Death with Dignity, or Suicide?

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Death with Dignity, or Suicide?
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On March 6, 1996, the Ninth Circuit Court of Appeals issued the first opinion by a federal appellate court involving the right to die and physician-assisted suicide. The decision, Compassion in Dying v. State of Washington,1 found a Washington state law prohibiting a person from aiding another person to attempt suicide to be unconstitutional as applied to terminally ill, competent adults who wish to hasten their own deaths. While binding only on the Ninth Circuit's nine western states, the case, which included a dissent, will substantially impact the right to die debate in the absence of a United States Supreme Court decision on the issue. This newsletter will examine the legal bases and reasoning for the Ninth Circuit's ruling; a future newsletter will examine the case's relationship with New Jersey law.

Under the Washington stat-ute, aiding another person to attempt suicide constituted a felony punishable by imprisonment of up to five years and a fine of up to $10,000. In assessing the statute's constitutionality, the Ninth Circuit reviewed attitude's toward suicide from Greek and Roman times to the present and examined concepts of personal choice, au-tonomy and dignity from cases involving abortion, and concluded that there is a constitutionally-protected liberty interest in "controlling the time and manner. of one's death." The court declared:

 

A competent terminally ill adult, having lived nearly the full measure of his life, has a strong liberty interest in choosing a dignified and humane death rather than being reduced at the end of his existence to a childlike state of helplessness, dia-pered, sedated, incontinent. . . . [T]here is, in short, a constitutionally recognized "right to die."

Nevertheless, the court cautioned that the recognition of such a liberty interest does not lead to a right to exercise that interest in all circumstances.

Rather, the state may regulate that interest consistent with due process:

 

State law or regulations governing physician-assisted suicide are both necessary and desirable to ensure against errors and abuse, and to protect legitimate state interests.

The court then considered whether the Washington assisted suicide law impermissibly curtailed that liberty interest. In weighing the com-peting interests of the individual and the state, the Ninth Circuit examined factors such as the importance of the relevant state interests (e.g., preserv-ing life, preventing suicide and protecting the integrity of the medical profession), the liberty interest's importance and the extent to which the challenged state action burdens the lib-erty interest. A significant factor influencing the court's decision was the finding that the state's interest in pre-venting suicide and preserving life is "substantially diminished" in the case of a competent, terminally ill adult who wishes to die. The court ob-served:

 

[T]he terminally ill [are] per-mitted to reject medical treat-ment. . . . Equally important, today, doctors are generally permitted to administer death-in-ducing medication, as long as they can point to a concomitant pain-relieving purpose.

Thus, the Compassion in Dying decision may be viewed as the logical extension of the individual's right to refuse medical treatment and/or remove life support.

Concluding that a competent, terminally ill adult's liberty interest outweighs the relevant state interests, the court proclaimed:

 

[A] statute that prohibits doctors from aiding terminally ill persons to hasten their deaths by providing them with prescription medications unconstitutionally burdens the liberty interests of the terminally ill.

The court expressly extended its ruling to other persons, such as pharmacists, health care workers and family members, whose services are necessary to assist the terminally ill patient and who act under a physician's supervision or direction.

The dissent in Compassion in Dying disagreed with the majority's initial determination as to the liberty interest in controlling the time and manner of one's death, arguing that there is no fundamental constitutional right "to commit physician-assisted suicide." The dissent also rejected the majority's assertion that the state's interest in preserving life diminishes in the case of the terminally ill:

 

As applied to terminally ill adults seeking physician-assisted suicide, the state's interest in preserving life remains at full strength.

The dissent concluded that the issue of whether terminally ill persons should be allowed to commit assisted suicide is a question for state legislators and voters, not the courts.

As noted above, the Supreme Court has not yet addressed the issue of physician-assisted suicide. The highly charged and divisive national debate on the issue, the two sides of which are highlighted in the Compassion in Dying decision's majority and dissent, will continue. It is important to note that the opinion does not address whether a surrogate decision maker could make an independent decision to hasten a terminally ill person's death. For now, the Ninth Circuit's recogni-tion of a constitutionally-protected liberty interest in controlling the time and manner of one's death is the only pronouncement relating to that issue on the federal appellate level. Further litigation will no doubt ensue until the Supreme Court addresses the issue on a national level.

1 1996 WL 94848 (9th Cir. Mar. 6, 1996).