In a decision laden with issues no less weighty than Life and Death, the U.S. Supreme Court ruled unanimously today that terminally ill people have no constitutional right to doctor-assisted suicide. The decision has already galvanized consumers on both sides of the issue of whether doctors should be free to prescribe lethal doses of drugs to terminally ill patients who request them to end their lives. Those opposed to doctor-assisted suicide have argued that death is a wrong, not a right–and that pain control is the key to easing the final suffering at the end of life. They decry assisted suicide as an easy out for greedy relatives or state officials anxious to do away with patients when their care becomes too costly or too inconvenient. Proponents of assisted suicide contend it is the ultimate form of self-help–the only hope for those destined to live in pain or carry on in a drug-numbed state in which life itself seems meaningless. They say that the decision to die is their own, not their doctors. And they downplay the fears of the wealthy opponents in the medical and religious communities who paint horror pictures of “physicians with needles chasing Grandma.” Most people, they say, invoke death only as the ultimate last resort. The Courts Below Two lower court decisions were joined in today’s Supreme Court case. One of them, Washington v. Glucksberg, was brought by three patients in the final ravages of AIDS, cancer and heart disease, four doctors who treat terminally ill patients and a nonprofit group that counsels them. They challenged the Washington law that makes it a felony for one person to aid another in a suicide attempt. The U.S. Court of Appeals for the Ninth Circuit held last March that individuals have a privacy interest, protected by the Due Process Clause of the Constitution, in choosing how and when to die, similar to a woman’s interest in choosing whether to have an abortion. Less than a month later the Second Circuit Court, across the country in New York, decided a similar case, setting the stage for Vacco v. Quill. That court reached a similar conclusion: that doctors may prescribe drugs to be self-administered by mentally competent patients who seek to end their lives during the final stages of a terminal illness. The court noted that New York law clearly allows terminally ill patients on life support systems to hasten their deaths by directing that the systems be removed. It held that by denying terminally ill patients who are not connected to life support the option of ending their lives, the law made an illegal distinction. Today’s U.S. Supreme Court decision overturned both circuit courts. Roots of the Right to Die Movement A closely related issue, the right to refuse medical treatment, has already been firmly recognized. In 1990, the U.S. Supreme Court decided the pivotal case of Nancy Cruzan, 30, who was permanently brain damaged and in a coma after being injured in a car accident. Her parents unsuccessfully pled with hospital officials to discontinue Cruzan’s artificially administered food and water so that she could be allowed to die. In an opinion penned by
Chief Justice Rehnquist, the Court ruled that everyone has a constitutional right to control his or her own medical care. In a poignant twist, Rehnquist’s wife, who was suffering from ovarian cancer, died the next year. In today’s decision, Rehnquist opined that there is a difference between a doctor’s duty to respect a patient’s right to refuse treatment for a terminal disease and in assisting a patient with suicide. Ponderings, Public and Private Whether assisted suicide is right or wrong has as much to do with personal ideals as it does with the law. But as more doctors and family members hear the pleas of patients kept technologically alive through long illnesses, many have softened their stances against assisted suicide. A 1994 Harris poll found that 73% of Americans favor physician-assisted suicide. And many doctors acknowledge, sotto voce, that they have helped seriously ill patients end their own lives, often by writing large prescriptions for Seconal or other drugs. According to a recent confidential survey by the American Society of Internal Medicine, one doctor in five admitted to helping in a patient’s suicide. In a 1995 study of San Francisco doctors specializing in treating AIDS patients, more than half acknowledged helping at least one patient die. One in four of the Washington doctors surveyed last year said they received requests for help in dying–and many admitted they responded by prescribing lethal drugs. So while many doctors freely help their patients to die behind closed doors, most are loathe to get caught in the act. So the public controversy has centered on one brazen advocate, Jack Kevorkian, a doctor practicing in Michigan. Seven years ago, Kevorkian took part in the first of a series of physician-assisted suicides and has since been accused of helping at least 50 others to die. Kevorkian has appeared in court on homicide charges clad in various costumes, and currently awaits trials on a number of them. Before helping individuals die through a combination of lethal injection and gas, he blatantly videotapes their final pleas for death over life. Kevorkian’s showmanship and fastidious records have made him the butt of opponents and darling of supporters–all of whom dub him “Dr. Death.” Kevorkian was not directly involved in today’s cases. But when asked if the decision would put a damper on Dr. Death’s campaign to make assisted suicide accessible, his attorney, Geoffrey Fieger said: ” Not Doctor Kevorkian. Hell, no.” The End Is Not Near Indeed, today’s Supreme Court decision will not end the controversy, as it leaves states free to the uneasy task of fashioning their own guidelines. Many states are already enmeshed in the fray. Oregon led the way with its Death With Dignity initiative–an on again, off again referendum allowing doctor-assisted suicide. It was later challenged in court and will be sent back to the state’s voters in November. Nearly half the state legislatures this year considered bills dealing with pain treatment for dying patients. Texas and Minnesota enacted laws allowing doctors to prescribe controlled substances for terminally ill patients.