Law allowing physician-assisted suicide reaches high court

WASHINGTON -- The Bush administration yesterday brought the emotionally charged issue of physician-assisted suicide to the Supreme Court, seeking permission to block a first-in-the-nation Oregon law that permits doctors to help terminally ill patients end their lives.

The case brought dozens of passionate demonstrators to the courthouse. Inside, the justices wrestled with Oregon's challenge to a November 2001 directive by former attorney general John Ashcroft, who announced that doctors who prescribe lethal drugs under the state law would lose their prescription-writing privileges and could be prosecuted.

With Chief Justice John G. Roberts Jr. presiding over his first major case, US Solicitor General Paul Clement argued that the Controlled Substances Act empowers the attorney general to determine that helping patients kill themselves is not a ''legitimate medical purpose" for a narcotic prescription, thereby giving the Bush administration the power to shut down the Oregon law.

But Oregon's senior assistant attorney general, Robert Atkinson, countered that Congress intended only to address recreational drug abuse when it passed the Controlled Substances Act. Because medical practices are regulated at the state level, he argued, Ashcroft exceeded his authority and his directive should be struck down.

''This is an issue of federalism, and the relationship between the sovereign states and the federal government," Atkinson said. ''We think it's clear that Congress intended to respect the responsibility of the states to regulate their medical practices."

In 1997, Oregon became the first state to allow doctors to help patients with fatal and painful conditions end their lives. Ashcroft's directive, aimed at blocking the Oregon measure, was heralded as a political victory by religious conservatives.

Since the law took effect, 208 people with terminal illnesses have used it to end their lives. Lawmakers in Vermont, California, and Hawaii have proposed similar measures, so far without success. Activists said the fate of the ''right to die" movement is riding on yesterday's case.

''This case has huge importance to dying Oregonians, who want to know that if the end of their lives becomes extremely prolonged and marked by severe suffering, they have the option for a peaceful and humane death," said Kathryn Tucker of Compassion & Choices, an advocacy group. ''It's important to them, and it's important to the nation, which is watching."

The case is also important to antiabortion groups, which want to draw attention to the value of preserving life even in difficult circumstances. The National Right to Life Committee coordinated the filing of briefs supporting the administration's position, said James Bopp Jr., the group's general counsel, who noted that most states have laws against assisted suicide.

''The vast majority of states recognize that every patient has quality and value, and they do not want patients to be forced into the choice of killing themselves" in a misguided attempt to save on medical costs, Bopp said.

Inside the courtroom, however, there was little talk of self- determination or the sanctity of life. Rather, the justices focused on the scope of the authority granted to the attorney general by the Controlled Substances Act.

Justice Sandra Day O'Connor interrogated Clement about whether a hypothetical future attorney general who opposed the death penalty could use the Controlled Substances Act to stop state executions by declaring that lethal injections were not a ''legitimate medical purpose." Clement said a 1984 federal death penalty law would probably prevent that from happening. O'Connor, who is retiring, may not take part in the decision if her replacement is confirmed before the court votes on the case. Earlier this week, President Bush named his White House counsel, Harriet E. Miers, to fill her seat.

The court last confronted the conflict between state medical regulations and federal drug laws last term when it ruled, 6 to 3, that the Bush administration could use its interstate commerce power to override a California law legalizing medical marijuana. Under federal law, marijuana may never be prescribed by a doctor.

In 1997, the court unanimously upheld state laws forbidding doctors from prescribing lethal drugs for terminally ill patients, holding that there is no constitutional ''right to die" but leaving the door open for states to pass their own laws.

Oregon's Death With Dignity Act was twice approved by voters. Under the law, two doctors must certify that patients who want to end their lives are mentally competent and that they have less than six months to live. A doctor then writes a prescription for a lethal dose of drugs, which the patients administer themselves.

Ashcroft's directive has never gone into effect because Oregon immediately sued him to block it, winning at both the district court and the appeals court levels. The Supreme Court is expected to issue its opinion in the case sometime before June 2006.