A TIME TO DIE:
The story of
Nöel David Earley

6/27/97
That conclusion had been vehemently opposed by Rhode Islander Nöel David Earley, who battled a state law banning assisted suicide before his death from Lou Gehrig's disease earlier this year.

By FELICE J. FREYER
Journal-Bulletin Medical Writer

      The U.S. Supreme Court ruled yesterday that terminally ill Americans do not have a constitutional right to physician-assisted suicide, in a unanimous decision that furthers rather than ends one of the most wrenching debates of modern times.
       The decision, written by Chief Justice William H. Rehnquist, upholds state laws in Washington and New York that prohibit assisted suicide. But it does not bar states from legalizing physician-assisted suicide -- a step that Rhode Island and several other states have considered but only Oregon has taken.
       "Throughout the nation, Americans are engaged in an earnest and profound debate about the morality, legality, and practicality of physician-assisted suicide," Rehnquist wrote. "Our holding permits this debate to continue, as it should in a democratic society."
       Although the decision was unanimous, five justices wrote separate, concurring opinions that, in the eyes of some, left open the possibility of future challenges in federal court. Those justices said that, for now, state legislatures may be a better forum than federal courts for dealing with this thorny issue, but did not rule out a right to assisted suicide in certain instances.
       By essentially tossing the question back to the states, the court added fuel to the debate surrounding the way we die that became especially emotional in Rhode Island, where Noel David Earley, a Lincoln man dying of Lou Gehrig's disease, devoted his final days fighting for the right to physician-assisted suicide. Earley's activism spurred the General Assembly to pass a law making it a felony for anyone to help any person commit suicide in Rhode Island.
       The reaction yesterday was equally emotional.
       "I'm ecstatic. I can't contain my joy," said Anna Sullivan of the Rhode Island State Right to Life Committee. "I wasn't expecting a unanimous decision."
       "We applaud the decision," said Maria C. Parker lobbyist for the Respect Life Office of the Roman Catholic Diocese of Providence. "To sanction the taking of innocent human life is to contradict a primary purpose of law in an ordered society."
       "I'm disappointed but not surprised," said state Sen. John M. Roney, D-Providence, who filed the unsuccessful bill to legalize and regulate physician-assisted suicide. "Within a generation, we'll look back, as we have in other aspects of civil rights, and wonder that there was ever so much controversy about what will surely be a recognized constitutional right."
       The Associated Press reported that at the American Medical Association's convention in Chicago, the 475-member House of Delegates applauded and cheered.
       But here, the lobbyist for the Rhode Island Medical Society, which has taken a neutral position on whether doctors should assist suicide, was disappointed.
       "The Supreme Court's decision coupled with the Rhode Island law is bad for patients," said Steven DeToy. "It is never helpful to have the legislature interested in issues between the patient and physician."
       President Clinton, whose administration had filed a brief opposing physician-assisted suicide, praised the decision in a statement. "The decision is a victory for all Americans -- it prevents us from going down a very dangerous and troubling path on this difficult and often agonizing issue," the president said. ". . . The risks and consequences of physician-assisted suicide are simply too great."

       THE SUPREME COURT yesterday was acting in two separate cases. Doctors in New York and Washington challenged state laws that barred them from prescribing lethal drugs to mentally competent, terminally ill patients who wanted to die. The patients involved in the cases have since died.
       Federal appeals courts sided with the doctors last year and struck down the state laws. The Supreme Court's ruling reversed those appellate decisions.
       Chief Justice Rehnquist was the author of the court's landmark decision in 1990 that permitted terminally ill people to refuse life-sustaining treatment. But in yesterday's opinion, Rehnquist, whose wife died in 1991 after a long battle with ovarian cancer, held that there is a clear distinction between withdrawing life support and assisting in a suicide.
       "When a patient refuses life-sustaining medical treatment, he dies from an underlying fatal disease or pathology," Rehnquist wrote, "but if a patient ingests lethal medication prescribed by a physician, he is killed by that medication."
       Citing an abhorrence of suicide deeply rooted in the nation's legal and cultural traditions, the court ruled that choosing to end one's life does not become a basic human right worthy of constitutional protection merely because, like abortion, it is "personal and intimate." Of greater weight than an individual's choice of suicide, Rehnquist wrote, is the state's interest in preserving life, preserving the integrity of the medical profession, and protecting the vulnerable from abuse.
       "In almost every state -- indeed, in almost every Western democracy -- it is a crime to assist a suicide. The states' assisted suicide bans are not innovations. Rather, they are longstanding expressions of the states' commitment to the protection and preservation of all human life."

       JUSTICES ANTONIN SCALIA, Anthony M. Kennedy, Clarence Thomas, and Sandra Day O'Connor joined Rehnquist's opinion. But O'Connor also wrote a separate opinion, which Ruth Bader Ginsburg and Stephen G. Breyer joined in part; John Paul Stevens, David H. Souter, Ginsburg and Breyer also wrote separate concurring opinions.
       O'Connor wrote that she concurred with the court's opinion "because I agree that there is no generalized right to `commit suicide.' " But she said that in the context of the cases before it, the court had no need to address the narrower question of whether individuals in certain circumstances might have the right to physician-assisted suicide.
       "There is no reason to think," O'Connor wrote, "the democratic process will not strike the proper balance between the interests of terminally ill, mentally competent individuals who would seek to end their suffering and the state's interest in protecting those who might seek to end life mistakenly or under pressure."
       In his separate concurring opinion, Justice John Paul Stevens wrote: "There remains room for vigorous debate about the outcome of particular cases that are not necessarily resolved by the opinions announced today." The state's interest in preserving human life, in Stevens' view, "is not itself sufficient to outweigh the interest in liberty that may justify the only possible means of preserving a dying patient's dignity and alleviating her intolerable suffering."
       Such language provided the silver lining for those who consider assisted suicide a basic human right.
       Laurence Tribe, the Harvard Law School professor who argued in favor of overturning New York's assisted suicide ban, said: "The really important federal constitutional question has been left open. The court came as close as it possibly could to punting . . . It's a far more encouraging result than anyone expected. The court is far from slamming the door."
       Jay Mahoney of the National Hospice Organization said the task ahead is to spread the word about the benefits of hospice care, which can prevent the lonely, painful deaths that many people fear.
       "While certainly the constitutional question is very important," he said, "the issue should be why should we even have to consider physician-assisted suicide? . . . We have to broaden the understanding of what is possible."
       Said Dr. Joanne Lynn, director of the Center to Improve Care of the Dying in Washington: "Almost all of our care systems are set up to make it unlikely that [dying] people will get very good care. We need to change that, and we may find that there is very little call for suicide at the end."
       Lynn acknowledged that 10 to 15 percent of patients cannot get pain relief and must be drugged into unconsciousness to be made comfortable. But that, she said, is preferable to the hazards of legalizing physician-assisted suicide, a practice she called impossible to regulate.
       Dr. Timothy E. Quill, one of the doctors who brought the challenge to New York's law, said the ruling "did not help us a great deal as clinicians to find solutions to the really tough cases. How do we respond when palliative care fails? . . . I see the whole decision as one step in a very long process."
       Because it is legal to end life support, Quill said, such decisions are made openly and with considerable care and discussion. But doctors faced with patients for whom all efforts to relieve suffering have failed sometimes act secretly to help them die -- without oversight, regulation or consultation.
       Dan W. Brock, a Brown University philosophy professor who favors legalization of physician-assisted suicide, said that the court's decision merely means that change will progress more slowly. Brock predicted that over the next decade three or four states will legalize assisted suicide, under restricted conditions. Each state's experience will provide evidence about whether the feared abuses actually take place.
       "That will give us the opportunity to study how the practice works in reality rather than simply speculating on what might happen," he said. "We will also give public opinion more opportunity to solidify in support of it."
       Assisted suicide is currently illegal in 44 states and the District of Columbia. The law is unclear in five other states. Oregon legalized assisted suicide in 1994, but that law has been tied up in court. Oregon voters will consider the issue again this fall.
       Eighteen states have been considering initiatives for and against assisted suicide in recent months, but no efforts supporting assisted suicide have passed recently.
       Meanwhile, the American Medical Association, which considers physician-assisted suicide "fundamentally incompatible with the physician's role as healer," said it plans to launch a program to educate doctors and patients on the best end-of-life care.

Copyright © 1997 The Providence Journal Company
Produced by www.projo.com