PAS ruling settles some questions, others left open

Opponents say doctors will abuse powers

Though the Supreme Court’s recent ruling in Gonzales v. Oregon says more about physicians’ authority to write prescriptions than about the right of states to pass laws permitting physician-assisted suicide (PAS), proponents of Oregon’s Death with Dignity law welcomed the ruling as a victory for physician discretion and patient autonomy.

Groups opposing PAS, however, plan to take their fight to Congress, where efforts are under way to draft legislation making it a federal crime for doctors to prescribe lethal doses of federally controlled drugs to assist suicide.

"The court held that the use of federally controlled drugs for the purpose of assisting suicide is not drug abuse’ because the physician is not facilitating drug addiction, but instead seeking to kill," stated Dorothy Timbs, legislative counsel for the National Right to Life Committee’s Robert Powell Center for Medical Ethics, in a statement released shortly after the ruling in January. "This is a shocking conclusion since one of the things that we most fear in drug abuse is danger to the life of the addict."

On the other side of the argument, Barbara Coombs Lees, president of Compassion & Choices, an organization supportive of assisted suicide, called the ruling "a watershed decision for freedom and democracy in the U.S." that "reaffirms the liberty, dignity, and privacy Americans cherish at the end of life."

The Gonzales case arose from Oregon’s 1997 passage of the Death with Dignity law permitting physicians to assist in the suicide of certain terminally ill patients by prescribing life-ending doses of drugs.

Congress failed in attempts in 1998 and 1999 to pass acts aimed at prohibiting PAS and overturning Oregon’s PAS law. Former U.S. Attorney General John Ashcroft issued an order in 2001 that physicians not prescribe federally controlled drugs for PAS, countered by a federal court injunction that put Ashcroft’s order on hold. The subsequent lawsuit, Ashcroft v. Oregon, became Gonzales v. Oregon when Ashcroft left office and was succeeded by Alberto R. Gonzales.

Oregon physicians wrote 325 prescriptions for life-ending drug doses between 1998 and 2004, the Oregon Department of Human Services reports. Of the 325 patients who received prescriptions, 208 patients used them.

Medical communities divided

The American Medical Association (AMA) did not file an amicus, or "friend of the court" brief, taking either side in Gonzales. AMA ethics code required physicians to respect patients’ end-of-life directives regarding the administration or withholding of treatment, and to ease suffering to the extent possible. But AMA delegates have in the past passed policy statements holding that PAS is "inconsistent with the physician’s role as healer."

The California Medical Association did file briefs in support of Oregon in the Gonzales case, out of concerns that if the attorney general prevailed, the federal government would gain authority over the states in determining the practice of medicine.

David Stevens, MD, director of the Tennessee-based Christian Medical and Dental Association, undoes patient protections that have existed "since the time of Hippocrates."

"Before Hippocrates, patients couldn’t know for sure if their doctor would heal them or kill them," says Stevens. "The ethical foundation of medicine is crumbling under the court’s jackhammer."

He predicts that the Gonzales ruling will energize efforts to pass laws permitting PAS in other states. The 6-3 ruling, written for the majority by Justice Anthony Kennedy, not only held that Ashcroft exceeded his authority under the Controlled Substances Act in issuing his order prohibiting use of controlled drugs for PAS, but also affirmed states as the primary regulators of medical practice. Kennedy was joined by Justices John Paul Stevens, Sandra Day O’Connor, David Souter, Ruth Bader Ginsburg, and Stephen Breyer in the majority decision.

Justices Clarence Thomas and Antonin Scalia and Chief Justice John Roberts dissented. Scalia wrote, "Virtually every relevant source of authoritative meaning confirms that the phrase legitimate medical purpose’ does not include intentionally assisting suicide."

Sandra Johnson, JD, LLM, professor of health care law and ethics at Saint Louis University School of Law and the Saint Louis University Center for Health Care Ethics, says the Gonzales case gives PAS efforts in other states "a significant boost," but "leaves the door open for Congress to enact legislation prohibiting physician-assisted suicide."

Johnson says the Supreme Court’s ruling should afford physicians some protection from the federal prosecutions some have faced over prescribing controlled substances to patients in pain.

NLRC’s Timbs, however, says those patients are the ones at risk under PAS laws.

"This sets a dangerous precedent for all vulnerable Americans, especially those with disabilities and life- or health-threatening illnesses," she insists. "Drugs should be used to cure and relieve pain, never to kill."

Resources

  • National Right to Life Committee, 512 10th St. NW, Washington, DC 20004. Phone: (202) 626-8800. E-mail: NRLC@nrlc.org.
  • Christian Medical and Dental Association, PO Box 7500, Bristol, TN 37621. Phone: (888) 230-2637.
  • Compassion & Choices, PO Box 101810, Denver, CO 80250. Phone: (800) 247-7421.
  • Sandra Johnson, JD, LLM, professor, Saint Louis (MO) University School of Law, Saint Louis (MO) University Center for Health Care Ethics. Phone: (314) 977-2791.