Gonzales v. Oregon

Date: January 17, 2006

Citation: 546 US 243 (2006)

Issue: Federalism

Significance: In a 6–3 decision, the Supreme Court of the United States upheld an Oregon state law that allowed physician-assisted suicide. The decision reinforced the boundaries between state and federal powers, although it did not preclude later challenges to assisted suicide laws.

Background

In 1994, Oregon voters approved a referendum that made it legal for terminally ill patients to obtain prescriptions from a licensed physician for a lethal dose of medication, enabling them to end their lives. This Death with Dignity Act (DWDA) was challenged in court, and an injunction delayed it from going into effect. The injunction was lifted in 1997, but a new referendum was placed on the state ballot that would repeal the law. Oregon voters rejected that referendum, 60 percent to 40 percent. The law put in place various safeguards to ensure that it could only be used in situations involving terminally ill patients who were fully competent and certain of their decision.

Opponents of the practice saw an opportunity to challenge the Oregon law in the Controlled Substances Act (CSA), passed by Congress in 1970. Aimed at helping combat drug abuse, the law criminalized the distribution of controlled substances. It also provided that the attorney general could revoke the licenses of physicians whose actions violated the act if they were found to be "inconsistent with the public interest" (Gonzalez v. Oregon 1). In 2001, Attorney General John Ashcroft issued a finding that the Oregon’s Death with Dignity Act violated the CSA because it allowed physicians to prescribe a controlled substance for a purpose that was not medically legitimate.

Oregon sued to secure an injunction that would prevent Ashcroft from implementing his order. A district court agreed in 2002 and issued a permanent injunction against the attorney general. On appeal, the Ninth Circuit Court of Appeals upheld the injunction, finding Ashcroft’s interpretive ruling to be invalid. The attorney general’s office appealed that decision to the United States Supreme Court. By the time the case was argued, Alberto Gonzalez had replaced Ashcroft as attorney general; hence his name appears as the plaintiff.

The central question the Court had to address was whether the attorney general’s interpretation of the CSA was legitimate and allowed him to act despite the state law sanctioning physician-assisted suicide. The Court heard oral arguments in October 2005 and issued its ruling the following January.

Opinion of the Court

Justice Anthony Kennedy wrote the majority opinion that conveyed the Court’s decision. Justice Kennedy found that Ashcroft exceeded his authority in issuing the rule. Looking at the CSA, Kennedy concluded that Congress intended physician-related provisions in the act to prevent "doctors from using their prescription writing powers as a means to engage in illicit drug dealing and trafficking as conventionally understood" but that Congress had "no intent to regulate the practice of medicine generally." He explained that the attorney general is not empowered by the statute to determine medical issues or to impose federal over state authority in the regulation of medical practice.

"The prescription requirement is better understood as a provision that ensures patients use controlled substances under the supervision of a doctor so as to prevent addiction and recreational abuse. As a corollary, the provision also bars doctors from peddling to patients who crave the drugs for those prohibited uses. . . . To read prescriptions for assisted suicide as constituting ‘drug abuse’ under the CSA is discordant with the phrase’s consistent use throughout the statute, not to mention its ordinary meaning."

Justice Antonin Scalia wrote a dissent, which Chief Justice John Roberts and Associate Justice Clarence Thomas joined. Scalia said that the attorney general’s finding was valid. First, he said, the attorney general had the authority to determine that the Oregon law incorrectly allowed the distribution of drugs when there was no "legitimate medical purpose" in that distribution. (Kennedy’s ruling had addressed his issue and disagreed.) In addition, the attorney general’s definition of "public interest" and "public health and safety" should be shown deference by the courts, under the power of regulating authorities to interpret and implement laws passed by Congress. In a separate dissent, Justice Thomas said that the majority deviated from the Court’s 2005 precedent in Gonzales v. Raich—which overturned a California law allowing the medicinal use of marijuana—and crippled the government’s power to interpret the CSA.

Impact

The impact of the Court’s decision in Gonzalez v. Oregon was relatively narrow. The decision did, of course, allow the Death with Dignity Act to stand and remain in operation. Given the narrow circumstances under which it applies, however, it has not affected large numbers of people. Between 1997 and 2014, fewer than 900 people in Oregon died as a result of physician-assisted suicide. The 105 people who died as a result of this practice in 2014 was the highest single year total.

The decision prompted some speculation that other states would follow Oregon’s lead and enact similar statutes. Voters in Washington State did approve a similar initiative in 2008; Vermont’s legislature passed such a law in 2013; and California passed the End of Life Option Act, allowing physician-assisted suicide, in 2015. In addition, the Montana State Supreme Court decided in 2009 that physician-assisted suicide did not violate that state’s Rights of the Terminally Ill Act. No other state has enacted a similar law, however. In 2012, voters in Massachusetts narrowly defeated a state referendum that would legalize the practice; the vote was 51 percent against and 49 percent for the law.

Ten years on, the US Supreme Court had not heard any related cases since the Gonzalez decision. In the absence of further rulings, precedents set in two cases decided on June 26, 1997, stand. In Washington v. Gluckberg and Vacco v. Quill, the Court said there was no constitutionally protected right to physician-assisted suicide but that the matter was one of state, rather than federal, concern.

More broadly, the Gonzalez decision involved the balance of federal and state power and of the regulatory authority of administrative agencies versus congressional power. On the one hand, the Court showed respect for the state power to regulate medical practice. On the latter point, Court’s main grounds for denying the attorney general the power that he claimed to criminalize physician-assisted suicide was, essentially, that he overstepped the bounds established by statute. These aspects of the decision added to the body of case law on these issues.

Bibliography

Bostrom, Barry A. "Gonzales v. Oregon." Issues in Law and Medicine 21.3 (2006): 203–210. Print.

"Death with Dignity Act." Oregon Health Authority. Oregon Health Authority, n.d. Web. 15 Jan. 2016.

Gonzalez v. Oregon. 546 US 243 2006. Supreme Court of the United States. Supreme Court of the U.S., 2004. Web. 15 Jan. 2016.

"Gonzalez v. Oregon." Oyez. Chicago-Kent College of Law at Illinois Tech, n.d. Web. 15 Jan. 2016.

Hilliard, Bryan. "The Politics of Palliative Care and the Ethical Boundaries of Medicine: Gonzalez v. Oregon as a Cautionary Tale." Journal of Law, Medicine, and Ethics 35.1 (2007): 158–174. Print.

Mathes, Michele. "Gonzales v. Oregon and the Legitimate Purposes of Medicine: Who Gets to Decide?" MEDSURG Nursing 15.3 (2006): 178–181. Print.

"Oregon’s Death with Dignity Act—2014." Oregon Public Health Division. Oregon Health Authority, n.d. Web. 15 Jan. 2016.