Physician-Assisted Suicide

Vacco v. Quill
Washington v. Glucksberg

On June 26th, the United States Supreme Court handed down decisions in the physician-assisted suicide (PAS) cases.

The Court held that state bans on physician-assisted suicide did not violate either the Equal Protection Clause or the Due Process Clause of the Fourteenth Amendment. The practical implication is that the decision to either ban or legalize physician-assisted suicide is left up to the states. There are several mechanisms by which this can occur: via the state legislatures, voter initiatives or the state courts (for example, a state court could find that a ban on assisted suicide violates it's own constitution.)

Definitions:


I. Vacco v. Quill

Opinion written by Chief Justice Rehnquist

Question: Whether New York's prohibition on assisting suicide violates the Equal Protection Clause of the Fourteenth Amendment.

Holding: By a 9-0 vote, the Supreme Court reversed the decision of the Second Circuit Court of Appeals holding that New York's ban on assisting suicide does not violate the Equal Protection Clause of the Fourteenth Amendment.

Important Issues:

  1. The Withholding or Withdrawal of Life-Sustaining Treatment:

    The Court of Appeals for the Second Circuit had blurred the distinction between the withdrawal of life-sustaining treatment and physician-assisted suicide indicating that "the ending by [the withdrawal of life-support systems] is nothing more nor less than assisted suicide."

    The Supreme Court found the distinction between the withholding or withdrawing of life-sustaining treatment and physician-assisted suicide to be "important", "logical" and "rational." Guided by the legal principals of causation and intent, the Court noted that when treatment is withdrawn the patient dies from the underlying pathology, unlike physician-assisted suicide where the patient is "killed" by the medication. Furthermore, the Court indicated that when a physician withholds or withdraws treatment the intent is to respect the patient's wishes and not to cause the person's death.

    In addition, the Court was very clear that "the Second Circuit erred in reading New York law as creating a 'right to hasten death'; instead, the authorities cited by the Court recognize a right to refuse treatment, and nowhere equate the exercise of this right with suicide."

  2. Cruzan

    The Court also clarified it's holding in Cruzan indicating that the right to refuse medical treatment was grounded not in the right to hasten death but on established rights to bodily integrity and freedom from unwanted touching.

  3. The Double Effect:

    The Supreme Court put its imprimatur on the concept of the double effect, indicating that the use of aggressive pain control medication is not PAS, even if it may hasten death, if the intent was to relieve pain.

Implication:

The decision clearly upheld the distinction between withholding and withdrawing treatment and assisted suicide. This distinction has been crucial for implementation of advance directive legislation and better acceptance on the part of physicians' and facilities of patient's wishes.

II. Washington v. Glucksberg

Opinion written by Chief Justice Rehnquist

Question: Whether the right to commit suicide, which itself includes a right to assistance in doing so, is a liberty interest protected by the Due Process Clause.

Holding: By a 9-0 vote, the Supreme Court reversed the en banc decision of the Ninth Circuit Court of Appeals holding that Washington's prohibition against "causing" or "aiding" a suicide does not offend the Due Process Clause of the Fourteenth Amendment.

Important Issues:

  1. The respondents relied on two cases, Cruzan and Casey, to support their contention that a mentally competent, terminally ill adult has the right to the assistance of a physician, in the form of a prescription of a lethal dose of medication, in order to hasten their death. Cruzan decided whether a severely injured woman in a persistent vegetative state had a right under the United States Constitution to have life-sustaining treatment withdrawn. In Casey, the Court had reaffirmed the essential holding of Roe v. Wade as to a woman's right to an abortion.

    The Court when analyzing the respondents claim looked to whether the purported right was "deeply rooted" in this nation's history, whether the right was implicit in the concept of ordered liberty and whether the purported right was carefully and clearly described.

  2. <FONT +1>Cruzan:

    The respondent's relied on Cruzan characterizing the right to die as one in which dying persons have the right to hasten their deaths by the removal of life-support treatment. As noted above, the Court clearly indicated that Cruzan stood for the principle that a competent person has a constitutionally protected liberty interest to refuse unwanted medical treatment. The decision in that case was based on a long legal tradition protecting the decision to refuse unwanted medical treatment. The Court noted that the right to physician-assisted suicide did not have a long legal tradition, in fact our Nation's history and traditions showed just the opposite.

  3. Casey:

    While Casey involved a woman's right to an abortion, the respondents relied on language from that case to encourage the Court to find a right to physician-assisted suicide. They contended that like the right to abortion, the right to physician-assisted suicide was an intimate and personal choice "central to personal dignity and autonomy." The Court, indicated that not all important, intimate, and personal decisions are protected by the constitution. Only those that are deeply rooted in the Nation's history are so protected.

  4. States' Interests:

    Once the Court determined that the right to physician-assisted suicide was not a liberty interest, they next had to analyze whether Washington's ban on assisted suicide was rationally related to the state's purported interest. The Court discussed several of the state's interests including the preservation of life, the protection of vulnerable populations, protecting the integrity and ethics of the medical profession and the state's fear that permitting PAS would lead down a slippery slope to voluntary and involuntary euthanasia. The Court found that it was not unreasonable for a state to conclude that it would be difficult to contain the right to competent, terminally ill adults.

III. Future Cases:

The Court indicated that these cases do not foreclose the possibility that some future application of a ban on physician-assisted suicide may be unconstitutional. However, any future claim would have to present different facts and a more particularized challenge.

For Example, a possible future claim might involve a patient whose pain can not be controlled or who is not being given adequate pain control or a physician who is actually criminally prosecuted.


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