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On January 17, 2006, the Supreme Court ruled that the 1970 Controlled Substances Act (CSA) does not give the U.S. attorney general the authority to prohibit Oregon doctors from prescribing lethal doses of drugs to certain terminally ill patients who want to end their own lives. The court's decision in Gonzales v. Oregon resolves a conflict between the state's Death with Dignity Act (DWDA) and the attorney general's interpretation of the federal drug statute. Oregon is currently the only state that has an assisted-suicide law.
When the Oregon law was first enacted in 1994, the Justice Department, under then-Attorney General Janet Reno, determined that the law did not violate the CSA. In 2001, however, then-Attorney General John Ashcroft reversed this finding and issued a ruling designed to halt the practice of physician-assisted suicide under Oregon's law. The "Ashcroft Directive," as it came to be known, stated that physician-assisted suicide was not a "legitimate medical purpose," as defined by the CSA. Thus, any prescriptions written for that purpose would be unlawful and expose the offending medical practitioner to civil, or even criminal, sanctions. Ashcroft's successor, Attorney General Alberto Gonzales, also endorsed the Directive.
The Supreme Court, by a 6-3 vote, ruled that the Directive exceeded the powers that Congress granted to the attorney general under the CSA. The court thus affirmed a ruling by the U.S. Court of Appeals for the Ninth Circuit that had held the Directive "unlawful and unenforceable." Dissenting in the case were Justices Antonin Scalia and Clarence Thomas, as well as Chief Justice John Roberts, who cast his first dissenting vote since joining the court on Sept. 29, 2005.
The immediate legal impact of the court's ruling is clear: Oregon physicians may prescribe drugs under the Death with Dignity Act without fear of federal penalty. The broader legal significance of the ruling, however, is less clear. Although other states may be encouraged to adopt similar provisions, those who oppose physician-assisted suicide will likely continue to try to use the CSA to impede the practice. Opponents may also attempt to press Congress to enact a nationwide assisted-suicide ban, although past efforts to pass such legislation have come to naught.
As explained below, the court in Gonzales v. Oregon did not completely close the door to federal regulation of physician-assisted suicide. In fact, it may not even have foreclosed administrative regulation of the practice under the CSA. If federal executive branch agencies, through their own processes for adopting administrative rules, end up remedying the defects identified by the court in Gonzales v. Oregon, the state's victory could be fleeting. If, however, the defects identified by the court relate to the more basic issue of the distribution of authority between state and federal government, then overcoming the court's decision will, at a minimum, require congressional action - action that, as already noted, Congress thus far has declined to take.