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  •   Unanimous Decision Points to Tradition of Valuing Life

    Right to Die

    1976
    The New Jersey Supreme Court sides with Karen Ann Quinlan's parents, who wanted their comatose daughter cut off from life-supporting devices. The state Supreme Court ruled that the state has no right to order her respirator continued. The U.S. Supreme Court refuses to intervene, setting no legal precedent.

    1990
    U.S. Supreme Court rules in a case involving Nancy Beth Cruzan that a person has a "right to die" grounded in the Fourteenth Amendment's guarantee of personal liberty. But the court also called attention to living wills by holding that states can require clear and convincing evidence of a patient's previously expressed wish to die.

    1990-present
    Michigan pathologist Jack Kevorkian, known as "Dr. Death," has admitted to assisting in 45 suicides. He has been charged with murder and other crimes but has never been convicted.

    1997
    Supreme Court upholds New York and Washington state laws that criminalize doctor-assisted suicide.

    By Joan Biskupic
    Washington Post Staff Writer
    Friday, June 27, 1997;
    Page A01

    A unanimous Supreme Court ruled yesterday that the Constitution does not guarantee Americans a right to commit suicide with the help of a physician, leaving the issue to state legislatures to decide.

    The court invoked moral and legal arguments in its ruling, acknowledging that the terminally ill can endure great agony but putting more emphasis on the American tradition of condemning suicide and valuing human life.

    The ruling upholds laws in New York and Washington states that make it a crime for doctors to give lethal drugs to dying patients who want to more quickly end their lives.

    The decision overturns a pair of lower court decisions that had found a constitutional right to die with the aid of a doctor.

    Yet while yesterday's ruling makes clear that states have a right to ban assisted suicide, it also left them with the power to legalize the practice. Oregon already has done so, though that law is currently being challenged in court.

    Ruling in the two separate cases, the justices stressed that states have an interest in protecting against potential abuses of society's most vulnerable. They also warned that assisted suicide could undermine the trust of the doctor-patient relationship by blurring the line between healing and harming.

    "The state's assisted suicide ban reflects and reinforces its policy that the lives of terminally ill, disabled, and elderly people must be no less valued than the lives of the young and healthy," Chief Justice William H. Rehnquist wrote as the court took up the question of assisted suicide for the first time.

    But in an important concurring opinion, Justice Sandra Day O'Connor left open the possibility that the Supreme Court could someday find that certain individuals who are particularly suffering could have an individual right to assisted suicide.

    "Every one of us at some point may be affected by our own or a family member's terminal illness," O'Connor wrote. "There is no reason to think the democratic process will not strike the proper balance between the interests of terminally ill, mentally competent individuals who would seek to end their suffering and the state's interest in protecting those who might seek to end life mistakenly or under pressure."

    Yesterday's paired rulings were arguably the most-awaited in a term full of unusually emotional disputes. The subject of assisted suicide has captured the nation's attention – and ambivalences – as advancing medicine has prolonged life but not necessarily made its last days less painful. The issue has divided the medical community, legal scholars and those who have the most at stake – the terminally ill. And it was personified through the exploits of retired Michigan pathologist Jack Kevorkian, who claims he has helped more than 45 people kill themselves.

    Advocates on both sides of the issue predicted a path ahead laden with more controversy and debate.

    "The clarity of these decisions should serve as a benchmark for other courts," said Mark Chopko, general counsel for the U.S. Catholic Conference, one of the organizations that has led the fight against assisted suicide. But he added, "the debate over the legalization of assisted suicide will continue in the political process."

    Faye Girsh, executive director of the national Hemlock Society, said that the 25,000-member organization would continue its decade-old efforts to persuade state legislators to pass "responsible, safeguarded" legislation allowing doctors to help terminally ill patients die.

    The Supreme Court first addressed the question of a right to die in 1990, when it ruled that a person has a constitutionally protected right to refuse unwanted medical treatment. But that ruling involved the rather passive withdrawal of artificial life supports.

    Yesterday's cases posed the more difficult dilemma of whether a physician could actually take an active role in bringing about a patient's death through lethal injection or other means.

    In its decisions, the court rejected an expansion of that right, either through the Constitution's equal protection clause or its liberty guarantee.

    In the New York dispute, the high court overturned a 2nd U.S. Circuit Court of Appeals ruling that found New York violated the 14th Amendment's equal protection guarantee because it treated groups of people differently: It allowed patients who wanted to disconnect artificial life supports to do so, but barred anyone who wanted to take lethal drugs from similarly hastening death.

    Yesterday, the high court rejected that line of reasoning, noting, in Vacco v. Quill that the two practices are significantly different.

    "[W]hen a patient refuses life-sustaining medical treatment, he dies from an underlying fatal disease or pathology," Rehnquist said, "but if a patient ingests lethal medication prescribed by a physician, he is killed by that medication." Rehnquist added that a physician who withdraws life supports may not want the patient to die, rather only want to respect his wishes to avoid futile treatment. A doctor who assists a suicide, by contrast, wants the patient dead.

    In the Washington state case, the 9th U.S. Circuit Court of Appeals found a privacy right to assisted suicide in the Constitution's guarantee of due process, likening it to protection for abortion rights and the "right to die" through the refusal of unwanted medical treatment. Yesterday, the justices unanimously rejected the notion of a fundamental "generalized" right to assisted suicide, such as the one the high court established with the right to die granted in the 1990 case of Cruzan v. Missouri Department of Health. Fundamental rights, like the right to marry and have children, are those that are deeply rooted in the nation's history and tradition.

    To find an assisted-suicide right, Rehnquist wrote in Washington v. Glucksberg, would mean a reversal of centuries of legal doctrine and practice, as well as the invalidation of most states' laws against it. He said the Anglo-American common law has punished or otherwise disapproved of assisting suicide for more than 700 years.

    But five other justices wrote separately on whether an individual might ever have a right to assisted suicide in particular circumstances. O'Connor, who was the fifth and critical vote on Rehnquist's opinion for the court, said it was still open whether "a mentally competent person who is experiencing great suffering has a constitutionally cognizable interest in controlling the circumstances of his or her imminent death."

    Justices Ruth Bader Ginsburg and Stephen G. Breyer, neither of whom signed Rehnquist's opinion but agreed with his ultimate judgment upholding the state bans, joined O'Connor's opinion. Separately, Justices John Paul Stevens and David H. Souter said it was too early to say whether there never could be a right to assisted suicide, given a particular individual's needs and a state's interest. All the justices emphasized the need for legislatures to delve into the issue.

    Harvard law professor Laurence H. Tribe, who represented physicians and dying patients in New York challenging its ban, said he was encouraged that five justices did not foreclose the possibility of an individual right to assisted suicide in some extreme cases.

    "In all 50 states, people are free to seek fuller protection for a right to die with dignity," Tribe said.

    New York Attorney General Dennis C. Vacco focused yesterday on the court's unanimous endorsement of the state's ban. "This ruling will protect Americans from a regime that says it's cheaper to kill patients than to treat them."

    In his argument before the court in January, Vacco referred to studies conducted in the Netherlands, the only Western nation allowing limited assisted suicide, pointing up conclusions that some patients are killed without their consent. Physicians in the Netherlands may assist suicides but euthanasia remains illegal. On another foreign front, Australian lawmakers earlier this year struck down the only law in the world more broadly allowing doctor-assisted suicide for the terminally ill.

    The result of yesterday's paired decisions was to leave it to the states to work out their own legislation, and as such the court resisted the path it took in its landmark abortion ruling in 1973. As states were developing regulations on abortion in the 1970s, the court usurped their actions by finding a fundamental constitutional right to end a pregnancy. In yesterday's cases, the justices stressed their deference to the democratic process on assisted suicide.

    © Copyright 1997 The Washington Post Company

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