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Preview of Assisted Suicide Case

by TChris

The Legal Information Institute at Cornell has started producing its always-helpful previews of cases that will be soon be argued before the Supreme Court. This is the preview of a case scheduled for argument on October 5 that raises fascinating questions (once again) about the federal government's power to trump state law.

Oregon's Death With Dignity Act permits a doctor to prescribe a lethal dose of a drug to a patient who is both terminally ill and competent to make a rational decision to commit suicide. In 1997, the DEA, relying on a federal law that requires doctors to prescribe medications only for a legitimate medical purpose, decided that it had the authority to arrest physicians who dispense drugs to assist suicide (a purpose DEA deems illegitimate).

Janet Reno declined to prosecute Oregon doctors who acted in accordance with state law, but John Ashcroft quickly changed course when he became Attorney General. He issued the Ashcroft Directive, concluding that "assisting suicide is not a legitimate medical purpose."

Oregon sued, and both the district court and the Ninth Circuit concluded that Ashcroft did not have the authority to override a state's decision about the legitimate medical purposes for which the state's doctors can prescribe drugs.

The linked preview provides the quick-and-dirty on the legal issues in the case, including the meaning and scope of the federal law, and the conflict between a state's right to regulate the practice of medicine within its borders and the federal desire to regulate the abuse of pharmaceutical drugs. Perhaps more interesting to those who don't thrill in the parsing of statutes is the discussion of the case's moral dimension.

Oregon ... insists that forbidding physicians from using [federally controlled] substances would eliminate "the most effective and humane means of easing death."

...

Some argue that a victory for Oregon would enable "enterprising purveyors of death", alluding to Dr. Kevorkian and the like, to capitalize on the suffering of the terminally ill by marketing lethal substances to physicians and patients. ... Others believe that a victory for Oregon will result in a domino effect of unethical practices, not unlike the Netherlands' experience with legalized assisted suicide—an experiment which evolved to encompass infants, minors, and the mentally ill.

The LII is not predicting a happy outcome for Oregon.

On its face, Gonzales v. Oregon (formerly Oregon v. Ashcroft), 368 F.3d 1118 (9th Cir. 2004), cert. granted, 125 S. Ct. 1299 (2005), is an intriguing case because it presents a clash of federal and state spheres of influence. On the one hand, the Attorney General has taken the position that Oregon's decision to permit physicians to distribute controlled substances for physician-assisted suicide is contrary to federal law. On the other hand, Oregon argues that the Attorney General has misinterpreted the [Controlled Substances Act] to invalidate state law that represents the democratic choice of the people of Oregon in the medical arena. These views present two different perspectives of the concept of federalism, while also implicating serious moral and policy concerns. Given framing of the central issues, the Court will not likely address this question on policy or moral grounds. The plain language of the CSA, Congressional intent and administrative law will all inform the Court's decision. The Court will likely avoid such slippery slope issues in favor of uniformity in the implementation of the CSA, perhaps a more preferable outcome to variable multi-state regulation. The safe route to resolving this case with the minimal amount of controversy suggests that change may be on the horizon for the Oregon Act.

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  • Re: Preview of Assisted Suicide Case (none / 0) (#1)
    by Edger on Sat Dec 17, 2005 at 01:04:10 PM EST
    Two questions: 1) Is suicide illegal in Oregon? 2) If it is not, could it be argued that a physician prescribing and administering the drugs is doing so to ease the pain of a patient who is performing a legal act?

    Re: Preview of Assisted Suicide Case (none / 0) (#2)
    by Che's Lounge on Sat Dec 17, 2005 at 01:04:10 PM EST
    Gee, how will they use the commerce clause here? IMHO assisted suicide could become a slippery slope. I don't know what the numbers are from OR. I would hope that the method for determining the prognosis would be similar to determinations of brain death, namely that more than one board certified specialist in the area is needed to confirm the diagnosis, or in these cases, the prognosis, which is not the name of the illness, but the survival rate, with and without further treatment. I've participated in many (too many) end of life decisions. It always comes down to the family being the final arbiters. Please remember that clinicians don't decide whether to end a person's life. That decision is made by the patient or the family. I found it very disturbing that, in the Schaivo case, the family's power to decide (or not) was usurped by the US congress. The more the government gets involved, the more slippery the slope.

    Re: Preview of Assisted Suicide Case (none / 0) (#3)
    by Edger on Sat Dec 17, 2005 at 01:04:10 PM EST
    Che: ..remember that clinicians don't decide whether to end a person's life. That decision is made by the patient or the family. And are the doctors just prescribing something to relieve suffering?

    Re: Preview of Assisted Suicide Case (none / 0) (#4)
    by aw on Sat Dec 17, 2005 at 01:04:10 PM EST
    Even if a terminally ill patient decides not to use the drugs after all, they feel better having the option. Remember the guy who said he could just go buy a gun. They couldn't stop him from doing that.

    Re: Preview of Assisted Suicide Case (none / 0) (#5)
    by Linkmeister on Sat Dec 17, 2005 at 01:04:10 PM EST
    For Oregon's numbers (from the Oregon Health Division, and not the most recent), see Section 6.10.

    Re: Preview of Assisted Suicide Case (none / 0) (#6)
    by peacrevol on Sat Dec 17, 2005 at 01:04:11 PM EST
    All people have the right to live. Shouldnt they also have the right to die?

    Re: Preview of Assisted Suicide Case (none / 0) (#7)
    by peacrevol on Sat Dec 17, 2005 at 01:04:11 PM EST
    If they dont have the right to live, then by definition, the "right" to live becomes an obligation.

    Re: Preview of Assisted Suicide Case (none / 0) (#8)
    by kdog on Sat Dec 17, 2005 at 01:04:11 PM EST
    Keep govt. and religous zealots out of our hospital rooms. There are fates worse than death.

    Re: Preview of Assisted Suicide Case (none / 0) (#9)
    by Talkleft Visitor on Sat Dec 17, 2005 at 01:04:11 PM EST
    My father just died on Sept 10th. He had advanced liver cancer and there was nothing they could do. He couldn't eat. (keep anything down) Keeping him alive via feeding tube was not an option as far as any of us were concerned. We got him home, called in Hospice ( a great organization) and made him as comfortable as we could. His Dr. confided in me that when the time came, he could 'speed things up' so my dad wouldn't suffer. All Dr's should be thinking this way! Many thanks to him and Hospice for letting my dad die with dignity. We should all have that option.

    Re: Preview of Assisted Suicide Case (none / 0) (#10)
    by glanton on Sat Dec 17, 2005 at 01:04:11 PM EST
    B.B., sorry about your Dad, and I agree with you 100% that all Drs. should think that way. Losing a loved one is hard enough without having to appease government officials.

    Re: Preview of Assisted Suicide Case (none / 0) (#11)
    by kdog on Sat Dec 17, 2005 at 01:04:11 PM EST
    Sorry for your loss BB.

    Re: Preview of Assisted Suicide Case (none / 0) (#12)
    by Talkleft Visitor on Sat Dec 17, 2005 at 01:04:12 PM EST
    Glanton / Kdog.. Thanks... I really appreciate that.

    Re: Preview of Assisted Suicide Case (none / 0) (#13)
    by Che's Lounge on Sat Dec 17, 2005 at 01:04:12 PM EST
    BB, Sorry. Hang in there.

    Re: Preview of Assisted Suicide Case (none / 0) (#14)
    by peacrevol on Sat Dec 17, 2005 at 01:04:12 PM EST
    condolences BB.

    Re: Preview of Assisted Suicide Case (none / 0) (#15)
    by Talkleft Visitor on Sat Dec 17, 2005 at 01:04:12 PM EST
    Che / peacrevol.. Thanks....