Justices’ Ruling Won’t End the Assisted-Suicide Issue

The men and women most affected by the long-awaited U.S. Supreme Court decision on assisted suicide no doubt spent Thursday doing what they’ve been doing--struggling to get through another day.

In upholding two state laws barring physician-assisted suicide, the high court’s unanimous decision is layered with constitutional principle and the language of the Bill of Rights: equal protection, due process, fundamental liberties. The language of those with end-stage cancer, advanced multiple sclerosis and other life-robbing diseases reflects more mundane concerns: the loss of dignity and the increase of helplessness, pain, despair.

The Supreme Court refused to create a new constitutional right to assistance in dying. But in validating the Washington and New York state laws, the court has neither ended efforts to legalize the practice nor altered the real-life dilemmas faced by patients and their families and physicians.

The justices’ decision was not unexpected. Lawyers representing the doctors, patients and assisted-suicide advocacy groups that sought to overturn the state bans were peppered with sharp and skeptical questions when the case was argued in January.

In its decision Thursday, the court reversed precedent-setting decisions by two federal appellate courts that struck down the state laws. Chief Justice William H. Rehnquist, in his opinion for the court, turned aside arguments that individuals incapacitated by illness and unable to take their own life have a constitutional right to the assistance of a physician in doing so. “The history of the law’s treatment of assisted suicide in this country,” he wrote, “has been and continues to be one of the rejection of nearly all efforts to permit it. That being the case, ... the asserted ‘right’ to assistance in committing suicide is not a fundamental liberty interest. . . .”

Rehnquist and his colleagues, in separate concurring opinions, tried to distinguish between assisting in suicide and letting death occur. Justice Stephen G. Breyer emphasized that both state laws “do not prohibit doctors from providing patients with drugs sufficient to control pain despite the risk that these drugs themselves will kill.”

Despite its seemingly easy unanimity, the court acknowledged the obvious: that the “earnest and profound debate” over the “morality, legality and practicality” of the practice will continue. Oregon may be the next legal testing ground; the state Legislature has put on this fall’s ballot a referendum approving assisted suicide. Voters passed the same measure in 1994 but local courts blocked its implementation pending an appeal to the U.S. Supreme Court. Lawmakers scheduled the re-vote, some believe, in hopes voters will turn it down this time and make the issue moot.

Courts and legislatures may never be able to provide meaningful guidance on wrenching and intensely personal end-of-life questions. Medical technology, which has permitted longer life, has also caused many to die protracted, painful deaths preceded by debilitation and indignity. That anguish confounds the justices no less than it does physicians who care for the dying and family members who witness the suffering. It is not a subject for clean constitutional resolution.