A right to physician-assisted suicide?Few Supreme Court decisions have the possibility of touching as many lives, directly or indirectly, as the recent rulings finding no constitutional right to physician-assisted suicide Noun 1. physician-assisted suicide - assisted suicide where the assistant is a physician
assisted suicide - suicide of a terminally ill person that involves an assistant who serves to make dying as painless and dignified as possible . Washington v. Glucksberg In Washington v. Glucksberg, 521 U.S. 702, 117 S. Ct. 2258, 138 L. Ed. 2d 772 (1997), the U.S. Supreme Court was asked to review the constitutionality of a Washington state statute prohibiting physician-assisted suicide. (1) and Vacco v. Quill Vacco v. Quill, 521 U.S. 793 (1997), is a landmark decision of the Supreme Court of the United States regarding the right to die. It ruled that a New York ban on physician-assisted suicide was not unconstitutional, and preventing doctors from assisting their patients, even (2) have the effect of upholding laws in 49 states prohibiting aiding another person in committing suicide.
Although the decisions were rendered without a single dissent, they left open the possibility of legal protection for this right both at the state level and in future Supreme Court rulings.
The Court had before it two decisions of U.S. courts of appeals The U.S. Courts of Appeals are intermediate federal appellate courts. Created in 1891 pursuant to Article III of the U.S. Constitution, the courts relieve the U.S. Supreme Court from the burden
of handling all appeals from cases decided by federal trial (district) courts. that had found a constitutional right to physician-assisted suicide. In one case, the Ninth Circuit, in an en banc [Latin, French. In the bench.] Full bench. Refers to a session where the entire membership of the court will participate in the decision rather than the regular quorum. In other countries, it is common for a court to have more members than are decision, had found that terminally ill Terminally Ill
When a person is not expected to live more than 12 months.
Any gifts given out by the afflicted person at this time may be considered as a dispersion of the estate rather than a gift. people have a fundamental liberty interest, protected under the Due Process Clause of the Fourteenth Amendment Fourteenth Amendment, addition to the U.S. Constitution, adopted 1868. The amendment comprises five sections. Section 1
Section 1 of the amendment declares that all persons born or naturalized in the United States are American citizens and citizens , to physician-assisted suicide.(3)
The Ninth Circuit had declared unconstitutional a Washington law that "a person is guilty of promoting a suicide attempt suicide attempt, suicide bid n → intento de suicidio
suicide attempt, suicide bid n → tentative f de suicide
when he knowingly causes or aids another person to attempt suicide."(4) The court had concluded that "the Constitution encompasses a due process liberty interest in controlling the time and manner of one's death--that there is, in short, a constitutionally recognized fright to die.'"(5)
In the other case, just a few weeks after the Ninth Circuit's ruling, the Second Circuit had declared unconstitutional a New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of law that prohibits aiding another in committing suicide.(6) Several physicians and gravely ill patients had challenged the New York statute that "a person is guilty of manslaughter in the second degree when . . . he intentionally causes or aids another person to commit suicide Verb 1. commit suicide - kill oneself; "the terminally ill patient committed suicide"
kill - cause to die; put to death, usually intentionally or knowingly; "This man killed several people when he tried to rob a bank"; "The farmer killed a pig for the holidays" ."(7) The Second Circuit had found that the New York law violated the Equal Protection Clause The Equal Protection Clause, part of the Fourteenth Amendment to the United States Constitution, provides that "no state shall… deny to any person within its jurisdiction the equal protection of the laws. of the Fourteenth Amendment.
The court explained that patients on artificial life support already have the right to physician-assisted suicide. In 1990, in Cruzan v. Director, Missouri Department of Health Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990), was a United States Supreme Court case argued on December 6, 1989 and decided on June 25, 1990. , the Supreme Court had ruled that competent adults have the right to refuse even life-saving medical treatment.(8) The Second Circuit said that in light of this decision, people not receiving artificial life support are discriminated against because they have no right to physician-assisted suicide. The court concluded that this latter group is denied equal protection.
Supreme Court reversal
The Supreme Court reversed both courts of appeals decisions. Chief Justice William Rehnquist Noun 1. William Rehnquist - United States jurist who served as an associate justice on the United States Supreme Court from 1972 until 1986, when he was appointed chief justice (born in 1924)
Rehnquist, William Hubbs Rehnquist wrote for the majority in each case. In Glucksberg, the Court rejected the claim that the Washington law prohibiting assisted suicide assisted suicide: see euthanasia. violated a fundamental right protected under the Due Process Clause.
Rehnquist began by observing that a right is protected as fundamental under the Due Process Clause only when supported by history or tradition. He said that "for over 700 years, the Years, The
the seven decades of Eleanor Pargiter’s life. [Br. Lit.: Benét, 1109]
See : Time Anglo-American common law tradition has punished or otherwise disapproved of both suicide and assisting suicide."(9)
Rehnquist noted that "in almost every state--indeed, in almost every western democracy--it is a crime to assist a suicide."(10) After reviewing the history of laws prohibiting suicide and assistance of suicide, Rehnquist said, "Despite changes in medical technology and notwithstanding an increased emphasis on the importance of end-of-life decision making, we have not retreated from this prohibition [of assisting suicide]."(11)
The Court concluded that "to hold for respondents, we would have to reverse centuries of legal doctrine and practice, and strike down the considered policy choice of almost every state."(12)
Because the Court determined that "the asserted `right' to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause,"(13) the Washington law was to be upheld so long as it met a rational basis test. The Court found that the law reasonably served many legitimate interests.
The Court found, for example, that the state has important interests in preserving life,(14) protecting the integrity and ethics of the medical profession,(15) protecting vulnerable groups,(16) and stopping the path to voluntary and even involuntary euthanasia.(17) Rehnquist said that the experience in the Netherlands indicated that "regulation of the practice may not have prevented abuses in cases involving vulnerable persons, including severely disabled neonates and elderly persons suffering from dementia."(18)
Similarly, in Quill, the Court held that laws prohibiting physician-assisted suicide do not violate the Equal Protection Clause. Rehnquist, again writing for the majority, initially noted that the prohibition neither discriminated against a suspect class, such as against a racial minority, nor violated a fundamental right, since Glucksberg had expressly repudiated that contention.(19) Under equal protection analysis, this means that the law was to be upheld so long as it met a rational basis test.
Moreover, the Court rejected the claim that New York's law discriminated against anyone. The Court noted that New York's law treated everyone equally: All have the right to refuse medical care, and all are prohibited from assisting another in a suicide.(20) The Court disagreed with the Second Circuit's conclusion that those not on artificial life support are discriminated against as compared with those who can receive physician-assisted suicide by demanding the termination of a respirator respirator /res·pi·ra·tor/ (res´pi-ra?ter) ventilator (2).
cuirass respirator see under ventilator. or artificial nutrition or hydration hydration /hy·dra·tion/ (hi-dra´shun) the absorption of or combination with water.
1. The addition of water to a chemical molecule without hydrolysis.
The Court said that this "distinction comports with fundamental legal principles of causation and intent."(21) The Court explained that "when a patient refuses life-sustaining medical treatment, he dies from an underlying fatal disease or pathology; but if a patient ingests lethal medication prescribed by a physician, he is killed by that medication."(22)
The Court also emphasized the importance of intent in laws prohibiting assisted suicide. The justices noted that "in some cases, painkilling drugs may hasten a patient's death, but the physician's purpose and intent is, or may be, only to ease his patient's pain. A doctor who assists a suicide, however, `must, necessarily and indubitably in·du·bi·ta·ble
Too apparent to be doubted; unquestionable.
Adv. 1. , intend primarily that the patient be made dead.'"(23) The Court said that the law traditionally has recognized this distinction in distinguishing between allowing refusal of treatment and prohibiting suicide.
Doors left open
Glucksberg and Quill thus seem to emphatically reject a constitutional right to physician-assisted suicide. Not a single justice in either case voted to declare unconstitutional either state law. Yet, the cases also left open some doors to future legal protection of a right to physician-assisted suicide.
First, states may enact statutes protecting this right. The Court's decisions emphasized the absence of constitutional limits on state laws. In other words Adv. 1. in other words - otherwise stated; "in other words, we are broke"
put differently , the issue of a right to die is left to the political process; largely unconstrained by the Constitution, states may prohibit or allow physician-assisted suicide. For example, in 1994, Oregon enacted, through a ballot initiative, a "Death with Dignity Act," which legalized physician-assisted suicide for competent, terminally ill adults.(24) Other states are sure to consider similar proposals in the future.
Second, five justices, in concurring opinions and opinions concurring in the judgment, left open the possibility that laws prohibiting physician-assisted suicide might be declared unconstitutional in specific cases. Justice Sandra Day O'Connor Sandra Day O'Connor (born March 26 1930) is an American jurist who served as the first female Associate Justice of the Supreme Court of the United States from 1981 to 2006. She was considered a strict constructionist. submitted the identical, short concurring opinion in both decisions.
She said that while there "is no generalized right to `commit suicide,'" the Court need not address the "narrower question whether a mentally competent person who is experiencing great suffering has a constitutionally cognizable The adjective "cognizable" has two distinct (and unrelated) applications within the field of law. A cognizable claim or controversy is one that meets the basic criteria of viability for being tried or adjudicated before a particular tribunal. interest in controlling the circumstances of his or her imminent death."(25)
O'Connor concluded by reiterating that "there is no need to address the question whether suffering patients have a constitutionally cognizable interest in obtaining relief from the suffering that they may experience in the last days of their lives."(26) Justices Stephen Breyer and Ruth Bader Ginsburg Ruth Joan Bader Ginsburg (born March 15 1933, Brooklyn, New York) is an Associate Justice on the U.S. Supreme Court. Having spent 13 years as a federal judge, but not being a career jurist, she is unique as a Supreme Court justice, having spent the majority of her career as an concurred in this opinion.
Also, Justice John Paul Stevens John Paul Stevens (born April 20, 1920) is currently the most senior Associate Justice of the Supreme Court of the United States. He joined the Court in 1975 and is the oldest and longest serving incumbent member of the Court. wrote an opinion concurring in the judgment in both cases that was joined by Justices Breyer, Ginsburg, and David Souter.(27) Stevens said that he wrote "separately to make it clear that there is also room for further debate about the limits that the Constitution places on the power of the states to punish the practice."(28)
Stevens said that although the Court rejected the facial challenges to the New York and Washington laws, that "does not foreclose fore·close
v. fore·closed, fore·clos·ing, fore·clos·es
a. To deprive (a mortgagor) of the right to redeem mortgaged property, as when payments have not been made.
b. that some possibility that some applications of the statute[s] might well be invalid."(29) He explained that in particular cases a person's claim of this right might be strong and the state's interests much less.
Likewise, Breyer wrote an opinion concurring in the judgment, and he was clearer than the other justices in explaining when a constitutional right to physician-assisted suicide might be recognized. He observed that the core of a person's claim would be "avoidance of severe physical pain (connected with death)."(30) He said that the New York and Washington laws were constitutional because they "do not prohibit doctors from providing patients with drugs sufficient to control pain despite the risk that those drugs themselves will kill."(31)
Breyer concluded that "were the legal circumstances different--for example, were state law to prevent the provision of palliative care palliative care (paˑ·lē·ā·tiv kerˑ),
n an approach to health care that is concerned primarily with attending to physical and emotional comfort rather , including the administration of drugs as needed as needed prn. See prn order. to avoid pain at the end of life--then the law's impact upon serious and otherwise unavoidable physical pain (accompanying death) would be more directly at issue."(32)
In other words, five justices left open the possibility of challenging the application of laws prohibiting physician-assisted suicide in particular cases. The strongest challenge might be brought if a state law prevented the provision of pain-relieving medication that likely would hasten a terminally ill patient's death. Similarly, a challenge might succeed if brought by someone whose pain was so severe that it could not be relieved by medication.
Should there be a right to die?
Ultimately, the key question in appraising the Supreme Court's decisions is whether terminally ill, competent adults should have a right to physician-assisted suicide. None of us can answer this question without reference to the experiences of our families and our own fears. O'Connor recognized this in beginning her concurring opinion: "Death will be different for each of us. For many, the last days will be spent in physical pain and perhaps the despair that accompanies physical deterioration and a loss of control of basic bodily and mental functions."(33)
Four years ago, my father was dying of lung cancer lung cancer, cancer that originates in the tissues of the lungs. Lung cancer is the leading cause of cancer death in the United States in both men and women. Like other cancers, lung cancer occurs after repeated insults to the genetic material of the cell. . He either was in great pain or sedated into sleep. When he awoke, he was lucid but obviously suffering enormously. A few days before he died, he asked his doctor for medication to end his life. He was far too weak to get out of his hospital bed, let alone act to end his own life. His doctor brushed aside his request by ignoring it, though my father repeated it several times.
I cannot consider the constitutional issue of a right to physician-assisted suicide without seeing in my mind the searing sear 1
v. seared, sear·ing, sears
1. To char, scorch, or burn the surface of with or as if with a hot instrument. See Synonyms at burn1.
2. image of my father in his hospital bed, gasping for each breath and wanting to end his pain. I cannot imagine any interest the state had in keeping my father alive for three more days.
If liberty means anything, I think it must include a right, for those like my father, to die with dignity.
(1.) No. 96-110, 1997 WL 348094 (June 26, 1997).
(2.) No. 95-1858, 1997 WL 348037 (June 26, 1997).
(3.) Compassion in Dying v. Washington, 79 F.3d 790 (9th Cir.1996) (en banc).
(4.) WASH. REV. CODE [sections] 9A.36.060(1) (1994).
(5.) 79 F.3d 790,816.
(6.) Quill v. Vacco, 80 F.3d 716 (2d Cir.1996).
(7.) N.Y. PENAL LAW [sections] 125.15 (McKinney 1987). Also, New York has a separate statute that makes it a felony when a person "intentionally causes or aids another person to attempt suicide." Section 120.30.
(8.) 497 U.S.261 (1990).
(9.) 1997 WL 348094, at *4.
(11.) Id. at *8.
(12.) Id. at *10.
(13.) Id. at *13.
(15.) Id. at *14.
(16.) Id. at *15.
(18.) Id. at *16.
(19.) 1997 WL 348037, at *3.
(20.) Id. at *4.
(23.) Id. at *5 (citation omitted).
(24.) OR. REV. STAT. [sections] 127.800 (1996). A federal district court declared the law unconstitutional on the ground that it does not provide sufficient safeguards for terminally ill patients. Lee v. Oregon, 891 E Supp.1429 (D. Or.1995), but this decision was vacated by the Ninth Circuit. Lee v. Oregon, 107 F.3d 1382 (9th Cir.1997).
(25.) 1997 WL 355983, at *1.
(26.) Id. at *2.
(27.) Additionally, in Washington v. Glucksberg, Justice Souter wrote a lengthy opinion concurring in the judgment that discussed the proper methodology for analyzing claims involving substantive due process The substantive limitations placed on the content or subject matter of state and federal laws by the Due Process Clauses of the Fifth and Fourteenth Amendments to the U.S. Constitution. .1997 WL 348094, at *25.
(28.) 1997 WL 355983, at *2.
(30.) Id. at *10.
(32.) Id. at *11.
(33.) Id. at *1.
Erwin Chemerinsky is Legion Lex See yacc.
1. (tool) Lex - A lexical analyser generator for Unix and its input language. There is a GNU version called flex and a version written in, and outputting, SML/NJ called ML-lex. Professor of Law and Political Science at the University of Southern California Law School The University of Southern California Law School (Gould School of Law), located in Los Angeles, California, is a graduate school within the University of Southern California. in Los Angeles.