Caseflicks

Supreme Court of the United States • 2006

Gonzales v. Oregon

546 U.S. 243 | 126 S. Ct. 904 | 163 L. Ed. 2d 748 | 2006 U.S. LEXIS 767

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Takeaway

In short, this case holds that the CSA did not give the Attorney General power to override Oregon's physician-assisted-suicide law by declaring the practice an illegitimate medical use of controlled substances.

Background

Oregon's Death with Dignity Act permits a state-licensed physician to prescribe a lethal dose of medication to a competent, terminally ill adult who meets detailed procedural safeguards. The patient must make a voluntary and informed request; a second physician must confirm the diagnosis and eligibility; and physicians must keep records subject to state review. The patient, rather than the physician, administers the medication.

The drugs used in Oregon's program are controlled substances regulated by the federal Controlled Substances Act (CSA). In 2001, Attorney General John Ashcroft issued an Interpretive Rule declaring that using controlled substances to assist suicide was not a "legitimate medical purpose" and violated the CSA, regardless of state law. The Rule warned that participating physicians could face criminal liability and loss of their federal registrations to prescribe controlled substances.

Oregon, along with physicians, a pharmacist, and terminally ill patients, challenged the Rule. The District Court permanently enjoined its enforcement. The Ninth Circuit affirmed, holding that the CSA did not clearly authorize the Attorney General to override Oregon's determination that physician-assisted suicide, subject to its safeguards, was legitimate medical practice. The Supreme Court affirmed the Ninth Circuit.

Issues

Issue #1

Whether the Attorney General's Interpretive Rule was entitled to controlling deference as an interpretation of the Attorney General's own regulation under Auer v. Robbins.

Holding

No. The Rule did not interpret an independent agency regulation in a manner warranting Auer deference; it effectively interpreted the CSA itself.

Reasoning

The relevant regulation requires a controlled-substance prescription to be issued for a "legitimate medical purpose" by a practitioner acting in the usual course of professional practice. But that language substantially repeats terms used in the CSA. The regulation does not answer the central question in the case: who has authority to decide whether physician-assisted suicide is a legitimate medical practice.

An agency does not gain special authority to resolve a statutory ambiguity simply by restating statutory language in a regulation. Because the Interpretive Rule's real subject was the meaning and reach of the CSA, rather than a distinct regulatory standard developed through the Attorney General's expertise, Auer deference did not apply.

The regulation also predated the 1984 CSA amendments on which the Government principally relied for the Attorney General's registration authority. The later Interpretive Rule therefore could not plausibly be treated as an explanation of the Attorney General's original regulatory intent.

Issue #2

Whether Congress delegated authority to the Attorney General to issue an Interpretive Rule with the force of law declaring physician-assisted suicide unlawful under the CSA.

Holding

No. The CSA did not delegate to the Attorney General authority to define general standards of medical practice or to declare Oregon's physician-assisted-suicide regime criminal.

Reasoning

Chevron deference applies only when Congress has delegated to an agency authority to make rules carrying the force of law and the agency acted under that delegated authority. Although "legitimate medical purpose" is an ambiguous general phrase, ambiguity alone does not establish that the Attorney General has authority to settle its meaning with binding force.

The CSA's rulemaking provisions are limited. They permit rules relating to registration and the control of controlled substances, and rules necessary for the efficient execution of the Attorney General's assigned functions. In the statute, "control" principally concerns scheduling substances and requires specified procedures and medical input; the Interpretive Rule neither scheduled a substance nor followed those procedures.

The Attorney General's power to register or deregister practitioners also did not support the Rule. Registration decisions require consideration of five statutory factors in individual cases. The Rule instead announced that an entire class of conduct was a federal crime, then treated possible deregistration as a consequence. That approach would convert a limited registration power into a broad, unconfined power to criminalize medical practices.

The CSA divides authority between the Attorney General and the Secretary of Health and Human Services. In areas requiring scientific and medical judgments, including drug scheduling and addiction treatment, Congress assigned an important and sometimes controlling role to the Secretary. That allocation makes it implausible that Congress silently gave the Attorney General, a law-enforcement official, sweeping authority to establish nationwide medical standards.

The claimed authority would allow the Attorney General to decide which uses of any controlled drug are medically legitimate and to threaten deregistration for any controversial treatment. Given the political and moral significance of physician-assisted suicide and the resulting shift in the federal-state balance, the Court would not infer such a major delegation from indirect statutory language.

Issue #3

Whether, even without Chevron deference, the CSA itself prohibits physicians from prescribing controlled substances for physician-assisted suicide authorized by Oregon law.

Holding

No. The CSA's text, structure, and purpose do not authorize the Attorney General to prohibit the use of controlled substances for physician-assisted suicide under Oregon's medical regime.

Reasoning

At most, the Interpretive Rule was entitled to Skidmore respect proportional to its power to persuade. Its persuasiveness was diminished by the Attorney General's lack of medical expertise, the absence of consultation outside the Justice Department, its inconsistency with the Department's earlier position, and its weak fit with the statute's structure.

The CSA was enacted principally to combat drug abuse and to regulate the legitimate and illicit traffic in controlled substances. Its provisions concerning physicians target conduct in which a doctor uses prescription authority as a means of drug dealing or trafficking, as in a case involving large-scale, profit-driven overprescribing. The statute does not manifest a general purpose to regulate medical practice as such.

The statute instead presupposes that States regulate the medical profession. A practitioner's eligibility for federal registration depends in part on state authorization; the Attorney General must consider state licensing authorities' recommendations and state-law compliance; and the CSA's express nonpreemption provision preserves state law absent a positive conflict.

Oregon did not merely remove penalties for assisted suicide. It created a detailed medical regime involving licensed physicians, eligibility findings, a confirming physician, informed-consent safeguards, counseling when impaired judgment is suspected, recordkeeping, and state oversight. That regime falls within the States' traditional authority over health, safety, and medical practice.

Read in context, the CSA's prescription requirement ensures that controlled substances are dispensed under medical supervision to prevent addiction, diversion, and recreational abuse. It also prevents physicians from functioning as drug peddlers. Nothing in the Act clearly extends that requirement to authorize the Attorney General to override a State's considered judgment on the permissible medical use of drugs in end-of-life care.

Congress knew how to establish nationwide standards of medical practice when it wished to do so. In the related statutory provisions governing treatment for narcotic addiction, Congress expressly assigned the Secretary authority to determine appropriate professional methods. The CSA contains no comparable authorization concerning physician-assisted suicide.

Dissents

Justice Scalia

Reasoning

Justice Scalia, joined by Chief Justice Roberts and Justice Thomas, argued that the Attorney General's Directive had three distinct components that the majority improperly merged: it interpreted "legitimate medical purpose" in the existing regulation, concluded that assisted-suicide prescriptions violated the CSA, and stated that such conduct could make a physician's registration inconsistent with the public interest. In his view, each component independently supported reversal.

He maintained that Auer deference controlled because the Attorney General was interpreting his own valid regulation. The regulation did more than repeat the statute: it gave substantive content to the undefined statutory term "prescription" by requiring an objectively legitimate medical purpose. The Directive's conclusion that intentionally prescribing drugs to cause death is not a legitimate medical purpose was neither plainly erroneous nor inconsistent with that regulation.

Justice Scalia also concluded that Chevron deference was proper even if the Directive were treated as interpreting the CSA directly. He read the Attorney General's authority to issue rules relating to the "control" of dispensing controlled substances in its ordinary sense, rather than as a narrow reference only to scheduling drugs. That authority, he reasoned, encompassed interpretation of prescription requirements and registration provisions.

On the merits, he viewed physician-assisted suicide as outside the ordinary and historically accepted meaning of medicine. Medical tradition, professional organizations, federal policy, and the laws of nearly every State treated a physician's intentional assistance in suicide as incompatible with the physician's role as healer. Thus, he regarded the Directive as the most natural reading of "legitimate medical purpose," even without deference.

He further argued that the Attorney General had explicit discretion to deny or revoke a registration when it would be inconsistent with the public interest, including where conduct threatens public health and safety. The Attorney General could announce in advance that assisted-suicide prescribing may bear on those factors and later apply the statutory five-factor test in an individual enforcement proceeding.

Justice Scalia rejected the majority's federalism rationale. The CSA's nonpreemption clause disclaimed only field preemption and allowed federal law to prevail in an actual conflict. In his view, the Directive did not preempt Oregon's law; it simply made conduct federally unlawful even if Oregon chose to permit it. Congress could use its commerce power to address assisted suicide, and he concluded that it had done so through the CSA.

Justice Thomas

Reasoning

Justice Thomas argued that the majority's narrow construction of the CSA was difficult to reconcile with Gonzales v. Raich, decided only months earlier. In Raich, the Court had described the CSA as a comprehensive regime governing which controlled substances may be used for medicinal purposes and the manner in which they may be used.

In his view, the majority had retreated from Raich by recasting the CSA as concerned only with illicit drug trafficking, addiction, and recreational abuse. The Attorney General's conclusion that using drugs to cause a patient's death is not a legitimate medical purpose was at least reasonable and should therefore have received deference.

Justice Thomas agreed that federalism concerns may counsel against broad federal regulation of state medical policy. But he believed those concerns had been rejected as a basis for limiting the CSA in Raich, where the Court allowed federal enforcement against intrastate, state-authorized medical marijuana. Once Raich accepted the CSA's broad reach, he concluded, the Court could not invoke the same federalism principles to narrowly interpret the Act in Oregon's favor.