Ruling on one of the most profound and deeply personal issues of modern times, the Supreme Court ruled Thursday that Americans do not have a constitutional right to a doctor’s help to end their lives.
In a unanimous decision, the justices upheld laws banning physician-assisted suicide in the states of Washington and New York. Despite shifting societal attitudes, the court said, to do otherwise would violate “our philosophical, legal and cultural heritages.”
Nonetheless, the court created what Northwestern University law professor Thomas Merrill described as “some ambiguity” as it left open the question of whether an exception could be made for mentally competent patients who are near death and in great pain.
In a series of concurring opinions, five justices indicated they might find in a future case that there is constitutional protection for a dying patient to control the manner of his death.
“I see no need to reach that question” in the two cases at hand, wrote Justice Sandra Day O’Connor.
The decision, though widely anticipated in one of the court’s most high-profile cases in years, will not end the national debate on physician-assisted suicide. More likely, the issue will move to the states, where legislators are free to decide whether to allow doctors to help patients die.
“Agitators for assisted suicide will still push for legalization,” said Clarke Forsythe, president of Chicago-based Americans United for Life.
Kathryn Tucker, lead attorney for Compassion in Dying, a Seattle-based organization that filed suit against the Washington statute, said the group would continue its efforts on three fronts: state legislative reform, challenges to state constitutions, and perhaps federal court lawsuits as well.
“Nine justices voted to uphold the laws in these two particular cases,” said Tucker.
“Five of them deferred judgment on whether there’s a constitutional right” to physician-assisted suicide under particular circumstances.
Some 35 states, including Illinois, Indiana, Missouri and Wisconsin, ban assisted suicide. Oregon is the only state that explicitly allows it. Oregon’s statute, enacted by referendum, is going back to the voters in November.
In Florida, a case is pending that claims the state’s constitution contains a right to physician-assisted suicide. Such challenges would not be affected by Thursday’s ruling, which applied to the federal Constitution.
In announcing the court’s decision, Chief Justice William Rehnquist cited the states’ “legitimate interest” in protecting life and preventing a slide into “Netherlands-style euthanasia,” an allusion to the fuzzy line in Holland between physician-assisted death and mercy killing.
Earlier this year, the justices heard heart-rending arguments about terminally ill people pleading for the right to end their lives with dignity rather than being forced to endure excruciating pain.
On the other side, equally impassioned voices called for respecting the sanctity of human life and avoiding a slippery moral slope that could lead to mercy killing and cold-blooded murder.
Outside parties joined in 100 “friend of the court” briefs, more than any other case in memory, underscoring the widespread interest in the issue of assisted suicide.
The U.S. Catholic Conference, which was among those who filed briefs in support of the state bans, said Americans should work together “to solve the real problems of terminally ill patients and their families.”
Last November, in a deeply personal letter just days before he died from pancreatic cancer, Chicago Cardinal Joseph Bernardin begged the court to reject assisted suicide.
“I am at the end of my earthly life,” the archbishop wrote. “As one who is dying, I have especially come to appreciate the gift of life.” For the court to accept assisted suicide, he said, would “send a false signal that a less-than-perfect life is not worth living.”
That sentiment was loudly echoed by Not Dead Yet, a Chicago-based group of disabled people who demonstrated in front of the Supreme Court in January and were overjoyed by the news of Thursday’s decision.
The oral argument in the case and the written opinions underscored that the justices know the agony of end-of-life choices from personal experience. Rehnquist’s wife died in 1991 after a long battle with ovarian cancer.
The chief justice, in the majority opinion, noted that, “because of advances in medicine and technology, Americans today are increasingly likely to die in institutions, from chronic illness. . . . Public concern and democratic action are therefore sharply focused on how best to protect dignity and independence at the end of life.”
As a result, he said, many states “now permit `living wills,’ surrogate health-care decision-making, and the withdrawal or refusal of life-sustaining medical treatment.”
But the court drew a sharp line between the right to refuse treatment and the right to request help in dying. Letting people die is permissible; actively hastening death, even at their express request, is not.
In the New York case, Vacco vs. Quill, the challengers argued that such a distinction violates the Constitution’s equal protection clause. Equal protection requires that similarly situated people be treated alike under the law.
Quill’s basic argument was that a mentally competent, terminally ill patient on a respirator is allowed to ask her doctor to pull the plug. If a similar patient, breathing on his own, does not have the right to ask his doctor for a fatal injection, this argument holds, that would be unconstitutional discrimination.
Although the federal appeals court in New York agreed with this logic, the Supreme Court did not. Nor did it accept the argument made in the other case, Washington vs. Glucksberg, that the state law violated the Constitution’s due process clause by abridging the individual’s right to decide how and when to die.
Under that argument, individuals have certain fundamental liberties that the state may not infringe without due process of law. The Supreme Court in the past has said those liberties include the right to use contraceptive devices, to abort an unviable fetus and to reject medical treatment.
On Thursday the court said those liberties do not extend to assisted suicide.
However, Justice John Paul Stevens noted in his concurring opinion that, under certain circumstances, if state bans on assisted suicide were found to “impose an intolerable intrusion on the patient’s freedom,” they could be invalidated.
His view was echoed in the other four concurrences by Justices O’Connor, Stephen Breyer, Ruth Bader Ginsburg and David Souter. O’Connor joined Rehnquist’s majority opinion, as did Justices Antonin Scalia, Anthony Kennedy and Clarence Thomas.
