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Writing the Rules of Death: State Regulation of Physician-Assisted Suicide

Published online by Cambridge University Press:  01 January 2021

Extract

If the Supreme Court affirms either Compassion in Dying v. State of Washington or Quill v. Vacco, state legislatures will be presented with a new and unwelcome task: regulating physician-assisted suicide (PAS). This article focuses on the states task of specific policy making in light of the due process reasoning in Compassion in Dying and the equal protection reasoning in Quill. Policy makers must try to predict whether a particular regulation would in practice achieve its intended objective. They must also try to predict whether the regulation would survive constitutional review if challenged. Finally, they must consider the extent to which they could, or should, maintain two different regulatory regimes: a more permissive one for decisions to forgo life-sustaining medical treatments, and a more restrictive one for decisions to obtain a prescription for a lethal dose of medication. This last issue will be especially challenging if the equal protection analysis in Quill prevails.

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Article
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Copyright © American Society of Law, Medicine and Ethics 1996

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References

Compassion in Dying v. State of Washington, 79 F.3d 790 (en banc), reh'g en banc by full court denied, 85 F.3d 1440 (9th Cir. 1996), cert. granted sub nom. Washington v. Glucksberg, 65 U.S.L.W. 3254 (U.S. Oct. 1, 1996) (No. 96–110).Google Scholar
Quill v. Vacco, 80 F.3d 716 (2d Cir. 1996), cert. granted, 65 U.S.L.W. 3254 (U.S. Oct. 1, 1996) (No. 95–1858).Google Scholar
Apart from passing references, I do not consider whether constitutionally permissible state regulations would in practice actually achieve the goals of regulation. For an argument that any attempted regulation of PAS is worthless, see Callahan, D. White, M., “The Legalization of Physician-Assisted Suicide: Creating a Regulatory Potemkin Village,” University of Richmond Law Review, 30 (1996): 183.Google Scholar
Cruzan v. Director, Missouri Dep't of Health, 497 U.S. 261 (1990).Google Scholar
Planned Parenthood v. Casey, 505 U.S. 833 (1992).Google Scholar
Compassion in Dying, 79 F.3d at 816.Google Scholar
Id. at 837.Google Scholar
Id. at 832.Google Scholar
Id. at 832–33.Google Scholar
Id. at 833.Google Scholar
Quill, 80 F.3d at 724–25.Google Scholar
Id. at 724.Google Scholar
Id. at 727.Google Scholar
Id. at 729.Google Scholar
Id. at 730 (quoting Casey, 505 U.S. at 851).Google Scholar
Id. at 731.Google Scholar
Id. at 731 n.4.Google Scholar
Statutes in thirty-five states prohibit assisted suicide. The list is in Compassion in Dying, 79 F.3d at 847 n.10 (Beezer, J., dissenting). In seven other states and the District of Columbia, assisted suicide may be punished as a common law crime. Meisel, A., The Right to Die (New York: Wiley, 2nd ed., 1995): § 18.17, at 470.Google Scholar
See, for example, Quill, T.E. Cassel, C.K. Meier, D.E., “Care of the Hopelessly Ill: Proposed Clinical Criteria for Physician-Assisted Suicide,” N. Engl. J. Med., 327 (1992): 1380-84.CrossRefGoogle Scholar
The Ninth Circuit itself did not adopt the “undue burden” test of Casey, but the court recognized that the outcome would have been the same had it done so. Compassion in Dying, 79 F.3d at 837 n. 137.Google Scholar
Casey, 505 U.S. at 875.Google Scholar
Quill, 80 F.3d at 729.Google Scholar
Oregon Death with Dignity Act, Or. Rev. Stat. §§ 127.800 et seq. (1995) (hereafter the “Oregon Act”).Google Scholar
Baron, C.H.et al., “A Model State Act to Authorize and Regulate Physician-Assisted Suicide,” Harvard Journal on Legislation, 33 (1996): 134 (hereafter the “Model Act”).Google Scholar
Meisel, , supra note 23, § 18.23, at 508.Google Scholar
Emanuel, E.J. Daniels, E., “Oregon's Physician-Assisted Suicide Law: Provisions and Problems,” Archives of Internal Medicine, 156 (1996): 825–29.CrossRefGoogle Scholar
Lee v. Oregon, 891 F. Supp. 1429 (D. Or. 1995).Google Scholar
Callahan, White, , supra note 3, at 75.Google Scholar
Compassion in Dying, 79 F.3d at 816.Google Scholar
For an account of why the logic of this limitation is dubious, once the premise of a constitutional right to PAS is accepted, see Kamisar, Y., “Against Assisted Suicide—Even a Very Limited Form,” University of Detroit Mercy Law Review, 72 (1995): 735–69.Google Scholar
Baron, et al., supra note 30, at 11, 26.Google Scholar
Quill, 80 F.3d at 731.Google Scholar
Id. at 729.Google Scholar
See, for example, State v. McAfee, 385 S.E.2d 651 (Ga. 1989).Google Scholar
See People v. Kevorkian, 527 N.W.2d 714, 732 n.9 (Mich. 1994), cert. denied, 115 S. Ct. 1795 (1995).Google Scholar
Citations to the various definitions are collected in Meisel, , supra note 23, § 11.9 at 94–96.Google Scholar
Or. Rev. Stat. § 127.800(12) (1995).Google Scholar
42 U.S.C. § 1395x(dd)(3)(A) (1994). The Model Act also uses the criterion of death within six months. Baron, et al., supra note 30, at 26. For an account of the clinical difficulty in making determinations of this kind, see Callahan, White, , supra note 3, at 45–47.Google Scholar
Abortion jurisprudence from the outset was able to identify a relatively precise point—viability—at which the state's interest in protecting the life of the fetus outweighed the woman's interest in deciding whether to continue the pregnancy. Roe v. Wade, 412 U.S. 113, 163 (1973).Google Scholar
Compassion in Dying, 79 F.3d at 837; and Quill, 80 F.3d at 731.Google Scholar
Or. Rev. Stat. §§ 127.800(11), 127.805 (1995).Google Scholar
Baron, et al., supra note 30, at 27.Google Scholar
The federal district court held the Oregon Act to be unconstitutional in part because it failed to protect against incompetency at the time the patient takes the prescribed medication. Lee, 891 F. Supp. at 1437.Google Scholar
In re Quinlan, 355 A.2d 647 (N.J.), cert. denied sub nom. Garger v. New Jersey, 429 U.S. 922 (1976).Google Scholar
National Center for State Courts, Guideline for State Court Decision Making in Life-Sustaining Medical Treatment Cases (Williamsburg: National Center for State Courts, 2nd ed., 1992): At 56 n.82.Google Scholar
Compassion in Dying, 79 F.3d at 794–95; and Quill, 80 F.3d at 720.Google Scholar
See, for example, Compassion in Dying, 79 F.3d at 821 (“the final stages of an incurable and painful degenerative disease”); and Quill, 80 F.3d at 730 (“the continuation of agony”).Google Scholar
See Bouvia v. Superior Court, 225 Cal. Rptr. 297 (Cal. App. 1986).Google Scholar
Baron, et al., supra note 30, at 11.Google Scholar
Or. Rev. Stat. § 127.800(12) (1995).Google Scholar
Cassell, E.J., “The Nature of Suffering and the Goals of Medicine,” N. Engl. J. Med., 306 (1982): 640–45.Google Scholar
New York State Task Force on Life and the Law, When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context (New York: New York State Task Force on Life and the Law, 1994): At 2.Google Scholar
Baron, et al., supra note 30, at 25.Google Scholar
Compassion in Dying, 79 F.3d at 831.Google Scholar
Id. at 832.Google Scholar
Quill, 80 F.3d at 730.Google Scholar
Among proponents, see Brock, D.W., “Voluntary Active Euthanasia,” Hastings Center Report, 22, no. 2 (1992): 1022; and Miller, F.G.et al., “Regulating Physician-Assisted Death,” N. Engl. J. Med., 331 (1994): 119–23. Among opponents, see Kamisar, , supra note 36.CrossRefGoogle Scholar
Both the Oregon Act and the Model Act maintain the distinction. Or. Rev. Stat. § 127.880 (1995); and Baron, et al., supra note 30, at 10. A state may include a definition of suicide to differentiate it from euthanasia. See, for example, Gentry v. State, 625 N.E.2d 1268, 1273 (Ind. App. 1993).Google Scholar
I do not attempt to canvass every conceivable type of regulation. For example, I do not discuss the potential role of palliative care consultants or committees, see Miller, et al., supra note 64; notification to family members, see Or. Rev. Stat. § 127.835 (1995); a residency requirement, see Or. Rev. Stat. § 127.860 (1995); or the use of public funds for assisted suicide, see the Assisted Suicide Funding Restoration Act, S. 2108, 104th Cong. (1996) (prohibiting federal funding of assisted suicides).Google Scholar
Compassion in Dying, 79 F.3d at 814 (internal quotation marks and citation omitted).Google Scholar
Beauchamp, T.L. Childress, J.F., Principles of Biomedical Ethics (New York: Oxford University Press, 4th ed., 1994): At 135.Google Scholar
See, for example, Appelbaum, P.S. Roth, L.H., “Competency to Consent to Research: A Psychiatric Overview,” Archives of General Psychiatry, 39 (1982): 951–58; and Freedman, M. Stuss, D.T. Gordon, M., “Assessment of Competency: The Role of Neuro-Behavioral Deficits,” Annals of Internal Medicine, 115 (1991): 203–08.Google Scholar
Young, E.W.D. Corby, J.C. Johnson, R., “Does Depression Invalidate Competence? Consultants' Ethical, Psychiatric, and Legal Considerations,” Cambridge Quarterly of Healthcare Ethics, 1 (1993): At 513.Google Scholar
Compassion in Dying, 79 F.3d at 833.Google Scholar
The evidence on this point is summarized in New York State Task Force on Life and the Law, supra note 58, at 126–28.Google Scholar
Baron, et al., supra note 30, at 29. The Oregon Act permits, but does not require, a counseling referral to a mental health specialist. Or. Rev. Stat. § 127.825 (1995).Google Scholar
Quill, 80 F.3d 731 n.4.Google Scholar
See, for example, Hendin, H. Klerman, G., “Physician-Assisted Suicide: The Dangers of Legalization,” American Journal of Psychiatry, 150 (1993): 143–45.Google Scholar
Beauchamp, Childress, , supra note 68, at 142.Google Scholar
Quill, 80 F.3d at 731 n.4.Google Scholar
Or. Rev. Stat. §§ 127.800(7), 127.815(2) (1995); and Baron, et al., supra note 30, at 27–28. For an argument that, in reality, the trappings of informed consent would often conceal subtle manipulation, see Callahan, White, , supra note 3, at 28–29; and New York State Task Force on Life and the Law, supra note 58, at 121–22. See also Miles, S.H., “Physicians and Their Patients' Suicides,” JAMA, 271 (1994): 1786-88.Google Scholar
The Model Act includes these requirements. Baron, et al., supra note 30, at 28–31.Google Scholar
Compassion in Dying, 79 F.3d at 833.Google Scholar
Id. See also Quill, 80 F.3d at 731 n.4.Google Scholar
Or. Rev. Stat. § 127.850 (1995).Google Scholar
Planned Parenthood v. Casey approved the facial constitutionality of a twenty-four-hour waiting period while leaving open the possibility that the requirement would be an undue burden in particular cases. Casey, 505 U.S. at 885–87.Google Scholar
Or. Rev. Stat. § 127.890(2) (1995).Google Scholar
See Bowe, J. Parker, D.H., Page on the Law of Wills (Cincinnati: W.H. Anderson, 1960): §§ 15.1–.14.Google Scholar
Compassion in Dying, 79 F.3d at 833; and Quill, 80 F.3d at 731.Google Scholar
Or. Rev. Stat. § 127.820 (1995).Google Scholar
Baron, et al., supra note 30, at 29.Google Scholar
See, for example, Md. Code Ann., Health-Gen. § 5–606 (1994).Google Scholar
79 F.3d at 833.Google Scholar
The Oregon Act contemplates administrative rules “to facilitate the collection of information regarding compliance” with the Act. Or. Rev. Stat. § 127.865 (1995). The Model Act would require reporting to the chief health officer of a state. Baron et al., supra note 30, at 30.Google Scholar
Id. at 28.Google Scholar
Meisel, , supra note 23, § 6.5, at 295.Google Scholar
Legislation requiring the courts to approve every case of requested suicide, whether disputed or not, would violate separation of powers principles by requiring courts to perform a nonjudicial function.Google Scholar
Bellotti v. Baird, 443 U.S. 622, 644 (1979).Google Scholar
Or. Rev. Stat. § 127.885(4) (1995).Google Scholar
Baron, et al., supra note 30, at 33.Google Scholar
Meisel, , supra note 23, § 17.23, at 430.Google Scholar
Compassion in Dying, 79 F.3d at 830.Google Scholar
Meisel, , supra note 23, § 19.12, at 549.Google Scholar
See generally, Law, S.A., “Silent No More: Physicians' Legal and Ethical Obligations to Patients Seeking Abortion,” New York University Review of Law and Social Change, 21 (1995): 279321.Google Scholar
Meisel, , supra note 23, § 8.2, at 470.Google Scholar
The gap between legal theory and clinical reality is illustrated by the outcome of the SUPPORT intervention trial. See the SUPPORT Principal Investigators, “A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment,” JAMA, 274 (1995): 1591–98. An explanation for results of this kind may be found in, for example, Orentlicher, D., “The Limits of Legislation,” Maryland Law Review, 53 (1994): 1255-305.Google Scholar
Quill, 80 F.3d at 729.Google Scholar
Cruzan, 497 U.S. at 278.Google Scholar
Annas, G.J., “The Promised End—Constitutional Aspects of Physician-Assisted Suicide,” N. Engl. J. Med., 335 (1996): 683–87.Google Scholar
In rejecting the reasoning of the lower court decisions, the Supreme Court can be expected to apply the constitutional analysis presented in, for example, Kamisar, Y., “Are Laws Against Assisted Suicide Unconstitutional?,” Hastings Center Report, 23, no. 3 (1993): 3241; Coleman, C.H. Miller, T.E., “Stemming the Tide: Assisted Suicide and the Constitution,” Journal of Law, Medicine & Ethics, 23 (1995): 389–97; and Capron, A.M., “Easing the Passing,” Hastings Center Report, 24, no. 4 (1994): 25–26.Google Scholar
Emanuel, E.J.et al., “Euthanasia and Physician-Assisted Suicide: Attitudes and Experiences of Oncology Patients, Oncologists, and the Public,” Lancet, 347 (1996): 1805-10. These results are consistent with other surveys. See, for example, Bachman, J.G.et al., “Attitudes of Michigan Physicians and the Public Toward Legalizing Physician-Assisted Suicide and Voluntary Euthanasia,” N. Engl. J. Med., 334 (1996): 303–09.CrossRefGoogle Scholar