In a 6-3 decision the US Supreme Court last week upheld Oregon's law on doctor assisted suicide. The dissenters were the chief justice, John Roberts, and judges Anthony Scalia and Clarence Thomas. The ruling said the 1997 Oregon law, which allows doctors to end the lives of terminally ill people who ask for it, trumped federal authority to regulate doctors.
This was a setback for the Bush administration's attempt, in a case called Gonzales versus Oregon, to punish doctors by prosecuting them for violating the federal Controlled Substances Act of 1970.
In 2001 the attorney general, John Ashcroft, called doctor assisted suicide “not a legitimate purpose” for prescribing drugs and vowed to prosecute Oregon doctors he said were violating the law.
Figure 1.
Scott Rice, whose wife used Oregon's assisted suicide law to end her life, holds up a sketch of the Supreme Court hearing
Credit: DON RYAN/AP/EMPICS
But in 2004 a federal appeals court ruled that in passing the Controlled Substances Act Congress did not give the attorney general the unilateral authority to penalise doctors who followed state law in prescribing federally regulated drugs (BMJ 2004;328: 1337). That was also the position taken in 1998 by Janet Reno, the attorney general in the Clinton administration.
The appeals court said that the federal law on drug control was intended to halt drug traffickers, not to regulate doctors or the practice of medicine. Historically, the licensing of doctors and regulation of medicine have been left to the individual states.
The Death with Dignity Act was approved twice by Oregon's voters and took effect in 1997. The law requires that patients wanting to die must have a life expectancy of less than six months, as determined by two doctors; must be mentally competent and not suffering from impaired judgment resulting from depression or another psychiatric disorder; must make an initial request to the doctor and then wait 15 days before making a written request that is witnessed by two people; and must be advised of all alternatives, such as hospice care and pain management. The doctor then prescribes the drugs but may not administer them. As of the last reporting period in 2004, 326 patients had received prescriptions and 208 actually used the drugs to end their lives.
The most commonly reported reasons given for assisted suicide between 1998 and 2004 were loss of autonomy (cited in 87% of cases), decreased ability to participate in activities that make life enjoyable (84%), and loss of dignity (80%).