant 
program, the Public Health Service Act, the Indian Health Care 
Improvement Act, the Federal Employees Health Benefit Program, 
the Military Health Care Program, and the Veterans' Medical 
Care Program. This list and the provisions in this section are 
not intended to be exclusive.

Reasons for change

    These amendments are necessary to ensure that the bill's 
provisions are incorporated into Medicare, Title XX, and other 
provisions of current Federal law.

                   Section 10. Relation to other laws

Current law

    No provision.

Explanation of provision

    The section states that provisions of the Act supersede 
other Federal laws (including subsequent laws) except to the 
extent specifically superseded. The Committee recognizes that 
any future Congress could elect to repeal or modify the 
restrictions on Federal funding contained in this bill, or to 
create new programs that specifically authorize Federal funding 
of assisted suicide, euthanasia, or mercy killing in them. 
However, in circumstances in which a future Congress creates 
new programs which simply authorize funding in broad, general 
terms (for example, for ``medical treatment''), it is the 
intent of the Committee in this section to ensure that the more 
specific limitations in this Act apply to Federal funding under 
such programs.

                       Section 11. Effective date

Current law

    No provision.

Explanation of provision

    The bill would take effect upon enactment and applies to 
payments made on or after enactment for items and services 
provided after enactment. It also would apply to contracts 
entered into or renewed after enactment and to current 
contracts to the extent the application of the provisions is 
permitted under the contracts.

      Section 12. Suicide prevention (including assisted suicide)

Current law

    No provision.

Explanation of provision

    The bill includes several provisions designed to reduce the 
rate of suicide, including assisted suicide, among persons with 
disabilities or terminal or chronic illness, by furthering 
knowledge and practice of pain management, depression 
identification, palliative care, and other issues related to 
suicide prevention.
    The bill amends the Public Health Service Act to establish 
research, training, and demonstration projects intended to help 
achieve the goal of reducing the rate of suicide (including 
assisted suicide). It authorizes the Secretary of Health and 
Human Services (the Secretary) to use resources already 
provided in Section 781 of the Act to support research 
projects, with preference given to those that assess the 
quality of care received by patients with disabilities or 
terminal or chronic illness, compare coordinated health care 
services to traditional health care delivery systems, or 
advance biomedical knowledge of pain management. The bill also 
authorizes the Secretary to use these resources to support 
training initiatives in such institutions as academic health 
centers and hospitals, with preference given to those that 
train health care practitioners and health professions faculty 
in pain management, depression identification, and issues 
related to palliative care and suicide prevention, or develop 
curricula regarding a broad range of issues relevant to 
individuals with disabilities, including the physical and 
psychosocial effects of living with disabilities, the need for 
and benefits of attendance and personal care services, and the 
types of assistive technologies available to people with 
disabilities. Finally, the bill authorizes the Secretary to use 
these resources to support demonstration projects that reduce 
restrictions on access to hospice programs, or fund home health 
care services, community living arrangements, and attendant 
care services.
    H.R. 1003 also includes a provision directing the General 
Accounting Office (GAO) to analyze the effectiveness and 
achievements of the grant programs it authorizes the Secretary 
to undertake. Under this provision, GAO is required to report 
back to Congress not later than one year after the Secretary 
awards the first of these grants. It is the Committee's 
intention to undertake whatever action it deems necessary to 
achieve the purpose of this section. With the knowledge the 
Committee expects to gain from the GAO analysis, the Committee 
anticipates that it will then be able to accurately determine 
whether and what any additional action is needed to further the 
knowledge and practice of pain management, depression 
identification, and issues related to palliative care and 
suicide prevention.

                       Committee on Ways and Means,
                                  House of Representatives,
                                     Washington, DC, April 8, 1997.
Hon. Thomas J. Bliley, Jr.,
Chairman, House Committee on Commerce, Rayburn House Office Building, 
        Washington, DC.
    Dear Chairman Bliley: I write regarding further 
consideration of H.R. 1003, the Assisted Suicide Funding 
Restriction Act of 1997. The bill, as introduced, was referred 
to the Committee on Commerce, and in addition to the Committee 
on Ways and Means, and others. On March 20, 1997, the Committee 
on Commerce ordered the bill favorably reported to the House, 
as amended.
    H.R. 1003 generally would prohibit Federal Funds from being 
used for the purpose of causing or assisting in causing the 
death of any individual by assisted suicide, euthanasia, or 
mercy killing. The restriction on Federal funding would apply 
to both Medicare (Title XVIII of the Social Security Act) and 
to the Title XX Social Services Block Grant (Title XX of the 
Social Security Act). The bill would further clarify Medicare 
rules regarding advance directives. As you know, both Medicare 
and Title XX fall within the jurisdiction of the Committee on 
Ways and Means.
    On March 18, 1997, the bill was ordered favorably reported 
by the Ways and Means Health Subcommittee to the full Committee 
by voice vote. A copy of the Subcommittee report has been 
forwarded to you. Under normal circumstances the full Committee 
would meet to consider the bill. However, it is my 
understanding that there is a desire to consider the bill on 
the floor as early as this week.
    Therefore, in order to expedite the consideration of this 
legislation, because the legislation in its current form is 
noncontroversial, and after consultation with the Minority, I 
do not believe a markup by the full Committee on Ways and Means 
will be necessary. However, this is being done with the 
understanding that the Committee will be treated without 
prejudice in the future as to its jurisdictional prerogatives 
on this or similar provisions, and it should not be considered 
as precedent for consideration of matters of jurisdictional 
interest to the Committee on Ways and Means in the future.
    Finally, I would appreciate your response to this letter, 
confirming this understanding with respect to H.R. 1003, and 
would ask that a copy our exchange of letters on this matter be 
included in the Committee on Commerce's report on H.R. 1003.
    Thank you for your cooperation and assistance on this 
matter. With best personal regards,
            Sincerely,
                                             Bill Archer, Chairman.
                                ------                                

                          House of Representatives,
                                     Committee on Commerce,
                                     Washington, DC, April 8, 1997.
Hon. Bill Archer,
Chairman, Committee on Ways and Means, House of Representatives, 
        Longworth House Office Building, Washington, DC.
    Dear Mr. Chairman: Thank you for your letter regarding your 
Committee's jurisdictional interest in H.R. 1003, the Assisted 
Suicide Funding Restriction Act of 1997.
    I acknowledge your interest in this legislation and 
appreciate your cooperation in moving the bill to the House 
floor expeditiously. I agree that your decision to forgo 
further action on the bill will not prejudice the Ways and 
Means Committee with respect to its jurisdictional prerogatives 
on this or similar provisions.
    Thank you again for your cooperation.
            Sincerely,
                                              Tom Bliley, Chairman.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3 of rule XIII of the Rules of the 
House of Representatives, changes in existing law made by the 
bill, as reported, are shown as follows (existing law proposed 
to be omitted is enclosed in black brackets, new matter is 
printed in italic, existing law in which no change is proposed 
is shown in roman):

                          SOCIAL SECURITY ACT

          * * * * * * *

        TITLE V--MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT

                    authorization of appropriations

  Sec. 501. (a) To improve the health of all mothers and 
children consistent with the applicable health status goals and 
national health objectives established by the Secretary under 
the Public Health Services Act for the year 2000, there are 
authorized to be appropriated $705,000,000 for fiscal year 1994 
and each fiscal year thereafter--
          (1) * * *
          * * * * * * *
Funds appropriated under this section may only be used in a 
manner consistent with the Assisted Suicide Funding Restriction 
Act of 1997.
          * * * * * * *

        TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED

          * * * * * * *

                    Part C--Miscellaneous Provisions

          * * * * * * *

        exclusions from coverage and medicare as secondary payer

  Sec. 1862. (a) Notwithstanding any other provision of this 
title, no payment may be made under part A or part B for any 
expenses incurred for items or services--
          (1) * * *
          * * * * * * *
          (14) which are other than physicians' services (as 
        defined in regulations promulgated specifically for 
        purposes of this paragraph), services described by 
        section 1861(s)(2)(K)(i) or 1861(s)(2)(K)(iii), 
        certified nurse-midwife services, qualified 
        psychologist services, and services of a certified 
        registered nurse anesthetist, and which are furnished 
        to an individual who is a patient of a hospital or 
        rural primary care hospital by an entity other than the 
        hospital or rural primary care hospital, unless the 
        services are furnished under arrangements (as defined 
        in section 1861(w)(1)) with the entity made by the 
        hospital or rural primary care hospital; [or]
          (15)(A) which are for services of an assistant at 
        surgery in a cataract operation (including subsequent 
        insertion of an intraocular lens) unless, before the 
        surgery is performed, the appropriate utilization and 
        quality control peer review organization (under part B 
        of title XI) or a carrier under section 1842 has 
        approved of the use of such an assistant in the 
        surgical procedure based on the existence of a 
        complicating medical condition, or
          (B) which are for services of an assistant at surgery 
        to which section 1848(i)(2)(B) applies[.]; or
          (16) in the case in which funds may not be used for 
        such items and services under the Assisted Suicide 
        Funding Restriction Act of 1997.
Paragraph (7) shall not apply to Federally qualified health 
center services described in section 1861(aa)(3)(B).
          * * * * * * *

                 agreements with providers of services

  Sec. 1866. (a) * * *
          * * * * * * *
  (f)(1) For purposes of subsection (a)(1)(Q) and sections 
1819(c)(2)(E), 1833(s), 1876(c)(8), and 1891(a)(6), the 
requirement of this subsection is that a provider of services 
or prepaid or eligible organization (as the case may be) 
maintain written policies and procedures with respect to all 
adult individuals receiving medical care by or through the 
provider or organization--
          (A) * * *
          * * * * * * *
  (4) For construction relating to this subsection, see section 
7 of the Assisted Suicide Funding Restriction Act of 1997 
(relating to clarification respecting assisted suicide, 
euthanasia, and mercy killing).
          * * * * * * *

      TITLE XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS

          * * * * * * *
  Sec. 1902. (a) * * *
          * * * * * * *
  (w)(1) For purposes of subsection (a)(57) and sections 
1903(m)(1)(A) and 1919(c)(2)(E), the requirement of this 
subsection is that a provider or organization (as the case may 
be) maintain written policies and procedures with respect to 
all adult individuals receiving medical care by or through the 
provider or organization--
          (A) * * *
          * * * * * * *
  (5) For construction relating to this subsection, see section 
7 of the Assisted Suicide Funding Restriction Act of 1997 
(relating to clarification respecting assisted suicide, 
euthanasia, and mercy killing).
          * * * * * * *

                           PAYMENT TO STATES

  Sec. 1903. (a) * * *
          * * * * * * *
  (i) Payment under the preceding provisions of this section 
shall not be made--
          (1) * * *
          * * * * * * *
          (14) with respect to any amount expended on 
        administrative costs to carry out the program under 
        section 1928; [or]
          (15) with respect to any amount expended for a 
        single-antigen vaccine and its administration in any 
        case in which the administration of a combined-antigen 
        vaccine was medically appropriate (as determined by the 
        Secretary)[.]; or
          (16) with respect to any amount expended for which 
        funds may not be used under the Assisted Suicide 
        Funding Restriction Act of 1997.
Nothing in paragraph (1) shall be construed as permitting a 
State to provide services under its plan under this title that 
are not reasonable in amount, duration, and scope to achieve 
their purpose.
          * * * * * * *

          TITLE XX--BLOCK GRANTS TO STATES FOR SOCIAL SERVICES

          * * * * * * *

                      limitations on use of grants

  Sec. 2005. (a) Except as provided in subsection (b), grants 
made under this title may not be used by the State, or by any 
other person with which the State makes arrangements to carry 
out the purposes of this title--
          (1) * * *
          * * * * * * *
          (8) for the provision of cash payments as a service 
        (except as otherwise provided in this section); [or]
          (9) for payment for any item or service (other than 
        an emergency item or service) furnished--
                  (A) by an individual or entity during the 
                period when such individual or entity is 
                excluded under this title or title V, XVIII, or 
                XIX pursuant to section 1128, 1128A, 1156, or 
                1842(j)(2), or
                  (B) at the medical direction or on the 
                prescription of a physician during the period 
                when the physician is excluded under this title 
                or title V, XVIII, or XIX pursuant to section 
                1128, 1128A, 1156, or 1842(j)(2) and when the 
                person furnishing such item or service knew or 
                had reason to know of the exclusion (after a 
                reasonable time period after reasonable notice 
                has been furnished to the person)[.]; or
          (10) in a manner inconsistent with the Assisted 
        Suicide Funding Restriction Act of 1997.
          * * * * * * *
                              ----------                              


                       PUBLIC HEALTH SERVICE ACT

          * * * * * * *

         TITLE II--ADMINISTRATION AND MISCELLANEOUS PROVISIONS

          * * * * * * *

                    Part B--Miscellaneous Provisions

          * * * * * * *

SEC. 246. RESTRICTION ON USE OF FUNDS FOR ASSISTED SUICIDE, EUTHANASIA, 
                    AND MERCY KILLING.

  Appropriations for carrying out the purposes of this Act 
shall not be used in a manner inconsistent with the Assisted 
Suicide Funding Restriction Act of 1997.
          * * * * * * *

                TITLE VII--HEALTH PROFESSIONS EDUCATION

          * * * * * * *

                     PART F--MISCELLANEOUS PROGRAMS

SEC. 781. RESEARCH ON CERTAIN HEALTH PROFESSIONS ISSUES.

  (a) * * *
          * * * * * * *
  (e) Research and Demonstration Projects on Suicide Prevention 
(Including Assisted Suicide).--
          (1) Research.--The Secretary may make grants to and 
        enter into contracts with public and private entities 
        for conducting research intended to reduce the rate of 
        suicide (including assisted suicide) among persons with 
        disabilities or terminal or chronic illness. The 
        Secretary shall give preference to research that aims--
                  (A) to assess the quality of care received by 
                patients with disabilities or terminal or 
                chronic illness by measuring and reporting 
                specific outcomes;
                  (B) to compare coordinated health care (which 
                may include coordinated rehabilitation 
                services, symptom control, psychological 
                support, and community-based support services) 
                to traditional health care delivery systems; or
                  (C) to advance biomedical knowledge of pain 
                management.
          (2) Training.--The Secretary may make grants and 
        enter into contracts to assist public and private 
        entities, schools, academic health science centers, and 
        hospitals in meeting the costs of projects intended to 
        reduce the rate of suicide (including assisted suicide) 
        among persons with disabilities or terminal or chronic 
        illness. The Secretary shall give preference to 
        qualified projects that will--
                  (A) train health care practitioners in pain 
                management, depression identification and 
                treatment, and issues related to palliative 
                care and suicide prevention;
                  (B) train the faculty of health professions 
                schools in pain management, depression 
                identification and treatment, and issues 
                related to palliative care and suicide 
                prevention; or
                  (C) develop and implement curricula regarding 
                disability issues, including living with 
                disabilities, living with chronic or terminal 
                illness, attendant and personal care, assistive 
                technology, and social support services.
          (3) Demonstration projects.--The Secretary may make 
        grants to and enter into contracts with public and 
        nonprofit private entities for the purpose of 
        conducting demonstration projects that will--
                  (A) reduce restrictions on access to hospice 
                programs; or
                  (B) fund home health care services, community 
                living arrangements, and attendant care 
                services.
          (4) Palliative medicine.--The Secretary shall 
        emphasize palliative medicine among its funding and 
        research priorities.
  [(e)] (f) Authorization of Appropriations.--For the purpose 
of carrying out this section, there is authorized to be 
appropriated $4,000,000 for each of the fiscal years 1993 
through 1995.
          * * * * * * *
                              ----------                              


                   INDIAN HEALTH CARE IMPROVEMENT ACT

          * * * * * * *

                       TITLE II--HEALTH SERVICES

          * * * * * * *


                       limitation on use of funds


  Sec. 225. Amounts appropriated to carry out this title may 
not be used in a manner inconsistent with the Assisted Suicide 
Funding Restriction Act of 1997.
          * * * * * * *
                              ----------                              


              SECTION 8902 OF TITLE 5, UNITED STATES CODE

Sec. 8902. Contracting authority

  (a) * * *
          * * * * * * *
  (o) A contract may not be made or a plan approved which 
includes coverage for any benefit, item, or service for which 
funds may not be used under the Assisted Suicide Funding 
Restriction Act of 1997.
                              ----------                              


              SECTION 1073 OF TITLE 10, UNITED STATES CODE

Sec. 1073. Administration of this chapter

  Except as otherwise provided in this chapter, the Secretary 
of Defense shall administer this chapter for the armed forces 
under his jurisdiction, the Secretary of Transportation shall 
administer this chapter for the Coast Guard when the Coast 
Guard is not operating as a service in the Navy, and the 
Secretary of Health and Human Services shall administer this 
chapter for the National Oceanic and Atmospheric Administration 
and the Public Health Service. This chapter shall be 
administered consistent with the Assisted Suicide Funding 
Restriction Act of 1997.
                              ----------                              


                      TITLE 38, UNITED STATES CODE

          * * * * * * *

   CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

                          subchapter i--general

Sec.
1701.  Definitions.
     * * * * * * *
1707.  Restriction on use of funds for assisted suicide, euthanasia, or 
          mercy killing.
     * * * * * * *

                         SUBCHAPTER I--GENERAL

          * * * * * * *

Sec. 1707. Restriction on use of funds for assisted suicide, 
                    euthanasia, or mercy killing

  Funds appropriated to carry out this chapter may not be used 
for purposes that are inconsistent with the Assisted Suicide 
Funding Restriction Act of 1997.
          * * * * * * *
                              ----------                              


                    SECTION 5 OF THE PEACE CORP ACT

                         peace corps volunteers

  (a) * * *
          * * * * * * *
  (e) Volunteers shall receive such health care during their 
service, applicants for enrollment shall receive such health 
examinations preparatory to their service, applicants for 
enrollment who have accepted an invitation to begin a period of 
training under section 8(a) of this Act shall receive such 
immunization and dental care preparatory to their service, and 
former volunteers shall receive such health examination within 
six months after termination of their service, as the President 
may deem necessary or appropriate. Subject to such conditions 
as the President may prescribe, such health care may be 
provided in any facility of any agency of the United States 
Government, and in such cases the appropriation for maintaining 
and operating such facility shall be reimbursed from 
appropriations available under this Act. Health care may not be 
provided under this subsection in a manner inconsistent with 
the Assisted Suicide Funding Restriction Act of 1997.
                              ----------                              


              SECTION 4005 OF TITLE 18, UNITED STATES CODE

Sec. 4005. Medical relief; expenses

  (a) Upon request of the Attorney General and to the extent 
consistent with the Assisted Suicide Funding Restriction Act of 
1997, the Federal Security Administrator shall detail regular 
and reserve commissioned officers of the Public Health Service, 
pharmacists, acting assistant surgeons, and other employees of 
the Public Health Service to the Department of Justice for the 
purpose of supervising and furnishing medical, psychiatric, and 
other technical and scientific services to the Federal penal 
and correctional institutions.
          * * * * * * *
                              ----------                              


      DEVELOPMENTAL DISABILITIES ASSISTANCE AND BILL OF RIGHTS ACT

          * * * * * * *

SEC. 122. STATE PLAN.

  (a) * * *
          * * * * * * *
  (c) State Plan Requirements.--In order to be approved by the 
Secretary under this section, a State plan shall meet the 
requirements in paragraphs (1) through (5).
          (1) * * *
          * * * * * * *
          (5) Assurances.--The plan shall contain or be 
        supported by the assurances described in subparagraphs 
        (A) through (N), which are satisfactory to the 
        Secretary.
                  (A) Use of funds.--With respect to the funds 
                paid to the State under section 125, the plan 
                shall provide assurances that--
                          (i) * * *
          * * * * * * *
                          (vi) not less than 65 percent of the 
                        amount available to the State under 
                        section 125 shall be expended for 
                        activities in the Federal priority area 
                        of employment activities, and, at the 
                        discretion of the State, activities in 
                        any or all of the three other Federal 
                        priority areas and an optional State 
                        priority area; [and]
                          (vii) the remainder of the amount 
                        available to the State from allotments 
                        under section 125 (after making 
                        expenditures required by clause (vi)) 
                        shall be used for the planning, 
                        coordination, administration, and 
                        implementation of priority area 
                        activities, and other activities 
                        relating to systemic change, capacity 
                        building, and advocacy to implement the 
                        responsibilities of the State 
                        Developmental Disabilities Council 
                        pursuant to section 124(c)[.]; and
                          (viii) such funds will be used 
                        consistent with the section 4 of the 
                        Assisted Suicide Funding Restriction 
                        Act of 1997.
          * * * * * * *

SEC. 142. SYSTEM REQUIRED.

  (a) * * *
          * * * * * * *
  (h) Legal Action.--
          (1) * * *
          * * * * * * *
          (3) Limitation.--The systems may only use assistance 
        provided under this chapter consistent with section 5 
        of the Assisted Suicide Funding Restriction Act of 
        1997.
          * * * * * * *

SEC. 152. GRANT AUTHORITY.

  (a) * * *
  (b) Training Projects.--
          (1) * * *
          * * * * * * *
          (5) Prohibited activities.--Grants awarded under this 
        subsection shall not be used for administrative 
        expenses for the university affiliated program under 
        subsection (a). Such grants shall not be used in a 
        manner inconsistent with section 4 of the Assisted 
        Suicide Funding Restriction Act of 1997.
          * * * * * * *

SEC. 162. GRANT AUTHORITY.

  (a) * * *
          * * * * * * *
  (c) Application and Other Grant Requirements.--No grant may 
be made under subsection (a) unless--
          (1) * * *
          * * * * * * *
          (4) the applicant demonstrates, where appropriate, 
        how the project will address, in whole or part, the 
        needs of individuals with developmental disabilities 
        from racial and ethnic minority backgrounds; [and]
          (5) the Secretary provides to the State Developmental 
        Disabilities Council in such State an opportunity to 
        review the application for such project and to submit 
        its comments on the application[.]; and
          (6) the applicant provides assurances that the grant 
        will not be used in a manner inconsistent with section 
        4 of the Assisted Suicide Funding Restriction Act of 
        1997.
          * * * * * * *
                              ----------                              


SECTION 105 OF THE PROTECTION AND ADVOCACY FOR MENTALLY ILL INDIVIDUALS 
                              ACT OF 1986

                          system requirements

  Sec. 105. (a) A system established in a State under section 
103 to protect and advocate the rights of individuals with 
mental illness shall--
          (1) * * *
          * * * * * * *
          (8) on an annual basis, provide the public with an 
        opportunity to comment on the priorities established 
        by, and the activities of, the system; [and]
          (9) establish a grievance procedure for clients or 
        prospective clients of the system to assure that 
        individuals with mental illness have full access to the 
        services of the system and for individuals who have 
        received or are receiving mental health services, 
        family members of such individuals with mental illness, 
        or representatives of such individuals or family 
        members to assure that the eligible system is operating 
        in compliance with the provisions of this title and 
        title III[.]; and
          (10) not use allotments provided to a system in a 
        manner inconsistent with section 5 of the Assisted 
        Suicide Funding Restriction Act of 1997.
          * * * * * * *
                              ----------                              


             SECTION 509 OF THE REHABILITATION ACT OF 1973

SEC. 509. PROTECTION AND ADVOCACY OF INDIVIDUAL RIGHTS.

  (a) * * *
          * * * * * * *
  (f) Application.--In order to receive assistance under this 
section, an eligible system shall submit an application to the 
Commissioner, at such time, in such form and manner, and 
containing such information and assurances as the Commissioner 
determines necessary to meet the requirements of this section, 
including assurances that the eligible system will--
          (1) * * *
          * * * * * * *
          (6) establish a grievance procedure for clients or 
        prospective clients of the system to ensure that 
        individuals with disabilities are afforded equal 
        opportunity to access the services of the system; [and]
          (7) provide assurances to the Commissioner that funds 
        made available under this section will be used to 
        supplement and not supplant the non-Federal funds that 
        would otherwise be made available for the purpose for 
        which Federal funds are provided[.]; and
          (8) not use allotments provided under this section in 
        a manner inconsistent with section 5 of the Assisted 
        Suicide Funding Restriction Act of 1997.
          * * * * * * *
                              ----------                              


                      OLDER AMERICANS ACT OF 1965

          * * * * * * *

TITLE VII--ALLOTMENTS FOR VULNERABLE ELDER RIGHTS PROTECTION ACTIVITIES

          * * * * * * *

                     Subtitle C--General Provisions

          * * * * * * *

SEC. 765. FUNDING LIMITATION.

  Funds provided under this title may not be used in a manner 
inconsistent the Assisted Suicide Funding Restriction Act of 
1997.
                              ----------                              


           SECTION 1007 OF THE LEGAL SERVICES CORPORATION ACT

                          grants and contracts

  Sec. 1007. (a) * * *
  (b) No funds made available by the Corporation under this 
title, either by grant or contract, may be used--
          (1) * * *
          * * * * * * *
          (9) to provide legal assistance with respect to any 
        proceeding or litigation relating to the desegregation 
        of any elementary or secondary school or school system, 
        except that nothing in this paragraph shall prohibit 
        the provision of legal advice to an eligible client 
        with respect to such client's legal rights and 
        responsibilities; [or]
          (10) to provide legal assistance with respect to any 
        proceeding or litigation arising out of a violation of 
        the Military Selective Service Act or of desertion from 
        the Armed Forces of the United States, except that 
        legal assistance may be provided to an eligible client 
        in a civil action in which such client alleges that he 
        was improperly classified prior to July 1, 1973, under 
        the Military Selective Service Act or prior 
        corresponding law[.]; or
          (11) to provide legal assistance in a manner 
        inconsistent with the Assisted Suicide Funding 
        Restriction Act of 1997.
          * * * * * * *
                            ADDITIONAL VIEWS

    Concern about federal funding for physician-assisted 
suicide has escalated as a result of fears that current court 
and State legislative activity could result in legalization of 
assisted suicide. These concerns persist despite the fact that 
no current federal policy or extant legislation permits payment 
or reimbursement for items or activities related to assisted 
suicide, or for the provision of services intended to result in 
suicide. In other words, no federal funds support assisted 
suicide. Thus, H.R. 1003 does not produce a change in current 
policy or practice, but merely, as the bill states, 
``continue[s] current policy.''
    However, there is at stake in this debate a social policy 
issue that is of great significance. It is the question, raised 
by every witness the Subcommittee on Health and Environment 
called to its hearing on assisted suicide, of why people 
request assisted suicide and what can be done to prevent this. 
These witnesses--who included health care providers, religious 
leaders, and advocates for the ill and the disabled--emphasized 
that people who are desperately ill, severely disabled, 
exceedingly frail, or in unrelenting severe pain require 
special care. And the witnesses lamented that, in many cases, 
such care is not available. This is not because health care 
providers lack compassion, but because they often are poorly 
equipped to identify the unique needs of these patient 
populations and to respond in the most effective ways to those 
needs. Simply stated, better training of health professionals 
is needed, in the very specialized and sensitive skills and 
knowledge needed to provide the best care to people who are 
dying.
    During the mark-up of H.R. 1003, an amendment was offered 
that was designed to turn this legislation into something that 
will accomplish a goal more valuable than simply restating the 
current situation: the goal of preventing assisted suicide by 
addressing the reasons that people are driven to seek an end to 
their lives. It would have required that health professions 
training programs funded by the federal government incorporate 
training in how to deal with death and dying, and, as well, 
authorized research, demonstration, and training on related 
issues. A small part of this amendment, which authorizes 
further study related to suicide and its causes, was adopted 
and is included in the legislation the House will consider. 
Although this is a positive step--and we look forward to 
working with our Republican colleagues to ensure that funds are 
allocated for the purpose of supporting these kinds of 
activities--it falls well short of meaningful public policy 
designed to prevent the conditions that cause people to seek 
suicide in the first place.
    The part of our amendment which related to appropriate 
training of health care providers in how to recognize and treat 
the conditions that lead to suicide, regrettably, failed. This 
was despite the fact that the provision would have done nothing 
more than require, as a condition of receiving federal 
discretionary grant funds, that grantees include this 
critically important component in their programs to train 
primary care providers. This provision would not have 
prescribed how such training should be provided, or the content 
of curricula. Nevertheless, the amendment failed by an 
essentially party-line vote, with every Republican voting 
against it and every Democratic Member of the Committee except 
one voting for it.
    As legislators and policy makers, we have an obligation to 
get to the root of a problem and try to solve it. Improving 
health professions training to achieve more appropriate care of 
people who are so desperate as to be seeking suicide is a 
significant positive step. Our amendment could have set us on 
the road to achieving that goal. It would have been the right 
thing to do. To quote the Subcommittee's witness, Professor 
Felicia Cohn of the George Washington University Center to 
Improve Care of the Dying, this legislation ``falls far short 
of what is needed. Congress has the opportunity--and the 
obligation--to set policy to improve care at the end of life. 
The care of persons at the end of their days in this country is 
a national disgrace. Much can and should be done, and the 
Congress has special opportunities and obligations to do so.'' 
Unfortunately, we have neither seized that opportunity nor 
fulfilled those obligations in this legislation.

                                   John D. Dingell.
                                   Edward J. Markey.
                                   Rick Boucher.
                                   Thomas J. Manton.
                                   Edolphus Towns.
                                   Frank Pallone, Jr.
                                   Sherrod Brown.
                                   Bart Gordon.
                                   Elizabeth Furse.
                                   Peter Deutsch.
                                   Ron Klink.
                                   Bart Stupak.
                                   Eliot L. Engel.
                                   Tom Sawyer.
                                   Albert R. Wynn.
                                   Gene Green.
                                   Karen McCarthy.
                                   Ted Strickland.
                            DISSENTING VIEWS

    The issue of physician-assisted suicide is controversial 
not merely because it implicates fundamental ethical questions 
and challenges our social norms, but because our country is in 
the midst of an unfinished debate over its merits and perils. 
Patients, families, health care providers, courts and 
legislatures are all actively engaged in a search for the place 
of assisted suicide in our society. The Congress has an 
important role to play in this inquiry, but the bill reported 
by the Commerce committee is nothing more than a precipitous 
attempt to curtail exploration of the sensitive ethical and 
cultural questions raised by assisted suicide.
    These questions are critical to an informed public 
judgment, but are as yet unanswered. Should individuals be 
entitled to choose for themselves how and when they may end 
their own lives? Is there a constitutional right to privacy or 
to equal protection which warrants such a policy? Are health 
care providers obligated to help mentally competent and 
terminally ill patients end their lives? What protections are 
required to assure that such choices are informed and freely 
made? Would there be a potential for abuse against older 
Americans and our most vulnerable citizens?
    Most importantly, as the witnesses before the committee 
uniformly emphasized, timely reforms to our systems of health 
care delivery and medical education would best serve patient 
interests by averting the pain and despair which so often 
compel patients to seek an end to their lives. Efforts to 
increase research and improve education in palliative care, 
recognition and management of the needs of dying patients, 
physician-patient communication, and pain management are 
urgently needed and long overdue. Moreover, as the American 
Geriatrics Society testified, ``Congress should lead these 
efforts.''
    Rather than assist in resolving unanswered questions or 
fulfilling unmet needs, H.R. 1003 simply prohibits Federal 
funding of assisted suicide. The bill is a solution in search 
of a problem. Today, assisted suicide is not a legal practice 
in any jurisdiction in the United States. The courts have 
enjoined the Oregon referendum legalizing assisted suicide from 
taking effect. Nor does the federal government or the States 
subsidize or compensate for the practice of physician-assisted 
suicide.
    For want of any substantial effect, the bill's actual 
purpose is easier to ascertain. As a congressional statement of 
disapproval, the bill is meant to curb our society's debate 
over assisted suicide. Just as the courts and States are 
engaged in the complex and serious work of establishing law and 
policy underlying assisted suicide, the Congress intends to 
restrain this enterprise with premature legislation. George 
Will recently wrote that we should allow ``the 50 state 
legislatures [to] proceed with the increasingly urgent task of 
educating themselves and the public through deliberations'' on 
assisted suicide.
    Broad public discussion is precisely what is needed, and 
what the Congress should encourage. It is not enough for us to 
ban funding or enact prohibitions. We have an obligation to 
dedicate time and careful attention to giving every patient a 
meaningful choice of health care alternatives to assisted 
suicide. Until then, we have acted too narrowly to protect the 
interests of patients and their families.
    As Justice Brandeis once observed, ``To stay 
experimentation in things social and economic is a grave 
responsibility. Denial of the right to experiment may be 
fraught with serious consequences to the Nation * * * [W]e must 
be ever on our guard, lest we erect our prejudices into legal 
principles. If we would guide by the light of reason, we must 
let our minds be bold.''

                                   Henry A. Waxman.
                                   Diana DeGette.