Choosing Life's End:
The Current Legal Landscape of the Death with Dignity Movement
By Eric Reutter
“There is a certain right by which we many deprive a man of life,
but none by which we may deprive him of death; this is mere cruelty.”
― Friedrich Nietzsche: Human, All Too Human
The term "Death with Dignity," also known as physician
assisted suicide, refers to when a physician provides a patient with the means
for hastening his/her death, most commonly via a medical prescription. The
concept of physician assisted suicide is different from the practice of
euthanasia, in which a physician administers the lethal medication directly,
rather than providing it to the patient for self-administration. While the
cultural battle regarding the role of Death with Dignity in our society is a
fascinating topic, this article focuses on the legal processes that have led to
the current Death with Dignity landscape.
Background: The Supreme Court of the United States Fails to
Provide Clear Guidance on End of Life Issues
During the 1990s, the Supreme Court of the United States heard two
major cases that dealt squarely with end of life issues. The first major case, Cruzan
v. Dir., Missouri Dep't of Health, saw a narrow 5-4 majority hold that a
patient has the legal right to refuse life-sustaining treatment. The Cruzan ruling,
although in some ways favorable to the Death with Dignity movement, was far
from a guarantee that the court would ever recognize physician assisted suicide
as a legally protected right. The decision was fragmented, as it contained two
concurring opinions, two dissenting opinions, and ultimately granted a great
deal of latitude to the states to serve as "laborator[ies]" for
procedurally safeguarding patients' rights regarding the refusal of life-sustaining
treatment.
In 1997, in Washington v. Glucksberg, the United States
Supreme Court was forced to address whether an individual has a
constitutionally protected right to physician assisted suicide. A coalition of
terminally ill patients and non-profit organizations had brought a challenge to
Washington State’s legal ban against assisted suicide. The Court ultimately
held that physician assisted suicide was not a constitutionally protected right
and, in an attempt to distinguish its Cruzan decision, it remarked that
the refusal of life-sustaining treatment was "widely and reasonably
regarded as quite distinct" from the decision to end one's life with the
assistance of another.
In an effort to distinguish the right to refuse life-sustaining treatment
from the right to physician assisted suicide, the court looked to the legal
historic treatment of both rights. The Court noted that, while the right to
refuse life-sustaining treatment was deeply rooted in the common-law tradition
of the courts, the right to assisted suicide has historically been rejected by
the legal system. The Court highlighted the fact that, at the time of its
decision, almost every state had rejected efforts to permit physician assisted
suicide. The Court justified this historical analysis by noting that it is not
simply a connection to personal autonomy that brings a liberty under the
protection of the Due Process Clause, but rather it is the legal and historic
treatment of a right that makes it a "fundamental liberty interest
protected by the Due Process Clause."
Justice Rehnquist, however, indicated that a future ruling on the
issue might produce a different result, remarking that, "I do not,
however, foreclose the possibility that an individual plaintiff seeking to
hasten her death, or a doctor whose assistance was sought, could prevail in a
more particularized challenge." Although there were no dissenting opinions
in the Glucksberg decision, the case produced five concurring opinions
and again demonstrated the divergent opinions held by the Supreme Court
Justices regarding end of life issues.
In short, the 1990s saw the Supreme Court take the step of
recognizing the legal right to refuse artificial nutrition/hydration, but
stopped short of declaring that physician assisted suicide is also such a
right. What remains unclear, in light of the growing acceptance of Death with
Dignity legislation among the states, is whether a future Supreme Court
decision on this issue would similarly categorize physician assisted suicide as
a right unprotected by the due process clause.
The First Adopters: Washington and Oregon Adopt Death with Dignity
Laws by a Popular Vote
In the spirit that the states are the laboratories of democracy,
four states have explicitly legalized physician assisted suicide. The first two
states to adopt physician assisted suicide, Oregon and Washington, did so by
putting the issue before the voters. In 1994, a narrow 51 percent margin of
Oregon voters passed Ballot Measure 16, making Oregon the first state in the
country to legalize physician assisted suicide. Over a decade later, in 2008,
Washington voters followed suit by passing Initiative 1000 with a 58 percent
majority.
Recent Trends: The Vermont and California State Legislatures Adopt
Death with Dignity Laws
The next two states to adopt Death with Dignity laws, Vermont and
California, did so through the passage of bills by state legislatures in 2013
and 2015, respectively. Although Oregon, Washington, Vermont and California
legalized physician assisted suicide in different years, the main features of
each state's law are remarkably similar. For example, all four states require
that the patient have state residency, be within six months of expected death,
be over the age of 18, and make three requests to his/her attending physician.
It appears, therefore, that these four states have created a general shared
template for future Death with Dignity legislation.
The Curious Case of Montana
Whether or not the State of Montana permits physician assisted suicide
often depends on who you ask. Although no law has been passed in the state to
explicitly allow for the practice, the Montana Supreme Court has ruled that a
physician who prescribes lethal medication to a terminally ill, competent adult
would be shielded from liability for homicide.
The 2009 case of Baxter v. Montana was predicated on a
lawsuit brought by four physicians and a terminally ill leukemia patient, who
argued that physician assisted suicide was a protected right under the Montana
state constitution. Although the lower court agreed with the plaintiffs and
ruled that the Montana constitution grants patients an affirmative right to
physician assisted suicide, the Montana Supreme Court resolved this issue on
much narrower statutory grounds. The supreme court concluded that a physician
would be free from criminal liability in the context of physician assisted
suicide because there was "no indication in Montana law that physician aid
in dying provided to terminally ill, mentally competent adult patients is
against public policy." The Montana Supreme Court, however, did not rule
on whether physician assisted suicide was a protected right under the state's
constitution.
While some commentators have declared that the ruling of the
Montana Supreme Court is effectively a legalization of physician assisted
suicide, others have argued that the Court's decision to shield doctors from
criminal liability does not go as far as to legalize the practice. The Montana
Legislature has failed to resolve this uncertainty, as both advocates and
opponents of the Death with Dignity movement have been unsuccessful in their
attempts to pass legislation through the state legislature to either ban or
condone the practice of physician assisted suicide. In the end, the narrow
language used by the Montana Supreme Court has created a situation in which
physician assisted suicide is "not against public policy," yet not
officially condoned by either the judiciary or the state legislature. It
appears that this legal grey-area will remain unresolved until the state
legislature can settle the issue.
Interestingly, this very same issue of whether physician assisted
suicide is protected by a state's constitution is currently pending in New
Mexico's Supreme Court, in the case of Morris v. Brandenburg.
Conclusion: A Gradual Trend towards Death with Dignity Laws
The future of the Death with Dignity movement in the United States
seems to be one of slow, state-by-state expansion. General popular opinion
seems to be shifting towards acceptance of the Death with Dignity movement, as
a 2015 Gallup Poll reported that nearly seven in ten Americans support allowing
Death with Dignity. This cultural shift towards accepting Death with Dignity
does not seem to be isolated to the United States, as Canada's highest court
recently overturned a ban on physician assisted suicide. The decision of
Canada's highest court was followed by Prime Minister Justin Trudeau's recent
introduction of nation-wide Death with Dignity legislation this past April.
The adoption of Death with Dignity laws in four states, shifting
public opinion in favor of the cause, and international trends towards Death
with Dignity legislation seems to indicate that other states will continue to
gradually adopt Death with Dignity legislation in the future. On the national
level, Congress seems too divided to support such a divisive cause in the near
future. As Justice Rehnquist declared in the Glucksberg decision,
however, it is not inconceivable that the United States Supreme Court would
alter course and protect the right to physician assisted suicide in a future
decision. Such a move by the Supreme Court depends greatly on the pending
appointment of the next Justice, and upon the changing legal landscape of Death
with Dignity legislation among the states.
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