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Washington v. Glucksberg
Citations: 138 L. Ed. 2d 772; 117 S. Ct. 2258; 521 U.S. 702; 1997 U.S. LEXIS 4039; 11 Fla. L. Weekly Fed. S 190; 97 Cal. Daily Op. Serv. 5008; 97 Daily Journal DAR 8150; 65 U.S.L.W. 4669Docket: 96-110
Court: Supreme Court of the United States; June 26, 1997; Federal Supreme Court; Federal Appellate Court
Washington's assisted suicide law criminalizes aiding or promoting a suicide attempt, classifying it as a felony. Four physicians and three terminally ill plaintiffs challenged this law, claiming it violates their Fourteenth Amendment right to make personal choices regarding physician-assisted suicide. They argued that the law imposes an undue burden on their liberty interest, a position supported by prior Supreme Court cases. The Federal District Court ruled in their favor, stating the ban was unconstitutional, a decision that was affirmed by the Ninth Circuit. However, the Supreme Court held that Washington's prohibition against assisting suicide does not infringe upon the Due Process Clause. The Court noted that historical legal traditions in Anglo-American law have disapproved of and criminalized assisting suicide for over 700 years, with similar prohibitions existing in nearly all states today. The Court emphasized that no exceptions have been made for terminally ill individuals and referenced recent federal legislation restricting funding for physician-assisted suicide. In evaluating the claim, the Court reiterated its framework for assessing fundamental rights under substantive due process, which requires that such rights be deeply rooted in the nation's history and tradition. The Court found that the respondents' various descriptions of the asserted right to assistance in suicide did not meet this criterion, ultimately concluding that the right to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause. The Court addresses whether the Fourteenth Amendment's protection of liberty includes a right to commit suicide and receive assistance in doing so. It concludes that such a right is not rooted in the nation's traditions, which have consistently rejected the notion, even for terminally ill and mentally competent adults. Upholding the state's assisted-suicide ban would not only align with historical legal doctrines but also maintain the collective policy decisions of nearly all states. The Court finds the respondents' argument unconvincing, noting that the right to refuse life-saving treatment, as established in *Cruzan*, is based on historical and traditional legal principles, rather than abstract personal autonomy. The Court emphasizes that not all intimate personal decisions are constitutionally protected. The law's requirement for rational relation to legitimate government interests is met by Washington’s ban, which serves to prevent intentional killing, protect vulnerable populations, and uphold the integrity of the medical profession. The interests in question are deemed important and legitimate, reinforcing the law's rationale. Ultimately, the Court affirms that Washington's prohibition against assisting suicide does not violate the Constitution. Promoting a suicide attempt is defined as knowingly causing or aiding another to attempt suicide, classified as a felony in Washington with penalties of up to five years in prison and a $10,000 fine. Washington's Natural Death Act stipulates that withholding or withdrawing life-sustaining treatment at a patient's request does not constitute suicide. The case involves the State of Washington and its Attorney General as petitioners against physicians who treat terminally ill patients and seek to assist them in ending their lives, which is barred by the state's assisted-suicide law. In 1994, these physicians and a nonprofit organization filed a lawsuit in federal court challenging the constitutionality of the assisted-suicide ban, asserting a liberty interest under the Fourteenth Amendment for terminally ill adults to choose physician-assisted suicide. The District Court ruled in favor of the plaintiffs, finding that the ban imposed an undue burden on constitutionally protected rights and violated the Equal Protection Clause. However, the Ninth Circuit initially reversed this decision, stating that no constitutional right to aid in suicide had been recognized. Following an en banc review, the Ninth Circuit reinstated the District Court's ruling, recognizing a constitutional due process liberty interest in controlling the manner of one's death, ultimately deeming the assisted-suicide ban unconstitutional for terminally ill competent adults wishing to hasten their deaths with prescribed medication. The Ninth Circuit did not address the equal protection claim, and the case was taken up by the Supreme Court, which subsequently reversed the lower court's decision. Due-process cases necessitate an examination of the nation’s history, legal traditions, and practices. In the context of assisted suicide, almost all states and western democracies criminalize such acts, reflecting a longstanding commitment to protecting human life. Historically, laws against assisted suicide are not new; they express a societal consensus that prioritizes life and treats homicide as a serious offense. This consensus is mirrored in the philosophical, legal, and cultural heritage of the nation. For over 700 years, the Anglo-American common law has disapproved of suicide and assisting suicide. Legal treatise writer Henry de Bracton noted that suicide could be as serious as homicide, leading to forfeiture of property. He differentiated between cases of suicide motivated by crime and those stemming from despair or bodily pain. Sir William Blackstone later echoed this sentiment, labeling suicide as "self-murder" and emphasizing its classification as a serious crime, while acknowledging that the punishments for suicide were overly harsh. Early American colonies largely adopted this common law perspective, with instances such as the 1647 declaration from the Providence Plantations, reflecting this legal tradition against suicide. Self-murder is universally acknowledged as unnatural, characterized as a premeditated act of hatred against one’s life. In cases of suicide, the deceased's goods and chattels revert to the king, while debts and land are exempt. Individuals deemed infants, lunatics, or mentally incapacitated forfeit nothing. Historically, colonies like Virginia mandated ignominious burials for suicides, with estates forfeited to the crown. However, harsh common-law penalties began to be abolished in the American colonies, starting with Pennsylvania in 1701. Chief Justice Zephaniah Swift later argued against punishing the deceased through the forfeiture of their property, recognizing the cruelty of impacting innocent family members. While the legal stance softened, suicide remained condemned as a serious public wrong, with courts reinforcing its criminal nature without accepting it as a personal right. Assisting suicide continued to be viewed as a serious offense; advising someone to commit suicide was regarded as murder. This reflects the prevailing view that while suicide was not treated as a felony, it was still considered a grievous act deserving of legal reproach. The principle that a homicide victim's consent is irrelevant to the perpetrator's guilt is emphasized, underpinning the inalienability of the right to life in common law. This principle extends to all individuals, regardless of their circumstances, including those who are terminally ill or even condemned criminals. Historical context is provided, noting that the first American law against assisted suicide was enacted in New York in 1828, followed by similar legislation in other states. A commission in New York drafted a criminal code between 1857 and 1865 that specifically prohibited aiding suicide, including providing lethal means to another. By the time the Fourteenth Amendment was ratified, most states had laws against assisting suicide. The Model Penal Code later reinforced these prohibitions, identifying a threat to the sanctity of life posed by participation in suicide, regardless of consent. Although these bans have historical roots, recent years have seen a reexamination of assisted-suicide laws, driven by medical advancements and changing public attitudes toward dignity and autonomy at the end of life, leading to legal provisions for living wills and other end-of-life decision-making options. Voters and legislators predominantly maintain prohibitions against assisting suicide across various states. The Washington statute in question, Wash. Rev. Code §9A.36.060, was enacted in 1975, and the Natural Death Act passed in 1979 explicitly defined the withholding of life-sustaining treatment as not constituting suicide and condemned mercy killing. A 1991 ballot initiative to permit physician-assisted suicide was rejected by Washington voters, leading to an exclusion of such practices from the Natural Death Act in 1992. Similarly, California voters rejected an assisted-suicide initiative in 1993, while Oregon legalized physician-assisted suicide through the "Death With Dignity Act" in 1994. Numerous legislative proposals for assisted suicide have since been introduced but have not been enacted, with Iowa and Rhode Island recently reaffirming their prohibitions. The Federal Assisted Suicide Funding Restriction Act of 1997 prohibits federal funding for physician-assisted suicide initiatives. New York's Task Force on Life and the Law, established in 1984, has thoroughly examined related issues and concluded that legalizing assisted suicide could pose significant risks to vulnerable individuals, outweighing potential benefits. Despite evolving attitudes towards suicide and advancements in medical technology, legal prohibitions against assisting suicide remain intact. The text also references the broader implications of the Due Process Clause, emphasizing the protection of liberty beyond mere physical restraint. The Due Process Clause safeguards individual liberties against certain governmental actions, irrespective of procedural fairness. It offers enhanced protection against government interference with fundamental rights and liberties. Established jurisprudence identifies specific rights protected under the Clause, including the rights to marry, have children, direct child education, marital privacy, contraception use, bodily integrity, and abortion. There is also a suggestion that it protects the right to refuse unwanted lifesaving medical treatment. The judiciary has been cautious about expanding substantive due process rights due to the lack of clear guidelines and the potential for judicial preferences to overshadow public debate and legislative action. The analysis of substantive due process consists of two key elements: recognition of rights that are deeply rooted in the nation's history and tradition, and the necessity for a precise description of the asserted fundamental liberty interest. The history and legal traditions of the nation serve as essential guideposts for decision-making in this area. The Fourteenth Amendment prohibits governmental infringement on fundamental liberties unless such actions are narrowly tailored to serve a compelling state interest. Justice Souter advocates for a departure from a restrained methodology in evaluating Washington's statute, suggesting an inquiry into whether it imposes "arbitrary impositions" or "purposeless restraints" contrary to the Due Process Clause of the Fourteenth Amendment. He emphasizes the evolution of substantive-due-process jurisprudence, which has refined the concept of "liberty" under the Fourteenth Amendment through specific examples of fundamental rights deeply rooted in legal tradition. This approach limits subjective elements in judicial review and necessitates that state actions implicate a fundamental right before requiring justification based on a legitimate state interest. The Court of Appeals has raised the critical question of whether a liberty interest exists in determining the time and manner of one's death, or a right to die. Respondents assert a "liberty to choose how to die" and control over their final days, framing this as a right to a humane, dignified death. However, substantive-due-process cases have historically been precise in defining interests at stake, as seen in the Cruzan case, which recognized a constitutionally protected right to refuse lifesaving treatment rather than a broad "right to die." The Washington statute prohibits assisting suicide, leading to the question of whether the Due Process Clause encompasses a right to commit suicide, including assistance. The analysis reveals a longstanding and nearly universal tradition rejecting such a right, including for terminally ill, mentally competent individuals. Upholding the respondents’ claims would necessitate overturning centuries of legal doctrine and the established policy decisions of nearly every state, demonstrating a strong reliance on historical practices in interpreting the Fourteenth Amendment. Doubts arise regarding the validity of the respondents' claim under "substantive due process" due to its novelty. Respondents argue that their asserted liberty interest aligns with established jurisprudence and historical practices in the U.S., citing cases like Casey and Cruzan to support a tradition of "self-sovereignty" and the protection of personal autonomy under the Due Process Clause. They contend that competent, terminally ill adults should have the right to make end-of-life decisions free from government interference. The central legal question is whether the Due Process Clause encompasses a right to assisted suicide. In Cruzan, the court addressed whether Nancy Beth Cruzan, in a persistent vegetative state, had a constitutional right requiring a hospital to withdraw life-sustaining treatment at her parents' request. The court established that common law recognizes the necessity of informed consent for medical treatment and inferred from previous decisions that a competent individual has a constitutionally protected right to refuse medical treatment. The court assumed, for that case, that the Constitution grants a competent person the right to refuse life-sustaining hydration and nutrition, although it allowed Missouri to enforce a requirement for clear evidence of a patient’s wishes regarding treatment withdrawal. Respondents assert that Cruzan supports the notion that competent, dying individuals can direct the removal of life-sustaining treatment to hasten death, thereby implying a parallel right to choose assisted suicide. The Court of Appeals echoed this sentiment, suggesting that recognizing a liberty interest in refusing artificial sustenance extends to hastening one's own death. The right to refuse unwanted medical treatment, as recognized in Cruzan, is grounded in longstanding common-law principles and constitutional traditions that protect personal autonomy, distinguishing it from the unprotected act of assisted suicide. Although the choice to commit suicide with assistance is deeply personal, it lacks the legal safeguards afforded to medical treatment refusals. The Court noted that most states prohibit assisted suicide and did not equate the right to refuse treatment with a right to seek assistance in dying. In referencing Casey, the Court affirmed the established rights surrounding abortion, emphasizing that personal decisions related to marriage, family, and health are protected under substantive due process. However, significant personal choices do not automatically imply a broad constitutional right to all intimate decisions, including assisted suicide. The legal history in the U.S. shows a consistent rejection of assisted suicide, indicating that such a right has not been recognized by the courts. The Court's analysis leads to the conclusion that the claimed right to assisted suicide is not supported by existing legal precedents or societal norms. Assisted suicide is not deemed a fundamental liberty interest protected by the Due Process Clause of the Constitution. However, Washington's ban on assisted suicide must be rationally connected to legitimate government interests. The court acknowledges that the ban serves multiple state interests, particularly the preservation of human life, which is deemed a critical concern reflected in homicide laws. This interest goes beyond practical implications, embodying symbolic values and societal norms regarding the gravity of life and death decisions. Washington's law asserts that all lives, regardless of individual circumstances, deserve full legal protection, rejecting any variable assessment based on medical conditions or personal wishes. The state also recognizes the significant public health issue posed by suicide, particularly among vulnerable populations, and maintains an interest in preventing it through identification and treatment of its causes. The law acknowledges that individuals who contemplate suicide often struggle with mental health issues, reinforcing the need for a comprehensive approach to the problem. More than 95% of individuals who commit suicide have a major psychiatric illness at the time of death, with uncontrolled pain being a significant risk factor for depression among the terminally ill. Research indicates that many patients who request physician-assisted suicide retract their requests when their depression and pain are effectively treated. However, the New York Task Force expressed concern that depression is often difficult to diagnose, leading to inadequate responses from medical professionals to the needs of seriously ill patients. Legalizing physician-assisted suicide may complicate the state's ability to protect depressed or mentally ill individuals, as well as those suffering from untreated pain, from suicidal impulses. The integrity of the medical profession is also at stake; the American Medical Association and other medical groups assert that physician-assisted suicide is fundamentally incompatible with the physician's role as a healer. Involving physicians in interventions that cause death could undermine the trust essential to the doctor-patient relationship, blurring the line between healing and harming. Furthermore, there are significant concerns about the protection of vulnerable groups, such as the poor, elderly, and disabled, from potential abuse, neglect, and coercion. The Court of Appeals dismissed these concerns as unfounded, but the New York Task Force highlighted the risks that legalizing physician-assisted suicide poses to individuals already compromised by various societal factors. An existing bias against individuals with disabilities, combined with cost-saving attitudes, necessitates statutory protection from physician-assisted suicide. This could lead to vulnerable individuals opting for assisted suicide to alleviate financial burdens on their families, which raises concerns about societal prejudice and stereotypes against the disabled and terminally ill. The state’s ban on assisted suicide aims to affirm the equal value of all lives, emphasizing that suicidal thoughts in seriously disabled individuals should be treated with the same gravity as in others. The state fears that legalizing assisted suicide may create a slippery slope toward broader euthanasia practices, potentially including involuntary euthanasia. The Court of Appeals' ruling, which invalidated Washington's ban for competent, terminally ill adults seeking to hasten death, is seen as potentially expansive, with implications that could extend beyond its intended scope. This includes the possibility of surrogate decision-makers acting on behalf of patients and the involvement of family members in the assisted suicide process, complicating the regulation of such practices. Historical data from the Netherlands highlights the risks involved, showcasing instances of euthanasia and assisted suicide occurring without explicit patient consent, further supporting the state's concerns about the potential consequences of legalizing assisted suicide. Euthanasia practices in the Netherlands have extended beyond the intended scope of competent, terminally ill adults experiencing physical suffering, leading to potential abuse involving vulnerable individuals, including disabled neonates and elderly patients with dementia. The New York Task Force highlighted the close connection between assisted suicide and euthanasia, warning that the risks of abuse are significant and not merely theoretical. This perspective influenced Washington State's decision to ban assisted suicide rather than regulate it, aligning with the view that such a ban is a reasonable measure for safeguarding vulnerable populations. The court upheld Washington's statute prohibiting assistance in suicide as not violating the Fourteenth Amendment, affirming its relevance to protecting legitimate state interests. The ongoing national debate surrounding the morality and legality of physician-assisted suicide continues to be acknowledged, and the court's ruling allows for this discourse to persist. The case, initially brought by terminally ill patients and physicians, questioned the statute's compatibility with substantive due process. Although the original plaintiffs have since passed away, the physicians involved still seek legal relief for future patient interactions under the statute, which remains a significant legal issue. An order granting summary judgment establishes that the patients involved were mentally competent and terminally ill, having made informed, voluntary requests for prescriptions to self-administer medications aimed at hastening their deaths. The State does not dispute that these patients faced more agonizing and prolonged deaths than they would through physician-assisted suicide, and that they would prefer the latter for personal dignity and pain relief. Each physician involved claims to regularly encounter similar patients seeking assistance in voluntarily terminating their lives. While there is no consensus on the medical obligation in such scenarios, it is accepted that prescribing medications to hasten death aligns with medical practice standards. The Washington statute is seen as obstructing physicians' professional judgment in administering appropriate dosages to enable patients to hasten their deaths. The doctors argue for the right to assist patients who have made informed decisions about their lives and bodies, acknowledging the need for the State to impose reasonable regulations to ensure patient competence and informed consent. In contrast, the State contends that the doctors' interest lacks constitutional recognition due to its absence of historical roots and raises concerns about potential negative consequences if such assistance were permitted. The State emphasizes that any attempt to limit the right to terminally ill patients may be unfeasible, as determining a patient’s lifespan can be uncertain. The document asserts that there is no principled basis to limit the right to physician-assisted suicide solely to terminally ill patients self-administering medication. The justification for the right, framed as the merciful termination of suffering, is deemed too broad for such constraints. The State contends that this right cannot be restricted to mentally competent individuals, as competence is not always easily assessed, and no clear distinction exists between competent patients acting independently and those using a competent surrogate. Additionally, the State argues that recognizing this right could lead to a broader interpretation that merges with other forms of life-ending assistance, such as euthanasia, and that it could be indistinguishable from assistance provided by non-physicians, raising concerns about risks of irresponsible suicides and euthanasia. The physicians claim that the Washington law infringes upon their right, protected by the Fourteenth Amendment's due process clause, to assist patients without adequate justification from the State. They argue that their claim pertains to substantive due process rights, which are often considered unenumerated rights. This raises skepticism regarding the vague nature of the Due Process Clause and its suitability for judicial review of state laws. The history of substantive due process is noted, highlighting its legitimacy and the challenges faced in previous cases, with references to the application of such principles in state courts prior to the Fourteenth Amendment ratification. A Connecticut court validated a statute recognizing previously illegitimate marriages as part of the "social compact," affirming its constitutional review authority (Goshen v. Stonington, 1822). Simultaneously, a Tennessee equity court deemed unconstitutional a statute allowing the state bank to sue debtors, labeling it as "partial legislation" violating the state constitution's "law of the land" clause (Bank of the State v. Cooper, 1831). The mid-19th century saw the Wynehamer case, where a statute making liquor possession illegal was struck down for violating the state's due process clause, which was deemed an excessive infringement on property rights (Wynehamer v. People, 1856). The judiciary's power to invalidate legislation conflicting with unenumerated principles of government was acknowledged, yet many legislative acts were upheld (e.g., Wilkinson v. Leland, Calder v. Bull). In Fletcher v. Peck (1810), the Court invalidated Georgia's attempt to rescind a land sale, citing prohibitions against bills of attainder and ex post facto laws, alongside general principles of free institutions. Dred Scott v. Sandford (1857) marked a significant instance of judicial review based on the due process clause of the Fifth Amendment, which invalidated the Missouri Compromise by asserting that Congress lacked authority to regulate property rights concerning slaves in territories, reflecting broader implications for governmental legitimacy. Following the ratification of the Fourteenth Amendment, the interpretation of "liberty" and "property" in due process clauses became a significant legal focus, primarily evaluated through the lens of reasonableness versus arbitrariness. Justice Bradley's dissent in the Slaughter-House Cases emphasized that the right to choose one's occupation is a fundamental aspect of liberty, linking it to property rights and underscoring that due process protections are undermined when these rights can be arbitrarily violated. Subsequent cases showed a willingness to scrutinize legislative actions for compliance with the Due Process Clause, despite often upholding those laws. The principle of judicial review of substantive statutes gained traction, particularly in Allgeyer v. Louisiana, where the Court invalidated a Louisiana law for excessively infringing upon the liberty to contract as protected by the Fourteenth Amendment. The Court articulated that this liberty encompasses the right to utilize one's faculties freely, choose one's residence and occupation, and enter into necessary contracts. However, the Court clarified that states retain the authority to exercise their police power, with the extent of such power being determined on a case-by-case basis. The Allgeyer decision initiated a period of economic legislation scrutiny reminiscent of the Dred Scott case, culminating in the Lochner Era, where the Court frequently invalidated economic regulations as arbitrary. Landmark cases during this period, such as Lochner v. New York and Adkins v. Children's Hospital, exemplified this approach by striking down laws regulating hours and wages, which later courts deemed constitutionally sound, marking a significant shift in the judicial interpretation of economic regulations. The excerpt addresses the evolution of substantive due process and the Court's role in reviewing legislation for arbitrariness and reasonableness. It notes the overruling of Adkins to support a minimum-wage law, emphasizing that regulations must be reasonable and in the community's interest to satisfy due process. The Lochner line of cases, while correct in invoking a standard of constitutional review, is critiqued for its absolutist approach reminiscent of Dred Scott. Precedents like Meyer v. Nebraska reaffirm the Fourteenth Amendment's protection of individual rights, including the freedom to contract, pursue education, and raise a family without undue state interference. The Court found Nebraska's ban on foreign language teaching arbitrary, paralleling this reasoning in Pierce v. Society of Sisters, which invalidated a statute that nearly eliminated private schools. The excerpt also discusses Palko v. Connecticut, where the Court established that oppressive legislative judgments could be overturned, focusing on the severity of hardships imposed by statutes. The cases Meyer and Pierce laid the groundwork for future rulings, particularly Skinner v. Oklahoma, which recognized procreation as a fundamental right requiring strict scrutiny in legislative actions affecting it. Overall, the passage illustrates the Court's increasing commitment to protecting individual liberties against arbitrary state regulations. Justice Harlan's dissent in Poe emphasizes that the level of justification required from a State hinges on the significance of the individual's interest at stake. This dissent laid the groundwork for the modern doctrine, later adopted in Griswold v. Connecticut and acknowledged in Planned Parenthood of Southeastern Pennsylvania v. Casey. Harlan highlights the judiciary's duty to conduct substantive due process reviews to ensure legislative conformity with constitutional standards. Historically, American courts have engaged in this review since before the Dred Scott decision, addressing critical issues such as segregation, interracial marriage, marital privacy, abortion, personal medical control, and physical confinement. Harlan argues that substantive limitations must be recognized within the Due Process Clause, as procedural safeguards alone would inadequately protect against legislative actions that could infringe on life, liberty, or property. The dissent stresses the importance of examining legislative resolutions of conflicting principles, rather than merely identifying extratextual absolutes. This comparison of opposing claims is essential to the judicial responsibility in substantive due process cases. Judicial review does not allow for the replacement of one reasonable resolution with another but permits intervention only when the existing balance between competing positions is unreasonable. The excerpt emphasizes the importance of detailed attention in substantive due process review, advocating for a balanced consideration of both sides in a dispute while respecting legislative authority within reasonable bounds. An understanding of unenumerated rights should avoid extreme positions, focusing instead on the concept of "ordered liberty," which includes a continuum of rights protecting individuals from arbitrary restrictions. Due process is characterized not by rigid formulas but by a historical balance between individual liberty and societal demands. This balance, informed by tradition, must be respected to ensure the legitimacy of judicial decisions. The text highlights that arbitrary limits on substantive due process are inappropriate; rather, they should stem from a careful acknowledgment of historical teachings and societal values. Additionally, post-Poe, the enforceable concept of liberty prohibits unreasonable statutory impositions, even at minor levels, where governmental restraints lack any rational justification. Such instances of overreach are expected to be rare, maintaining a presumption of constitutionality unless a statute's rationale is implausible. Claims of arbitrariness concerning unenumerated substantive rights require careful scrutiny of the state's justifications for abridging significant interests in liberty. Such interests are deemed "fundamental," necessitating that the state demonstrate a compelling interest to justify any infringement, rather than relying on mere rationality or a presumption of constitutionality. Courts must weigh the importance of contending interests, adhering to constitutional values that are either explicitly stated or deeply rooted in national traditions. Judicial review should not be based on personal or subjective notions but rather on principles that reflect the established legal process. Additionally, constitutional review focuses on assessing whether a statute reasonably balances the interests of the state against individual rights, rather than creating new legal standards. Legislation must yield when its justifying principle is disproportionately applied to individual interests, indicating an arbitrary use of the statute. A claimant can assert a constitutional right only if the balance of liberty interests against state interests disfavor the statute. Establishing a "liberty interest" under the Due Process Clause initiates a balancing act, requiring careful scrutiny of competing interests, as highlighted in cases like Cruzan v. Director and Youngberg v. Romeo. The Poe dissent emphasizes the necessity of a reasoned judgment in reviewing substantive due process claims, underscoring the importance of detailed examination of interests and historical principles. While it rejects a universal formula for due process analysis, it affirms that adjudication requires a traditional method of reasoned judgment, where the framing of competing principles significantly influences outcomes. The common-law approach favors nuanced, incremental understanding over rigid dichotomies, advocating for a living tradition that adapts through careful considerations of established principles and emerging examples. A new legal decision must be contextualized against previous rulings and inform future interpretations. Justice Harlan emphasized the importance of framing due process claims accurately, particularly in Poe, where the right to use contraceptives was linked to privacy within marriage. This framing served two crucial functions: it limited the claim's scope, avoiding a challenge to all state regulation of contraception, and it positioned the claim within a broader liberty against unreasonable intrusions into family life, supported by constitutional protections such as the Third and Fourth Amendments. Harlan distinguished between areas of government regulation, allowing for privacy in marital intimacy while acknowledging state interests in regulating sexual morality. He argued that while the state could enforce limits on contraceptive use through means like divorce laws, criminalizing such use in the marital bedroom would unjustly invade personal privacy. Harlan's analysis underscored the need for precision in evaluating governmental interests and the contexts of regulatory measures, advocating for a nuanced approach to balancing individual rights and state interests. This framework remains relevant in contemporary discussions about the specificity of claims and justifications for restrictions on personal liberties. The dissenting opinion emphasizes the necessity for careful evaluation of the claims presented, contrasting them with earlier cases that lacked such discrimination. The focus is on a specific claim that seeks to establish a right for a limited group to assist others in a narrow set of circumstances regarding assisted suicide. The claimants argue that a terminally ill patient, facing imminent death and capable of making a voluntary choice, should have the right to receive assistance from a physician to end their life. This claim challenges the existing Washington statute prohibiting such assistance. Respondents do not assert a historical basis for the right to suicide but instead highlight that the State has moved away from its historical prohibitions, thereby allowing for claims that align with other recognized rights to bodily autonomy. They argue that the tradition of medical assistance in end-of-life scenarios is robust and that denying such assistance is arbitrary, given that physicians can aid individuals exercising other rights. Historically, Western legal systems condemned suicide, treating it as a crime, with penalties for attempts and consequences for the deceased's estate. While the U.S. has largely moved away from penalizing suicide directly, many states still criminalize assisting in the act, as illustrated by the Washington statute in question. The history in Washington is significant for its rejection of traditional criminal prohibitions against suicide, indicating a shift away from viewing such laws as essential. However, the respondents clarify that this decriminalization does not suggest the State has abandoned its interest in discouraging suicide or regulating assistance with it. The rationale behind decriminalization may be rooted more in practical law enforcement challenges than in a fundamental re-evaluation of life’s value. The State may choose to refrain from interfering with suicide itself while maintaining prohibitions against aiding it. Decriminalization does not equate to a constitutional right to suicide but allows for the recognition of a liberty interest in bodily integrity and medical care. This right to bodily integrity has been echoed in legal precedents, affirming that adults have the right to make decisions regarding their own bodies, especially concerning medical interventions. The Constitution restricts state interference in personal bodily decisions, as established in cases related to medical treatment and end-of-life choices. Constitutional protections extend to the rights of individuals to refuse life-sustaining treatment and to seek medical interventions like abortion. Notably, the abortion cases highlight the significance of bodily integrity and the right to medical assistance in decision-making regarding one’s own body. A law that restricts a pregnant woman's right to terminate her pregnancy through a licensed physician is deemed unconstitutional, emphasizing the critical relationship between patient and physician. The state may have a legitimate interest in discouraging abortions; however, the right to a physician's counsel and care is upheld. The court draws parallels between abortion and assisted suicide, noting that without physician assistance, a woman's right to abortion may devolve into self-harm, and similarly, terminal patients would face painful, crude methods of dying without medical help. The court acknowledges the physician's role extends beyond mere technical ability to encompass moral support and holistic care. The decision to assist in ending life aligns with recognized rights under the Constitution and state law, particularly in the context of terminal illness where patients seek dignity in death. Respondents cite existing state laws that allow physicians to withdraw life-sustaining treatment and manage pain, even if it hastens death, illustrating an evolving recognition of patient care traditions. Physicians are permitted to administer powerful medications to terminally ill patients to alleviate pain, even if such medications may hasten death, provided the patient is fully aware and consents. The legal framework, as outlined in Washington law, allows for this practice. The argument supporting the respondents' position unfolds in three main points: 1. **Decriminalization of Suicide**: The historical prohibition against suicide and aiding suicide has been weakened due to societal changes, allowing for questioning of previous legal norms. 2. **Freedom of Choice**: The State's decriminalization of suicide parallels the recognized right to bodily autonomy in other contexts, such as abortion, highlighting that individuals should have choice in matters of life and death. 3. **Right to Medical Care**: Respondents assert their claim based on the traditional right to medical assistance, especially when death is imminent, advocating that this right should extend to seeking physician assistance in such circumstances. The importance of the individual interest in this context demands careful scrutiny against the State's interests, which include protecting life, discouraging suicide, and safeguarding terminally ill patients against involuntary actions related to euthanasia. While the State presents significant justifications for its law, the potential for a fundamental right to medical assistance in dying remains a contentious issue. The third justification for opposing the respondents' claim centers on the state's interest in protecting nonresponsible individuals and those without a direct relationship to their physicians. The State asserts a need to safeguard patients from mistakenly deciding to end their lives, as well as to prevent both voluntary and involuntary euthanasia. Potential issues include inadequate palliative care leading to erroneous terminal prognoses and the risk of coercion due to financial burdens from medical expenses. The argument posits that once physicians are allowed to prescribe lethal medications, they may struggle to differentiate between patients who choose to end their own lives and those who cannot request death, potentially leading to abuse of this authority. The State contends that the implications of the respondents' claim are broader than they appear, suggesting that any recognition of their interests would also affect others and could lead to unintended consequences that the State has a legitimate reason to avert. The State challenges the sufficiency of relying solely on physician oversight to prevent abuses, arguing that determining a patient's responsible capacity and the influence of external factors is complex. It highlights that distinguishing a "knowing and voluntary" decision is more difficult than previously recognized due process rights, noting that physicians may be inclined to accommodate patient wishes due to compassion or financial incentives, particularly in managed care contexts. A physician providing a drug for a patient to self-administer raises concerns about the potential overlap between assisted suicide and euthanasia, including the risk of involuntary euthanasia. This situation presents a slippery slope argument, suggesting that recognizing one right may lead to the recognition of others without clear legal boundaries. Proposed state regulations aim to mitigate these risks by requiring confirmation from two qualified physicians regarding the patient's condition and competence, multiple requests from the patient, and strict reporting and penalties for coercion. However, the effectiveness of these regulations is uncertain, drawing parallels to the Netherlands' experience with similar guidelines. Critics argue that Dutch regulations have failed to prevent involuntary euthanasia, citing instances where patients were euthanized without their explicit request. Others contest this perspective, claiming that Dutch physicians are cautious and that significant abuses are not evident. The ongoing debate emphasizes the complexity of the issue, suggesting that the current lack of consensus on the effectiveness of such regulations is critical in evaluating due process claims regarding assisted suicide and euthanasia at this time. Judicial review may be limited in cases where a legislature's actions are not deemed arbitrary if three conditions are met: (1) there exists a serious factual controversy regarding the feasibility of recognizing a claimed right without hindering the state's legitimate powers; (2) the necessary facts to resolve this controversy are not easily accessible through judicial means but are better suited for legislative investigation and experimentation; and (3) the state’s interest in protecting individuals who cannot make informed decisions justifies its restriction on assistance to only those who are both aware and responsible in their intent to end their life, as well as its prohibition of euthanasia. The legitimacy of the state's authority to deny physicians the option to assist anyone other than a knowing and responsible individual is acknowledged. However, the state's capacity to safeguard vulnerable populations if respondents succeed in their claims raises genuine questions, particularly highlighted by the discrepancies in understanding the Dutch experience with similar issues. The complexity of factual questions at the heart of this case cannot be reliably resolved through judicial means at this time, especially given the limited existing literature on the subject. Legislatures are better positioned to gather pertinent facts and can adapt their strategies based on emerging evidence, suggesting that some states may pursue experimentation in this area. While courts can address constitutional claims, there may be instances where political branches are more appropriate venues for resolving such issues, as indicated by past rulings like Bolling v. Sharpe. Legislative reasonableness in Washington is scrutinized, highlighting that both the Legislature and the Court exhibit uncertainty regarding the implications of recognizing a new constitutional right, particularly in the context of assisted suicide. The preference is for legislative processes to address emerging issues, as they are better suited to evaluate unknown facts that could be critical to the matter. Recognizing an unenumerated right without assurance of its durability would undermine the constitutional framework and the Court’s duty for finality in its decisions. Unlike the Court, legislatures can experiment with such issues, making legislative deliberation desirable. While the Court does not definitively reject the recognition of the claim, it acknowledges the Legislature’s superior competence to evaluate it at this time. Additionally, the excerpt references historical statutes regarding assisted suicide and Washington's Natural Death Act, which affirms adults' rights to make healthcare decisions, including the withdrawal of life-sustaining treatment under specific conditions. Lastly, the declarations from various individuals indicate that plaintiffs are in severe, terminal phases of illness. Declarations from individuals assert their mental competence and desire for assistance in ending their lives. The District Court applied the "undue burden" standard from Casey to evaluate the plaintiffs' facial challenge against the assisted-suicide ban, ultimately ruling the statute unconstitutional as it applied to terminally ill, mentally competent patients. Although the court's decision was not limited to specific plaintiffs, it acknowledged that declaring a statute unconstitutional for a group is not uncommon. The Court of Appeals noted the equal protection argument was significant but refrained from opining on a related case, Lee v. Oregon, which involved challenges to Oregon's Death With Dignity Act. In contrast, the Court upheld New York's assisted-suicide ban as compliant with the Equal Protection Clause. Overall, forty-four states, the District of Columbia, and two territories prohibit assisted suicide, reflecting a common legal stance among western democracies. Recent legislative actions in Louisiana, Rhode Island, and Iowa have further solidified statutory bans on assisted suicide. Historical context reveals that England's prohibition on suicide originated from ecclesiastical law, reaffirmed in the 7th century and restated by legal scholars in later centuries. Suicide has historically been viewed as a serious offense against nature, God, and the sovereign, with legal interpretations treating it as a form of murder. By the mid-16th century, the Court at Common Bench asserted that suicide is contrary to nature and morally reprehensible. Sir Edward Coke classified suicide as murder, leading to the forfeiture of the goods of a sane individual who commits suicide, although lands were exempt from this forfeiture. William Hawkins echoed Coke's abhorrence of the act in his legal treatise. California adopted English common law in 1850, categorizing assisting suicide as a crime, which was further defined in 1874 to make it a felony to aid, advise, or encourage another in committing suicide. The American Law Institute's Model Penal Code established that aiding or soliciting suicide resulting in death could lead to felony charges. Proposed legislation in Washington aimed to amend the Natural Death Act to allow physician-assisted dying under certain conditions, but similar initiatives faced legal challenges regarding their constitutionality and protective measures for terminally ill patients. Numerous states have introduced bills addressing assisted suicide, reflecting ongoing debates on the topic. Internationally, Canada’s Supreme Court denied a claim that the right to assisted suicide is a fundamental right under its Charter of Rights and Freedoms. The British House of Lords Select Committee on Medical Ethics determined not to recommend changes to the prohibition of assisted suicide in Great Britain, stating no circumstances warrant its legalization. In 1995, New Zealand's Parliament rejected a "Death With Dignity Bill" that sought to allow physician-assisted suicide. Conversely, the Northern Territory of Australia legalized assisted suicide and voluntary euthanasia in 1995, with three reported cases of assisted deaths by February 1997. However, on March 24, 1997, the Australian Senate voted to repeal this law. In contrast, on May 20, 1997, Colombia's Constitutional Court legalized voluntary euthanasia for terminally ill individuals. Various U.S. court cases, including Quill v. Vacco and Compassion in Dying v. Washington, have addressed the constitutional basis for a right to assisted suicide, concluding that such a right lacks support in the Constitution. The analysis emphasized that while some cases have referenced Justice Harlan's dissent on due-process grounds, the established approach of the Court remains focused on fundamental rights deeply rooted in history and tradition. Intrusions into the marital bedroom are deemed to violate rights that predate the Bill of Rights, disrupting the fundamental family relationship. The freedom to marry is recognized as essential to the pursuit of happiness, and the decision to marry is classified as a fundamental right. Historical context shows that women had broader rights regarding pregnancy termination in the past. Marriage and procreation are also considered fundamental rights, which are protected under liberty interests recognized at common law. The court identified six legitimate state interests concerning physician-assisted suicide: preserving life, preventing suicide, avoiding third-party involvement or undue influence, protecting family members, maintaining the integrity of the medical profession, and preventing potential abuses like euthanasia. While respondents acknowledge these interests, they argue for regulation rather than prohibition of physician-assisted suicide. States express disapproval of both suicide and assisted suicide through various statutes, including those regarding durable powers of attorney and living wills, and they allow involuntary commitment for individuals at risk of self-harm. Justice Souter notes that concerns about a slippery slope are valid, as recognizing one due process right could lead to unmanageable expansions of rights. The reasonable skepticism about the lack of a principled basis for limiting such rights is acknowledged, emphasizing the risks of abandoning a complete prohibition on physician-assisted suicide. Assisted suicide's legality raises significant arguments for euthanasia, as noted by multiple legal scholars and ethical councils. Justice Stevens views the case as a facial challenge to the constitutionality of a statute prohibiting physician-assisted suicide, rather than an as-applied challenge to specific plaintiffs. The court emphasizes its rejection of the lower court's ruling that deemed the statute unconstitutional in its application. While acknowledging the potential for individual challenges to be made in the future, the court asserts that the existing framework under the Due Process Clause of the Fourteenth Amendment does not provide enhanced protection for the right to end one's life with medical assistance. Additionally, the Equal Protection Clause does not substantially add to the argument beyond what is covered by Due Process. The document cites historical cases and opinions, including Justice Harlan's dissent in Poe v. Ullman, to illustrate the evolution of judicial review related to individual liberties and societal demands. It also references the Slaughter-House Cases to highlight the limited scope of the Privileges or Immunities Clause, which has influenced the court's reliance on the Due Process Clause for substantive rights analysis. The Lochner Era Court recognized the validity of criticisms against the Slaughter-House decision's interpretation of the Privileges or Immunities Clause but chose to uphold that interpretation, relying instead on the Due Process Clause for substantive judicial review. Legal scholar J. Ely argues that the Privileges or Immunities Clause should be the basis for judicial oversight of state legislation, although the use of the Due Process Clause for this purpose predates the 1873 decision. Historical context is provided by Judge Johnson's commentary in Wynehamer v. People, emphasizing that a legislature cannot deprive individuals of secured rights without due process, as doing so would render the constitutional provision ineffective. The document acknowledges that not all laws that slightly hinder fundamental liberties require compelling justification. It cites Casey, which indicates that while states can regulate the manufacturing and sale of contraceptives, significant obstacles to exercising fundamental liberties must be justified with substantial reasoning. Justice Harlan's views are referenced, illustrating that requiring fundamental rights to receive heightened scrutiny helps avoid excessive complexity in legal analysis. Various terms have been used in case law to describe fundamental liberty interests, indicating the need for careful scrutiny in certain situations. Liberty interests may be equated with rights, particularly when they outweigh governmental interests, as established in cases like Youngberg v. Romeo and Roe v. Wade. The term "right" is reserved for scenarios where individual liberty interests take precedence over government regulation, leading to legally enforceable claims. An individual's claimed right must be analyzed within the context of broader legal traditions, which may demand varying levels of constitutional scrutiny. For example, abortion could be viewed through the lens of women’s reproductive freedom or fetal protection laws, necessitating a careful determination of which legal principle applies. The "compelling interest test" is used to assess whether regulations that significantly burden a protected liberty are justified, requiring that such regulations be narrowly tailored to serve a compelling state interest. The evaluation of both the strength of the government’s interest and the burden on the individual's liberty is crucial in this analysis. The summary also notes that some states, like Washington and New York, have criminalized attempted suicide historically, referencing the common law's influence on their legal frameworks. In 1828, New York reclassified the offense of assisting suicide from murder to manslaughter in the first degree. In 1881, a new penal code was adopted, criminalizing attempted suicide with penalties of up to two years in prison or fines, while maintaining the prohibition on assisting suicide as manslaughter in the first degree. By 1919, the law prohibiting attempted suicide was repealed. The 1937 New York Report of the Law Revision Commission traced the ban on assisting suicide to ancient common law, noting that the stigma of suicide as a crime had been removed and that liability for assisting suicide needed to be defined as a substantive offense. In 1965, New York revised its penal law to classify someone who intentionally aids another in committing suicide as guilty of manslaughter in the second degree. Washington's legislative history reflects similar trends; in 1854, the first territorial legislature designated assisting suicide as manslaughter, a provision that was re-enacted in subsequent years. In 1909, Washington enacted laws based on New York’s legal framework, retaining the prohibition against assisting suicide as manslaughter. However, in 1975, Washington repealed these provisions and enacted a new ban on assisting suicide, which was influenced by the recognition that those attempting suicide should not face criminal punishment if unsuccessful. Many states have since enacted laws prohibiting assisted suicide, reflecting a broader legal trend across the country. Numerous states have enacted laws regarding the administration of pain relief medications, exempting licensed healthcare providers from assisted suicide prohibitions when such treatments may hasten death, provided there is no intent to cause death. Specific references include statutes from Indiana, Iowa, Kentucky, Minnesota, Ohio, Rhode Island, South Dakota, and Tennessee, among others. Some states allow patients to sign healthcare directives authorizing pain treatment that could hasten death, as seen in legislation from Maine, New Mexico, South Carolina, and Virginia. The excerpt discusses the rationale behind these exemptions, emphasizing that the primary intent of administering pain relief is to alleviate suffering rather than to end life. This indicates a lesser state interest in preserving life in cases involving pain management and the discontinuation of artificial life support, as such measures are often seen as interventions against natural processes. In contrast, when a physician prescribes medication specifically intended to aid in dying, it raises significant ethical considerations regarding the patient’s competence and responsibility in making such decisions. The distinction between alleviating pain and facilitating death is pivotal in assessing the legality and morality of these practices.