Washington v. Glucksberg, 521 U.S. 702 (1997)
In January 1994, Dr. Harold Glucksberg and three other doctors, three terminally ill patients, and an organization called Compassion in Dying filed suit in federal court for a declaration that Washington State’s assisted suicide ban was unconstitutional as applied to terminally ill, mentally competent adults. The U.S. Supreme Court unanimously decided that Washington’s assisted suicide ban was not unconstitutional.
The Court observed that in “almost every State – indeed, in almost every western democracy – it is a crime to assist a suicide. The Court concluded that “we are confronted with a consistent and almost universal tradition that has long rejected the asserted right, and continues explicitly to reject it today, even for terminally ill, mentally competent adults.” The Court declared that to “hold for respondents, we would have to reverse centuries of legal doctrine and practice, and strike down the standard policy choice of almost every state.” Because assisted suicide has been consistently rejected in the history and tradition of our nation, the Court wrote, “the asserted ‘right’ to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause.” The Court’s ruling was 9-0.
Vacco v. Quill, 521 U.S. 793 (1997)
Dr. Timothy Quill, along with two other physicians and three terminally ill persons, challenged the assisted suicide ban in New York State. They alleged it violated the due-process liberty and equal protection guarantees of the Fourteenth Amendment. The U.S. Supreme Court unanimously held that New York’s prohibition on assisting suicide does not violate the equal protection rights of terminally ill adults seeking physician assistance in committing suicide.
The Court rejected the notion that ending or refusing lifesaving medical treatment is nothing more or less than assisted suicide. The Court held that the “distinction comports with fundamental legal principles of causation and intent … 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.” A doctor who assists in suicide and a patient who consumes a lethal prescription have the specific intent of causing death, “while a patient who refuses or discontinues treatment might not.”
In addition, the Court stated, “On their faces, neither New York’s ban on assisting suicide nor its statutes permitting patients to refuse medical treatment treat anyone differently than anyone else or draw any distinctions between persons. Everyone, regardless of physical condition, is entitled, if competent, to refuse unwanted life-saving medical treatment; no one is permitted to assist a suicide.” The Court’s ruling was 9-0.
Gonzales v. Oregon, 546 U.S. 243 (2006)
The Oregon Death with Dignity Act grants civil and criminal immunity to physicians who dispense or prescribe a lethal dose of drugs upon the request of a terminally ill patient. In 2001, the U.S. attorney general issued an Interpretive Rule to address the enforcement of the federal Controlled Substances Act (CSA) with respect to the Oregon Act, declaring that using controlled substances to assist suicide is not a “legitimate medical purpose” and that dispensing or prescribing them for this purpose is unlawful under the CSA.
The State of Oregon, a physician, a pharmacist, and some terminally ill state residents challenged the Interpretive Rule. The U.S. Supreme Court held that the CSA does not allow the attorney general to prohibit physicians from prescribing federally regulated drugs for use in physician-assisted suicide under a state law permitting prescriptions of lethal drug overdoses upon the request of terminally ill patients.
The Court ruled that the legislative intent of the CSA was to regulate medical practice only insofar as it bars physicians from using their prescription writing powers as a means to engage in illicit drug dealing and trafficking. Beyond this, the Court held that the CSA showed no intent to regulate the practice of medicine generally. The attorney general did not have authority to make a rule declaring illegitimate a medical standard for patient care and treatment specifically authorized under state law. The Court’s ruling was 6-3, with Justices Scalia, Roberts and Thomas dissenting.
Nutrition and Hydration
This is a brief summary of Wisconsin Supreme Court decisions on nutrition and hydration, giving the citations, date, and holding.
In re Guardianship of L.W., 167 Wis.2d 53 (1992). L.W. had a long history of schizophrenia and had been institutionalized since 1951. He had no close relatives or friends, and had never indicated his wishes concerning life-sustaining medical treatment to anyone. He may “never have been competent.” On May 25, 1989, a corporation was appointed as guardian for L.W. About a week later, 79-year-old L.W. suffered a cardiac arrest. A few days later L.W.’s attending physicians told the guardian that “L.W. was in a chronic, persistent vegetative state” and that if his “condition did not improve within the following four weeks, they would request the guardian to consent to withdrawal of all life-sustaining medical treatment, including artificial nutrition and hydration, and thus occasion L.W.’s death.” On June 8, 1989, the guardian petitioned the court to determine whether the guardian had authority to consent to such withdrawal.
The Wisconsin Supreme Court concluded “that an incompetent individual in a persistent vegetative state has a constitutionally protected right to refuse unwanted medical treatment, including artificial nutrition and hydration” and “that a court-appointed guardian may consent to withdrawal of such treatment where it is in the ‘best interests’ of the ward to do so.” The Court stressed that its “opinion is limited in scope to persons in a persistent vegetative state.”
The “guardian must begin with a presumption that continued life is in the best interests of the ward.” However, this presumption can be overcome by a guardian’s “good faith” assessment of countervailing factors. The Court rejected the clear and convincing evidence standard for determining the person’s wishes. When nontreatment is in the ward’s best interests, “the guardian has not only the authority to but a duty to consent to the withholding or withdrawal of treatment.” The Court’s ruling was 6-1, with Justice Steinmetz dissenting.
In the Matter of the Guardianship and Protective Placement of Edna M.F., 210 Wis.2d 557 (1997). At the time of the case, Edna M.F. was a 71-year-old woman who had been diagnosed with Alzheimer’s dementia. She was bedridden, but doctors indicated that she responded to stimulation from voice and movement. She also appeared alert at times, with her eyes open, and she responded to mildly noxious stimuli. Her condition did not meet the definition of a “persistent vegetative state”. In 1988, a permanent feeding tube was surgically inserted. She was breathing without a respirator.
On January 12, 1995, Edna’s sister and court-appointed guardian, Betty Spahn, sought permission to direct the withholding of Edna’s nutrition and hydration, claiming that her sister would not want to live in this condition. Spahn asked the Wisconsin Supreme Court to extend its ruling in the L.W. case to include incompetent wards who are not in a “persistent vegetative state”.
The Wisconsin Supreme Court unanimously refused to extend the scope of L.W. to include incompetent patients who are afflicted with incurable or irreversible conditions of health. The Court held that if a ward is not in a “persistent vegetative state,” it is not in the best interests of the ward “as a matter of law” to withdraw life-sustaining treatment, including a feeding tube, “unless the ward has executed an advance directive or other statement clearly indicating his or her desires.”
There was very little evidence of what Edna’s desires would be under the current circumstances. A statement made 30 years ago was too remote. There was no clear statement of what her desires would be under the current conditions. She never executed any advance directives expressing her wishes while she was competent. In Wisconsin there is “a presumption that continuing life is in the best interests of the ward.” The Court held that there was not enough evidence to rebut the presumption that Edna would choose life.