Washington v. Glucksberg
FOURTH AMENDMENT PROTECTION
In January 1994 four Washington State doctors, three terminally ill patients, and the organization Compassion in Dying filed a suit in the U.S. District Court. The plaintiffs sought to have the Washington Revised Code 9A.36.060(1) (1994) declared unconstitutional. This Washington law states: "A person is guilty of promoting a suicide attempt when he knowingly causes or aids another person to attempt suicide."
According to the plaintiffs, mentally competent terminally ill adults have the right, under the Equal Protection Clause of the Fourteenth Amendment, to a physician's assistance in determining the time and manner of their death. In Compassion in Dying v. Washington (850 F. Supp. 1454, 1459, [WD Wash. 1994]), the U.S. District Court agreed, stating that the Washington Revised Code violated the Equal Protection Clause's provision that "all persons similarly situated … be treated alike."
In its decision the District Court relied on Planned Parenthood of Southeastern Pennsylvania v. Casey (a reaffirmation of Roe v. Wade's holding of the right to abortion, 505 US 833, 1992) and Cruzan v. Director, Missouri Department of Health (the right to refuse unwanted life-sustaining treatment, 497 US 261, 1990). The court found Washington's statute against assisted suicide unconstitutional because the law "places an undue burden on the exercise of [that] constitutionally protected liberty interest."
In 1995 a panel (three or more judges but not the full court) of the Court of Appeals for the Ninth Circuit Court reversed the District Court's decision, stressing that in the 205 years of United States history, no court had ever recognized the right to assisted suicide (Compassion in Dying v. Washington, 49 F. 3d 586, 591, 1995). In 1996 the Ninth Circuit Court reheard the case en banc (by the full court), reversed the panel's decision, and affirmed the U.S. District Court's ruling (Compassion in Dying v. Washington, 79 F. 3d 790, 798, 1996).
The en banc Court of Appeals for the Ninth Circuit Court did not mention the Equal Protection Clause violation as indicated by the District Court; however, it referred to Casey and Cruzan, adding that the U.S. Constitution recognizes the right to die. Quoting from Casey, Judge Stephen Reinhardt wrote:
Like the decision of whether or not to have an abortion, the decision how and when to die is one of "the most intimate and personal choices a person may make in a lifetime,… central to personal dignity and autonomy."
THE U.S. SUPREME COURT DECIDES
The state of Washington and its attorney general appealed to the U.S. Supreme Court (Washington et al v. Harold Glucksberg et al, 117 S.Ct 2258, 1997). U.S. Supreme Court Chief Justice William Rehnquist, instead of addressing the plaintiffs' initial question of whether mentally competent terminally ill adults have the right to physician-assisted suicide, reframed the issue, focusing on "whether Washington's prohibition against 'caus[ing]' or 'aid[ing]' a suicide offends the Fourteenth Amendment to the United States Constitution."
Chief Justice Rehnquist recalled the more than seven hundred years of Anglo-American common-law tradition disapproving of suicide and assisted suicide. He added that assisted suicide is considered a crime in almost every state, with no exceptions granted to mentally competent terminally ill adults.
PRIOR SUBSTANTIVE DUE-PROCESS CASES
The plaintiffs argued that in prior substantive due-process cases, such as Cruzan, the U.S. Supreme Court had acknowledged the principle of self-autonomy by ruling "that competent dying persons have the right to direct the removal of life-sustaining medical treatment and thus hasten death." Chief Justice Rehnquist claimed that, although committing suicide with another's help is just as personal as refusing life-sustaining treatment, it is not similar to refusing unwanted medical treatment. In fact, according to the chief justice, in Cruzan, the court specifically stressed that most states ban assisted suicide.
STATE'S INTEREST
The U.S. Supreme Court pointed out that Washington's interest in preserving human life includes the entire spectrum of that life, from birth to death, regardless of a person's physical or mental condition. The court agreed with the state that allowing assisted suicide might imperil the lives of vulnerable populations such as the poor, the elderly, and the disabled. The state included the terminally ill in this group.
The U.S. Supreme Court justices agreed with the state of Washington that legalizing physician-assisted suicide would eventually lead to voluntary and involuntary euthanasia. Because a health care proxy's decision is legally accepted as an incompetent patient's decision, what if the patient cannot self-administer the lethal medication? In such a case a physician or a family member would have to administer the drug, thus committing euthanasia.
The U.S. Supreme Court unanimously ruled that:
[The Washington Revised] Code … does not violate the Fourteenth Amendment, either on its face (in all or most cases in which it might be applied) or "as applied to competent terminally ill adults who wish to hasten their deaths by obtaining medication prescribed by their doctors." Our holding permits this debate to continue, as it should in a democratic society. The decision of the en banc Court of Appeals is reversed, and the case is remanded [sent back] for further proceedings consistent with this opinion.
PROVISION OF PALLIATIVE CARE
U.S. Supreme Court Justices Sandra Day O'Connor and Stephen Breyer, concurring, wrote that "terminally ill patients in New York and Washington … can obtain palliative care (care that relieves pain but does not cure the illness), even potentially lethal doses of drugs that are foreseen to result in death." Hence, the justices did not see the need to address a dying person's constitutional right to obtain relief from pain. Justice O'Connor believed the court was justified in banning assisted suicide for two reasons: "The difficulty of defining terminal illness and the risk that a dying patient's request for assistance in ending his or her life might not be truly voluntary."
Vacco v. Quill
REFUSING LIFE-SUSTAINING TREATMENT ESSENTIALLY THE SAME AS ASSISTED SUICIDE
In 1994 three New York physicians and three terminally ill patients sued the state attorney general. They claimed, before the U.S. District Court, that New York violated the Equal Protection Clause by prohibiting physician-assisted suicide. The state permits a competent patient to refuse life-sustaining treatment, but not to obtain physician-assisted suicide. These, claimed the plaintiffs, are "essentially the same thing" (Quill v. Koppell, 870 F. Supp. 78, 84-85 [SDNY 1994]). The court disagreed, stating that withdrawing life support to let nature run its course differs from intentionally using lethal drugs to cause death.
The plaintiffs brought their case to the Court of Appeals for the Second Circuit (appellate court), which reversed the District Court's ruling (Quill v. Vacco, 80 F. 3d 716, 1996). The appellate court found that the New York statute does not treat equally all competent terminally ill patients wishing to hasten their deaths. The court stated:
The ending of life by [the withdrawal of life-support systems] is nothing more or less than assisted suicide…. To the extent that [New York's statutes] prohibit a physician from prescribing medications to be self-administered by a mentally competent, terminally ill person in the final stages of his terminal illness, they are not rationally related to any legitimate state interest.
REFUSING LIFE-SUSTAINING TREATMENT DIFFERS FROM ASSISTED SUICIDE
New York's attorney general appealed the case to the U.S. Supreme Court (Dennis C. Vacco, Attorney General of New York et al v. Timothy E. Quill et al, 117 S.Ct 2293, 1997). The Supreme Court distinguished between withdrawing life-sustaining medical treatment and assisted suicide. The court contended that when a patient refuses life support, he or she dies because the disease has run its natural course. On the other hand, if a patient self-administers lethal drugs, death results from that medication.
The court also distinguished between the physician's role in both scenarios. A physician who complies with a patient's request to withdraw life support does so to honor a patient's wish because the treatment no longer benefits the patient. Likewise, when a physician prescribes pain-killing drugs, the needed drug dosage might hasten death, although the physician's only intent is to ease pain. However, when a physician assists in suicide, his or her prime intention is to hasten death. The U.S. Supreme Court, therefore, reversed the ruling made by the Court of Appeals for the Second Circuit.
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