In addressing what it called one of "the most intimate and personal choices a person may make in a lifetime," a federal appeals court Wednesday correctly ruled that a mentally competent, terminally ill adult has a constitutional right to seek a doctor's assistance in hastening death.
The decision loosed immediate and passionate reaction in support and opposition. Even for many Americans generally comfortable with this ruling and its practical intent--to permit those suffering terminal illnesses to end their lives--its sweeping nature will cause unease. The reach and ramifications are enormous, generating an explosion of questions on the specifics of what is called assisted suicide.
The 9th Circuit Court has now unequivocally lifted this issue above anguished whispered conversations, acknowledging it as a crisis of modern life that is best decided personally and privately.
The ruling reinstates a 1994 decision by a Seattle federal district judge. She had found that a Washington state law making physician-assisted suicide a felony violated due process and placed an undue burden on people seeking to speed their death with the help of a doctor. The case before her involved three terminally ill patients who have since died.
This week an 11-member panel of the 9th Circuit agreed with her ruling. Writing for the 8-3 majority, Judge Stephen Reinhardt of Los Angeles held that individuals, not the state, have the right "to make the decisions that so profoundly affect their very existence." These decisions, the court held, are intimate and personal, like the decision to have an abortion, and thus deserve constitutional protection. "A competent, terminally ill adult, having lived nearly the full measure of his life, has a strong liberty interest in choosing a dignified and humane death rather than being reduced at the end of his existence to a childlike state of helplessness, diapered, sedated, incompetent," Reinhardt wrote.
The opinion represents the first time in U.S. history that a federal appeals court has addressed the issue of assisted suicide. It applies in nine western states, including California. That means California's ban on assisted suicide, similar to Washington's, is by implication also unconstitutional. Washington officials are considering making an appeal to the U.S. Supreme Court.
Medical advances of recent decades, by achieving ways to prolong life and by challenging long-standing definitions of life and death, have generated new and troublesome issues. The suffering of patients with incurable cancer, Alzheimer's disease and AIDS is undeniable. Many make clear their desire to die rather than continue to suffer with no hope of recovery. Yet, as Judge Reinhardt acknowledged, religious and ethical convictions sharply divide Americans over the morality, let alone the constitutionality, of assisted suicide.
The reasoning of the 9th Circuit invites further division. The majority found precedent in U.S. Supreme Court decisions upholding a woman's right to choose an abortion. The Constitution protects the right of an individual to choose to die, the 9th Circuit said, in the same way the Constitution allows an individual to choose to terminate her pregnancy. Because the abortion rulings are themselves as controversial as any of the 20th century, this connection will no doubt add heat to the debates over both abortion and the right to die.
Wednesday's decision raises a host of concerns for judges and legislators and, most important, for patients and their families. Many fear that the ethical and moral line between assisted suicide and euthanasia--between free choice and coercion--will disappear. Will disparities in income and race determine the quality and nature of medical care for patients in their last weeks even more than these factors do now, influencing decisions about assisted suicide? Similarly, what authority should family members have to speak for a severely incapacitated patient in the absence of a living will?
Thirty-three states have statutes formally prohibiting doctor-assisted suicide. The appellate ruling has opened the door, not closed it, on this difficult national issue.