Regulating the Right to Die:

The Supreme Court Considers Physician-Assisted Suicide

Questions concerning the right to end one's life have long generated storms of controversy. These questions, involving intensely personal views on issues no less profound than the meaning of life and liberty, are unlikely to disappear any time soon. The conservative nature of the medical profession, and the organized opposition of the "right to life" movement, along with disagreement among disabilities rights organizations, perpetuate the controversy. The heat from the debate in turn only intensifies the difficult choices people with end-stage AIDS, and their loved ones, may face when life is overwhelmed by irreversible illness and unrelenting pain.

The politicized nature of the debate also is not without its ironies. The Clinton White House, having rebuffed requests last year to support the gay plaintiffs in the historic Romer case, sided with the AMA and the Catholic Church in opposing legalization of assisted suicide in favor of "better" pain management for the terminally ill. At the same time, the Clinton Administration has threatened prosecution of doctors who prescribe marijuana to alleviate the pain of terminal AIDS and cancer patients.

The U.S. Supreme Court concluded years ago that a patient's expressed wishes regarding discontinuation of treatment that prolongs life must be respected. However, the battle over assisted suicide rages on. Suicide is not a crime. But it is illegal in all 50 states to assist someone who, rather than refusing treatment, seeks medication to accelerate impending death.

Lambda joined friend-of-the-court briefs in two historic cases recently heard by the Supreme Court. Our goal was to make clear the historic importance of personal autonomy in decision-making for individuals with disabilities such as AIDS. The fundamental right of self-determination logically must apply to all significant life decisions, including what is perhaps the most intimate and personal decision of all, whether to hasten death if one's condition becomes terminal. The protection of this right becomes particularly compelling when the only real choices remaining are intolerable suffering or indefinite confinement in a morphine-induced haze.

In March 1996, the Ninth Circuit Court of Appeals recognized for the first time the right of a terminally ill person to seek assistance from a physician to hasten death. The path-breaking decision in the case, Compassion in Dying v. State of Washington, holds that there is a constitutionally protected liberty interest in determining the time and manner of one's own death, and that a Washington law which barred doctors from prescribing medication to end life for terminally ill, competent adults who had requested it, violates this right.

The court acknowledged that the state also has interests at stake -- the preservation of life, and the related interests in preventing undue influence on the elderly or disabled, and protecting the integrity of the medical profession. Through a "balancing test" in Compassion in Dying, the court determined the state's interests do not justify the government's level of intrusion into a person's dignity and freedom.

A month later, the Second Circuit Court of Appeals issued a similar ruling in Quill v. Vacco, but took a different approach. It explicitly rejected the existence of a constitutionally protected liberty interest in committing physician-assisted suicide. However, relying on the recognized right of the terminally ill to reject life-sustaining medical treatment, the court concluded that to allow competent, terminally ill people to refuse treatment that would keep them alive but to prevent them from accepting treatment to hasten impending death serves no rational purpose. By treating these people differently, the law violates the equal protection clause.

Lambda participated in amicus briefs on behalf of the plaintiffs in both of these cases which included gay men with end-stage AIDS. When the cases moved to the Supreme Court, Lambda joined Gay Men's Health Crisis and five individuals with disabilities as amici.

Certainly the right to physician-assisted suicide is not as immediate an issue as securing the right to affordable and decent health care for most people living with HIV. Still, the right to determine when meaningful life has come to an end is a fundamental aspect of personal autonomy and self-empowerment. These values are at the heart of the struggle of people with AIDS who have fought for access to new treatments and a role in determining the course of their treatment.

Catherine Hanssens is the AIDS Project Director for Lambda Legal Defense and Education Fund, a national organization committed to achieving full recognition of the civil rights of lesbians, gay men, and people with HIV/AIDS through impact litigation, education, and public policy work.

This article is reprinted from the Winter 1997 edition of Lambda's tri-annual newsletter, The Lambda Update.