In 1975, 21-year-old Karen Ann Quinlan was admitted to the hospital in a coma, and was later declared by doctors to be in a "persistent vegetative state." After five months on a ventilator, her parents requested that the ventilator be removed and that Ms. Quinlan be allowed to die. After doctors refused, her parents brought the matter to court.
The New Jersey Superior Court denied her parents' request, but the New Jersey Supreme Court reversed and ruled that Quinlan's "right to privacy" included her right to be removed from the ventilator.
"Although the Constitution does not explicitly mention a right of privacy, Supreme Court decisions have recognized that a right of personal privacy exists and that certain areas of privacy are guaranteed under the Constitution." (p. 23)
"We think that the State's interest contra weakens and the individual's right to privacy grows as the degree of bodily invasion increases and the prognosis dims. Ultimately there comes a point at which the individual's rights overcome the State interest. It is for that reason that we believe Karen's choice, if she were competent to make it, would be vindicated by the law. Her prognosis is extremely poor..." (p. 24)
"Our affirmation of Karen's independent right of choice, however, would ordinarily be based upon her competency to assert it. The sad truth, however, is that she is grossly incompetent and we cannot discern her supposed choice based on the testimony of her previous conversations with friends, where such testimony is without sufficient probative weight... Nevertheless we have concluded that Karen's right of privacy may be asserted on her behalf by her guardian under the peculiar circumstances here present." (p. 24)
"The termination of treatment pursuant to the right of privacy is, within the limitations of this case, ipso facto lawful. Thus, a death resulting from such an act would not come within the scope of the homicide statutes proscribing only the unlawful killing of another. There is a real and in this case determinative distinction between the unlawful taking of the life of another and the ending of artificial life-support systems as a matter of self-determination." (p. 34)
Nancy Beth Cruzan was involved in an automobile accident that left her in a "persistent vegetative state." After being sustained for several weeks by artificial feedings, her parents attempted to end life-support, but state hospital officials refused to do so without court approval.
A state trial court authorized the termination of feeding, but the Missouri Supreme Court reversed. In a 5-4 decision, the U.S. Supreme Court upheld the ruling of the Missouri Supreme Court, finding that the State of Missouri's actions to preserve human life were constitutional in the absence of "clear and convincing evidence" that Cruzan desired treatment to be withdrawn.
"The United States Constitution does not forbid Missouri to require that evidence of an incompetent's wishes as to the withdrawal of life-sustaining treatment be proved by clear and convincing evidence." (p. 1)
"A competent person has a liberty interest under the Due Process Clause in refusing unwanted medical treatment... However, the question whether that constitutional right has been violated must be determined by balancing the liberty interest against relevant state interests. For purposes of this case, it is assumed that a competent person would have a constitutionally protected right to refuse lifesaving hydration and nutrition. This does not mean that an incompetent person should possess the same right." (p. 2)
"The Due Process Clause does not require a State to accept the 'substituted judgment' of close family members in the absence of substantial proof that their views reflect the patient's." (p. 3)
Harold Glucksberg, MD, along with three other doctors, three gravely ill patients, and the nonprofit organization Compassion in Dying, brought a suit challenging the state of Washington's ban on physician-assisted suicide.
The plaintiffs asserted that the Washington ban was unconstitutional, arguing that the existence of a liberty interest protected by the Fourteenth Amendment allows mentally competent, terminally ill adults to commit physician-assisted suicide. The District Court ruled that the ban was unconstitutional, and the Ninth Circuit affirmed.
The Supreme Court, in a 9-0 decision, reversed, finding that the ban on physician-assisted suicide does not violate the Fourteenth Amendment.
"In almost every State -- indeed, in almost every western democracy -- it is a crime to assist a suicide. The States' assisted suicide bans are not innovations. Rather, they are longstanding expressions of the States' commitment to the protection and preservation of all human life."
"The decision to commit suicide with the assistance of another may be just as personal and profound as the decision to refuse unwanted medical treatment, but it has never enjoyed similar legal protection. Indeed, the two acts are widely and reasonably regarded as quite distinct." (p. 10)
"That many of the rights and liberties protected by the Due Process Clause sound in personal autonomy does not warrant the sweeping conclusion that any and all important, intimate, and personal decisions are so protected." (p. 10)
"The asserted 'right' to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause." (p. 11)
Timothy Quill, MD, along with two other physicians and three gravely ill patients, challenged the constitutionality of New York state's ban on physician-assisted suicide. The plaintiffs argued that New York's ban violated the Equal Protection Clause of the Fourteenth Amendment, as the law allowed for patients to refuse life-sustaining treatment, but not for them to receive assistance in suicide.
The District Court ruled in favor of the State of New York, and the Second Circuit reversed in favor of Dr. Quill. The Supreme Court, in a 9-0 ruling, upheld the constitutionality of New York's ban on physician-assisted suicide.
"New York's statutes outlawing assisting suicide affect and address matters of profound significance to all New Yorkers alike. They neither infringe fundamental rights nor involve suspect classifications." (p. 2)
"We think the distinction between assisting suicide and withdrawing life sustaining treatment, a distinction widely recognized and endorsed in the medical profession and in our legal traditions, is both important and logical." (p. 3)
"Even as the States move to protect and promote patients' dignity at the end of life, they remain opposed to physician assisted suicide." (p. 4)
"Our assumption of a right to refuse treatment was grounded not, as the Court of Appeals supposed, on the proposition that patients have a general and abstract 'right to hasten death'... but on well established, traditional rights to bodily integrity and freedom from unwanted touching." (p. 5)
Fifty-two year old Thomas Youk was suffering from Lou Gehrig's disease when, upon Youk's request, Jack Kevorkian, MD, administered a lethal drug to Youk, who died as a result.
Dr. Kevorkian filmed Youk's death and the trial court jury, who saw the videotapes in court, convicted Kevorkian of second-degree murder, despite his claims that he had committed a "mercy killing." The Michigan Court of Appeals affirmed the conviction.
"Succinctly put, there is no principled basis for us to legalize euthanasia." (p. 2)
"In summary, defendant does not, nor could he, ask us to hold that his actions were legally justifiable because he simply helped Youk exercise his right to refuse medical care. Defendant does not, nor could he, ask us to hold that he was lawfully attempting to alleviate Youk's pain and suffering by any means other than causing his death. Defendant does not, nor could he, ask us to hold that his actions constituted a legal form of assisted suicide. In a nutshell, and using his own terminology, defendant asks us to legalize euthanasia." (p. 9)
"Defendant's argument that the people have reserved the right to euthanasia under the Ninth Amendment and its Michigan counterpart is basically formless." (p. 9)
"It is one thing to assert, as defendant does, that there is a large body of case law suggesting that due process sometimes relies on the right to privacy to protect fundamental liberty interests. It is quite another thing, however, to conclude that the right to privacy encompasses euthanasia." (p. 10)
Theresa Schiavo had been in a persistent vegetative state since 1990. The Second District Court of Florida allowed for the removal of her nutrition and hydration tube on Oct. 15, 2003. On Oct. 21, 2003, the Florida Legislature enacted chapter 2003-418, and Governor Jeb Bush signed the Act into law, issuing executive order No. 03-201 to stay the continued withholding of nutrition and hydration from Theresa.
Michael Schiavo, Theresa's husband and guardian, challenged the Act in circuit court, and the circuit court ruled in his favor, finding the Act unconstitutional. The Florida Supreme Court affirmed.
"In this case, the undisputed facts show that the guardianship court authorized Michael to proceed with the discontinuance of Theresa’s life support after the issue was fully litigated in a proceeding in which the Schindlers were afforded the opportunity to present evidence on all issues... Thus, the Act, as applied in this case, resulted in an executive order that effectively reversed a properly rendered final judgment and thereby constituted an unconstitutional encroachment on the power that has been reserved for the independent judiciary. (p. 15)
"The Act is unconstitutional on its face because it delegates legislative power to the Governor." (p. 18)
In 1994, Oregon passed the Death with Dignity Act, the first state law permitting physicians to prescribe lethal doses of controlled substances to terminally ill patients. U.S. Attorney General John Ashcroft declared in 2001 that the Act violated the Controlled Substances Act of 1970, and threatened to revoke the medical licenses of physicians who engaged in physician-assisted suicide.
Oregon sued the Attorney General in federal district court. The district court and the Ninth Circuit both held that Ashcroft's directive was illegal.
The U.S. Supreme Court, in a 6-3 opinion, also held that the Controlled Substances Act did not authorize the Attorney General to ban the use of controlled substances for physician-assisted suicide.
"The CSA [Controlled Substances Act] does not allow the Attorney General to prohibit doctors from prescribing regulated drugs for use in physician-assisted suicide under state law permitting the procedure." (p. 2)
"The Attorney General has rulemaking power to fulfill his duties under the CSA. The specific respects in which he is authorized to make rules, however, instruct us that he is not authorized to make a rule declaring illegitimate a medical standard for care and treatment of patients that is specifically authorized under state law." (p. 16)
"In the face of the CSA’s silence on the practice of medicine generally and its recognition of state regulation of the medical profession it is difficult to defend the Attorney General’s declaration that the statute impliedly criminalizes physician-assisted suicide." (p. 30)