Supreme Court Ruling: Administration Cannot Use Federal Drug Laws to Block Oregon's Assisted Suicide Law -- Attempts Increased Pain Levels Among Dying 1/20/06

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In a decision handed down Tuesday, the US Supreme Court upheld Oregon's assisted suicide law, ruling that the Bush administration could not use the nation's drug laws to punish doctors who prescribe drugs to help people kill themselves. Splitting 6-3, the court held that former attorney general John Ashcroft exceeded his authority under the Controlled Substances Act when he ruled that doctors who prescribed lethal doses of drugs would lose their federal prescription privileges covered by the act.

The United States Supreme Court
Oregon is the only state to allow physician-assisted suicide for patients facing terminal illness, with voters twice approving the state's Death With Dignity Act before it took effect in 1997. The act limits the right to suicide to people who have less than six months to live and who are mentally competent. Doctors must advise patients of alternatives to suicide, such as improved pain management or hospice care, and the doctor who prescribes the lethal drugs cannot administer them. More than 300 patients had received prescriptions by the end of last year and 208 actually used them to kill themselves.

Oregon's law stuck in the craw of John Ashcroft, who had opposed it even before he was attorney general. In an effort to block the will of Oregon voters, Ashcroft used his position as attorney general to rule that the Controlled Substances Act allowed him to jerk the licenses of doctors who prescribed for suicides. The Bush administration's effort to undo the law continued under Ashcroft's successor, current attorney general Alberto Gonzales.

Ashcroft's was not the first federal action taken against the Oregon law, however, nor did it originate in the Bush administration. In 1997, a week after the initiative was enacted, the Drug Enforcement Administration (DEA) under administrator Thomas Constantine and Clinton era attorney general Janet Reno threatened punishment of Oregon's doctors who assisted in suicides under the new law.

The threat took an immediate if unintended toll: A study done at Oregon Health Sciences University released in June 2000 reported that the level of pain suffered by the dying in Oregon increased sharply during November and December of that year. An article in the Associated Press reported that some observers believed the increased under-treatment of pain in the dying was probably caused by the DEA threat. Ann Jackson, head of the Oregon Hospice Association, told the AP, "I think that it's very likely that there's a connection here."

Concern for ordinary pain treatment -- which relies heavily on opioids, drugs that can also be used for assisted suicide -- drove a broad coalition of medical and patient groups, divided on the assisted suicide issue but distrustful of the DEA's baneful effect on pain treatment, to oppose federal legislation, the 1998 "Lethal Drug Abuse Prevention Act," that would have authorized the DEA to revoke the federal prescription licenses of doctors prescribing for the purpose of assisting a suicide. Allowing the DEA to scrutinize medical decisions would further discourage physicians from treating pain adequately, part of a more divided community argued in the context of the 1999 "Pain Relief Promotion Act," which also went nowhere.

The Clinton administration similarly attempted to use the Controlled Substances Act to punish doctors who recommended marijuana to patients in states where it is legal, an effort the courts found violated the First Amendment rights of doctors. Again, the CSA would have been used as a club against state policies disfavored by the feds.

Writing for the majority in Gonzales v. Oregon, eight years and two months after the Oregon law was first passed, Justice Anthony Kennedy acknowledged the "political and moral debate" surrounding assisted suicide, but noted that the issue facing the court was a more limited one -- the scope of the Controlled Substances Act, and whether Ashcroft exceeded his powers in applying it. While the act "gives the attorney general limited powers, to be exercised in specific ways" to fight drug abuse, those powers do not include the power to declare illegitimate "a medical standard for care and treatment of patients that is specifically authorized under state law," Kennedy wrote.

The federal government cannot simply run roughshod over state laws on medical issues, the court said, and interpreting prescriptions for suicide drugs as "drug abuse" was a stretch. In fact, wrote Kennedy, the law's language calls for the attorney general to defer to the secretary of Health, Education, and Welfare on some medical issues, and the administration's argument that Ashcroft made a legal decision -- not a medical one -- did not withstand scrutiny. "All would agree, we should think, that the statutory phrase 'legitimate medical purpose' is a generality, susceptible to more precise definition and open to varying constructions, and thus ambiguous in the relevant sense," he wrote.

Justice Antonin Scalia dissented strongly. "If the term 'legitimate medical purpose' has any meaning, it surely excludes the prescription of drugs to produce death," wrote the Catholic conservative. Citing medical authorities from Hippocrates to the American Medical Association, Scalia scorned the very idea of physician-assisted suicide. "The entire legitimacy of physician-assisted suicide "ultimately rests, not on 'science' or 'medicine,' but on a naked value judgment," he wrote. Joining Scalia in dissent were Chief Justice John Roberts and Justice Clarence Thomas.

At a Tuesday news briefing, White House spokesman Scott McClellan lamented the ruling. "The president remains fully committed to building a culture of life, a culture of life that is built on valuing life at all stages," McClellan said. That disappointment was echoed by the conservative American Center for Law and Justice. "This is a disappointing decision that is likely to result in a troubling movement by states to pass their own assisted suicide laws," he told the Associated Press.

But Oregon State Solicitor Mary Williams had a different reaction. "For Oregon's physicians and pharmacists, as well as patients and their families, today's ruling confirms that Oregon's law is valid and that they can act under it without fear of federal sanctions," she told the AP.

While assisted suicide is not a drug issue per se, on multiple levels the issues are intertwined, as is so often the case. And the scope of the Controlled Substances Act is not unlimited, no matter how badly some might wish it were so. With a ruling that relied at least in part on federal statute, however, federal legislation could again threaten Oregon's law, with patients wanting relief from pain getting snared further in the crossfire.

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Issue #419 -- 1/20/06

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Feature: Alaska Bill to Recriminalize Marijuana Fast-Tracked, Passes Senate | Feature: With Conservatives Poised to take Power, Canadian Drug Reform Ponders an Unfriendly Future | Feature: Swiss Marijuana Legalization to Go to Voters... Unless Parliament Acts First | Law Enforcement: This Week's Corrupt Cops Stories | Supreme Court Ruling: Administration Cannot Use Federal Drug Laws to Block Oregon's Assisted Suicide Law -- Attempts Increased Pain Levels Among Dying | Medical Marijuana: San Diego Term Limits Initiative Filed in Response to Supervisors' Attacks on State Medical Marijuana Law | Medical Marijuana: New Mexico Governor Puts Compassionate Use Act on Legislative Agenda | Mothering: Utah Appeals Court Overturns Child Endangerment Charge in Marijuana Breast-Feeding Case, But Upholds Law Itself | Marijuana: "Weeds" Actress Mary Louise Parker Wins Golden Globe, Says "Legalize It" | Europe: Britain Will Not Reclassify Cannabis as a More Harmful Drug -- Advisory Council Calls Risk of Mental Illness "Very Small" | Latin America: Colombian President Forced to Probe Paramilitary Influence-Buying | Weekly: This Week in History | Weekly: The Reformer's Calendar |


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