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Mr. Lanting, a member of South Holland Protestant Reformed Church, is a practicing attorney.

We disagree with the claim that the distinction between refusing lifesaving medical treatment and assisted suicide is “arbitrary” and “irrational.” Granted, in some cases, the line between the two may not be clear, but certainty is not required, even if it were possible. By permitting everyone to refuse unwanted medical treatment while prohibiting anyone from assisting a suicide, New York law follows a long-standing and rational distinction.

Vacco v. Quill, U.S. Supreme Court (June, 1997).

In the last decade or so, the U.S., Canada, Britain, and other countries have been embroiled in an intense debate over the morality and legality of physician-assisted suicide. The “Death with Dignity Act” adopted in 1994 by a voter referendum in Oregon, Dr. Kevorkian’s continued antics in Michigan, and cases filed in Canada have heightened the controversy.

Forty-four states in the U.S. have statutes making it a crime to aid another person to attempt suicide. Although many proposals to legalize assisted suicide have been introduced in state legislatures across the nation, none have been enacted, notwithstanding intense lobby efforts by “right-to-die” proponents.

But then in 1996, federal appellate courts in New York and Washington declared the laws criminalizing physician-assisted suicide in those states to be unconstitutional (see Standard Bearer, vol. 73, p. 162). Both of these cases were appealed to the U.S. Supreme Court. This summer the Court unanimously overruled the lower courts, holding that state laws criminalizing physician-assisted suicide are not constitutionally defective.

The Washington Case

In 1994, four physicians and Compassion in Dying, a nonprofit organization that counsels people considering suicide, sued the state of Washington seeking a declaration that Washington’s law penalizing physician-assisted suicide was violative of patients’ constitutional rights. In a decision that shocked the nation, the federal court of appeals struck down the Washington law banning assisted suicide, holding that the law violated a newly discovered constitutional right of a terminally ill patient to “determine the time and manner of one’s death” or the “right to choose a humane, dignified death.”

Although there was absolutely no legal precedent for this novel decision, the appellate court nonetheless fearlessly forged this innovative “right to die,” relying almost exclusively on the abortion decisions. The appellate court, finding the abortion decisions “highly instructive” and “almost prescriptive” ruled:

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, a choice central to personal dignity and autonomy.” … the Constitution encompasses a due process liberty interest in controlling the time and manner of one’s death—that there is, in short, a constitutionally recognized “right to die.”

Supreme Court Rejects a Right to Die

The Supreme Court found the appellate court’s argument unpersuasive. The Court noted that for over 700 years the Anglo-American common-law tradition has always punished or otherwise disapproved of both suicide and assisting suicide. The Court also reviewed recent unsuccessful attempts to revoke assisted suicide bans in numerous states, and noted that an “overwhelming majority” of state legislatures continue explicitly to prohibit assisted suicide. The Court also attempted to distinguish the abortion decisions, arguing that those decisions (generating the controversial “right to choose an abortion”) do not “warrant the sweeping conclusion that any and all important, intimate, and personal decisions are so protected.”

The Court also declared that the state ban on assisted suicide is related to legitimate government interests: preserving human life; protecting the integrity and ethics of the medical profession; the protection of vulnerable groups (the poor, elderly, disabled) from abuse, neglect, and mistakes; and finally, avoiding the path that leads to voluntary and involuntary euthanasia. In this regard, the Court noted the alarming reports from the Netherlands, where assisted suicide has been legalized, including a 1990 Dutch government study which discovered some 6,000 death cases where physicians administered lethal drugs without the patient’s explicit request or consent.

The New York Case Also Overruled

Another federal appellate court on the east coast struck down New York’s ban on physician-assisted suicide, but for different reasons than the Washington court. This court held that the challenged law violated the terminally ill patients’ equal protection rights because New York penalizes terminally ill persons who wish to hasten their deaths by self-administering prescribed drugs, but allows others to do so by removing life-support systems. In the appellate court’s view “the ending of life by withdrawal of life-support systems is nothing more or less than assisted suicide.” Consequently, it is unconstitutional, the court held, for New York to permit withdrawal of life-support systems for the terminally ill, but criminalize administration of lethal drugs, when both result in hastening death.

But the Supreme Court likewise overruled the New York case, rejecting the notion that the assisted suicide ban violated the Equal Protection Clause of the Constitution by treating similar cases differently. The Court ruled that neither the assisted suicide ban nor the law permitting patients to refuse medication treatment treats anyone differently from anyone else or draws any distinction between persons. This is because everyone has the right to refuse unwanted medical treatment; no one is permitted to assist a suicide.

Most importantly, the Court vehemently rejected the lower court’s contention that refusing lifesaving medical treatment “is nothing more or less than assisted suicide”:

Unlike the Court of Appeals, we think the distinction between assisting suicide and withdrawing life-sustaining treatment, a distinction widely recognized and endorsed in the medical profession and in our legal tradition, is both important and logical. When a patient refuses life-sustaining medical treatment, he dies from an underlying fatal disease or pathology; but if a patient ingests lethal medication prescribed by a physician, he is killed by that medication.

The Court then entered into a somewhat philosophical discussion attempting to distinguish acts that may have the same consequence, but are done with widely different intents (e.g., when a physician administers a palliative drug to lessen pain, that drug may in fact hasten death, but because the physician does not intend to kill the patient, such procedures are moral and legal).

The Court concluded that New York’s laws permitting everyone to refuse unwanted medical treatment while prohibiting anyone from assisting a suicide are in accordance with “long-standing and rational distinctions,” and are, therefore, constitutionally valid.

Comment

Reformed Christians, Right-to-Life proponents, and others breathed a sigh of relief this past June when the Supreme Court overruled these two federal appellate decisions which would have struck down all state laws criminalizing physician-assisted suicide. But the battle is hardly over. Right-to-die advocates, bitterly disappointed by the Supreme Court decision which would have repealed the assisted suicide laws in some forty states, have announced that they will re-double their efforts to sponsor voter referenda to repeal these laws on a state-by-state basis. They can do this because, although the Supreme Court held that the Constitution does not give Americans a right to physician-assisted suicide, the Court nonetheless invited states to resolve the controversial issue through the political process.

Oregon has accepted the invitation. On November 4, 1997, Oregon voters, by a resounding 20% margin, approved the state’s 1994 controversial groundbreaking law legalizing physician-assisted suicide. Consequently, Oregon is now the first state in the U.S. to allow physicians to assist the “terminally ill” end their lives by ingesting lethal drugs. This unprecedented law has generated widespread concern that the U.S. has now embarked on a course many fear will lead to euthanasia—”compassionate death” for the elderly, incompetent, and infirm. Physicians for Compassionate Care, a group of doctors opposing assisted suicide, declared the new Oregon law to be a “monumental paradigm shift” in the history of law and medicine.

Press releases in the past few weeks reported that right-to-die advocates have now launched a ballot initiative in Michigan, hoping that Michigan will be the next state to bypass the state legislature and legalize assisted suicide by voter referendum. Experts are divided on whether Michigan and other states will follow the Oregon experience, but recent surveys show that the voter initiatives may have quick success. Polls show that an ever increasing percentage of voters approve of suicide for “terminally ill patients.” A 1996 survey published in the New England Journal of Medicine found that 56% of responding doctors in Michigan preferred legalizing assisted suicide. Another survey disclosed that 60% of the responding doctors in Oregon supported legalizing assisted suicide. As right-to-die propaganda continues to influence doctors and the general population, it is sadly predictable other states may soon follow Oregon’s example and repeal laws criminalizing assisted suicide.