Provider groups cheered last week at their constituents' escape from regulatory and legal hassles as the U.S. Supreme Court said physician-assisted suicide is not a constitutional right.
Drawing a line between assisted suicide and the right to refuse life-saving medical treatments, the nine justices last week issued a unanimous decision that upholds laws in Washington state and New York that outlaw physician-assisted suicide.
If the high court instead had upheld lower court rulings that declared the state bans on physician-assisted suicide illegal, hospitals and physicians surely would have found themselves entangled in administrative and regulatory red tape as well as facing new liability risks.
Publicly, special-interest groups representing providers urged the high court to reject physician-assisted suicide because of their avowed commitment to patients' rights.
But, in briefs filed with the high court, the American Hospital Association, the American Medical Association and other provider organizations argued that legalization of physician-assisted suicide would necessitate complex regulations to protect against its misuse (Feb. 17, p. 2).
The high court's ruling doesn't discuss the burden of regulations on providers. Instead it asserts states' interests in protecting the ethics of the medical profession, preserving human life and preventing the victimization of vulnerable people, such as the mentally ill.
Nevertheless, the debate over assisted suicide is far from settled.
Although the high court ruled that states have the right to outlaw assisted suicide, it left open whether states can choose to make it legal.
The matter will come up soon in Oregon, where voters face a November referendum on the state's 1994 law legalizing assisted suicide. The law hasn't taken effect because of legal challenges to the measure.
Both the AHA and the AMA said they will step up campaigns to improve care for dying patients.
"The whole issue around care at the end of life is very complex to begin with," said Jonathan Lord, M.D., chief operating officer of the AHA. "Adding a constitutional right to assisted suicide would just make life crazy. But regardless of any court ruling, the clear-cut message from the public is that we've got to do a better job."
AMA President-elect Nancy Dickey, M.D., said the AMA will lobby for the loosening of regulations, particularly in the Medicaid program, that make it difficult for physicians to prescribe pain-easing drugs to dying patients.
Elsewhere, a coalition of Roman Catholic providers is developing models of comprehensive care for the dying and a professional mentoring program to help doctors deliver better care (June 23, p. 44).
The Washington state and New York laws addressed by the high court last week made it illegal for physicians to give life-ending drugs to mentally competent but terminally ill patients who no longer want to live.
Lower courts had ruled the Washington law infringed on due-process rights and the New York law violated equal-protection rights by banning assisted suicide but allowing other patients to refuse treatment.
In distinguishing the right to die from a right to assisted suicide, the Supreme Court, which heard oral arguments in the case in January, said forced medication has long been considered battery in the Anglo-Saxon tradition, while aiding suicide has been viewed as a grave public wrong.
Chief Justice William H. Rehnquist, whose wife died in 1991 after a long battle with ovarian cancer, wrote the opinion for the high court.