Supreme Court Upholds Oregon Right-to-Die Law

The Supreme Court rejected the Bush administration’s challenge to the nation’s only right-to-die law Tuesday, ruling that then-Atty. Gen. John Ashcroft had overstepped his authority when he sought to punish Oregon doctors who helped terminally ill patients end their lives.

The 6-3 decision was a victory for states and their independent-minded voters, and a defeat for social conservatives.

The case also showed Chief Justice John G. Roberts Jr. in the camp of the court’s most conservative members in his first significant decision. Roberts, Antonin Scalia and Clarence Thomas were the dissenters.

The high court majority said states -- not federal authorities -- long had had the power to regulate the practice of medicine and the licensing of doctors. They said Ashcroft was claiming an “extraordinary authority” to impose his view on what was proper medical care for those who were near death.

The decision clears the way for other states, notably California, to consider adopting similar measures.

“This is a watershed decision [that] reaffirms the liberty, dignity and privacy Americans cherish at the end of life,” said Barbara Coombs Lee, president of Compassion in Dying Federation, which sponsored the Oregon law.

But the ruling leaves open the possibility that the Republican-controlled Congress could amend federal drug control laws and forbid physicians from prescribing lethal medications. Congress also could pass laws explicitly banning doctor-assisted suicide, as it tried to do in 1999.

Then, the House easily approved such a bill. It died in the Senate after Sen. Ron Wyden (D-Ore.) threatened a filibuster. With Congress more conservative today, odds of passage have probably improved.

Sen. Tom Coburn (R-Okla.), a physician, said Tuesday that the court’s decision was troubling and that it created “another class of human beings whose lives have no value.... Nowhere does our Constitution give doctors the right to take the lives of their patients.”

Wyden praised the ruling but said it was not a final victory.

“The court’s decision has stopped, for now, the administration’s attempts to wrest control of decisions rightfully left to the states and individuals,” he said. “I will fight tooth and nail any congressional attempt to overturn this court ruling.”

White House spokesman Scott McClellan said President Bush was disappointed by the decision. “The president remains fully committed to building a culture of life -- a culture of life that is built on valuing life at all stages,” he said.

Last year, Bush and the Republican-led Congress moved quickly to intervene in a Florida case when state courts ordered a feeding tube removed from Terri Schiavo, a woman who had suffered irreversible brain damage years before.

The Supreme Court refused to take up the Schiavo case, and polls showed widespread disapproval of Washington’s intervention.

Suicide has long been against the law, as has aiding another’s suicide.

In 1994, however, Oregon voters approved the Death With Dignity Act, which authorized doctors to prescribe a lethal dose of medication to dying people who requested it. Two doctors must confirm the patient is an Oregon resident with a terminal illness and no more than six months to live. The doctors must also confirm the patient is of sound mind.

Through 2004, about 200 people used medication to end their lives since the law took effect in late 1997.

The Supreme Court appeared to endorse a state’s right to take such a step in 1997. Although the Constitution does not give individuals a right to die, states are free to decide for themselves whether to permit physician-assisted suicide, the court said unanimously in a case from Washington state.

But some social conservatives, including then-Sen. Ashcroft (R-Mo.) and Rep. Henry J. Hyde (R-Ill.), strongly opposed doctors giving patients medicine that would end their lives. They urged the Clinton administration’s attorney general at the time, Janet Reno, to take action against Oregon and its doctors.

Reno refused, saying she did not have the authority to “displace the states as the primary regulators of the medical profession.”

Shortly after taking office as attorney general in 2001, Ashcroft reversed Reno’s decision and declared that a doctor’s prescription of legal drugs to bring a life to an end did not serve a “legitimate medical purpose.”

Citing a federal law against drug trafficking, the attorney general said Oregon doctors who persisted would lose their rights to prescribe medication.

But Ashcroft’s order ran into a legal challenge from the start.

Oregon state officials and several doctors went to court to block it, and they won at every stage. A federal judge in Oregon, the U.S. 9th Circuit Court of Appeals in San Francisco and now the Supreme Court ruled that Ashcroft had exceeded his authority.

Writing for the court Tuesday, Justice Anthony M. Kennedy said Ashcroft had claimed a power that Congress had not given him. The federal drug control act of 1970 gave the attorney general the power to combat “drug dealing and trafficking as conventionally understood,” not the power to tell doctors how they could use legal medications, Kennedy said.

Ashcroft stepped down last year after Bush’s reelection, but the administration appealed his case to the Supreme Court and defended his position.

Kennedy said the administration’s position, if upheld, would “delegate to a single executive officer the power to effect a radical shift of authority from the states to the federal government to define general standards of medical practice in every locality.” When Congress passed the drug trafficking laws, it “did not have this far-reaching intent to alter the federal-state balance,” he concluded in Gonzales vs. Oregon.

Kennedy’s opinion underscores the likelihood that, with the imminent departure of Justice Sandra Day O’Connor, he will probably play an even greater role in the court’s decisions. Like O’Connor, he is often in the ideological middle, between the court’s liberal and conservative blocs on the most contentious issues.

Justices John Paul Stevens, David H. Souter, Ruth Bader Ginsburg, Stephen G. Breyer and O’Connor joined Kennedy’s opinion in the Oregon case.

Scalia said the court should have deferred to Ashcroft’s decision.

“It is perfectly consistent with an intelligent ‘design of the statute’ to give the nation’s chief law enforcement official, not its chief health official, broad discretion over” those who prescribe medication, Scalia wrote. “That is especially true where the contested ‘scientific and medical’ judgment at issue has to do with the legitimacy of physician-assisted suicide, which ultimately rests, not on ‘science’ or ‘medicine’, but on a naked value judgment.”

He said physician-assisted suicide had been condemned by law and by most medical societies. “If the term ‘legitimate medical purpose’ has any meaning, it surely excludes the prescription of drugs to produce death,” Scalia said.

Roberts did not write a separate dissent.

The right-to-die movement gained national attention in the 1990s from the activities of retired Michigan pathologist Jack Kevorkian, a longtime advocate of assisted suicide who helped 130 seriously ill people end their lives.

Michigan’s voters defeated a ballot proposal in 1998 to legalize physician-assisted suicide, and a Michigan jury convicted Kevorkian of second-degree murder in the 1998 death of a victim of Lou Gehrig’s disease. Now 77, Kevorkian is serving a prison term of 10 to 25 years.

California voters have faced the issue before. In 1992, the state would have been the first in the nation to permit doctors to help dying patients end their lives, but 54% of California’s voters rejected Proposition 161. Opponents said the measure could have opened the way for doctors to take the lives of dying patients.

To counter such charges, the leaders of Oregon’s right-to-die movement were determined to put in strict controls to limit the law’s effect and to make sure that decisions would remain in the hands of patients.

Doctors in Oregon say many dying patients request a prescription of lethal medication, fearing the pain and agony of a slow death. But many find they can manage the pain and do not take the lethal drugs, choosing to die naturally.

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(BEGIN TEXT OF INFOBOX)

Death by prescription

Oregon voters passed the Death With Dignity Act in 1994. In effect since late 1997, it allows terminally ill people to get a doctor’s prescription to end their lives.

Provisions of the Oregon law

A person seeking a prescription must be:

* An Oregon resident

* At least 18 years old

* Capable of making and communicating healthcare decisions for oneself

* Diagnosed with no more than six months to live

To get the prescription, a person must give a doctor:

* A written request signed by two witnesses

* Two oral requests separated by 15 days

Before a prescription is issued, two physicians must:

* Confirm the diagnosis

* Determine that the person is capable

* Inform the person of alternatives, including pain control

* Ask, but not require, that the person tell family members

Terminally ill people must take the drugs themselves and doctors must notify the state.

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Source: Oregon Department of Human Services. Graphics reporting by Nancy Vogel