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the U.S. Supreme Court in two cases decided in 1997. These were brought by
patients and physicians contesting state laws in Washington state [Washington v.
Glucksberg, 521 U.S. 702 (1997).] and in New York [Vacco v. Quill, 521 U.S. 793,
117 S.Ct. 2293 (1997).] that banned physician participation in assisted suicide. It is
important legally that the cases were about the right of a physician to participate in
assisted suicide, not about the general right of assisted suicide. Although it is clear
from the Court’s ruling that a state could ban assisted suicide in general, the court did
not need to reach this issue because the states have very broad authority under the
police powers to regulate medical practice. There are many things that the state can
prevent physicians from doing as a condition of licensure that it might not be able to
do as a general rule for all citizens.
The Court found that there was no constitutional right to have a physician assist in a
suicide, so that the states were free to prohibit physicians from participating in
suicides. The Court found that converse was also true: there was nothing to prevent
the states from allowing both assisted suicide and physician participation in assisted
suicide, so long as Congress does not preempt their authority by passing a law
banning physician- assisted suicide nationally.
3. Right to Pain Relief
The most persuasive evidence before the court was the scientific studies indicating
that much of the demand for assisted suicide is driven by patients with inadequate
pain relief and depression, with the depression complicated by the pain. These
studies indicated that most patients with adequate pain relief and psychological
treatment do not demand suicide. Advocates of assisted suicide countered that such
levels of pain medication often shortened the patient’s life and were, in themselves, a
form of assisted suicide. Thus, if the Court banned assisted suicide, it must also ban
dosages of pain medication that would shorten the patient’s life. The Court rejected
this argument, finding that the distinction between assisting suicide and providing
care that might, as a side-effect, shorten life, was well established legally:
The distinction comports with fundamental legal principles of causation and
intent. First, when a patient refuses life- sustaining medical treatment, he dies
from an underlying fatal disease or pathology; but if a patient ingests lethal
medication prescribed by a physician, he is killed by that medication. See,
e.g., People v. Kevorkian, 447 Mich. 436, 470- 472, 527 N.W.2d 714, 728
(1994), cert. denied, 514 U.S. 1083, 115 S.Ct. 1795, 131 L.Ed.2d 723 (1995);
Matter of Conroy, 98 N.J. 321, 355, 486 A.2d 1209, 1226 (1985) (when
feeding tube is removed, death “result[s]... from [the patient’s] underlying
medical condition”); In re Colyer, 99 Wash.2d 114, 123, 660 P.2d 738, 743
(1983) (“[D]eath which occurs after the removal of life sustaining systems is
from natural causes”); American Medical Association, Council on Ethical
and Judicial Affairs, Physician- Assisted Suicide, 10 Issues in Law &
Medicine 91, 92 (1994) (“When a life-sustaining treatment is declined, the
patient dies primarily because of an underlying disease”).
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