Ashcroft tried to stop doctors from prescribing medicines for physician-assisted suicide. He threatened to use a federal anti-drug law to punish them.
The state of Oregon went to court to fight Ashcroft. Eventually, the Supreme Court ruled that Ashcroft did not have the power to stop doctors from prescribing legal drugs in a way that was legal in Oregon. This decision allowed physician-assisted suicide to continue in Oregon.
In 1994, the people of Oregon voted to pass the Death with Dignity Act.[1] Under this law, if a terminally ill adult wants to, they can get a lethal prescription from a doctor. They can only do this if they are a competentadult (they are able to make decisions on their own). They must also meet many other requirements.[a][2]
By the end of 2001, when Ashcroft got involved, 150 people had gotten prescriptions under the Death with Dignity Act. Ninety-nine of these people used their prescriptions to end their lives. The other 51 (about one out of every three people) chose never to use their prescriptions.[1]
In 2001, Attorney General Ashcroft tried to stop Oregon's doctors from prescribing medicines for physician-assisted suicide by using the Controlled Substances Act.[1]
The Controlled Substances Act
The Controlled Substances Act is a federal law sets the United States' rules about legal and illegal drugs. It includes rules about what medicines doctors can and cannot prescribe. It also includes a list of medicines, called "controlled substances," which doctors cannot prescribe without a special license from the United States Drug Enforcement Administration (DEA).[3]
DEA rules limit when doctors with this license can prescribe controlled substances:
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"[A] prescription for a controlled substance ... must be issued for a legitimate medical purpose by an individual [doctor] acting in the usual course of his professional practice.[4]
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This means that doctors can only prescribe controlled substances if their patients need them for real medical problems. Basically, the doctor has to be acting like a doctor, not a drug dealer.
The goal of this rule was to stop doctors who prescribed drugs to people who abused them.[5] If doctors did this, they would be violating the Controlled Substances Act. The punishment for doctors who do this is to lose their DEA license to prescribe controlled substances.[6]
The Ashcroft Directive
In 1994, when Oregon first passed the Death with Dignity Act, Janet Reno was the Attorney General. She decided the Death with Dignity Act did not violate the Controlled Substances Act.[7]
However, in November 2001, Attorney General Ashcroft put out a new rule (which became known as "The Ashcroft Directive"[7]). He reversed Reno's position. He said the Death with Dignity Act did violate the Controlled Substances Act.
Ashcroft had decided physician-assisted suicide was not a "legitimate medical purpose" for any medication. Because of this, he said, any doctor in Oregon who wrote another prescription for physician-assisted suicide would be breaking the Controlled Substances Act. As punishment, the DEA could take away these doctors' licenses to prescribe controlled substances. This would make it impossible for those doctors to prescribe medicines for physician-assisted suicide. The DEA could also fine the doctors or even charge them with crimes.[7]
Appeals
The day after Ashcroft issued his Directive, the state of Oregon went to federal court to fight it. Doctors, other health care providers, and people with terminal illnesses joined Oregon's lawsuit against Ashcroft. On April 17, 2002, U.S. District Judge Robert Jones ordered an injunction – a judge's order saying that Ashcroft's rule could not be enforced. However, the court did not have the jurisdiction to hear the whole lawsuit. It moved the case to a higher (more powerful) court: the United States Court of Appeals for the Ninth Circuit.[8]
The Ninth Circuit agreed with Judge Jones's injunction. They ruled that Congress obviously did not mean for the Controlled Substances Act to be used to control physician-assisted suicide. They meant for it to control illegal drug dealing. They also ruled that Ashcroft did not have the power to control a state's medical practices. That was the state's own business to control, the Court said.[9]
Ashcroft asked the Supreme Court to hear the case. By the time they did, there was a new Attorney General: Alberto Gonzales. However, Gonzales supported the Ashcroft Directive, and continued Ashcroft's fight against the Death with Dignity Act.[7]
Supreme Court decision
On January 17, 2006, the Supreme Court decided in favor of Oregon.
The Supreme Court did not rule on whether physician-assisted suicide, or the Oregon Death with Dignity Act, were legal. Instead, they made their decision based on the ideas of federalism – the separation between the powers of the United States government and the individual states.[5][10]
Like the Ninth Circuit, the Supreme Court ruled that the Controlled Substances Act was meant to fight drug use and drug dealing. Congress never meant for the law to deal with physician-assisted suicide.[5]
The Court said that Congress also never meant for the Controlled Substance Act to control medical practices. The states had always had the right to control their own medical practices. Ashcroft decided that he could create a meaning of "legitimate medical practice" that every state would have to follow. The Court ruled that the Attorney General did not have this power to take away the states' rights to decide this for themselves.[10] Also, since he was not a medical expert, he should not be deciding what "legitimate medical practice" was.[5]
Finally, the Court ruled that under the Controlled Substances Act, the Attorney General had a very small role. He did not have the power to cancel a state law. He also did not have the right to punish doctors like criminals for acting in ways that were legal in Oregon. The Attorney General did not have the power to take these rights from Oregon.[5]
Importance
Their ruling in Gonzales showed the states that the Supreme Court would not stop them from making physician-assisted suicide legal. As of 2016, four more states have made physician-assisted suicide legal: Washington, Montana, Vermont, and California. Now physician-assisted suicide is legal in five states – 10% of the states in the country. If the Supreme Court had made a different ruling in Gonzales, this never would have been possible.[5]
A different ruling in Gonzales would have also given the Attorney General much more power over the states and their doctors. It would have taken away the states' rights in some important areas. Instead, it ruled in favor of states' rights and the separation of powers between the states and the federal government.[10]
Notes
↑For example, to use the Oregon Death with Dignity Act, a person must meet these requirements:[2]
They must ask their doctor for physician-assisted suicide three different times, separated by at least 15 days
Two different doctors have to agree that the person has a disease that will kill them
They must have talked to their doctor about other choices, like hospice care
