The court upholds a state law prohibiting physician-assisted suicide.

• Author: Feinberg, Brett
• Position: Supreme Court Review - Case Note

Vacco v. Quill, 117 S. Ct. 2293 (1997)

1. INTRODUCTION

   In Vacco v. Quill,(1) the United States Supreme Court addressed whether a terminally ill person has a constitutionally protected right to commit suicide with the assistance of a physician.(2) The Court held that state laws prohibiting physician-assisted suicide are constitutionally permissible since they do not violate the Equal Protection Clause.(3) In making its decision, the Court determined that the right to die with assistance is not a fundamental right.(4) The Court also concluded that the withdrawal of lifesaving medical treatment is distinguishable from physician-assisted suicide.(5)

   This Note argues that the Supreme Court incorrectly concluded that the right to die with assistance is not a fundamental right.(6) In addition, this Note contends that the Court improperly distinguished withdrawal of lifesaving equipment from physician-assisted suicide.(7) This Note further argues that the state has no legitimate interest in preventing terminally ill patients from seeking assistance from a physician to hasten their death.(8) Finally, this Note addresses the ramifications of the Court's decision.(9)

2. BACKGROUND

   1. THE "RIGHT TO DIE"

      Physician-assisted suicide involves a doctor's performance of an act that results in the patient's death.(10) The debate over physician-assisted suicide begins with the judicially recognized "right to die."(11) The term "right to die" refers to an individual's right to discontinue lifesaving medical treatment, even though the patient will die if treatment is ended.(12)

      The "right to die" developed as a judicial response to patients' desires to make critical decisions regarding their own treatment, decisions traditionally left to the discretion of the doctor.(13) Beginning with the 1976 case In re Quinlan,(14) courts, physicians, and the public grew to accept the idea that patient autonomy, in certain circumstances, extends to life-or-death treatment decisions. The New Jersey Supreme Court was the first court to issue a written decision recognizing the right to refuse life-sustaining treatment in Quinlan.(15) The case involved Karen Ann Quinlan, a twenty-two-year-old female who was in a persistent vegetative state.(16) The condition resulted from two fifteen-minute periods in which she had stopped breathing.(17) Karen's parents wanted to disconnect their daughter's respirator and other devices which were keeping her alive.(18)

      The New Jersey Supreme Court held that Karen had a constitutional right to be removed from the lifesaving treatment and that her guardian father could exercise that right on her behalf.(19) The court explained that this right to die emanated from the constitutional right of privacy.(20) Although the court acknowledged that the state had a strong interest in preserving life, it reasoned that the state's interest is attenuated when there is no chance of the patient regaining cognitive life and is outweighed by the attendant bodily invasion necessitated by medical care.(21)

      Thus, Quinlan established precedent permitting terminally ill patients to withdraw from lifesaving treatment. More importantly, Quinlan lay the foundation for the principle later espoused by the Supreme Court: A patient has the right to end life-sustaining treatment so long as there is clear and convincing evidence of the individual's wish for withdrawal of treatment.(22)

      The Supreme Court addressed the "right to die" in Cruzan v. Director, Missouri Department of Health.(23) Cruzan presented the issue of whether a state may prohibit the withdrawal of life-sustaining treatment. In Cruzan, the plaintiffs' daughter, Nancy Beth Cruzan, was severely injured in a car accident.(24) After remaining in a coma for three weeks, she slipped into a persistent vegetative state, "a condition in which a person exhibits motor reflexes but evinces no indications of significant cognitive function."(25) In order to keep her alive, feeding and hydration tubes were implanted in her stomach.(26)

      With no hope that Nancy's condition would improve, her parents requested that the hospital end the lifesaving treatment.(27) The hospital, however, refused to do so without a court order.(28) Accordingly, Nancy's parents filed a declaratory judgment action to terminate the artificial hydration and nutrition being supplied to their daughter.(29) They argued that Nancy had a Fourteenth Amendment(30) right not to be kept alive by unwanted medical procedures.(31)

      The state probate court held that Nancy had a state and a federal constitutional right to refuse treatment.(32) However, the Missouri Supreme Court reversed the probate court and held that since Nancy was unable to make any judgments, she did not have a right to refuse life-sustaining treatment.(33) The court argued that the state interest in preserving life "outweighs any rights invoked on Nancy's behalf to terminate treatment in the face of the uncertainty of Nancy's wishes and her own right to life."(34) The Cruzans appealed and the U.S. Supreme Court granted certiorari.(35) The Supreme Court upheld the Missouri Supreme Court's decision, ruling that Missouri's continuation of lifesaving treatment did not violate Nancy's Fourteenth Amendment rights.(36) The Court determined that a competent adult has a right to refuse lifesaving treatment based on the common law right to informed consent to treatment and on privacy or liberty interests found in the Constitution.(37) The Court explained that, although an individual has a liberty interest under the Due Process Clause of the Fourteenth Amendment,(38) the inquiry does not end there.(39) Rather, to ascertain whether an individual's rights have been violated, a court must "balance his liberty interests against the relevant state interests."(40)

      Second, the Court stated that when a patient is incompetent, lifesaving treatment will not be discontinued unless there is clear and convincing evidence that the incompetent individual would want to withdraw treatment.(41) The Court determined that there was not clear and convincing evidence that Nancy would have wanted the lifesaving procedures terminated; accordingly, the Court upheld the Missouri Supreme Court's ruling.(42) However, although the Court did not permit Nancy's parents to end their daughter's lifesaving treatment, it did recognize for the first time that the "right to die" can exist in other factual contexts.(43)

   2. THE RIGHT TO PHYSICIAN-ASSISTED SUICIDE

      Historically, most societies have discouraged acts of physician-assisted suicide.(44) This view is demonstrated in the Hippocratic Oath(45) which states, "I will give no deadly medicine to anyone if asked, nor suggest such counsel ...."(46) In ancient times, suicide was a criminal offense, punishable by forfeiture of property to the king and a dishonorable burial.(47) An individual who assisted in a suicide was guilty of murder since he was a "second-degree principal to the death."(48) Today, no state treats suicide itself as a felony, although most states have retained laws criminalizing assisted suicide.(49)

      In 1995, the issue of assisted suicide came to the forefront of legal debate when an Oregon district court(50) held that a law authorizing physician-assisted suicide violates the Equal Protection Clause.(51) In Lee v. Oregon, a court for the first time analyzed whether physician-assisted suicide violated the Equal Protection Clause.(52) The plaintiffs(53) claimed that Oregon's "Death With Dignity Act"(54) violates the Equal Protection Clause, arguing that its classification of terminally ill patients is not rationally related to a legitimate state interest.(55) The court agreed with the plaintiffs and held the act unconstitutional.(56)

      In finding the law unconstitutional, the court described several inadequacies of the Act's protections for the terminally ill.(57) In addition, the court found no rational relationship between the state interests and the terminally ill/non-terminally ill distinction.(58) Lee v. Oregon was the first time a court found a statute

      permitting physician-assisted suicide to be unconstitutional on equal protection grounds.

      Recently, the Supreme Court analyzed whether physician-assisted suicide violates the Due Process Clause.(59) The Due Process Clause of the Fourteenth Amendment(60) protects individuals from government interference in fundamental rights and liberty interests.(61) In Washington v. Glucksberg,(62) the Supreme Court held that the asserted right to physician-assisted suicide is not a fundamental liberty interest protected by the Due Process Clause.(63)

      In 1994, three terminally ill patients, four physicians, and a nonprofit organization challenged a Washington statute(64) prohibiting assisted suicide, arguing that it violated the Due Process and Equal Protection Clauses of the Constitution.(65) The District Court for the Western District of Washington found the statute unconstitutional,(66) upon which the State of Washington appealed.(67) The Ninth Circuit, in a 2-1 decision, concluded that there was no constitutional basis to invalidate the statute and reversed the lower court's decision.(68) Subsequently, the Ninth Circuit en banc determined that the statute violated the Due Process Clause and affirmed the district court's decision.(69)

      The Supreme Court reversed the decision of the Ninth Circuit, holding that statutes prohibiting physician-assisted suicide do not violate the Due Process Clause of the Fourteenth Amendment.(70) Writing for the majority, Chief Justice Rehnquist began with an historical analysis of assisted suicide from which he concluded that society has made it a crime to assist in a suicide.(71) The Chief Justice then addressed the due process issue, explaining that the Due Process Clause is to be applied only in narrow circumstances.(72) The Court determined that the Washington statute does not present one of these circumstances; it does not involve a liberty specially protected by...