Supreme Court decision
By: William H. Rehnquist
Date: June 26, 1997
Source: Rehnquist, William H. Vacco v. Quill 521 U.S. 793 (1997). Available online at http://laws.findlaw.com/us/521/793.html; website home page: http://laws.findlaw.com (accessed May 4, 2003).
About the Author: William H. Rehnquist (1924–), after military service in World War II (1939–1945), received degrees from Stanford and Harvard, before graduating from Stanford Law School. President Richard Nixon (served 1969–1974) appointed Rehnquist to the Supreme Court in 1971. In 1986, President Ronald Reagan (served 1981–1989) appointed Rehnquist Chief Justice. He has generally led the Court in a more conservative direction.
The right to privacy and to be left alone is implied in many amendments of the Bill of Rights. Perhaps the most direct place is the Fourth Amendment, which states that one's property cannot be seized without a search warrant, and search warrants cannot be issued except for probable cause. As early as 1928, Justice Louis D. Brandeis expanded upon the Fourth Amendment, arguing that one has "a right to be left alone." In the criminal arena, the whole issue of search warrants was a murky one, but the waters became much muddier when a person's body was the object of this search warrant.
In the 1970s, the laws concerning the beginnings of life, and the choice of giving birth to a new life were changing based on the right to privacy. This right was officially recognized in Griswold v. Connecticut, which held that a state could not ban the use of contraceptives. The right to privacy was further expanded in 1973 in Roe v. Wade, which held that a woman had a right to an abortion in the first trimester.
Around the same time, there was a great deal of controversy and discussion about the ending of life. Dr. Kubler-Ross and others began to write more about death and coming to terms with death, urging people to accept death as just another stage of life. Many different cultures have different ways of celebrating one's passing, but death was seldom discussed in America as a whole. In 1990, a very public court case came in front of the Supreme Court dealing with a "right to die." Nancy Cruzan, a young woman, had been in a car accident and had slipped into an irreversible coma. Her parents wished to remove her feeding tube and let her die. The state, however, did not think that her parents had the legal right to make this decision. The Supreme Court decided against the parents, citing that the parents had not proven Nancy's wish not to be kept alive. The parents were able to prove the daughter's wishes clearly on remand, and the feeding tube was removed. (Nancy died twelve days later.)
In the 1990s, the whole issue of death remained in the media. Jack Kevorkian, an unlicensed pathologist, began arguing for a right to die, saying that terminally ill people should be able to get help in dying. He gave lethal injections to several individuals, and was convicted of homicide. Most states banned this "assisted suicide." Whether such a ban was legal reached the Supreme Court in Vacco v. Quill.
The Supreme Court upheld the ban on assisted suicide, distinguishing assisted suicide from the right to die issues in Cruzan. The Court found that while an individual can make the decision not to be resuscitated, and can make the decision to die with dignity, the intervention of another person in an assisted suicide moves the decision enough beyond a privacy issue—and a state can ban assisted suicide. Since Vacco, the whole issue of assisted suicide has somewhat passed from the national radar screen, although there have been several state referendums on the issue. While Vacco allows a state to ban assisted suicide, it does not force a state to do so—leaving open to the question of how individuals want to die, and what assistance they may obtain to do so.
Primary Source: Vacco v. Quill [excerpt]
SYNOPSIS: Rehnquist first notes that it is a crime in New York to assist in a suicide. He then discusses that the refusal to accept medical treatment is permitted because of the equal protection clause, banning assisted suicide does not violate this principle. Rehnquist clearly differentiates these two paths. He notes how the Supreme Court has agreed with this distinction as well, and then upholds the law.
Chief Justice Rehnquist delivered the opinion of the Court.
In New York, as in most States, it is a crime to aid another to commit or attempt suicide, but patients may refuse even lifesaving medical treatment. The question presented by this case is whether New York's prohibition on assisting suicide therefore violates the Equal Protection Clause of the Fourteenth Amendment. We hold that it does not.…
The Equal Protection Clause commands that no State shall "deny to any person within its jurisdiction the equal protection of the laws." This provision creates no substantive rights.… Instead, it embodies a general rule that States must treat like cases alike but may treat unlike cases accordingly.… If a legislative classification or distinction "neither burdens a fundamental right nor targets a suspect class, we will uphold [it] so long as it bears a rational relation to some legitimate end." …
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.… These laws are therefore entitled to a "strong presumption of validity." …
On their faces, neither New York's ban on assisting suicide nor its statutes permitting patients to refuse medical treatment treat anyone differently than anyone else or draw any distinctions between persons. Everyone, regardless of physical condition, is entitled, if competent, to refuse unwanted life-saving medical treatment; no one is permitted to assist a suicide. Generally speaking, laws that apply evenhandedly to all "unquestionably comply" with the Equal Protection Clause.
… 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; it is certainly rational.…
The distinction comports with fundamental legal principles of causation and intent. First, when a patient refuses life sustaining medical treatment, he dies from an underlying fatal disease or pathology; but if a patient ingests lethal medication prescribed by a physician, he is killed by that medication.…
Furthermore, a physician who withdraws, or honors a patient's refusal to begin, life sustaining medical treatment purposefully intends, or may so intend, only to respect his patient's wishes and "to cease doing useless and futile or degrading things to the patient when [the patient] no longer stands to benefit from them." …
The law has long used actors' intent or purpose to distinguish between two acts that may have the same result.…Given these general principles, it is not surprising that many courts, including New York courts, have carefully distinguished refusing life sustaining treatment from suicide.… In fact, the first state court decision explicitly to authorize withdrawing life-saving treatment noted the "real distinction between the self infliction of deadly harm and a self determination against artificial life support." … And recently, the Michigan Supreme Court also rejected the argument that the distinction "between acts that artificially sustain life and acts that artificially curtail life" is merely a "distinction without constitutional significance—a meaningless exercise in semantic gymnastics," insisting that "the Cruzan majority disagreed and so do we." …
Similarly, the overwhelming majority of state legislatures have drawn a clear line between assisting suicide and withdrawing or permitting the refusal of unwanted lifesaving medical treatment by prohibiting the former and permitting the latter.… And "nearly all states expressly disapprove of suicide and assisted suicide either in statutes dealing with durable powers of attorney in health care situations, or in 'living will' statutes." … Thus, even as the States move to protect and promote patients' dignity at the end of life, they remain opposed to physician assisted suicide.
New York is a case in point. The State enacted its current assisted suicide statutes in 1965. Since then, New York has acted several times to protect patients' common law right to refuse treatment.…In so doing, however, the State has neither endorsed a general right to "hasten death" nor approved physician assisted suicide. Quite the opposite: The State has reaffirmed the line between "killing" and "letting die." … More recently, the New York State Task Force on Life and the Law studied assisted suicide and euthanasia and, in 1994, unanimously recommended against legalization.… In the Task Force's view, "allowing decisions to forego life sustaining treatment and allowing assisted suicide or euthanasia have radically different consequences and meanings for public policy." …
This Court has also recognized, at least implicitly, the distinction between letting a patient die and making that patient die. In Cruzan… we concluded that "[t]he principle that a competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment may be inferred from our prior decisions," and we assumed the existence of such a right for purposes of that case.… But 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.… In fact, we ob served that "the majority of States in this country have laws imposing criminal penalties on one who assists another to commit suicide." … Cruzan therefore provides no support for the notion that refusing life sustaining medical treatment is "nothing more nor less than suicide."
For all these reasons, we disagree with respondents' claim that the distinction between refusing lifesaving medical treatment and assisted suicide is "arbitrary" and "irrational." … Granted, in some cases, the line between the two may not be clear, but certainty is not required, even were it possible. Logic and contemporary practice support New York's judgment that the two acts are different, and New York may therefore, consistent with the Constitution, treat them differently. By permitting everyone to refuse unwanted medical treatment while prohibiting anyone from assisting a suicide, New York law follows a longstanding and rational distinction.
New York's reasons for recognizing and acting on this distinction—including prohibiting intentional killing and preserving life; preventing suicide; maintaining physicians' role as their patients' healers; protecting vulnerable people from indifference, prejudice, and psychological and financial pressure to end their lives; and avoiding a possible slide towards euthanasia—are discussed in greater detail in our opinion in Glucksberg.… These valid and impor tant public interests easily satisfy the constitutional requirement that a legislative classification bear a rational relation to some legitimate end.
The judgment of the Court of Appeals is reversed.
It is so ordered.
Battin, M. Pabst, et. al. Physician Assisted Suicide: Expanding the Debate. New York: Routledge, 1998.
Davis, Sue Justice. Rehnquist and the Constitution. Princeton, N.J.: Princeton University Press, 1989.
Demy, Timothy J., and Gary Stewart. Suicide: A Christian Response: Crucial Considerations for Choosing Life. Grand Rapids, Mich.: Kregel Publications, 1998.
Loving, Carol. My Son, My Sorrow: The Tragic Tale of Dr. Kevorkian's Youngest Patient. Far Hills, N.J.: New Horizon Press, 1998.
Uhlmann, Michael M. Last Rights?: Assisted Suicide and Euthanasia Debated. Washington, D.C.: Ethics and Public Policy Center, 1998.
Waymack, Mark H., and George Taler. Medical Ethics and the Elderly: A Case Book. Chicago: Pluribus Press, 1988.
AUDIO AND VISUAL MEDIA
Physician-assisted Suicide after Vacco v. Quill & Washington v. Glucksberg Millersville, Md: Recorded Resources Corp., Videocassette, 1998.