Currently before the Supreme Court - A challenge against physician-assisted suicide

RBM

CAGiversary!
In a nutshell:
1.) In 1997, The Supreme Court ruled that dying patients have no constitutional right to assisted suicide. This decision did not explicitely drive nor discourage states passing their own laws, as Oregon voters soon did. Oregon is the only state to have passed such a law.

2.) In 1998, the state of Oregon passed a law enabling physician-assisted suicide--with multiple constraints--and to date, more than 200 people have chosen to make use of this Death with Dignity Act. The citizens of Oregon would vote to keep this state law twice, in the coming years.

3.) In 1999, Dr. Jack Kevorkian was convicted of murder for assisting in the suicides of people in Michigan. He has since appealed this conviction, unsuccessfully.

4.) On the week of October 5, 2005, the Bush administration went to the Supreme Court to challenge Oregon's physician-assisted suicide law.
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Now. What is NOT not on the table: removal of medical treatment. Therefore, cases involving the removal of respirators or feeding tubes (such as the Schiavo case) would *not* be effected. Oregon's Death With Dignity Act allows physicians to actively assist suicides by prescribing lethal doses of narcotics, so this active form of suicide assistance is what is at stake.

Opponents to physician-assisted suicide: Medical technology is here to preserve life and not to end it prematurely. Doing so de-values life and supports the idea that suicide is a valid way of dealing with the troubles and travails of life. Furthermore, if this practice is allowed, then life-saving measures will be at the mercy of market pressures, and HMO's will have even more brutal ways to factor the survival of select patients/demographics against profit margins. Generally speaking, hospice care is preferred, in desperate cases.

Proponents for physician-assisted suicide: the willingness to endure pain, loss of personal freedom and/or dignity (e.g. due to loss of control over one's bodily functions,) and the infliction of financial burdens upon loved ones is something which varies from case to case. However, when these factors lead to a person's desire to hasten his own impendending death, his physician should be able to help ease the pain of doing so. Oregon's law is designed to stave off people with depression, those who are not in the late stages of terminal illness, and those without access to multiple physician's opinions. Furthermore, they cite the absence of any escalation in the incidence of suicide over the past 8 years, and also cite the preponderence of upper-middle class people with medical insurance who have used physician-assisted suicide (as opposed to destitute people without health insurance)...thus indicating that this Act has not been used to target the poor (quite the opposite, in fact.)
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I think the Death with Dignity Act in Oregon was drafted with great care, and I don't relish the idea of DEA narcs prosecuting physicians who cross the line from "treating pain" to "facilitating suicide" in cases with terminally ill patients in a great deal of constant pain. (This NPR program provides some interesting input from both sides of the issue) Furthermore, since the Supreme Court has not set forth a federal law to explicitely ban or condone physician-assisted suicide, I would prefer that individual states choose their own legislation in this matter, as Oregon has done, without some half-assed measure like attempts to use the DEA to hamstring a key step of the process.

[edit: more than 200 people, Zion (#2.) That's about 1 in every 800 deaths in Oregon. Average age of such patients has been 69, diagnosed with terminal cancer. Although some have been as young as 25.]
 
I don't suppose you'd know the number of times Oregon's law has been used to date?

The last time I checked I remember it being a very small number, despite all the attention it gets.
 
I agree that assisted suicide should be legal, but I find the arguments here to be weak usually. There are some good arguments and counter arguments I think though that I do not see in the u.s., they are:

Not allowing assisted suicide is discrimination against the disabled. Suicide is legal to everyone, and is available to every person, but the disabled due not have the right to take their life if their disability would bar them from doing that. I think the legality or basic suicide differs by state in the u.s., but it's a good moral argument for it, even if it isn't always a good legal one. This is the argument adopted by the major disabled rights group in canada, which originally denounced her position for the below reason, then decided it was discriminatory and adopted the above reason.

The danger in allowing assisted suicide is not so much the devaluing of life, but the danger it could force terminally ill patients, severely disabled people, or people who have a medical issue, but do not want to die, to feel that it is their duty to end their life. It could also make doctors reluctant to treat dying people, in the belief that it is pointless and they should agree to euthanize themselves.

Here's what happened in canada when a woman tried to get assisted suicide legalized. She failed, but it provides argument for and against and really humanized the situation. You can just read the arguments, the video is supplementary.
http://archives.cbc.ca/IDC-1-69-1135-6554/life_society/sue_rodriguez/clip1

I have no idea what will happen here. If the decision is arrived at before miers (or someone else) takes o'conners place, then thats a good thing for oregons law. Also, many of them are sick themselves and, possibly being a personal issue for them, may be more sympathetic to the view than if it was an alien concept (like men and abortion).

Oregon has had 208 assisted suicides according to NPR. To recieve assisted suicide, you need to be within the last 6 months of life, have a 15 day waiting period, make 2 oral and 1 written request, recieve a second opinion and counseling if any psychological impairment is suspected by either doctor.

I also found something interesting, in the netherlands doctors intervene in 18% of assisted suicides with injections(http://www.internationaltaskforce.org/orrpt7.htm, assuming it's accurate which I'm not certain about) due to complications that arise from the medication. It is illegal for doctors to do that in oregon.

Since he was brought up, I'd just like to say I admire kevorkian. I wish I had the courage to do something like that. I remember growing up and hearing my mother say how bad she felt that people like that had to fight just to stay out of jail. It's a wake up call when you're the one making the decision to keep someone alive or pull the plug, which she did with her mother after watching her suffer, knowing she was dying. Before that she couldn't understand how anyone could justify it.
 
I thought that suicide was illegal, which is why there are so many consequences for suicide and attempted suicide.
 
Another example of "big brother" Dubya overextending the powers of the federal government by trumping state laws when this should left to the states. Again, so much for "smaller government". :roll:
 
[quote name='alonzomourning23']Not allowing assisted suicide is discrimination against the disabled.. the disabled due not have the right to take their life if their disability would bar them from doing that.[/QUOTE]
That actually strikes me as a very odd point of view. Talking about "the right" to commit suicide sounds bizarre (it certainly isn't in the Constitution.) Most able-bodied people have the *ability* to do so, which some handicapped or disabled people may not...but saying that it is a right which everybody deserves to be able to act upon doesn't make sense to me. If I am a quadriplegic, I lack the ability to commit suicide on my own, or to play basketball. However, neither action is a "protected right" under the law, so I don't see why it would be discrimination against me if a physician is not available to help me end my life or a physical therapist to help me shoot some hoops.
[quote name='alonzomourning23'] The danger in allowing assisted suicide is not so much the devaluing of life, but the danger it could force terminally ill patients, severely disabled people, or people who have a medical issue, but do not want to die, to feel that it is their duty to end their life. It could also make doctors reluctant to treat dying people, in the belief that it is pointless and they should agree to euthanize themselves. [/QUOTE]
Well, Oregon's law has been in place for about eight years, and neither side has (so far) attempted to make the case that any of the people who have enlisted the aid of physicians to help ease the pain of their deaths have done so out of some perceived duty to do so. Hell, we can't even get the average Joe to drive over to a polling station and cast a ballot on election day...how could legalizing the ability of physicians to offer assistance in terminally ill cases get people to prematurely/inapproriately agree to die?
[quote name='alonzomourning23']I also found something interesting, in the netherlands doctors intervene in 18% of assisted suicides with injections(http://www.internationaltaskforce.org/orrpt7.htm, assuming it's accurate which I'm not certain about) due to complications that arise from the medication. It is illegal for doctors to do that in oregon.[/QUOTE]
I think you're right; Oregon doctors have only prescribed lethal quantities of narcotics to terminally ill patients in the late end (and painful) stages of dying; they haven't administered the injections themselves. In fact, half of those prescriptions in Oregon wind up going unused...the patients simply appreciated having them there, should the end prove too painful. I know that I would certainly want that option, for myself and for my loved ones. Even if the difference were just a day or two of mindless agony.

If there were cases of physicians using the Oregon Act as a front for drug-running, I would understand the move to have the DEA intercede in this situation. Since this hasn't happened in the 8 years that the Act has been in place, I don't see the rationale for the current case before the Supreme Court. Without Oregon, everyone would have to argue with hypotheticals. With Oregon, we have eight years and over 200 cases to use as a basis for discussion...now granted, that's a small basis for extrapolation onto a national scale...but what concerns regarding physician-assisted suicide have been borne out thus far?
 
Most able-bodied people have the *ability* to do so, which some handicapped or disabled people may not...but saying that it is a right which everybody deserves to be able to act upon doesn't make sense to me.

I believe in a right to die, and some countries do have suicide as being legal. I think, in the u.s., there is no federal law on suicide and it's a states issue. If that's true, then a state where suicide is a legal right would result in the disabled not being able to decide their death like any able bodied person could.

Well, Oregon's law has been in place for about eight years, and neither side has (so far) attempted to make the case that any of the people who have enlisted the aid of physicians to help ease the pain of their deaths have done so out of some perceived duty to do so. Hell, we can't even get the average Joe to drive over to a polling station and cast a ballot on election day...how could legalizing the ability of physicians to offer assistance in terminally ill cases get people to prematurely/inapproriately agree to die?

I don't agree with that point of view, but I do believe in a right to determine your own death. I can't disprove it though since assisted suicide, even in places like Oregon, is more limited than I would like to see it. If assisted suicide became an acceptable way to avoid painful imminent suffering, even if death isn't imminent (like we do with other animals), then I guess you could have a few isolated cases of a person being pressured. But I don't think that's really an issue, a decent point, but not one that is likely to be true.

In fact, half of those prescriptions in Oregon wind up going unused...the patients simply appreciated having them there, should the end prove too painful. I know that I would certainly want that option, for myself and for my loved ones. Even if the difference were just a day or two of mindless agony.

I just wish they could fully legalize it. If a person is in the hospital they could give them general anesthesia and then give them a lethal injection. That way there would be absolutely no pain or suffering involved in death.

With the way Oregons laws are, if I had a disease that would result in me dying painfully, I may use it. But, if I had to administer the drugs myself, and decided I was going to use the option, I would likely do it earlier than I would if the doctor could euthanize me. If I waited until I was too disabled or weak to administer medicine into my own mouth, then I would miss my opportunity.
 
[quote name='alonzomourning23']a state where suicide is a legal right would result in the disabled not being able to decide their death like any able bodied person could. [/QUOTE]
To reiterate, I am unaware of any instance where "the right to end one's own life" is protected by law. You allude to such a possibility, but I have yet to encounter it. I have certainly seen instances of the opposite, such as Delalware's statutory law, which would brand me mentally ill if I am considered likely to harm myself and consign me to hospital care and treatment.

Obviously, no law whatsoever can touch me if I actually decide to and successfully commit suicide. They can put me on a suicide watch or some such, but that's only if I try and fail...and I have only seen evidence of laws which condemn such attemts as indicators of mental illness (none which affirm any right to end one's own life.)
[quote name='alonzomourning23']if I had to administer the drugs myself, and decided I was going to use the option, I would likely do it earlier than I would if the doctor could euthanize me. If I waited until I was too disabled or weak to administer medicine into my own mouth, then I would miss my opportunity.[/QUOTE]
A point which opponents of physician-assisted suicide are quick to emphasize; nobody knows how long you could hang in there. Ask 3 doctors and you might receive 3 different estimates, and what if the discrepancy ran into the years? Stephan Hawking was given an estimate of 2yrs life expectancy when first diagnosed with Lou Gehrig's disease, and that was over thirty years ago.

Oregon's approach seems sensible to me: by leaving lethal injections with terminally ill patients, you give control to either the patient himself or (presumably) to close relatives...and that's where I believe the decision should reside. Their precautionary measures are well thought-out, and you are not committed to actually use the option. This is the one area of health care which I feel transcends the physician's decision-making capabilities. Once death is certain and the only question is that of deciding when to let go, then modern medicine should afford you the luxury of choosing a painless end over a protracted and painful one.
 
[quote name='RBM']
Obviously, no law whatsoever can touch me if I actually decide to and successfully commit suicide. They can put me on a suicide watch or some such, but that's only if I try and fail...and I have only seen evidence of laws which condemn such attemts as indicators of mental illness (none which affirm any right to end one's own life.)[/quote]

But whether such a law exists is significant. If a country or state legalizes suicide, then the discrimination argument can be legally made.


Oregon's approach seems sensible to me: by leaving lethal injections with terminally ill patients, you give control to either the patient himself or (presumably) to close relatives...and that's where I believe the decision should reside. Their precautionary measures are well thought-out, and you are not committed to actually use the option. This is the one area of health care which I feel transcends the physician's decision-making capabilities. Once death is certain and the only question is that of deciding when to let go, then modern medicine should afford you the luxury of choosing a painless end over a protracted and painful one.

The problem with making the patients actually do it is the method may be more traumatic. Overdosing on drugs is not as peaceful as general anesthesia, and then euthanizing the person while they are unconscious.
 
http://www.washingtonpost.com/wp-dyn/content/article/2006/01/17/AR2006011700435.html

Supreme Court Upholds Oregon Suicide Law
By GINA HOLLAND
The Associated Press
Tuesday, January 17, 2006; 12:04 PM


WASHINGTON -- The Supreme Court upheld Oregon's one-of-a-kind physician-assisted suicide law Tuesday, rejecting a Bush administration attempt to punish doctors who help terminally ill patients die.

Justices, on a 6-3 vote, said that a federal drug law does not override the 1997 Oregon law used to end the lives of more than 200 seriously ill people. New Chief Justice John Roberts backed the Bush administration, dissenting for the first time.

The administration improperly tried to use a drug law to punish Oregon doctors who prescribe lethal doses of prescription medicines, the court majority said.

"Congress did not have this far-reaching intent to alter the federal-state balance," Justice Anthony M. Kennedy wrote for himself, retiring Justice Sandra Day O'Connor and Justices John Paul Stevens, David Souter, Ruth Bader Ginsburg, and Stephen Breyer.

Kennedy is expected to become a more influential swing voter after O'Connor's departure. He is a moderate conservative who sometimes joins the liberal wing of the court in cases involving such things as gay rights and capital punishment. The ruling was a reprimand to former Attorney General John Ashcroft, who in 2001 said that doctor-assisted suicide is not a "legitimate medical purpose" and that Oregon physicians would be punished for helping people die under the law.

Kennedy said the "authority claimed by the attorney general is both beyond his expertise and incongruous with the statutory purposes and design."

Justice Antonin Scalia, writing for himself, Roberts and Justice Clarence Thomas, said that federal officials have the power to regulate the doling out of medicine. "If the term `legitimate medical purpose' has any meaning, it surely excludes the prescription of drugs to produce death," he wrote.

Scalia said the court's ruling "is perhaps driven by a feeling that the subject of assisted suicide is none of the federal government's business. It is easy to sympathize with that position."

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...and yet it seems that Justice Scalia voted in favor of having the federal government regulate (or punish, rather) the practice of physician-assisted suicide.

Still, I am glad to see that the see-saw pattern of federal vs. state regulation of this matter has veered once again back to state laws. The Supreme Court already lobbed the ball into the States' courts, so to speak, and this recent attempt to wrest the matter back into federal jurisdiction speaks more of politicking than judicial concern (in my opinion.)
 
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