Caseflicks

Supreme Court of the United States • 1997

Washington v. Glucksberg

521 U.S. 702 | 117 S. Ct. 2258 | 138 L. Ed. 2d 772 | 1997 U.S. LEXIS 4039 | 11 Fla. L. Weekly Fed. S 190 | 97 Cal. Daily Op. Serv. 5008 | 97 Daily Journal DAR 8150 | 65 U.S.L.W. 4669

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Takeaway

In short, this case held that the Constitution does not create a fundamental right to physician-assisted suicide, leaving States free to prohibit or regulate the practice through ordinary democratic processes.

Background

Washington made it a felony to knowingly cause or aid another person’s attempted suicide. Its law had long prohibited assisted suicide, while separately allowing competent patients to refuse or withdraw life-sustaining treatment. Washington’s Natural Death Act expressly provided that withdrawing such treatment at a patient’s direction was not suicide.

Four Washington physicians, several terminally ill patients, and Compassion in Dying challenged the law. The physicians alleged that they would provide medication to help competent, terminally ill patients end their lives but for the criminal ban. The District Court held the ban unconstitutional, reasoning that it imposed an undue burden on a protected liberty interest. A Ninth Circuit panel reversed, but the en banc Ninth Circuit reinstated the result, holding that competent, terminally ill adults had a due-process liberty interest in controlling the time and manner of death. The Supreme Court granted review and reversed.

Issues

Issue #1

Whether the Fourteenth Amendment’s Due Process Clause protects a fundamental right of competent, terminally ill adults to obtain physician assistance in committing suicide.

Holding

No. The asserted right to commit suicide with another’s assistance is not a fundamental liberty interest protected by substantive due process.

Reasoning

The Court used its established substantive-due-process method: it carefully described the claimed liberty interest and asked whether that interest is deeply rooted in the Nation’s history and tradition and implicit in ordered liberty. This approach, the Court explained, restrains judges from constitutionalizing personal policy preferences and removing unsettled matters from democratic debate.

The relevant claimed right was not a broad right to autonomy, dignity, or control over the manner of death. Because Washington’s statute prohibited aiding a suicide, the Court defined the claim as a right to commit suicide with another’s assistance. The Court rejected the Ninth Circuit’s broader formulation of a general “right to die.”

History and tradition strongly cut against recognizing that right. Anglo-American law had long condemned suicide and assistance in suicide; by the time the Fourteenth Amendment was ratified, most States criminalized assisting suicide; and nearly every State continued to do so in 1997. These prohibitions historically applied even to persons who were terminally ill or suffering severe pain.

Cruzan did not establish a right to assisted suicide. Cruzan assumed that a competent person has a protected interest in refusing unwanted life-sustaining treatment, but that conclusion rested on the common-law rules against unwanted bodily touching and the established doctrine of informed consent. The Court regarded refusing medical intervention and obtaining another person’s help to cause death as legally and morally distinct acts.

Casey likewise did not make every intimate or personally important decision a fundamental constitutional right. Although Casey recognized that certain decisions involving marriage, family, procreation, contraception, and abortion implicate dignity and autonomy, those decisions had roots in constitutional tradition that assisted suicide lacked. Personal importance alone could not establish a new fundamental right.

Issue #2

Whether Washington’s categorical ban on assisting suicide is rationally related to legitimate state interests.

Holding

Yes. Because no fundamental right was implicated, rational-basis review applied, and Washington’s prohibition reasonably furthered multiple legitimate and important interests.

Reasoning

Washington had a legitimate interest in preserving human life and in refusing to make legal judgments that some lives, because of illness, disability, age, or suffering, are less worthy of protection. The State could protect all lives equally rather than adopt a sliding scale based on a person’s medical condition or stated desire to die.

The State could also seek to prevent suicide and protect people whose requests for death may arise from depression, untreated pain, mistaken prognosis, or other remediable conditions. The Court emphasized evidence that suicidal wishes, including those of terminally ill patients, may change when pain and depression are adequately treated.

Washington reasonably relied on its interest in protecting vulnerable people—including the poor, elderly, disabled, and seriously ill—from coercion, abuse, neglect, mistake, prejudice, and financial pressure. End-of-life decisions can involve subtle influence from family members, caregivers, and health-care institutions, and the State was entitled to guard against those risks through a prohibition rather than regulation.

The ban also served the State’s interest in preserving medical ethics and the physician-patient relationship. Washington could accept the view, supported by the American Medical Association and other professional organizations, that physician-assisted suicide is incompatible with the physician’s traditional role as healer and could undermine patient trust.

Finally, Washington could reasonably fear that authorizing physician-assisted suicide would be difficult to confine to competent, terminally ill adults who self-administered medication. The Court accepted concerns that the practice could expand toward euthanasia, surrogate decisionmaking, and assistance by nonphysicians. The State therefore could prevent this potential erosion by maintaining a categorical prohibition.

Concurrences

Justice O'Connor

Reasoning

Justice O'Connor joined the Court's result, but justice O’Connor agreed that there is no generalized constitutional right to commit suicide or receive assistance in doing so. She nevertheless stressed that the case did not require the Court to decide whether a mentally competent, imminently dying patient has a narrower liberty interest in controlling the circumstances of death and obtaining relief from extreme suffering.

That narrower question was unnecessary because Washington permitted physicians to provide palliative medication sufficient to alleviate pain, even if the treatment risked unconsciousness or hastened death. In her view, the risks of error in identifying terminal illness, impaired competence, and genuine voluntariness justified the State’s general prohibition on physician-assisted suicide.

She also emphasized institutional restraint. States were actively studying end-of-life care and experimenting with policy responses, so the democratic process and the states as policy laboratories should ordinarily determine the appropriate balance between patient autonomy and protections against abuse.

Justice Stevens

Reasoning

Justice Stevens agreed that the plaintiffs had not established that Washington’s statute was unconstitutional on its face or as applied to the broad class recognized by the Ninth Circuit. But he rejected the implication that the decision necessarily validated every future application of the statute to a particular dying patient or physician.

In his view, Cruzan reflected a broader liberty interest in dignity and in deciding how to confront imminent death, not merely a common-law right to refuse medical treatment. A patient who is terminally ill, experiencing intolerable suffering, and unable to avoid a degrading death may possess a constitutionally significant interest in choosing how to cross the threshold of death.

The State’s interests in preserving life, preventing suicide, protecting vulnerable people, and preserving medical ethics are powerful as general matters, but their force may vary in a particular case. When a competent, informed patient makes a voluntary decision free from depression, coercion, or inadequate pain treatment, those interests may not always outweigh the patient’s liberty and dignity interests.

Justice Stevens also noted tension between the legal distinction drawn by the State and actual medical practice. Physicians may legally withdraw life support or administer terminal sedation knowing that death will be hastened. Although the distinction between causing death and allowing death can sustain the statute generally, intent and causation may be less distinct in individual cases.

Justice Souter

Reasoning

Justice Souter concurred in the judgment but rejected the majority’s rigid history-and-tradition formulation as the sole substantive-due-process test. Drawing on Justice Harlan’s Poe v. Ullman dissent, he would ask whether the statute imposed an arbitrary or purposeless restraint after a careful, contextual comparison of the individual liberty interest and the State’s competing interests.

The asserted interest, as Justice Souter framed it, was narrow: a competent, terminally ill patient facing imminent death, severe suffering, and indignity seeking a physician’s advice and medication to end life. That interest drew support from traditions of bodily integrity, informed medical decisionmaking, the right to refuse treatment, and the role of physicians in helping patients make profound personal medical decisions.

Even so, Justice Souter concluded that Washington’s interests defeated this challenge at this time. The State could reasonably worry that rules limited to informed, competent, terminally ill patients would prove hard to administer, that competence and voluntariness are difficult to assess, and that physicians might not reliably maintain the line between assisted suicide and euthanasia.

The disputed evidence about the Dutch experience illustrated why the Court should not displace legislative judgment. Legislatures have better tools for factfinding and experimentation and can revise their choices as evidence develops. Justice Souter therefore left open the possibility that future facts or future cases could justify a different constitutional result.

Justice Ginsburg

Reasoning

Justice Ginsburg concurred in the judgment substantially for the reasons given by Justice O’Connor. She agreed that the facial challenge failed without resolving whether a narrower interest in relief from suffering at the end of life might receive constitutional recognition in a different case.

Justice Breyer

Reasoning

Justice Breyer agreed with Justice O’Connor that the Court should not reject the claim simply by describing it as a right to commit suicide with assistance. He believed the more relevant potential liberty interest was a right to die with dignity, involving personal control over the manner of death, professional medical assistance, and avoidance of severe physical suffering.

He found it unnecessary to decide whether that interest was fundamental because Washington law allowed physicians to provide palliative care and pain-relieving drugs even when those drugs could hasten death. Thus, the laws did not directly force dying patients to endure otherwise unavoidable severe pain.

Justice Breyer reserved the possibility that a different constitutional question would arise if state law barred adequate palliative treatment or prevented physicians from relieving severe end-of-life suffering.