High court allows physician-assisted suicide

Physician-assisted suicide is legal in Oregon.

So declared the US Supreme Court on Tuesday in deciding that Oregon's Death With Dignity Act is not barred by the Bush administration's interpretation of federal drug laws.

The 6-to-3 ruling allows Oregon residents who are mentally competent and diagnosed as terminally ill to continue to have the option of asking a physician to prescribe a lethal dose of drugs. More than 200 Oregon residents have relied on the law to end their lives since 1997, when the measure took effect.

The high court ruling also opens the door for other states considering enacting similar assisted death laws, setting the stage for bitter fights ahead.

"We are very confident that a number of states throughout the country will now move forward in attempts to replicate Oregon's very specific law," says Robert Kenneth, spokesman for the Death With Dignity National Center. Both Vermont and California have bills pending in their legislatures, and Washington State is considering drafting a similar law.

Opponents of assisted-suicide say the high court ruling is unlikely to trigger a rush to adopt similar laws in other states.

"The movement has been moribund. They had been unable to move the agenda forward throughout the country like they thought they would, after Oregon legalized assisted suicide in 1994," says Wesley Smith of the International Task Force on Euthanasia and Assisted Suicide.

A Pew Research Center survey conducted last November showed the public almost evenly divided on physician-assisted suicide, with 46 percent in favor of laws permitting it and 45 percent opposed. [Editor's note: The original version described the wrong findings from the Pew Research Center survey.]

In reaching its determination, the high court said former Attorney General John Ashcroft overstepped his authority in November 2001 when he rewrote regulations under the federal Controlled Substances Act (CSA) making it illegal for Oregon doctors to prescribe drugs to help a patient die.

"The authority claimed by the attorney general is both beyond his expertise and incongruous with the statutory purposes and design," wrote Justice Anthony Kennedy for the majority. "The idea that Congress gave the attorney general such broad and unusual authority through an implicit delegation in the [Controlled Substances Act's] registration provision is not sustainable."

Mr. Ashcroft said that federally controlled drugs could be prescribed only for a "legitimate medical purpose," and that helping someone to end his or her life was contrary to the healing mission of physicians.

Justice Antonin Scalia said in a dissent that Ashcroft's directive should be accorded deference by the courts and allowed to stand. He added that he found reasonable the former attorney general's conclusion that helping someone die was not a "legitimate medical purpose."

"Virtually every medical authority from Hippocrates to the current American Medical Association confirms that assisting suicide ... is not a 'legitimate' branch of that science and art," Justice Scalia wrote. "If the term 'legitimate medical purpose' has any meaning, it surely excludes the prescription of drugs to produce death."

Scalia was joined in his dissent by Chief Justice John Roberts and Justice Clarence Thomas.

In rejecting the so-called Ashcroft directive, the majority justices said the CSA is aimed at policing drug abuse, addiction, and narcotics trafficking rather than providing an avenue for federal micromanagement of state efforts to regulate healthcare and end-of-life issues.

Congress intended to leave it to the states to define what is a legitimate medical purpose, the majority said. That reading of the federal drug laws is consistent with the broader constitutional structure of the government as an organization of dual sovereigns with both federal and state spheres of power, Justice Kennedy said.

The government's position in defending the Ashcroft directive would "effect a radical shift of authority from the states to the federal government to define general standards of medical practice in every locality," Kennedy wrote. "The text and structure of the CSA show that Congress did not have this far-reaching intent to alter the federal-state balance and the congressional role in maintaining it."

Oregon's Death With Dignity Act was first approved by ballot initiative in 1994. The law took effect three years later after voters defeated a second ballot initiative aimed at repealing the measure.

The Death With Dignity Act sets out a procedure in which a mentally competent individual who is diagnosed as terminally ill may ask a doctor to provide medication to help end his or her life in a "humane and dignified manner."

As the law was about to take effect in 1997, some federal officials raised questions about whether the Death With Dignity Act might violate provisions of federal drug laws. The head of the Drug Enforcement Administration at the time said it would and that the federal government could take action against doctors who - in the view of federal officials - abuse their prescription privileges under the federal narcotics-control regime.

Attorney General Janet Reno overturned that determination, saying the US could not take action against physicians acting in compliance with the Oregon law.

After Ashcroft became attorney general in 2001, he overturned Ms. Reno's decision and issued what is known as the Ashcroft directive. In it, he declared that anyone administering federally controlled drugs to assist in a suicide would be in violation of the Controlled Substances Act.

Oregon immediately filed suit in federal court challenging the Ashcroft directive. Both a federal judge and a divided panel of the Ninth US Circuit Court of Appeals sided with Oregon. The appeals court ruled that Ashcroft exceeded his authority in issuing the directive.

In affirming the appeals court, the majority justices said they had reached a "common-sense conclusion" that CSA does not empower the attorney general to impose a federal bar on Oregon doctors engaged in assisting suicide "in the face of a state medical regime permitting such conduct."