Physician Assisted Suicide Should Be Legalized In The United States
The case of Gonzales v. Oregon was a landmark decision from the U.S. Supreme Court in 2006 that upheld Oregon’s Death With Dignity Act (ODWDA). This law, passed in 1997, allows Oregon physicians to prescribe a lethal drug dose to a patient that has “an incurable and irreversible disease that, within reasonable medical judgment, will cause death within six months” (Hilliard, p.160).
Oregon’s voters believed that a competent adult who has a terminal illness should have the right to ask a physician for assistance in ending his or her life. This allows a patient to control the dying process and manage their illness with dignity. Instead of trying to end his/her life in a secretive or shameful manner, the patient has the right to seek professional medical advice and receive a painless, humane way to end life under his/her control. Under ODWDA, the steps are very specific, providing the patient an opportunity to understand their condition and seek counseling if desired. Once the patient expresses desire in the lethal treatment, a second physician provides an independent examination and confirms the initial physician’s findings. Finally, the physician can issue the prescription, but the patient must take the medication on their own; the physician cannot administer the lethal dose to the patient. This groundbreaking law by Oregon set the precedent for other states to issue similar laws since physician-assisted suicide is illegal in the United States.
Although the state law allowing the practice of physician-assisted suicide was passed in 1997, the federal government tried to oppose the law on the basis that physicians should not be encouraging a patient to end their life. On November 6, 2001, the Department of Justice (DOJ) Attorney General John Ashcroft issued the “Ashcroft Directive” that prohibited:
Physicians from dispensing or prescribing medications to assist in the suicides of patients … [the] Attorney General’s conclusion applies regardless of whether state law authorizes or permits such conduct by practitioners or others and regardless of the condition of the person whose suicide is assisted. (Hilliard, 2007, p. 161)
The federal government, was trying to regulate how the states could practice medicine, a power not explicitly granted by the Constitution, so Attorney General Ashcroft used an interpretation of the Controlled Substances Act (CSA) that regulates narcotics and other medications “based on their potential for abuse or dependence, their accepted medical use, and their accepted safety for use under medical supervision” (Hilliard, p. 160). Through his Directive, Attorney General Ashcroft prevented physicians from prescribing a lethal dose of medication. If a doctor issued a lethal prescription, this action would invalidate his/her license and subject them to criminal prosecution under the CSA. The Ashcroft Directive nullified the ODWDA.
Outraged by the Ashcroft Directive, a group of Oregon residents challenged the constitutionality of this executive law that contradicted the will of Oregon’s voters. After the lower courts overturned the Ashcroft Directive, the case was presented to the U.S. Supreme Court for final judgment. Attorney General Gonzales represented the federal government; he replaced Attorney General Ashcroft in February 2005.
The case was decided on January 17, 2006. Out of the nine Supreme Court justices, six justices voted in favor of overturning the Ashcroft Directive on the grounds that “Congress did not delegate to the Attorney General the authority to promulgate a rule ‘declaring illegitimate a medical standard for care and treatment of patients that is specifically authorized under state law’” (Hilliard, p. 162). Hilliard believes that although the Court felt that the Attorney General could control the issuance of drugs [through the CSA], he would not be able to control drugs based on his perspective of legitimate medical use (p. 162).
The dissenting opinion led by Justice Scalia focused on the Ashcroft Directive’s attempt to perform three main actions — participation in physician-assisted suicide violates the public interest, issuing federally controlled substances for suicide assistance goes against the CSA, and interpreting “‘legitimate medical purpose’ as it appears in the regulation to exclude physician-assisted suicide” (Hilliard, p. 163). Justice Scalia also acknowledges that the “prohibition on assisted suicide is not one of the Constitution’s enumerated powers conferred by the United Stated government … [but] the federal government often uses its enumerated powers … ‘for the purpose of protecting public morality’” (Hilliard, p. 164). According to Hilliard, “the Supreme Court has a long tradition of supporting the federal government as it acts ‘within the realm of public morality’ to protect citizens” (p.164). Furthermore, Hilliard adds, “assisted suicide is certainly an activity that falls within the public morality, and the federal government is certainly free, through its commerce clause power, to prohibit it” (p. 164). Justice Scalia and the other two judges did not endorse physician-assisted suicide and believed that Attorney General Ashcroft worked within the limits of his position to “make the occasional judgment regarding what constitutes legitimate medical practice” (Hilliard, p. 164). The dissenting Justices felt that physicians’ actions should be directed towards the preservation of life instead of termination.
In addition to the dissenting Justices’ opinion, Hilliard explains that groups that oppose physician-assisted suicide fear that “physicians would force their terminally ill patients who were poor, uneducated, uninsured, disabled, elderly, or otherwise vulnerable to commit suicide” (p. 160). As part of the reporting requirements of the ODWDA, physicians “must keep detailed records of the process leading to the final prescription, records that Oregon’s Department of Human Services reviews” (Hilliard, p. 160). Data collected during the first six years since the ODWDA was passed contradict those unsupported fears:
Patients with a college or graduate degree were 7.6 times more likely than those without a high school diploma to choose assisted death, that 90% were enrolled in Medicare or had private health insurance, and that 86% of patients opting for physician-assisted suicide were enrolled in hospice. (Hilliard, 2007, p. 160)
In conclusion, the Supreme Court’s decision to uphold physician-assisted suicide was a demonstration of the States’ ability to regulate medicine within their borders that the federal government cannot deny, confirming the opinion of Oregon voters that a terminally ill patient should have the right to end their life with dignity. Since physician-assisted suicide is still illegal under federal law, it is up to the voters in each state to determine if their terminally ill patients will be given the right to end their life under their control.
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