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            In the recent decision of Vacco v. Quill, and Washington State v. Glucksberg, groups of physicians and patients petitioned the United States Supreme Court to determine if New York and Washington statutes prohibiting physician-assisted suicide violated the United States constitution. These doctors and patients asserted that the ban on physician-assisted suicide violated the equal protection and due process clauses of the federal constitution. They argued that most states had recognized a right of physicians to withdraw treatment from patients, and that such withdrawal would eventually lead to the patient's death. However, patients were being denied the right to have doctors assist in their death by prescribing medication to hasten death. This, they claimed, was a denial of these patients' constitutional rights.

            In the New York case, The Second Circuit Court of Appeals had agreed with the patients and determined that terminating life-saving medical treatment is nothing more nor less than assisted suicide. In its decision, however, the Supreme Court of the United States disagreed with the Second Circuit. The Supreme Court stated that the distinction between letting a patient die and making that patient die is important, logical, rational, and well-established and that it comports with fundamental legal principles of causation. The court noted that this distinction has been widely recognized and endorsed by the medical profession, state courts, and the overwhelming majority of state legislatures which have permitted the withdrawal of life-saving treatment but prohibited the prescribing of medication to bring about death. The Supreme Court held that there is a distinction between the withdrawal of treatment and letting a patient die from an underlying illness, versus the prescription of medications to bring about a patient's death. The Court noted that causation has long been an element of concern in American law and legal principles. In discussing the differences in causation and intent, the U.S. Supreme Court stated that when a patient refuses life-sustaining medical treatment, he dies from an underlying fatal disease but if a patient takes lethal medication prescribed by a physician, his death is caused by that medication. The Court went on to state that the same distinction holds true when a doctor provides aggressive palliative care. In some cases the Court stated the pain-killing drugs may hasten a patient's death, but the physician's purpose and intent is only to ease his patient's pain. The Court distinguished this from the situation where a doctor who assists a suicide must necessarily and intentionally bring about the patient’s death by prescribing medication to do so. Therefore, the Court stated that there is a rational distinction between the states allowing the withdrawal of medical treatment that a patient no longer wishes to undergo, as opposed to a patient requesting a physician to prescribe medications to cause the patient's death.

 

  In the Washington State case, the Ninth Circuit Court of Appeals held that the Constitution encompasses a liberty interest in controlling the time and manner of one’s death.” Therefore, the Appeals Court concluded that Washington’s ban on physician assisted suicide was unconstitutional. The Supreme Court disagreed and determined that there is not a constitutionally protected right to commit suicide. The concerns expressed by Washington and other states about allowing patients to commit suicide were found to be both important and legitimate. Therefore, the enactment of statutes prohibiting physician assisted suicide did not violate a patient’s federally protected due process rights.

            This decision by the Supreme Court is not really a surprise to those involved in the legal-medical professions. First of all, the current Court is inclined to allow states to resolve these issues on their own without mandates from the federal government. This ruling is consistent with that philosophy in that it allows states to enact legislation that would prohibit physician assisted suicide by physicians. Secondly, there is a strong sense within the medical profession that physician-assisted suicide should be prohibited. The American Medical Association and a number of other amicus briefs were submitted on behalf of this proposition. Finally, states have long been afforded the authority to regulate professional activities, particularly professions that have a direct and immediate impact upon the citizenry of a state. By having licensure authority over doctors and lawyers and other professions, a state can regulate the manner in which they practice to ensure that it is consistent with the overall goals and objectives of society. The regulation of these practices has for the most part been left to the jurisdiction of the state governments.

            Presumably, these decisions would not prohibit a state from permitting and regulating physician assisted suicide. As Justice Rehnquist stated in the Glucksberg opinion: “Throughout the nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician assisted suicide. Our holding permits this debate to continue, as it should in a democratic society.” Thus the debate will not cease, but is likely to intensify in the arena of state legislatures. For states are now free to enact different approaches to this difficult issue, approaches which will hopefully mirror the values and beliefs of its citizens.


Physician Assisted Suicide

by Attorney Frank E. Reardon

August 1997