SCOTUS: Fed. Gov’t Can’t Usurp State Law On Medical Issues

… In 1994, voters in the state of Oregon approved Measure 16, aballot initiative that established the Oregon Death with Dignity Act, by a margin of 31,962 votes, or 51.3%. The Act legalized physician-assisted suicide. A 1997 referral by the Oregon Legislative Assembly aimed to repeal the Death with Dignity Act, but was defeated by a 60% margin, with 220,445 votes cast against it. The law permits physicians to prescribe a lethal dose of medication to a patient agreed by two doctors to be within six months of dying from an incurable condition. As of 2006, 292 individuals had ended their lives under the law.

On November 9, 2001, Attorney GeneralJohn Ashcroft issued an Interpretive Rule that assisted-physician suicide was not a legitimate medical purpose, and that any physician administering federally controlled drugs for that purpose would be in violation of the Controlled Substances Act. The State of Oregon, joined by a physician, a pharmacist, and a group of terminally ill patients, all from Oregon, filed a challenge to the Attorney General's rule in the U.S. District Court for the District of Oregon.[3] The court ruled for Oregon and issued a permanent injunction against the enforcement of the Interpretive Rule. The ruling was affirmed by the Ninth Circuit Court of Appeals.

In a 6-3 decision written by Justice Anthony Kennedy, the Court affirmed the Ninth Circuit's judgment, but employed different reasoning. The majority opinion did not dispute the power of the federal government to regulate drugs, but disagreed that the statute in place empowered the U.S. Attorney General to overrule state laws determining what constituted the appropriate use of medications that were not themselves prohibited. The court found that it was inappropriate to apply Chevron deference toward the Attorney General's "interpretive rule" that controlled substances could not medically be used for the purpose of euthanasia.

Justice Scalia, in a dissent joined by Chief Justice Roberts and Justice Thomas, argued that under the Supreme Court precedent deference was due to the Attorney General's interpretation of the statute. He wrote that "[i]f the term 'legitimate medical purpose' has any meaning, it surely excludes the prescription of drugs to produce death".

On January 17, 2006, the Supreme Court ruled that the 1970 Controlled Substances Act (CSA) does not give the U.S. attorney general the authority to prohibit Oregon doctors from prescribing lethal doses of drugs to certain terminally ill patients who want to end their own lives. The court's decision in Gonzales v. Oregon resolves a conflict between the state's Death with Dignity Act (DWDA) and the attorney general's interpretation of the federal drug statute. Oregon is currently the only state that has an assisted-suicide law.

When the Oregon law was first enacted in 1994, the Justice Department, under then-Attorney General Janet Reno, determined that the law did not violate the CSA. In 2001, however, then-Attorney General John Ashcroft reversed this finding and issued a ruling designed to halt the practice of physician-assisted suicide under Oregon's law. The "Ashcroft Directive," as it came to be known, stated that physician-assisted suicide was not a "legitimate medical purpose," as defined by the CSA. Thus, any prescriptions written for that purpose would be unlawful and expose the offending medical practitioner to civil, or even criminal, sanctions. Ashcroft's successor, Attorney General Alberto Gonzales, also endorsed the Directive.

The Supreme Court, by a 6-3 vote, ruled that the Directive exceeded the powers that Congress granted to the attorney general under the CSA. The court thus affirmed a ruling by the U.S. Court of Appeals for the Ninth Circuit that had held the Directive "unlawful and unenforceable." Dissenting in the case were Justices Antonin Scalia and Clarence Thomas, as well as Chief Justice John Roberts, who cast his first dissenting vote since joining the court on Sept. 29, 2005.

The immediate legal impact of the court's ruling is clear: Oregon physicians may prescribe drugs under the Death with Dignity Act without fear of federal penalty. The broader legal significance of the ruling, however, is less clear. Although other states may be encouraged to adopt similar provisions, those who oppose physician-assisted suicide will likely continue to try to use the CSA to impede the practice. Opponents may also attempt to press Congress to enact a nationwide assisted-suicide ban, although past efforts to pass such legislation have come to naught.

The court in Gonzales v. Oregon did not completely close the door to federal regulation of physician-assisted suicide. In fact, it may not even have foreclosed administrative regulation of the practice under the CSA. If federal executive branch agencies, through their own processes for adopting administrative rules, end up remedying the defects identified by the court in Gonzales v. Oregon, the state's victory could be fleeting. If, however, the defects identified by the court relate to the more basic issue of the distribution of authority between state and federal government, then overcoming the court's decision will, at a minimum, require congressional action — action that, as already noted, Congress thus far has declined to take.

Bruce Eden

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