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According to a Washington state statute, “a person is guilty of promoting a suicide when he knowingly causes or aids another person to attempt suicide.” In Compassion in Dying v. State of Washington, a group of physicians, patients, and patient advocates challenged this law under the U.S. Constitution—and prevailed.
The patients, who were all terminally ill, wanted to commit suicide by taking physician-prescribed drugs. In Washington and other U.S. states, committing suicide is not illegal. However, a physician who prescribes drugs to help a patient commit suicide is breaking the law.
The Ninth Circuit Court of Appeals recognized the interest of terminally ill patients in controlling the time and manner of their death. But the Court also recognized Washington state's valid interests, which include preserving life, protecting individuals from undue influence, and preserving the integrity of the medical profession. The Ninth Circuit felt that the interests of the terminally ill patients outweighed those of the state. Although the Court felt regulation was desirable to protect citizens from errors and abuse, it decided this statute went too far. As a result, they found that the challenged section of the Washington law violates the Due Process Clause of the 14th Amendment and is therefore invalid.
The facts of the second case are very similar. In Quill v. Vacca, a group of physicians and patients challenged a New York law which makes it a felony to aid another person to commit suicide. One of the plaintiffs was Dr. Timothy Quill, a physician who was investigated by a grand jury after admitting in the New England Journal of Medicine that he had given barbiturates to a dying cancer patient.
The Second Circuit Court of Appeals heard this case and invalidated the New York law. But its reasoning was quite different from the Ninth Circuit's. Instead of finding a violation of an individual's right to due process, it found a violation of a person's Constitutional right to equal protection under the law. The Court said that New York did not treat all competent, terminally ill persons equally. It noted that terminally ill patients on life support systems could hasten their death with their physicians' help by removing these systems. However, patients who were not on life support systems could not hasten death with their physicians' help. The Court did not find a rational basis for the state to distinguish between these two groups of terminally ill patients. It therefore held that physicians who are willing to do so may prescribe drugs to mentally competent patients who want to end their lives during the final stages of a terminal illness.
Because two federal appellate courts have now struck down state statutes and have applied two different Constitutional rationales for their actions, the question of the whether the states can forbid physician-assisted suicide is likely to find its way to the United States Supreme Court. Interestingly, a primary issue before the Court will be how much discretion a state should be given in establishing the parameters for these decisions. Unlike the Supreme Court of the sixties and seventies, this Court has shown a much greater reluctance to interfere in matters that can be regulated at the state level.
For the last two decades, state and federal courts have recognizd four important state interests in termination of treatment cases. As the 9th Circuit pointed out, these interests are the preservation of life, the prevention of suicide, maintaining the ethical integrity of the medical profession, and the protection of minors. Many courts have determined these interests justify significant regulation of the activities of health care professionals and individuals involved in medical decision making for terminally or incurably ill patients.
Even now, states approach this issue very differently. For example, while Washington and New York want to prohibit physicians from providing life shortening medical treatment, Massachusetts is considering legislation which, under certain circumstances, would allow this type of conduct. The ultimate questions is whether the Supreme Court will allow this variability among the states to continue.
This is a difficult topic for society to confront. In many ways, it strikes at the heart of a society's wish to allow for individual autonomy while striving to maintain a culture that recognizes the sanctity of human life and protects the ethical standards of medical practitioners. It is likely that the debate surrounding this issue will last for some time as Courts, legislators, and medical professionals attempt to define an appropriate approach to these difficult situations.
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