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Suicide law still draws emotional responses (The Oregonian
interviews four doctors who work with dying patients about the Oregon
Death With Dignity Act, the state's unique physician-assisted suicide law
that took effect in 1997.)

The Oregonian
letters to editor:
letters@news.oregonian.com
1320 SW Broadway
Portland, OR 97201
Fax: 503-294-4193
Web: http://www.oregonlive.com/

Suicide law still draws emotional responses

* Four doctors, two for and two against, offer their personal feelings on
helping the terminally ill take their own lives

Monday, December 28 1998

By Erin Hoover Barnett
of The Oregonian staff

Since the Oregon Death With Dignity Act took effect in 1997, all doctors in
Oregon who work with dying patients have had to face a question many may
have preferred to avoid: Would they help terminally ill patients take their
own lives?

The state's physician-assisted suicide law doesn't force doctors to
participate. But it does give dying patients the right to ask and to find a
doctor who might help them.

Now, more than a year since the law took effect, assisted suicide is still
not a topic that most doctors want to discuss publicly. One doctor said it
isn't even discussed among colleagues.

But the following physicians, approached by The Oregonian, were willing to
share how this issue is playing out in their practices. Two have assisted
patients and two have not. All have grappled with where they draw their own
line and why.

Dr. Jim Patterson, 56, pulmonologist

Almost once a week, one of Dr. Jim Patterson's patients dies. From lung
cancer. From emphysema. From chronic obstructive pulmonary disease.

But Patterson has never assisted in a patient's suicide -- and doesn't
believe he needs to. He says that in more than 20 years as a pulmonologist
and critical care doctor, the two patients who even hinted at wanting to die
early changed their outlook when he promised attentive care.

That does not mean that he has not helped people to die. He often must help
with the decision to remove life support, and he will use medication to
treat suffering aggressively even if that also hastens death. He draws a
clear line between this and assisted suicide, where a patient obtains a
lethal dose to swallow.

"My experience doesn't lead me to think physician-assisted suicide is a
necessary or even important part of taking care of a dying patient,"
Patterson said. "I am so interested in focusing on the educational process
of caring for the terminally ill. I think that's where it's at. Not
physician-assisted suicide."

Patterson said he would not get in the way of a person's right to have help
with assisted suicide and has felt humbled by stories of the suffering that
some people experience as they die.

But for him, giving a person a lethal prescription to take at will --
particularly with lung disease patients for whom it's hard to predict
survival time -- feels like abandonment.

Patterson feels that most patients do not want to die prematurely. They also
do not want to suffer. He thinks that doctors schooled in pain management
and respectful of the choices patients already have can help people die
comfortably.

Patterson remembers how, soon after he went into practice at Providence
Portland Medical Center in 1976, a woman in her 60s helped him understand
the distinction that medical ethicists make between ordinary and
extraordinary care. Intelligent and aware, the woman had emphysema and could
breathe only with the help of a ventilator.

She couldn't talk because of the tube down her throat to her lungs. But she
told him -- by shaking and nodding her head -- that she did not want to stay
on the ventilator, even though she knew she would die.

Patterson had grown attached to the woman. It hurt to give up.

The woman was Catholic. Patterson is not. But an elderly priest eased
Patterson's mind as well as his patient's. The priest told the woman that
she had no obligation to stay on the ventilator, and that Patterson had no
obligation to keep her on the machine. He told the woman that she would
still go to heaven.

That didn't make it easy for Patterson when he gave her morphine to relax
any anxious drive to breathe and removed the tube from her lungs with her
family around her. But it did help him to see how he could help a person die
in terms acceptable to them.

Dr. Mark Rarick, 44, oncologist

Dr. Mark Rarick tells patients in his Portland oncology practice that they
are the captain. His job is to guide them. He will discourage bad choices.
But he believes patients do better when they can make their own decisions.

That's why Rarick was uncomfortable a few years back when he could not help
a woman in the way she clearly wanted.

The woman was near death from breast cancer. It hurt just to move. She slept
upright on the couch. She didn't want more pain medication. She was ready to
die.

"I felt handicapped," Rarick said. "I was able to treat her through her
whole illness, but at the end, I couldn't help her."

All Rarick could do was give her more morphine until she died more than 10
days later.

With Oregon's physician-assisted suicide law, Rarick feels that he can help
patients with a fuller range of choices they may decide to make.

"My support is of a person's right to choose," said Rarick. "They have the
right to choose chemotherapy, to choose resuscitation, and they have a right
to choose their death."

Rarick has always openly discussed with his terminally ill patients at
Kaiser Permanente how they want to die -- whether they want to be revived if
they stop breathing or when to get hospice care. He deters patients whom he
feels may be looking to die when treatment or other care may still be
desirable options.

Even when he's sure they're sure, though, he finds the process tough.

He cared for one woman with breast cancer for more than a year, and knew
that she was near death. She told him she wanted control. She filled out an
advance directive and consulted with a psychiatrist. Rarick, in turn, knew
she was clear in her request, and not acting rashly. He took comfort in the
guidance he got from Kaiser Permanente's process to help physicians handle
patient requests appropriately under the law.

Still, he remembers getting a headache from trying so hard to be certain he
covered the checklist of things required by the law -- the second opinion,
her mental competency, whether she understood her options for pain control.

"I remember feeling trembly. Every time I checked things off, I felt it was
really happening," Rarick said.

He even checked her driver's license with the state to be sure she was a
resident. He remembers exactly where he was sitting in his office when the
pharmacist came by and Rarick signed his name on the prescription. He and
the pharmacist paused and looked at each other. Rarick drew a breath and let
it out.

But Rarick took comfort in his queasiness. He didn't want to feel at ease
about writing a lethal prescription.

In the end, the woman chose not to use the prescription. But Rarick learned
from her friends that she was buoyed by knowing that she had the choice if
she wanted it.

When Rarick learned she had died, he felt sad. He also felt he had done
right by her as her physician.

"I felt that she was in control to the end, and I was able to help her do
that," Rarick said. "I met my goals of helping her through her illness and
her death."

Dr. Walter Urba, 46, oncologist

Dr. Walter Urba isn't confused about physician-assisted suicide. He won't do it.

His feelings, which became clear to him very early in the assisted suicide
debate, grew out of his own struggle with facing his patients' deaths and
his realizations about the value of excellent care and not cutting short a
patient's dying.

Urba is concerned that assisted suicide could interrupt that opportunity for
healing and closure that can make a death so much gentler for the patient,
family and caregivers.

He remembers in particular a young woman who came to the Robert W. Franz
Cancer Research Center at Providence Portland Medical Center, which Urba
directs.

In her 20s, the woman was full of vitality and an avid skier. But she had
skin cancer and had moved with her husband to Oregon for treatment.

Urba and his colleagues tried experimental therapies to eradicate the
cancer. When those failed, they tried treatments to slow it down.

The cancer kept spreading.

Urba had to tell the woman and her husband that she was going to die. She
told Urba she wanted to return to her home state. Urba made sure she had
hospice care there. Before she left Portland, she turned to Urba and thanked
him for trying. Urba remembers realizing that he would never see her again.

Urba couldn't help but feel that he had failed.

"We all have the sense that we didn't get the job done," Urba said.

She died at home with her family around her.

Not long after her death, he heard a knock at his office door. In strode the
woman's husband, baseball cap on backwards, and her parents.

They had come to sprinkle the woman's ashes in Oregon. They wanted to see
Urba to say thank you. They planned to start a scholarship fund to allow
young people to come to the cancer research center to study. Her husband
shook Urba's hand.

Urba was overwhelmed.

Years later, his throat still tightens when he talks about it. But the
experience has helped him to understand how something as dreadful as losing
a young woman in the prime of her life can create something larger and
stronger that did not exist before.

"It's proof to me of the principle that caring and compassionate people can
provide good end of life for people," Urba said.

He won't abandon a dying patient who wants assistance committing suicide; he
will refer the patient to someone who can help. He, however, doesn't want
his patients confused about what his job is.

"I've never had a doubt how I would behave toward my patients. My role is as
a healer and to relieve suffering and not to help my patients commit
suicide," Urba said. "Nobody needs to look at me and see anything else."

Dr. Pete Reagan, 52, family practice

When Dr. Pete Reagan was asked by the right-to-die group Compassion in Dying
last spring to evaluate a patient who wanted a lethal prescription, Reagan
felt frightened, worried -- and honored.

Reagan believes deeply in people's right to control their lives.

As a Quaker and a radical pacifist, he was placed on probation in lieu of
three years in prison for resisting the draft during the Vietnam War.

As a family doctor in private practice in Portland, Reagan tries to advise,
not dictate to, his patients. "It's not my job to set their goals," he said.
"It's my job to help them figure out how to reach theirs."

But when Reagan met the patient he calls Helen, he was in for a profound
test of his personal convictions.

Reagan saw that Helen qualified for a prescription under the law. In her
mid-80s, she had cancer throughout her body. Reagan and a pulmonologist
concluded her prognosis was measured in weeks. Reagan saw no indication of
depression, nor did the psychiatrist who extensively evaluated her. She had
plenty of money for care. Hospice nurses attended to her. But she felt she
had had a good life. Now she was done.

For Reagan, that was the hard part. In the past, he had a patient die angry
when he could not help him die. Another slashed his wrists with scissors in
a nursing home. But now that he faced a patient he could legitimately
assist, the magnitude of it felt frightening.

Reagan worried about the controversy swirling around the law. He worried
about the consequences for him professionally. And, most of all, he
struggled with Helen's "shocking impatience" to die.

Reagan sought out the consulting physician and the psychiatrist. They talked
for hours, trying to figure out if they'd missed something, trying to
understand Helen's determination.

Reagan talked with his wife during supper and before bed. He talked with
Helen and her family, trying to get to know them and understand their feelings.

Helen realized his struggle. As he left her home one afternoon, Reagan
remembers her saying from her wheelchair, "When you do this thing, you'll be
able to sleep well at night because you will know what you did was right."

Helen chose the evening she wanted to die. Reagan saw other patients
throughout the day. But Helen weighed on his mind. He looked out the window
of his office at the lovely spring weather. The notion of leaving the earth
felt sad to him. But when he saw Helen that night, he knew she did not share
that sadness.

She was sitting up in bed with her family around her, reminiscing. She
repeated her wishes. She took the milkshake-like concoction containing the
powdered barbiturates in her hand and drank it immediately. She smiled a
small smile and shrugged, like she was proud at getting it all down. Then
she fell asleep.

Reagan said the mood in the room was sad, yet strangely triumphant. She had
reached her goal.

Within a half hour, she was dead. For Reagan, the suddenness was unnerving.

Reagan still grapples with his experience. He has declined other requests
from patients who weren't qualified. But if he meets another patient who is
qualified, he will help. To him, it would feel like abandonment if he didn't.

"It doesn't feel good to write a prescription for someone to kill
themselves," Reagan said. "But sometimes it feels like the right thing to
do. It feels worse to not do it."

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The Last Worst Place (The San Francisco Chronicle visits Florence,
Colorado's $60 million ADX prison - governmentese for "administrative
maximum." Unparalled in America, it is the only prison specifically designed
to keep each of its 400 occupants in near-total solitary confinement.)

Date: Mon, 28 Dec 1998 18:11:37 -0800
From: owner-mapnews@mapinc.org (MAPNews)
To: mapnews@mapinc.org
Subject: MN: US CO: The Last Worst Place
Sender: owner-mapnews@mapinc.org
Reply-To: owner-mapnews@mapinc.org
Organization: Media Awareness Project http://www.mapinc.org/lists/
Newshawk: compassion23@geocities.com (Frank S. World)
Pubdate: Monday, December 28, 1998
Source: San Francisco Chronicle (CA)
Page: A3
Copyright: 1998 San Francisco Chronicle
Contact: chronletters@sfgate.com
Website: http://www.sfgate.com/chronicle/
Forum: http://www.sfgate.com/conferences/
Author: Michael Taylor, Chronicle Staff Writer

THE LAST WORST PLACE

The isolation at Colorado's ADX prison is brutal beyond compare. So are the
inmates

This is it. The end of the line. The toughest ``supermax'' prison in
the United States.

If you make it here, the odds are you'll be an old man when you get
out of custody -- if you get out.

ADX-Florence -- governmentese for ``administrative maximum'' -- is the
place where the federal government puts its ``worst of the worst''
prisoners, mainly felons sent from other federal prisons after they
killed their fellow inmates, or on occasion, their guards.

Among its current 400 residents, the ADX also houses a handful of
high-profile prisoners, among them Unabomber Theodore Kaczynski,
serving four life sentences plus 30 years. But the criminally renowned
-- less than 5 percent of the ADX population -- are just a sideshow to
the real raison d'etre of this place: to try and extract reasonably
peaceful behavior from extremely violent career prisoners. Here,
rehabilitation is hardly an issue. The goal is to release inmates to a
less restrictive prison to serve out the rest of their days.

The ominous objective might seem an odd match for the arid
surroundings of Florence, population 4,000, in what was once cattle
and coal country, south of Colorado Springs.

But today, this is prison country. There were already nine state-run
lockups in the county when eager Florence residents bought 600 acres
and gave the land to the federal government, which used it to build
four correctional facilities, including the ADX.

Unparalled in America, it is the only prison specifically designed to
keep every occupant in near-total solitary confinement, rarely
allowing inmates to see other prisoners.

The worst behaved men could serve an entire sentence -- decades -- in
isolation. And for some, it doesn't matter.

They are the men, former Warden John M. Hurley says, who have
``decided that life is inside the walls of a prison. They don't think
about what's going on in Colorado Springs or Detroit. . . . They're
not motivated in trying to be a better citizen. If you're 42 years old
and your release date is in August 2034, you're not thinking about
getting out and getting a job.''

Prison psychology experts, like Dr. Craig Haney of the University of
California at Santa Cruz, say this long-term solitary confinement can
have devastating effects. ``That's what is new about these so-called
supermax prisons,'' he said, ``of which Florence is the most extreme
example.''

Indeed, Florence is the leader in a nationwide trend toward supermax
prisons: in the past few years, 36 states have built strongbox
facilities to house their most dangerous inmates. In California, the
most notorious are the Security Housing Units at Pelican Bay and
Corcoran, already the subjects of numerous lawsuits and investigations
into alleged cruel and unusual punishment, as well as the staging, by
guards, of deadly fights among inmates.

In state facilities, though, isolation cells are just one segment of a
large, general population prison. At Florence, isolation is all there
is.

The ADX has a three-year program that keeps inmates in their cells 23
hours a day for the first year, then gradually ``socializes'' them
with other inmates and staff. In their last year, prisoners can be out
of their cells from 6 a.m. to 10 p.m. and eat meals in a shared dining
room, rather than having food shoved through a slot in their steel
cell door.

``We have the agency's most violent and dangerous offenders,'' said
Hurley, shortly before he retired after nearly 30 years in the world
of corrections. ``It is something we emphasize to our staff day in and
day out.''

More than half the inmates have murdered somebody in or out of prison,
said Blake Davis, Hurley's assistant. A third of the men are in prison
gangs, including the well-known Aryan Brotherhood, Black Guerrilla Family
and Mexican Mafia, as well as lesser known but just as deadly outfits such as
the Dirty White Boys. The average sentence is 36 years.

It is spent, typically, in a 12-by-7- foot cell. Beds, desks and
stools are made of poured concrete. Toilets have a valve that shuts
off the water if an inmate tries to flood his cell by stopping it up.
Sinks have no taps, just buttons -- inmates used to unscrew the taps
and use the plumbing parts as shanks.

A 42-inch window, 4 inches wide, looks out on a one-man concrete
recreation yard, which prisoners with good behavior can eventually
use.

When prison guards unlock a cell door they quickly cover their key
with an aluminum shield. Some inmates, said prison research analyst
Tom Werlich, can glance at the key, memorize the configuration and
size of its teeth and later duplicate it from materials picked up
around the prison.

``They have a lot of time to figure these things out,'' said a guard
who preferred to remain anonymous, lest he begin to get threats from
inmates' friends or relatives.

Out of reflex, the guard on a recent tour walked to a cell shower and
thumped the drain with his baton. ``They tie a weapon to a piece of
string,'' he said, ``then drop it down the drain to hide it.''

The ADX goes to great lengths to bring everything into the cells --
books, food, television -- so that inmates never need to leave. A 12-
inch black-and-white TV in each cell shows closed-circuit classes in
psychology, education, anger management, parenting and literacy.
Religious services of numerous denominations are piped in from a small
chapel, where prison officials display for the videocamera the
religious objects appropriate for a given faith.

The harsh quarantine is rooted in equally harsh reality: a single,
deadly day 15 years ago gave birth to the ADX.

On Oct. 22, 1983, two handcuffed inmates at the federal prison in
Marion, Ill. killed two guards in separate incidents.

In the first, ``The inmate was walking down the hall, with his hands
cuffed in front of him,'' Werlich said. So fast and practiced was the
prisoner, he ``was able to suddenly turn and shove his cuffed hands
into the cell of a friend, who quickly unlocked the cuffs with a
stolen key, handed his friend a knife and the inmate turned around and
killed the guard.'' Later that day, another inmate used the same
lethal tactic.

Up until then, Marion -- the place where the Bureau of Prisons
formerly sent its worst offenders -- was an old-style, open population
prison. When trouble broke out, the prison was locked down and all
inmates kept in their cells until a few days later, when it would open
back up. And then the killings and assaults would resume.

For Norman Carlson, then director of the Federal Bureau of Prisons,
the deaths of the two guards was the turning point.

``I decided I had no alternative but to bite the bullet and do it'' --
institute a permanent lockdown at Marion -- ``and hope the courts
would understand,'' Carlson said.

``There is no way to control a very small subset of the inmate
population who show absolutely no concern for human life,'' he said.
``These two characters (who killed the two guards) had multiple life
sentences. Another life sentence is no deterrent.''

Carlson, now retired, persuaded the government to build a new and
different prison that would effectively isolate prisoners from each
other and, for the most part, from prison staff. The result was
Florence, which opened four years ago.

Since then, to the government's credit, the $60 million ADX has not
drawn the same kind of withering criticism as its state cousins, such
as Pelican Bay.

``The Bureau of Prisons has taken a harsh punitive model and done it
as well as anybody I know,'' said Jamie Fellner, an attorney with
Human Rights Watch, the largest U.S.- based human rights organization.
Fellner was recently given a tour of the prison. ``What I'd like to
see is more debate within the BOP to see how we can minimize the need
for supermaxes,'' she said.

Haney, the Santa Cruz psychologist who has testified as an expert
witness in cases involving supermax confinement, said the effect of
isolation in places like Florence is dramatic. Prisoners ``become
extremely depressed and lethargic -- sleeping, lying on their bunks,
staring at the ceiling, declining to go out and exercise,'' he said.
They begin to lose memory, can't concentrate and suffer severe panic
attacks, he said, or become uncontrollably enraged over insignificant
things.

Haney and others suggest that prison officials pay more attention to
the individual needs of supermax inmates rather than spending so much
time and money on high-tech prison gadgetry and oppressive controls.

But Davis, the warden's assistant, says extreme control, for some
prisoners, is the only way to save bloodshed.

``Behavior puts them here,'' Davis said, repeating what has become the
prison motto. ``And behavior gets them out.''

IMFAMOUS INMATES

Among the prisoners at Colorado's ADX-Florence:

-- THEODORE KACZYNSKI, 56, the Unabomber, serving four consecutive life
sentences.

-- TIMOTHY McVEIGH, 30, sentenced to death for the 1995 bombing of the
Oklahoma City federal building which killed 168 people.

-- TERRY NICHOLS, 43, McVeigh's accomplice, is now serving life in prison.

-- CHARLES HARRELSON, 59, the father of actor Woody Harrelson, is serving
two life sentences for the murder of a federal judge.

-- RAYMOND LUC LEVASSEUR, 51, member of a U.S. radical group, serving 40
years for bombing buildings and attempted bombings in the 1970s.

-- EYAD ISMOIL, 27, serving 240 years for driving the rental van holding
the bomb in the World Trade Center attack.

-- YU KIKUMURA, 46, Japanese Red Army terrorist, serving 30 years for
transporting bombs in preparation for an attack on a Navy recruiting center.

-- LUIS FELIPE, 35, leader of New York's Latin Kings gang, who ordered the
murders of six gang members from his jail cell and is serving a life sentence.

-- RODNEY HAMBRICK, 33, serving a 68-year sentence on bomb charges.

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VA To Take A Look At How To Treat Pain (The Grand Rapids Press,
in Michigan, says beginning in January, the U.S. Department of Veterans
Affairs will do what few health-care providers have done. It will assess
a patient's level of pain along with other vital signs such as temperature,
blood pressure and pulse. Veterans facilities ranging from hospitals
to nursing homes to clinics will use the assessments to develop long term
strategies for treating both chronic and acute pain. The VA serves more than
25 million veterans, and one third of American medical residents and about
half of American medical students are trained in VA facilities.)

Date: Thu, 31 Dec 1998 21:53:29 -0800
From: owner-mapnews@mapinc.org (MAPNews)
To: mapnews@mapinc.org
Subject: MN: US: VA To Take A Look At How To Treat Pain
Sender: owner-mapnews@mapinc.org
Reply-To: owner-mapnews@mapinc.org
Organization: Media Awareness Project http://www.mapinc.org/lists/
Newshawk: Lee T. Neidow
Pubdate: Monday, 28 Dec 1998
Source: Grand Rapids (Michigan) Press
Copyright: 1998, Grand Rapids Press
Contact: pulse@ccmail.gr-press.com
Fax: 616-222-5212
Website: http://www.gr.mlive.com
Author: Sarah Kellogg - Grand Rapids Press Bureau

VA TO TAKE A LOOK AT HOW TO TREAT PAIN -

The Assessments Could Be Used To Develop A National Treatment Policy.

WASHINGTON - How to you ease a patient's persistent, severe pain? Soon, the
federal government hopes to find an answer.

Beginning in January, the U.S. Department of Veterans Affairs will do what
few health-care providers have done. It will assess a patient's pain as it
gauges other vital signs, such as temperature, blood pressure and pulse.

Veterans facilities, ranging from hospitals to nursing homes to clinics,
will use the assessments to develop long term strategies for treating both
chronic and acute pain.

"One of the goals of this national strategy is that no dying veteran shall
suffer from preventable pain while being cared for by the VA health-care
system", said Bonnie Ryan, the VA's chief of home and community based care.

"We want to get pain assessment performed in a consistent manner. We also
want to assure (patients) that pain treatment is prompt and appropriate,"
Ryan added.

The medical overseer of the Grand Rapids Outpatient Clinic believes the new
strategy could help some veterans avoid a trip to Ann Arbor for pain
management.

"We would be addressing these issues on a comprehensive basis" said Dr.
Sita Kondapaneni, chief of physical medicine and rehabilitation for the
Battle Creek based Veterans Affairs Medical Center.

Kondapaneni said officials will asses veterans who use the Grand Rapids
clinic to see who might benefit from such an approach, which would convene
specialists in rehabilitation, anesthesiology, psychology, psychiatry to
determine the best course of pain treatment.

"We will be able to do more than we have in the past" Kondapaneni said.

Michigan medical officials believe the new VA policy will do more than help
veterans. It will also set an example for health care providers.

A change in VA policy can have that kind of impact because the system is so
large. It serves more than 25 million veterans nationally.

One-third of the nation's medical residents and about half of the medical
students are trained each year in VA facilities, VA officials say.

"The need is out there", said Robert Werner, who directs the Ann Arbor VA
Medical Center's physical medicine and rehabilitation program. "Not enough
people ... know how to manage (pain). A national strategy will not only
focus on pain clinics like ours, but will focus on educating our primary
care doctors in all our facilities."

Plus, the new VA policy may show physicians that the federal government
cares as much about easing pain as it does about stopping doctors who are
trafficking in drugs.

"The government's war on drugs has had a chilling effect on liberal
prescribing for patients who have legitimate needs," said Dr. John Finn,
medical director for the Hospice of Michigan, a non-profit group that
operates 25 hospices throughout the state.

"It's stunted physicians attitudes as well as skills in regards to pain
management. Finally the government is saying we have a problem here."

In Michigan, the VA main management strategy will be implemented in it's
five medical centers in Ann Arbor, Battle Creek, Detroit, Iron Mountain and
Saginaw.

Veterans, about 949,000 in Michigan, also will be able to receive
assistance with pain at outpatient clinics in Gaylord and Grand Rapids.

Physicians expect the assessment procedure to be difficult to implement if
only because it's so individual. It probably will be done verbally with the
patient rating his or her pain on a scale from 1 to 10.

Once assessed, doctors will need to match the treatment with a patient's
specific needs. Is it a pain related to cancer treatments? Or is it a pain
as a result of back or muscle injuries? Treatments could range from
exercise regimens to narcotics, such as morphine, to using electrical
devices to interrupt nerve impulses.

"It's not so much that this is new knowledge," Ryan said. "It's bringing
all kinds of information together in a new way to make it easy for people
to do the right thing (for patients)."

Michigan hospitals and doctors are watching. Many hope the strategy will
spur efforts in private facilities.

"We are in the infancy of pain assessment and management," said Dr. Cathy
Blight, president of the Michigan State Medical Society, a group
representing about 11,000 Michigan doctors. "Pain is very subjective. What
one person can handle ... another person can't, so that requires a very
specialized response to each individual patient."

Up to now, the medical responses have been guided, in part, by wary
physicians who feared losing their drug prescribing licenses to anti-drug
government regulators.

That wasn't helped much by Congress' attempts this year to establish a
tracking system for addictive drugs and the physicians who prescribe them.
The bill, spurred by fears that physicians might abuse Oregon's assisted-
suicide law, eventually died in committee.

Meanwhile, the state Legislature took a less aggressive step, passing bills
requiring physicians to be educated about severe pain and how to treat it.
The legislation is awaiting Gov. John Engler's signature.

"I'd like to see a statement from state lawmakers or the federal government
outlining what is good care and adequate care," said Finn. "The public's
attitudes are changing, so should the government's."

The VA's pain management strategy may be just that. It surely is the best
example of the medical community's recognition of the role it plays in end-
of-life care.

Death has always been viewed as a failure of the health care system," said
Patrick Foley, spokesman for the Michigan Health and Hospital Association,
which represents hospitals and health maintenance organizations. "There's a
realization now that death is an integral part of life. Hospitals are
taking more seriously their roles in providing dignified, end-of-life care
for all their patients."

-------------------------------------------------------------------

First conviction lands man 25 years to life under Rockefeller laws
(The Associated Press says Albert Brunner was convicted about 10 years ago
of selling nearly two pounds of cocaine. Under New York state's mandatory
minimum sentencing guidelines for drug-law violators, the first-time,
non-violent offender was sentenced to 25 years to life in prison. His younger
sister, Margaret Liberatore, a school teacher on maternity leave,
is circulating petitions calling for reform, and hopes to gather 3,000
signatures by mid-January to send to Gov. George Pataki.)

From: "Bob Owen@W.H.E.N." (when@olywa.net)
To: "_Drug Policy --" (when@hemp.net)
Subject: Rockefeller laws 1st conviction lands man 25 yr to life
Date: Tue, 29 Dec 1998 18:25:46 -0800
Sender: owner-when@hemp.net

Newshawk: ccross@november.org
Online:
http://www.boston.com/dailynews/wirehtml/362/First_conviction_lands_man_25_y
ears.shtml

First conviction lands man 25 years to life under Rockefeller laws

Associated Press, 12/28/98 01:07

AUBURN, N.Y. (AP) - About 10 years ago, Albert Brunner was convicted under
the old Rockefeller drug laws for selling nearly two pounds of cocaine. It
was his first conviction for a non-violent drug crime, yet Brunner was
sentenced to 25 years to life in prison - a jail term comparable to one
meted out for murder.

``Ten years ago, people thought go ahead, lock them up and throw away the
key,´´ said Brunner´s younger sister, Margaret Liberatore. ``But it hasn´t
changed the availability of drugs out there. ... There´s more drugs out
there than ever.´´

The sentence doesn't make sense to Liberatore, a school teacher on maternity
leave who lives in Auburn. She's circulating petitions calling for reform of
the state's drug sentencing laws.

She told the Syracuse Newspapers that she's hoping to gather 3,000
signatures by mid-January to send to Gov. George Pataki.

Twenty-five years ago, the Rockefeller drug laws established mandatory
sentences for the sale and possession of narcotics that are among the
harshest in the nation. A conviction for the sale of two ounces of cocaine
or heroin, an A-1 felony, carries a minimum sentence of 15 years to life.
First-degree murder, also an A-1 felony, has a minimum sentence of 20 years;
first-degree rape, a B-felony, requires a minimum of six years behind bars.

In 1974, the year after the laws were enacted, 713 inmates were sent to
prison on drug felonies. As of December 1997, there were 8,800 drug
offenders locked up in state prisons under the Rockefeller drug laws,
according to the state Department of Correctional Services.

Cayuga County Court Judge Peter E. Corning, who sentenced Brunner, said he
now opposes such mandatory sentences.

``I was district attorney when Rockefeller put those laws in place,´´ said
Corning. ``He believed they would be a deterrent. It has not worked out.´´
James Flateau, speaking for the state department of corrections, said that
some inmates sentenced under Rockefeller laws who don't have a violent past
have been released under work release and good behavior programs.

But not everyone qualifies for those programs. Because he was convicted of
an A-1 felony, Brunner is not eligible for the new work release or merit
programs.

By the time Brunner's eligible for release - Oct. 22, 2014 - taxpayers will
have spent roughly $750,000 to keep him locked up, his sister estimates.

Since he has been in jail at the Green Haven Correctional Facility in
Stormville, 40-year-old Brunner has earned an associate's degree in business
and works as a liaison in disputes between inmates and the prison
administration.

He even married five years ago, a woman from Rochester he met as a pen pal.

But none of this, or anything else he does, will help spring him from prison
any sooner under current law. ``No matter what good things he does, no
matter what positive actions he takes, there´s no early release,´´
Liberatore said. ``It´s so frustrating, so unjust, so illogical. It makes no
sense.´´

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Sharp Drop in Violent Crime Traced to Decline in Crack Market
(The New York Times discusses the many theories about why new statistics
released Sunday by the Justice Department show violent crime has dropped
seven straight years after an upsurge in the 1980s. The annual survey,
carried out for the Justice Department by the Census Bureau, asks 80,000
people ages 12 and older whether they have been victims of a crime in the
past year. The newspaper favors the theories that the decline is due
primarily to a withering away of the crack market and police efforts to seize
handguns from criminals and juveniles.)

Date: Wed, 30 Dec 1998 09:25:46 -0800
From: owner-mapnews@mapinc.org (MAPNews)
To: mapnews@mapinc.org
Subject: MN: US: NYT: Sharp Drop in Violent Crime
Traced to Decline in Crack Market
Sender: owner-mapnews@mapinc.org
Reply-To: owner-mapnews@mapinc.org
Organization: Media Awareness Project http://www.mapinc.org/lists/
Newshawk: Richard Lake (rlake@mapinc.org)
Pubdate: Mon, 28 Dec 1998
Source: New York Times (NY)
Contact: letters@nytimes.com
Website: http://www.nytimes.com/
Forum: http://forums.nytimes.com/comment/
Copyright: 1998 The New York Times Company
Author: Fox Butterfield

SHARP DROP IN VIOLENT CRIME TRACED TO DECLINE IN CRACK MARKET

New statistics released Sunday by the Justice Department are helping
criminologists resolve a contentious mystery -- why violent crime has
dropped seven straight years after an upsurge in the 1980s.

The statistics, showing that robbery fell a stunning 17 percent in 1997,
suggest that while there are many factors behind the decline in crime in
the 1990s, the crucial ones may be the withering away of the crack market
and police efforts to seize handguns from criminals and juveniles.

The two crimes that have fallen the most sharply since 1991 are homicide
and now robbery, the two most often committed with handguns and most
associated with the crack cocaine epidemic in the late 1980s,
criminologists say.

"Homicide and robbery were the two crimes most impacted by crack markets,
with the biggest increases, and now as crack markets have declined,
homicide and robbery have led the way down," said James Alan Fox, dean of
the college of criminal justice at Northeastern University.

The figures on robbery were released Sunday by the Bureau of Justice
Statistics, a branch of the Justice Department, as part of its National
Crime Victimization Survey. The annual survey, carried out for the Justice
Department by the Census Bureau, asks 80,000 people ages 12 and older
whether they have been victims of a crime in the past year. It complements
the other major national set of crime statistics, the FBI's Uniform Crime
Report, which measures crimes reported to police.

Overall, the Justice Department said, both violent and property crimes have
fallen to their lowest levels since 1973, when the victimization survey was
started. In fact, the rate of property crime -- which includes burglary,
theft and motor vehicle theft -- has fallen by more than half, to 248 per
1,000 households in 1997, down from 555 per 1,000 households in 1973.

Property crime, unlike violent crime, has been dropping steadily since
1975. Among the reasons, experts say, are the aging of the baby boom
population beyond its prime years for committing crime, the increased use
of security alarms and the switch of many criminals from burglary to
robbery in the 1980s as a quicker way to make money and buy the crack they
needed.

Violent crime surged unexpectedly with the crack epidemic starting about
1985, and then began to fall, equally unexpectedly, in 1991. Only in
retrospect have law-enforcement authorities and criminologists been able to
theorize about the causes of the rise and decline in violent crime.

At a conference of leading experts in New Orleans this month sponsored by
the Harry Frank Guggenheim Foundation, Alfred Blumstein, a criminologist at
Carnegie Mellon University, outlined research on what has come to be the
most widely accepted view -- that all of the huge increase in homicide in
the late 1980s and early 1990s was attributable to a rise in killing by
juveniles and young people ages 24 and under, since homicide by adults ages
25 and older has fallen since 1980.

This increase in killing was driven by the sudden spread of crack markets
and the growing use of high-powered semiautomatic handguns. In fact,
Blumstein said, "The growth in homicides by young people, which accounted
for all the growth in homicides in the post-1985 period, was accounted for
totally by the growth in homicides committed with handguns."

Since 1991, homicides have dropped 31 percent, from 9.8 per 100,000 to 6.8
per 100,000 in 1997, while robberies have fallen 32 percent, from 272 per
100,000 to 185 per 100,000 in 1997, according to the FBI. These are the
largest declines for any of the major violent or property crimes.

Bruce Johnson and Andrew Golub, scholars at the National Development and
Research Institutes in New York City, showed the critical role of crack in
leading violent crime up and then down. When crack arrived in New York in
1985, it created a huge new market for users and dealers. Unlike heroin, it
was sold in small amounts that provided an intense but short-lasting high
that required users to go on constant "missions" to find more.

Thousands of unskilled, unemployed young men from New York's poor inner
city neighborhoods jumped into the crack business as sellers, and to
protect themselves in an unstable business environment, they acquired
handguns. An explosion in homicides and robberies resulted from the
combination of impulsive youth, the confused market situation, the paranoia
induced by crack and the increased firepower of the new handguns.

The sharp drop in violent crime starting in 1991 can be accounted for by
the reversal of these same forces, in what Johnson and Golub described as
"an indigenous shift," as youths who came of age in the 1990s turned
against smoking or selling crack.

"The primary reason" these young people give for avoiding crack, Johnson
and Golub reported, "is the negative role models in their lives. They
clearly do not want to emulate their parents, older siblings, close
relatives or other associates in their neighborhoods who were enmeshed with
crack." Crack produced "devastation" in their lives, and they now shun or
deride anyone who smokes crack.

Among other factors that have played a role in the decline in violence, the
experts at the New Orleans conference pointed in particular to aggressive
new actions by the police in many cities to stop gun violence, either by
frequent searches, as has happened in New York, or by improved efforts to
trace guns used in crimes and arrest gun traffickers, a Boston tactic.

The booming economy of the 1990s has also helped, the experts agreed,
providing legitimate jobs to some urban young people who had worked in the
drug trade.

Evidence on the role of imprisonment in curbing crime is less clear, the
experts said. There is no question that the almost quadrupling of the
number of people incarcerated since 1970, to 1.8 million, has incapacitated
many criminals and prevented many crimes.

But since the prison population has expanded steadily over the past 25
years, it does not explain why crime increased sharply in the late 1980s or
decreased in 1991. Here, said Fox, it may be necessary to look separately
at the incarceration of adults and juveniles, a study which has not yet
been done.

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Drug Traffickers Terrorize Upscale Zone In Rio (Reuters says shops
and restaurants near the governor's palace in Rio de Janeiro, Brazil,
reopened on Monday after drug traffickers forced them to close
over the weekend to honour a drug lord killed by police. Residents
and business owners in the middle-class neighbourhoods of Laranjeiras
and Cosme Velho said shootouts between rival gangs in the nearby shantytowns
were common, but the forced closings showed a new level of brashness.)

Newshawk: General Pulaski
Pubdate: Mon, 28 Dec 1998
Source: Reuters
Copyright: 1998 Reuters Limited.
Author: Tracey Ober

DRUG TRAFFICKERS TERRORIZE UPSCALE ZONE IN RIO

RIO DE JANEIRO, Dec 28 (Reuters) - Shops and restaurants near the governor's
palace in Rio reopened on Monday after drug traffickers forced them to close
over the weekend to honour a drug lord killed by police, community leaders said.

Residents and business owners in the middle-class neighbourhoods of
Laranjeiras and Cosme Velho said shootouts between rival gangs in the nearby
shantytowns were common, but the forced closings showed a new level of
brashness.

"I've lived in the neighbourhood for more than 20 years and I've never seen
businesses shut down like this," said Thereza Amayo, a former president of
the residents' association. She said it felt like they were living in a war
zone.

The most recent spate of violence began early Saturday with a fierce gun
battle between rival gangs in a shantytown. Police said they got involved
when four armed men leaving the fight on motorcycles engaged them in gunfire
in Laranjeiras.

One officer was wounded and convicted drug lord Claudio Passos da Rocha,
known as "Portuguesinho" or "the little Portuguese boy," was shot and
killed. At the same time, police gunned down two alleged drug traffickers in
another shantytown near Cosme Velho.

Later on Saturday and Sunday business owners in the two neighbourhoods
apparently received phone calls warning them to close their restaurants and
shops or risk them being targeted in drive-by shootings.

"They said that people were showing disrespect toward the dead," said a
worker at a grill called Gaucha, which normally serves some 1,500 people for
Sunday lunch. "The grill has existed since 1939 and I've never seen anything
like this."

Residents took to the streets to protest the violence earlier this year
after four men armed with assault rifles blocked a car driven by an
18-year-old student in Laranjeiras and killed her with a spray of bullets.

Also in Laranjeiras in April, a thief brazenly walked through security at a
Rio state government building and robbed a bank branch inside.

"The question of security is national. It's unacceptable that armed bands
control areas of the city as if they were safe-havens," said former
presidential candidate Alfredo Sirkis, a local resident.

Police say Brazil is battling a growing drug trade as pressure on
traffickers has increased in the neighbouring cocaine-producing nations of
Colombia, Bolivia and Peru. In the state of Rio alone, police confiscated
more than 1,000 pounds (450 kg) of cocaine and four tonnes (3,600 kg) of
marijuana in the first nine months of this year.

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Top-secret Cannabis Ready For Medicinal Harvest (The Times, in London,
says Britain's first crop of government-licensed cannabis is to be harvested
secretly this week, in preparation for trials on up to 2,000 people
that will begin once medicine has been distilled from the plants.)

Date: Mon, 28 Dec 1998 16:42:02 -0800
From: owner-mapnews@mapinc.org (MAPNews)
To: mapnews@mapinc.org
Subject: MN: UK: Top-secret Cannabis Ready For Medicinal Harvest
Sender: owner-mapnews@mapinc.org
Reply-To: owner-mapnews@mapinc.org
Organization: Media Awareness Project http://www.mapinc.org/lists/
Newshawk: Pelle Moulante
Source: Times, The (UK)
Contact: letters@the-times.co.uk
Website: http://www.the-times.co.uk/
Copyright: 1998 Times Newspapers Ltd
Pubdate: Monday 28 December 1998
Author: Helen Rumbelow

TOP-SECRET CANNABIS READY FOR MEDICINAL HARVEST

BRITAIN'S first crop of government-licensed cannabis is to be harvested
secretly for medical research this week by a specially vetted team of
mature botanists. No younger staff were employed to grow the crop because
of fears that they might be tempted to mix business with pleasure.

Trials on up to 2,000 people will begin once medicine has been distilled
from the plants in the spring, in the hope of developing treatments for
illnesses such as multiple sclerosis and epilepsy.

The crop has been guarded round the clock as hundreds of fully potent
plants have reached 8ft in the past four months. No one but the Home Office
and the staff of GW Pharmaceuticals know the location of the greenhouse in
southern England.

Geoffrey Guy, chairman of the company, holds the only licence for growing
the controlled drug for medical research, and the trials will take several
years. Next week the Government is set to approve guidelines for a separate
series of trials by the Royal Pharmaceutical Society.

Dr Guy said that Britain was alone in its pragmatic and open-minded
approach to research of the drug. "We enjoy a very liberal research
environment," he said. "Our first objective is to get research done, not to
find a thousand reasons to block it."

Botanists chose ten varieties for the first crop, aimed at getting a high
yield of tetrahydrocannabinol (THC) and cannabidiol (CBD). The estimated
1,000 MS sufferers who use cannabis illegally buy a product high in THC,
the pyschoactive ingredient liked by recreational users for its euphoric
and drowsy effects.

Scientists are also interested in CBD as it is believed to reduce the
side-effects of THC and be useful in treating strokes and epilepsy. Dr Guy
said: "Eventually we aim to breed a special MS variety or epilepsy variety."

After the harvest, the plants will be hung up to dry, then processed to
produce a treacly liquid. This is cleaned up and can be modified into a
thinner liquid for use in inhalers.

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[End]