Court upholds assisted suicides


Charlene Andrews, 68, plaintiff and terminally ill breast cancer patient, second from right, celebrates after speaking at a news conference in Portland, Ore., after the decision of the U.S. Supreme Court was announced on Tuesday.

The Associated Press
Published: Wednesday, January 18, 2006 at 6:01 a.m.
Last Modified: Tuesday, January 17, 2006 at 11:04 p.m.
WASHINGTON - The Supreme Court removed an obstacle on Tuesday to state efforts to authorize physician-assisted suicide, ruling 6-3 that John Ashcroft, the former attorney general, acted without legal authority five years ago when he threw the federal government's weight against the Death With Dignity Act in Oregon.
With the new chief justice, John G. Roberts Jr., in dissent, the decision removed a major obstacle to state initiatives like the one in Oregon, which has the only assisted-suicide law in the country.
Justice Anthony M. Kennedy's majority opinion did not say that Congress could not act to block such laws, only that it had not given the attorney general the "extraordinary authority" that Ashcroft claimed when he threatened Oregon doctors who followed the state law with losing their federal prescription-writing privileges.
While the court's decision was based on standard principles of administrative law, and not on the Constitution, it was clearly influenced by the majority's view that the regulation of medical practice belonged, as a general matter, to the states. Ashcroft acted contrary to "the background principles of our federal system," Kennedy said in his 28-page opinion.
The court was clearly aware that it was venturing into "an earnest and profound debate," as Kennedy noted, quoting from the court's 1997 opinion in an assisted-suicide case.
In that case, Washington v. Glucksberg, the court said that the Constitution did not convey a right to assistance in dying, but that states were free to experiment with the issue. "The dispute before us," Kennedy said, "is in part a product of this political and moral debate."
The decision on Tuesday upheld rulings by two lower federal courts. Ashcroft, while attorney general, appealed to the Supreme Court in November 2004. His successor, Alberto R. Gonzales, embraced his position and pursued the appeal after the justices agreed last February to hear the case.
Roberts did not write a dissenting opinion of his own, instead signing a dissent written by Justice Antonin Scalia. Justice Clarence Thomas also wrote a dissenting opinion, in which he said it was "perplexing to say the least" to find the court interpreting federal drug law narrowly in this instance when only months ago, it had upheld broad federal authority to prevent states from authorizing the use of marijuana for medical purposes.
Oregon voters approved the Death With Dignity Act in 1994 and reaffirmed it in 1997. The law says that doctors who follow specific procedures may prescribe lethal doses of federally regulated medications to help their mentally competent, terminally ill patients end their lives. Through 2004, 325 people had obtained the lethal prescriptions, and 208 had used them.
When the Oregon measure took effect, Ashcroft was a senator from Missouri. Along with other members of Congress, he asked the Clinton administration to take steps to block the law.
Attorney General Janet Reno refused, writing a letter to Congress in June 1998 to say she had no authority to act because there was no evidence that Congress "intended to displace the states as the primary regulators of the medical profession." Ashcroft then co-sponsored a bill to give the government this authority, but it did not pass.
As attorney general, Ashcroft took action and announced in November 2001 that doctors who prescribed lethal doses of drugs for the purpose of assisting a suicide risked losing their federal licenses to prescribe all "controlled substances." Without such a license, known formally as a "registration," doctors would find it difficult to practice medicine, because controlled substances include many prescription pain relievers and other commonly used medications.
Oregon sued to block enforcement of the new rule, joined by a doctor, a pharmacist and several terminally ill patients.
As authority for his action, Ashcroft invoked the Controlled Substances Act, a 1970 law that established the framework for federal drug policy, as well as an implementing regulation issued by the Justice Department the following year. The regulation requires that every prescription for a controlled substance "be issued for a legitimate medical purpose." Assisted suicide is "not a legitimate medical purpose," Ashcroft said in what he called an "interpretive rule."
In his opinion on Tuesday, Gonzales v. Oregon, No. 04-623, Kennedy went out of his way to emphasize, with evident disapproval, the unilateral nature of Ashcroft's action, taken "without consulting Oregon or apparently anyone outside his department."
The attorney general's rule was not entitled to the deference the court usually gave to interpretations of governing statutes by executive branch officials, he said, because Congress had not given the attorney general the authority he was invoking.
"The authority claimed by the attorney general is both beyond his expertise and incongruous with the statutory purposes and design," Kennedy said.
Scalia, in his dissenting opinion, took issue with the argument that Congress could not have intended to delegate medical judgments of this sort to the attorney general. The legitimacy of physician-assisted suicide "ultimately rests, not on 'science' or 'medicine,' but on a naked value judgment," he said, adding, "It no more depends upon a 'quintessentially medical judgment' than does the legitimacy of polygamy or eugenic infanticide."
In any event, Scalia said, Ashcroft's action was "the most reasonable interpretation" of the statute and the regulation because "virtually every relevant source of authoritative meaning confirms that the phrase 'legitimate medical purpose' does not include intentionally assisting suicide."
For those eager for any hint about the new chief justice's predilections, his silent joining of this strongly worded opinion was intriguing. When the case was argued on Oct. 5, his second day on the bench, Roberts was an active participant but did not tip his hand.
In the short months since the argument, the question of how skeptically the Supreme Court will be willing to examine the exercise of power by the executive branch has become considerably more prominent. This issue also seemed to mark a divide between the majority and the dissent.
In his majority opinion, Kennedy said that Ashcroft was claiming the "extraordinary authority" to declare as criminal actions that Congress had not designated as crimes, and that he was seeking "a radical shift of authority from the states to the federal government to define general standards of medical practice in every locality."
But Congress had no such intent in passing the Controlled Substances Act, Kennedy said. "The structure and operation of the CSA presume and rely upon a functioning medical profession regulated under the states' police powers," he said, adding that "Oregon's regime is an example of the state regulation of medical practice that the CSA presupposes."
Justices John Paul Stevens, Sandra Day O'Connor, David H. Souter, Ruth Bader Ginsburg and Stephen G. Breyer signed the majority opinion.
One question now is whether the debate will move from the court to Congress. Peg Sandeen, executive director of the Death With Dignity National Center in Portland, Ore., said her group would move to push legislation or voter initiatives in several states. But Sandeen said the organization was concerned that "a Congress that would intervene in the death of Terri Schiavo" might be galvanized into action by this decision.
Scott McClellan, the White House press secretary, said at his briefing on Tuesday, "We are disappointed at the decision." McClellan added, "The president remains fully committed to building a culture of life, a culture of life that is built on valuing life at all stages."

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