Vacco v. Quill 1997

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Vacco v. Quill 1997

Petitioners: Dennis C. Vacco, Attorney General of New York

Respondents: Timothy E. Quill, Samuel C. Klagsbrun, Howard A. Grossman

Petitioners' Claim: That New York's ban on physician-assisted suicide did not violate the Equal Protection Clause.

Chief Lawyers for Petitioners: Barbara Gott Billet, Daniel Smirlock, Michael S. Popkin

Chief Lawyers for Respondents: Laurence H. Tribe, David J. Burman, Carla A. Kerr, Peter J. Rubin, Kari Anne Smith, Kathryn L. Tucker

Justices for the Court: Stephen Breyer, Ruth Bader Ginsburg, Anthony M. Kennedy, Sandra Day O'Connor, Chief Justice William H. Rehnquist, Antonio Scalia, David H. Souter, John Paul Stevens, Clarence Thomas

Justices Dissenting: None

Date of Decision: June 26, 1997

Decision: Ruling in favor of New York state, the Court decided laws banning physician-assisted suicide do not violate the constitutional equal protection guarantees.

Significance: The ruling provided constitutional support to state laws banning physician-assisted suicide. The Court recognized a legal difference between ending life-prolonging treatment to terminally ill patients and assisted suicide.

Advances in medical science had greatly extended human life expectancy by the dawn of the twenty-first century. Although generally viewed as a desirable development, prolonging the lives of terminally ill (not expected to recover) patients can lead to great suffering. Desiring a quick and dignified death, terminal patients sometimes turned to others, especially physicians to help end their life. Many individuals sympathized with this need including a number of doctors (physicians) in the medical profession. Physician-assisted suicide, or simply assisted suicide, means that one individual, most often a doctor, helps another to take his own life. Generally, a physician does this by prescribing a lethal (deadly) dose of a drug which the patient may then use to commit suicide. The issue of physician-assisted suicide is hotly debated among the general public and in legislative activities.

"Right to Die," or "Death With Dignity"

The debate reached the U.S. Supreme Court in 1990 in Cruzan v. Director, Missouri Department of Health. In Cruzan the Court recognized the right of a competent (able to make decisions) adult to refuse unwanted medical treatment even if exercising that right would most likely result in death. The Court defined this right as a constitutional liberty protected under the Fourteenth Amendment. The Fourteenth Amendment provides that no state shall "deprive any person of life, liberty, or property, without due process of law [fair legal procedures]." To be ruled a constitutionally protected liberty, an activity must be supported by a long tradition. The Court's decision that refusing medical treatment is a protected liberty was based on an ancient common law (common practices of individuals carried on for centuries) tradition of protecting patients from unwanted medical treatment. In historical times this protective tradition was known as freedom from "unwanted touching."

In 1997 the Court tackled physician-assisted suicide in two cases, Washington et al. v. Glucksberg and Vacco v. Quill, both involving the Fourteenth Amendment. In Washington et al., the Court found that physician-assisted suicide, unlike the right to refusing medical treatment, was not a constitutionally protected liberty and, therefore, not protected by Due Process Clause of the Fourteenth Amendment. The Court found that physician-assisted suicide was not rooted either in common law practices or in U.S. history. Rather, it has generally been considered a crime and prohibited in almost every state.

The Court took the opportunity in Vacco v. Quill (1997) to explain further the difference between refusing life sustaining support and assisted-suicide.

Dying in the State of New York

In 1965 New York passed laws prohibiting assisted suicide. By the early 1990s, New York laws allowed physicians to withhold life-prolonging treatment to terminally ill patients who did not wish to receive it. This did not mean the state endorsed physician-assisted suicide, however. New York carefully drew a line between "killing" and "letting die."

Three New York state physicians, Timothy E. Quill, Samuel C. Klagsbrun, and Howard A. Grossman, were sympathetic to patients wishing to end their lives. They were willing to prescribe lethal medication for competent, terminally-ill patients but could not because of the state's ban on assisted suicide. To challenge the ban, the three physicians and three terminally-ill patients sued the New York's attorney general, Dennis C. Vacco. The three physicians claimed New York's law violated the Equal Protection Clause of the Fourteenth Amendment. The physicians argued that terminally-ill patients receiving life-prolonging treatment could choose to die by ending the treatment, but those not receiving life-prolonging treatment could not choose to end their lives with medical assistance. They claimed refusing the treatment was essentially the same as physician-assisted suicide. Therefore, the New York law did not treat all terminally-ill competent persons wishing to end their life the same. It treated those on life support one way and those not on life support another way and, therefore, violated "equal protection under the laws."

The Equal Protection Clause commands that no state shall "deny to any person within its jurisdiction (geographical area over which it has control) the equal protection of the laws." Equal protection of the laws means individuals in like situations must be treated the same.

Upholding the state law, the District Court disagreed with the physicians but the Court of Appeals for the Second Circuit reversed (changing an earlier decision by a lower court) the district court's decision. The court of appeals viewed removal of life support and assisted suicide as like actions. Allowing those on life support to "hasten their deaths" by removing their support but not allowing those who happened not to be on life support to hasten death with prescribed drugs was unequal treatment or unequal protection under the New York law. New York appealed to the U.S. Supreme Court and the Court agreed to hear the case.

The Same or Different?

Determining whether refusing life supporting medical care and physician assisted suicide are the same or different activities was the key point on which the case turned. Agreeing with the earlier district court decision, the Supreme Court ruled that New York's assisted suicide ban did not violate the Equal Protection Clause of the Fourteenth Amendment. Chief Justice William H. Rehnquist wrote the opinion for the unanimous, 9-0, Court. Rehnquist rejected the Court of Appeals' conclusion that removal of life support and assisted suicide were the same:

When a patient refuses life-sustaining medical treatment, he dies from an underlying fatal disease . . . but if a patient ingests lethal medication prescribed by a physician he is killed by that medication.

Rehnquist wrote that this distinction "has been widely recognized and endorsed in the medical profession, the state courts, and the overwhelming majority of state legislatures." Since the two actions are different, they can be dealt with differently without conflicting with equal protection. According to the Rehnquist, the Equal Protection Clause "embodies [contains] a general rule that States must treat like cases alike but may treat unlike cases accordingly [differently]." Rehnquist pointed out the Constitution does not require things that are different in fact or opinion to be treated by law as though they were the same.

Chief Justice Rehnquist listed New York's many important reasons for forbidding assisted suicide:

prohibiting intentional killing and preserving life; preventing suicide; maintaining physicians' role as their patients' healers; protecting vulnerable people . . . pressure to end their lives; and avoiding a possible slide toward euthanasia [assisted suicide].

A Perplexing Issue

The Court announced its decision in Vacco on the same day it announced its decision in Washington et al. v. Glucksberg. Vacco and Washington et al. each ruled specifically on two state laws banning assisted suicide, New York's and Washington's. The rulings confirmed states could enact


J ack Kevorkian, known as "Dr. Death" or "the suicide doctor," was born in Pontiac, Michigan in 1928. Jack's parents were Armenian refugees who had many relatives murdered in what is referred to as the Armenian holocaust during World War I. Kevorkian graduated from the University of Michigan School of Medicine in 1952 and served in the medical profession as a pathologist, a doctor who performs autopsies. One of his experiences during medical school involved dealing with a terminally-ill cancer patient who seemed to be pleading for a quick death. At this time Kevorkian decided that assisted suicide was ethical, regardless of public opinion.

Beginning in the late 1950s and continuing until the late 1980s, Kevorkian engaged in controversial research and writing concerning such topics as the appearance of the eyes of dying patients and legalizing medical experiments on death-row inmates. Kevorkian was banished from the medical establishment and did not hold a hospital staff position after 1982. By 1989 he developed a suicide machine that would allow people to kill themselves by touching a button. During the 1990s Kevorkian admittedly assisted in 130 suicides. He was charged with murder several times but always acquitted until 1999 when he was found guilty of murdering Thomas York who suffered from Lou Gehrig's disease.

Kevorkian, assisted suicide's most visible advocate, became Inmate No. 284797 in a Michigan prison. However, supporters of assisted suicide as well as opponents say he sparked their debate and brought the issue to the forefront of American society.

such laws without violating either the Due Process Clause or the Equal Protection Clause of the Fourteenth Amendment. However, several justices wrote concurring opinions (agreeing but for different reasons) that applied to both cases and expanded discussions on how to treat "death with dignity" issues.

Justice Sandra Day O'Connor, joined by Justice Ruth Bader Ginsburg, stressed that finding a proper balance between the interests of terminally ill patients and the interests of society is best left to the states. Both Justice John Paul Stevens and Justice Stephen Breyer remained open to the possibility that death with dignity might include a competent patient's right to control the manner of death and degree of physician intervention. In certain situations the patient's interest in hastening death might outweigh a state's interest in preserving life.

In the year 2000 only Oregon allowed assisted suicide and no cases challenging the law had yet reached the courts. Americans continued their earnest debate about the legality and morality of physician-assisted suicide.

Suggestions for further reading

Humphrey, Derek, and Mary Clement. Freedom to Die: People, Politics, and the Right-to-Die Movement. New York: St. Martin's Press, 1998.

McKhanna, Charles F. A Time to Die: The Place for Physician Assistance. New Haven: Yale University Press, 1999.

Woodman, Sue. Last Rights: The Struggle Over the Right to Die. New York: Plenum Press, 1998.