A million vulnerable patients have died in the last decade, and while I have no doubt the rate of overdose and poisoning will drop nationwide—killing a million vulnerable patients has that effect eventually—I choose not to contribute to that death rate. This decision is in accordance with my deeply held beliefs. In 2014, Governor Asa Hutchinson signed the Arkansas Conscience Protection Act into law, supposedly protecting health care professionals who refuse to participate in treatments or actions they find morally or ethically unacceptable. This law exists so that doctors have some legal protection if they choose not to engage in acts or treatments they believe violate their deeply held beliefs. In March 2021, the same governor reaffirmed this commitment by signing the Medical Ethics and Diversity Act, further protecting health care workers from being forced to violate their religious, moral, ethical, or philosophical principles.

The General Assembly found that:

1. The right of conscience is a fundamental and unalienable right.
2. The right of conscience was central to the founding of the United States, has been deeply rooted in the history and tradition of the United States for centuries, and has been central to the practice of medicine through the Hippocratic oath for millennia.
3. Despite its importance, threats to the right of conscience of medical practitioners, health care institutions, and health care payers have become increasingly more common and severe in recent years.
4. The swift pace of scientific advancement and the expansion of medical capabilities, along with the notion that medical practitioners, health care institutions, and health care payers are mere public utilities, promise only to exacerbate the current crisis unless something is done to restore the importance of the right of conscience.
5. It is the public policy of this state to protect the right of conscience of medical practitioners, health care institutions, and health care payers.

It is the purpose of this subchapter to protect all medical practitioners, health care institutions, and health care payers from discrimination, punishment, or retaliation as a result of any instance of conscientious medical objection.

The spectrum of human belief is broad. The Christian Scientist may eschew almost all modern medical treatments, and the Scientologist denounces all psychotropic medications. While these are not the general opinions, when it comes to their personal actions, we must protect their right to believe and act in accordance with their conscience. But when it comes to when human life begins and how it should end, almost all of us are divided equally into two camps. Euthanasia literally means “a good death,” referring to one that is peaceful or painless in most cases. Still, it was also used to describe the cessation of life-preserving technologies for those who are “brain dead” and therefore cannot be consciously aware of pain. Over time, it has come to mean the hastening of any death through medical means and is distinct from medically assisted suicide. The first state in America to allow medically assisted suicide was Oregon, through the Death with Dignity Act, passed in 1994.

This act required that a patient, who was a resident of Oregon with a terminal illness determined to have six months or less to live by two physicians and declared mentally competent by psychological evaluation, could make a voluntary request to end their life through medically assisted means. There could be no evidence of coercion, and the patient had to be educated on all available alternatives, such as hospice care and pain management. However, no doctor, pharmacist, or health care professional could be required to participate if they were personally or professionally opposed to it. Despite having been passed by ballot initiative, a federal lawsuit was filed but was eventually shot down by the 9th Circuit Court of Appeals. However, John Ashcroft, the United States Attorney General during the George W. Bush Administration, still objected.

Following his own deeply held personal beliefs, AG Ashcroft issued a directive stating that any physician who prescribed medications under Oregon’s assisted suicide law could be prosecuted under the Controlled Substances Act, arguing that this was not a “legitimate medical purpose” under federal law and that he and the DEA had authority over such practices. In a 6-3 decision, the U.S. Supreme Court’s majority opinion, penned by Justice Kennedy, stated:

“Physicians are considered to be acting as practitioners under the statute if they dispense controlled substances ‘in the course of professional practice.’ §802(21). The regulation uses the terms ‘legitimate medical purpose’ and ‘the course of professional practice,’ ibid., but this just repeats two statutory phrases and attempts to summarize the others. It gives little or no instruction on a central issue in this case: Who decides whether a particular activity is in ‘the course of professional practice’ or done for a ‘legitimate medical purpose’? Since the regulation gives no indication of how to decide this issue, the Attorney General’s effort to decide it now cannot be considered an interpretation of the regulation. Simply put, the existence of a parroting regulation does not change the fact that the question here is not the meaning of the regulation but the meaning of the statute. An agency does not acquire special authority to interpret its own words when, instead of using its expertise and experience to formulate a regulation, it has elected merely to paraphrase the statutory language.”

This is decidedly true. Our laws are supposed to be clear and easily understood, but this one clearly is not, as was clearly stated by the Supreme Court in Ruan (2022).

No one without a medical education or years of dedicated study to the subject can even begin to have a valid opinion on what is and is not a “legitimate medical purpose” and which practices are “in the course of professional practice.” But that doesn’t stop the DEA from doing so anyway. Throughout history, some of the greatest harm to the causes of freedom and liberty has been done by those convinced that their personal beliefs were righteous and that if we can just get past a difficult period—where those opposed will be put down, and the unworthy dealt with “humanely”—utopia will be at hand. This was always the argument of the most prolific murderers in history. From the communist dictates of Stalin, Mao, and Pol Pot to the ethnic and religious “cleansing” of Germany, Rwanda, and Serbia, these movements have taken millions from us.

One could fairly say that the road to the crematorium is often paved with good intentions. During a recent pandemic, some doctors in the state of Arkansas and elsewhere used a deworming medication, Ivermectin, as a preventative treatment for a virus. Federal authorities like the CDC and many others disagreed with this treatment, feeling that there was insufficient evidence to support its use for this purpose and that there could be significant side effects. The physicians prescribing this medication felt that if they and their patients were well informed of these issues and had decided that the benefits outweighed the risks, they could make their own decisions, free of federal mandates or interference. The governor of the state of Arkansas, Sarah Huckabee, and many others supported these doctors and their patients in this decision. Without agreeing with the doctors’ conclusions, I support their rights.

The rules have been that once a medication is deemed safe by the FDA, physicians, not federal attorneys and agents, are to decide how it is used. But for some reason, those same supporters sit idly by while the greatest ideological purge in our nation’s history continues in the form of the opioid panic. No one can reasonably argue that doctors should be more careful when starting someone on controlled medications, including opiates. The paradigm shift of the early 90s from strict limitation to the aggressive treatment of pain was correcting itself by 2010, and doctors were being more cautious, with prescriptions already dropping over the next several years. At the same time, it was quickly recognized that there were severe dangers to taking someone off of opiate or benzodiazepine therapy once it had been started.

In fact, stopping a benzodiazepine when it has been used with an opiate increases the patient’s mortality by 60 percent over just continuing it and moderating the dose. So, while doctors became much more reluctant to start any controlled medication therapy, those who were current in their continuing medication education were loathe to simply stop in legacy patients, as our knowledge of the effects of this decision equated to a form of euthanasia. I know this is more likely to kill you, but I’m going to do it anyway because the federal authorities have told me to, did not fly well at Nuremberg and should not here. The physicians’ corrections were not good enough for the federal authorities, who, because of faulty CDC analysis, confused illicit fentanyl poisonings with prescription medication–related deaths and decided to teach the medical community a lesson and prove that they could indeed get the job done.

As I write this, over three thousand physicians have been sent to prison, with many, including Arkansas’ own Dr. Hinderliter, dying there. Dr. Hinderliter, in his 80s, was one of the first physicians targeted as the DEA made good on its threat to incarcerate up to five Arkansas physicians if we did not practice according to their opinions. We would not know of this threat if one courageous Arkansas Pain Review Board member did not disclose it during a public hearing. The DEA had come to the state of Arkansas to dictate the practice of medicine, and, while the Supreme Court had made clear that the DEA does not have that authority, the DEA, in its zeal to cover up its abject failure to secure America’s borders, seemed determined to prove to the court and the public that it still had the power to do so. And where are these politicians now? Now that the boots are indeed at the door? Nowhere to be found.

This is often the case when reality meets theory. We all think we would have stood up to Hitler or marched with King, but the truth is, most of us would have kept our heads down. It is always safer for every individual soldier on any battlefield to do so—at least in the short term. But in the long term, it guarantees that we will lose every war. It is impossible to win a single battle by keeping your head down. That is why it is so important, during this self-made crisis of understanding, for doctors and patients to speak out for each other. If physicians had stood together when that first threat was made, if we had quoted 42 U.S.C. 1395’s mandate prohibiting any federal employee from even trying to influence the practice of medicine in this country, we would not be where we are today. But we did not, and here we are. Thousands of doctors in prison, and over a million patients dead.

I do not fault the government for committing the most common mistake in science: confusing correlation with causation. But I do fault them for committing the most common mistake in politics: doubling down when you were clearly wrong. The CDC was wrong about prescription-related medical deaths and now says so to doctors at conferences and even in a book. Greed to Do Good was penned by Dr. Charles LeBaron, a CDC scientist for thirty years, and it clearly documents how the CDC made this grave error. But what it does not do is help any of the still-living physicians and patients who are fighting both against the terrible disease of severe chronic pain and the federal police agencies of its own government, who spend millions of taxpayer dollars trying to entice a physician into making any error that would justify incarceration or find any innocent event they could twist into blame.

For me, this came in the form of the death of one of my patients in a jail cell in Plano, Texas. He had gotten up early and driven himself all the way from south of Texarkana to Dallas to see the doctors at the Texas Back Institute. He had come to me after a decade of opiate treatment by a local physician for severe chronic pain and benzodiazepine treatment for severe back spasms after an industrial accident had crushed his lumbar spine. As if that wasn’t enough to deal with, his PCP had moved out of state just before a sliding steel door had crushed his hand. He came to me straight from the ER. His hand was wrapped in gauze where the door had torn away most of one finger. I treated him like any other patient, talking to him about the difficulties of living with severe chronic pain and how we would deal with this new acute pain that we both hoped would not last long.

We talked about his part-time teaching and his hopes to one day go to medical school, as he had a bachelor’s degree in biology. He told me he was worried about how old he would be when he graduated. I asked him how old he would be in four years if he didn’t go, and we had a good laugh. That is what I remember most about him. Throughout the next two years, as the stump of a finger got infected and had to be amputated further up, and that infection spread into the bone, requiring hand surgery to disarticulate the knuckle, he always smiled through the pain when we spoke. This is what I was thinking of as I sat in a courtroom, watching the video of his arrest for weaving while trying to read a map on the way to the spine specialist, where he was going for preop for the last surgery we hoped he would need.

That surgery would have been a repair of a cervical injury when the traction from the door crushing his hand had pulled on his arm hard enough to disrupt his shoulder joint and injure his neck. My last note on the 1st of August, 2018, says that I would make no medication changes until after the surgery. On that first visit, I had dropped him down from three opiates to two and from two benzodiazepines to one, explaining why and how we would need room for adjustment as he had further surgeries. He had agreed with a smile, despite the agony that must have caused, and over the next two years, I had gotten him down from 330 MDE to 275 and had reduced both his opiates and benzodiazepines in the months before his arrest. But this was not enough for the DEA. And when my patient was arrested for weaving, reading a map while trying to navigate to the cervical specialist’s office from the back institute…

From the moment he was pulled over, it was clear he would be arrested, as the officers searched for an excuse to do so. Finally finding a single non-narcotic antidepressant out of its box, they took him to jail for possessing a “dangerous narcotic.” In jail, they refused to give him any of his medications as, despite an alcohol level of zero, he had still been booked for DWI. If they had checked with a doctor, nurse, or even a medical student, they would have known that abruptly stopping benzodiazepines often causes fatal seizures. But they did not bother to check, and my patient was found unresponsive about six hours after his arrest. The guards didn’t bother calling for help, instead making a throat-slicing gesture according to the internal affairs investigator’s report on a video never made available to the defense. They waited an hour to call for medical assistance, and by then, it was too late. His heart gave out, and he died.

I had my day in court, charged with being responsible for his death and for putting a veteran with spinal fractures and a paraplegic with a metal rod up his spine “at risk” of addiction. I was certified to treat addiction, but that didn’t matter to Dr. DEA. The government always knows best. I was also prosecuted for treating cough in four patients, but it had been dropped to two by the time the trial started. All the patients had been treated before me with the same medication, but two had been treated after. Even the DEA can only stretch false metrics and innuendo so far. MDEs were added for years and divided by patient, but not by month, leaving the press and the public, who don’t seem to like math, the impression that I was an “overprescriber.” If they had made the last division by months seen, the average would have been 36 MDE per patient per month.

This is 72 percent of the state’s warning level and just 40 percent of the CDC’s voluntary warning suggestion. It’s hard to call something “voluntary” when men with large guns order you to do something or else, but still, my practice was reasonable. Or at least reasonable enough to satisfy a CMS investigation and the medical board’s review of my pain treatment (though they were mad about the cough syrup). The government’s expert told the jury that if I was worried about addiction in a patient, then I had to stop the medication. This would preclude me from ever treating any patient, as I worry about addiction in everyone. It also ignores the fact that stopping medication can often kill your patient or hasten their death, and this must always be factored into any prescribing decision. Stopping a medication a patient is already on is not a benign act. It has consequences. Just as it did for my patient in Plano.

Despite the clear risks and proven detrimental effects, the criminalization of medical decision-making has become prevalent everywhere, with state medical boards bowing their heads to the threat of arrest and incarceration by forces immune to oversight or even the law itself. If proof of this assertion is required, the Chairman of the Little Rock Airport Commission was gunned down in his home not long ago when he dared to arm himself and investigate a break-in, shot in the head by federal “police.” The term itself is contradictory, as nowhere does the Constitution give the federal government the authority to police the public. Their obligation is to protect the Constitution, and in this regard, they have failed miserably. Instead of prosecuting the jailers for violating my patient’s rights, they engage in a coverup to protect the jail, framing me for his death.

I was blessed that the jury at least saw through this, with the help of the coroner and medical examiner, finding me not responsible for his death. And I was acquitted for treating the paraplegic, as he eloquently defended me in testimony. The veteran did too, but the government’s witness said that all the VA doctors who treated him before me were wrong, and I should have known it. And of course, the patient who died in police custody was not there to defend me. His sister spoke of his pain and suffering, and perhaps blamed me for that, believing the lies that he had died of an overdose over twenty hours after last taking his medications. And the cough syrup patients, of course. Chronic conditions should be treated every five days, according to the government’s expert, and Black patients shouldn’t be treated with it at all, according to the notes from one Pain Review Board member.

On the 9th of October, I will walk myself into federal prison, and while a few well-meaning folks have suggested an unscheduled vacation, I will not knowingly break the law. I will be there on time as my Marines and Air Force service taught me to be. But when it comes to forcing patients off their medications because of an unlawful and unconstitutional federal mandate, I have a different opinion. I believe that involuntary opiate de-prescribing, as the DEA is mandating, is a form of malignant euthanasia, and the state of Arkansas does not have an assisted suicide law. In fact, it has the opposite. The Arkansas Chronic Intractable Pain Act states that pain management plays an important role in good medical practice and that physicians should recognize the need to make pain relief accessible to all patients with chronic intractable pain, viewing it as a regular part of medical practice.

It goes on to say that a doctor may, based on the evaluation and management of a patient’s individual needs, prescribe dangerous, controlled drugs to relieve a patient’s pain and can continue to treat as long as the pain persists. The doctor can do so in amounts or combinations that might not be appropriate for treating other medical conditions if the benefit of relief outweighs the risk, even if its use may increase the risk of death, as long as the purpose is not to cause or assist in a patient’s death. The AMA recently came out with a clear statement supporting my understanding of these matters, and while, like the CDC’s supportive corrections that came out a few weeks after my trial, it is much too little too late, it is still appreciated. It has always been my intention to improve and prolong the health of my patients, giving them a tolerable quality of life, and no one will force me to do otherwise, even with a gun.

L. Joseph Parker is a research physician.