text:
Vacco v. Quill, 521 U.S. 793 (1997)
Supreme Court of the United States
Filed: June 26th, 1997
Precedential Status: Precedential
Citations: 521 U.S. 793, 117 S. Ct. 2293, 138 L. Ed. 2d 834, 1997 U.S. LEXIS 4038
Docket Number: 95-1858
Supreme Court Database ID: 1996-092
Author: John Paul Stevens

521 U.S. 793 (1997)
VACCO, ATTORNEY GENERAL OF NEW YORK, ET AL.
v.
QUILL et al.

No. 95-1858.
United States Supreme Court.

Argued January 8, 1997.
Decided June 26, 1997.
CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT
*794 Rehnquist, C. J., delivered the opinion of the Court, in which O'Connor, Scalia, Kennedy, and Thomas, JJ., joined. O'Connor, J., filed a concurring opinion, in which Ginsburg and Breyer, JJ., joined in part, ante, p. 736. Stevens, J., ante, p. 738, Souter, J., post, p. 809, Ginsburg, J., ante, p. 789, and Breyer, J., ante, p. 789, filed opinions concurring in the judgment.

Dennis C. Vacco, Attorney General of New York, pro se, argued the cause for petitioners. With him on the briefs were Barbara Gott Billet, Solicitor General, and Daniel Smirlock and Michael S. Popkin, Assistant Attorneys General.

Acting Solicitor General Dellinger argued the cause for the United States as amicus curiae urging reversal. With him on the brief were Assistant Attorney General Hunger, Deputy Solicitor General Waxman, Deputy Assistant *795 Attorney General Preston, Barbara C. Biddle, and Ann Hubbard.

Laurence H. Tribe argued the cause for respondents. With him on the brief were Peter J. Rubin, Kathryn L. Tucker, David J. Burman, Kari Anne Smith, and Carla A. Kerr.[*]

*796 Chief Justice Rehnquist delivered the opinion of the Court.

In New York, as in most States, it is a crime to aid another to commit or attempt suicide,[1] but patients may refuse even *797 life saving medical treatment.[2] The question presented by this case is whether New York's prohibition on assisting suicide therefore violates the Equal Protection Clause of the Fourteenth Amendment. We hold that it does not.

Petitioners are various New York public officials. Respondents Timothy E. Quill, Samuel C. Klagsbrun, and Howard A. Grossman are physicians who practice in New York. They assert that although it would be "consistent with the standards of [their] medical practice[s]" to prescribe lethal medication for "mentally competent, terminally ill patients" who are suffering great pain and desire a doctor's help in taking their own lives, they are deterred from doing so by New York's ban on assisting suicide. App. 25-26.[3] Respondents, and three gravely ill patients who have since died,[4] sued the State's Attorney General in the United States *798 District Court. They urged that because New York permits a competent person to refuse life-sustaining medical treatment, and because the refusal of such treatment is "essentially the same thing" as physician-assisted suicide, New York's assisted-suicide ban violates the Equal Protection Clause. Quill v. Koppell, 870 F. Supp. 78, 84-85 (SDNY 1994).

The District Court disagreed: "[I]t is hardly unreasonable or irrational for the State to recognize a difference between allowing nature to take its course, even in the most severe situations, and intentionally using an artificial deathproducing device." Id., at 84. The court noted New York's "obvious legitimate interests in preserving life, and in protecting vulnerable persons," and concluded that "[u]nder the United States Constitution and the federal system it establishes, the resolution of this issue is left to the normal democratic processes within the State." Id., at 84-85.

The Court of Appeals for the Second Circuit reversed. 80 F.3d 716 (1996). The court determined that, despite the assisted-suicide ban's apparent general applicability, "New York law does not treat equally all competent persons who are in the final stages of fatal illness and wish to hasten their deaths," because "those in the final stages of terminal illness who are on life-support systems are allowed to hasten their deaths by directing the removal of such systems; but those who are similarly situated, except for the previous attachment of life-sustaining equipment, are not allowed to hasten death by self-administering prescribed drugs." Id., at 727, 729. In the court's view, "[t]he ending of life by [the withdrawal of life-support systems] is nothing more nor less than assisted suicide. " Id., at 729 (emphasis added). The Court of Appeals then examined whether this supposed unequal treatment was rationally related to any legitimate state *799 interests,[5] and concluded that "to the extent that [New York's statutes] prohibit a physician from prescribing medications to be self-administered by a mentally competent, terminally-ill person in the final stages of his terminal illness, they are not rationally related to any legitimate state interest." Id., at 731. We granted certiorari, 518 U.S. 1055 (1996), and now reverse.

The Equal Protection Clause commands that no State shall "deny to any person within its jurisdiction the equal protection of the laws." This provision creates no substantive rights. San Antonio Independent School Dist. v. Rodriguez, 411 U.S. 1, 33 (1973); id., at 59 (Stewart, J., concurring). Instead, it embodies a general rule that States must treat like cases alike but may treat unlike cases accordingly. Plyler v. Doe, 457 U.S. 202, 216 (1982) ("`[T]he Constitution does not require things which are different in fact or opinion to be treated in law as though they were the same' ") (quoting Tigner v. Texas, 310 U.S. 141, 147 (1940)). If a legislative classification or distinction "neither burdens a fundamental right nor targets a suspect class, we will uphold [it] so long as it bears a rational relation to some legitimate end." Romer v. Evans, 517 U.S. 620, 631 (1996).

New York's statutes outlawing assisting suicide affect and address matters of profound significance to all New Yorkers alike. They neither infringe fundamental rights nor involve suspect classifications. Washington v. Glucksberg, ante, at 719-728; see 80 F. 3d, at 726; San Antonio School Dist., 411 U. S., at 28 ("The system of alleged discrimination and the class it defines have none of the traditional indicia of suspectness"); id., at 33-35 (courts must look to the Constitution, not the "importance" of the asserted right, when deciding whether an asserted right is "fundamental"). These laws *800 are therefore entitled to a "strong presumption of validity." Heller v. Doe, 509 U.S. 312, 319 (1993).

On their faces, neither New York's ban on assisting suicide nor its statutes permitting patients to refuse medical treatment treat anyone differently from anyone else or draw any distinctions between persons. Everyone, regardless of physical condition, is entitled, if competent, to refuse unwanted life saving medical treatment; no one is permitted to assist a suicide. Generally speaking, laws that apply evenhandedly to all "unquestionably comply" with the Equal Protection Clause. New York City Transit Authority v. Beazer, 440 U.S. 568, 587 (1979); see Personnel Administrator of Mass. v. Feeney, 442 U.S. 256, 271-273 (1979) ("[M]any [laws] affect certain groups unevenly, even though the law itself treats them no differently from all other members of the class described by the law").

The Court of Appeals, however, concluded that some terminally ill people—those who are on life-support systems— are treated differently from those who are not, in that the former may "hasten death" by ending treatment, but the latter may not "hasten death" through physician-assisted suicide. 80 F. 3d, at 729. This conclusion depends on the submission that ending or refusing life saving medical treatment "is nothing more nor less than assisted suicide." Ibid. Unlike the Court of Appeals, we think the distinction between assisting suicide and withdrawing life-sustaining treatment, a distinction widely recognized and endorsed in the medical profession[6] and in our legal traditions, is both important and *801 logical; it is certainly rational. See Feeney, supra, at 272 ("When the basic classification is rationally based, uneven effects upon particular groups within a class are ordinarily of no constitutional concern").

The distinction comports with fundamental legal principles of causation and intent. First, when a patient refuses lifesustaining medical treatment, he dies from an underlying fatal disease or pathology; but if a patient ingests lethal medication prescribed by a physician, he is killed by that medication. See, e. g., People v. Kevorkian, 447 Mich. 436, 470-472, 527 N.W.2d 714, 728 (1994), cert. denied, 514 U.S. 1083 (1995); Matter of Conroy, 98 N. J. 321, 355,  486 A.2d 1209, 1226 (1985) (when feeding tube is removed, death "result[s]. . . from [the patient's] underlying medical condition"); In re Colyer, 99 Wash. 2d 114, 123, 660 P.2d 738, 743 (1983) ("[D]eath which occurs after the removal of life sustaining systems is from natural causes"); American Medical Association, Council on Ethical and Judicial Affairs, PhysicianAssisted Suicide, 10 Issues in Law & Medicine 91, 93 (1994) ("When a life-sustaining treatment is declined, the patient dies primarily because of an underlying disease").

Furthermore, a physician who withdraws, or honors a patient's refusal to begin, life-sustaining medical treatment purposefully intends, or may so intend, only to respect his patient's wishes and "to cease doing useless and futile or degrading things to the patient when [the patient] no longer stands to benefit from them." Assisted Suicide in the *802 United States, Hearing before the Subcommittee on the Constitution of the House Committee on the Judiciary, 104th Cong., 2d Sess., 368 (1996) (testimony of Dr. Leon R. Kass). The same is true when a doctor provides aggressive palliative care; in some cases, pain killing drugs may hasten a patient's death, but the physician's purpose and intent is, or may be, only to ease his patient's pain. A doctor who assists a suicide, however, "must, necessarily and indubitably, intend primarily that the patient be made dead." Id., at 367. Similarly, a patient who commits suicide with a doctor's aid necessarily has the specific intent to end his or her own life, while a patient who refuses or discontinues treatment might not. See, e. g., Matter of Conroy, supra, at 351,  486 A. 2d, at 1224 (patients who refuse life-sustaining treatment "may not harbor a specific intent to die" and may instead "fervently wish to live, but to do so free of unwanted medical technology, surgery, or drugs"); Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 743, n. 11,  370 N.E.2d 417, 426, n. 11 (1977) ("[I]n refusing treatment the patient may not have the specific intent to die").

The law has long used actors' intent or purpose to distinguish between two acts that may have the same result. See, e. g., United States v. Bailey, 444 U.S. 394, 403-406 (1980) ("[T]he . . . common law of homicide often distinguishes . . . between a person who knows that another person will be killed as the result of his conduct and a person who acts with the specific purpose of taking another's life"); Morissette v. United States, 342 U.S. 246, 250 (1952) (distinctions based on intent are "universal and persistent in mature systems of law"); M. Hale, 1 Pleas of the Crown 412 (1847) ("If A. with an intent to prevent a gangrene beginning in his hand doth without any advice cut off his hand, by which he dies, he is not thereby felo de se for tho it was a voluntary act, yet it was not with an intent to kill himself"). Put differently, the law distinguishes actions taken "because of" a given end *803 from actions taken "in spite of" their unintended but foreseen consequences. Feeney, 442 U. S., at 279; Compassion in Dying v. Washington, 79 F.3d 790, 858 (CA9 1996) (Kleinfeld, J., dissenting) ("When General Eisenhower ordered American soldiers onto the beaches of Normandy, he knew that he was sending many American soldiers to certain death. . . . His purpose, though, was to . . . liberate Europe from the Nazis").

Given these general principles, it is not surprising that many courts, including New York courts, have carefully distinguished refusing life-sustaining treatment from suicide. See, e. g., Fosmire v. Nicoleau, 75 N.Y. 2d 218, 227, and n. 2, 551 N.E.2d 77, 82, and n. 2 (1990) ("[M]erely declining medical care . . . is not considered a suicidal act").[7] In fact, the first state-court decision explicitly to authorize withdrawing life saving treatment noted the "real distinction between the self-infliction of deadly harm and a self-determination against artificial life support." In re Quinlan, 70 N. J. 10, 43, 52, and n. 9, 355 A.2d 647, 665, 670, and n. 9, cert. denied sub nom. Garger v. New Jersey, 429 U.S. 922 (1976). And recently, the Michigan Supreme Court also rejected the argument that the distinction "between acts that artificially sustain life and acts that artificially curtail life" is merely a "distinction without constitutional significance—a meaningless *804 exercise in semantic gymnastics," insisting that "the Cruzan majority disagreed and so do we." Kevorkian, 447 Mich., at 471, 527 N.W. 2d, at 728.[8]

Similarly, the overwhelming majority of state legislatures have drawn a clear line between assisting suicide and withdrawing *805 or permitting the refusal of unwanted life saving medical treatment by prohibiting the former and permitting the latter. Glucksberg, ante, at 710-711, 716-719. And "nearly all states expressly disapprove of suicide and assisted suicide either in statutes dealing with durable powers of attorney in health-care situations, or in `living will' statutes." Kevorkian, supra, at 478-479, and nn. 53-54, 527 N.W. 2d, at 731-732, and nn. 53-54.[9] Thus, even as the *806 States move to protect and promote patients' dignity at the end of life, they remain opposed to physician-assisted suicide.

New York is a case in point. The State enacted its current assisted-suicide statutes in 1965.[10] Since then, New York has acted several times to protect patients' commonlaw right to refuse treatment. Act of Aug. 7, 1987, ch. 818, § 1, 1987 N. Y. Laws 3140 ("Do Not Resuscitate Orders") (codified as amended at N. Y. Pub. Health Law §§ 2960-2979 (McKinney 1993 and Supp. 1997)); Act of July 22, 1990, ch. 752, § 2, 1990 N. Y. Laws 3547 ("Health Care Agents and Proxies") (codified as amended at N. Y. Pub. Health Law §§ 2980-2994 (McKinney 1993 and Supp. 1997)). In so doing, however, the State has neither endorsed a general right to "hasten death" nor approved physician-assisted suicide. Quite the opposite: The State has reaffirmed the line between "killing" and "letting die." See N. Y. Pub. Health Law § 2989(3) (McKinney 1993) ("This article is not intended to permit or promote suicide, assisted suicide, or euthanasia"); New York State Task Force on Life and the Law, LifeSustaining Treatment: Making Decisions and Appointing a Health Care Agent 36-42 (July 1987); Do Not Resuscitate Orders: The Proposed Legislation and Report of the New York State Task Force on Life and the Law 15 (Apr. 1986). More recently, the New York State Task Force on Life and *807 the Law studied assisted suicide and euthanasia and, in 1994, unanimously recommended against legalization. When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context vii (1994). In the Task Force's view, "allowing decisions to forgo life-sustaining treatment and allowing assisted suicide or euthanasia have radically different consequences and meanings for public policy." Id., at 146.

This Court has also recognized, at least implicitly, the distinction between letting a patient die and making that patient die. In Cruzan v. Director, Mo. Dept. of Health, 497 U.S. 261, 278 (1990), we concluded that "[t]he principle that a competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment may be inferred from our prior decisions," and we assumed the existence of such a right for purposes of that case, id., at 279. But our assumption of a right to refuse treatment was grounded not, as the Court of Appeals supposed, on the proposition that patients have a general and abstract "right to hasten death," 80 F. 3d, at 727-728, but on well-established, traditional rights to bodily integrity and freedom from unwanted touching, Cruzan, 497 U. S., at 278-279; id., at 287— 288 (O'Connor, J., concurring). In fact, we observed that "the majority of States in this country have laws imposing criminal penalties on one who assists another to commit suicide." Id., at 280. Cruzan therefore provides no support for the notion that refusing life-sustaining medical treatment is "nothing more nor less than suicide."

For all these reasons, we disagree with respondents' claim that the distinction between refusing lifesaving medical treatment and assisted suicide is "arbitrary" and "irrational." Brief for Respondents 44.[11] Granted, in some cases, *808 the line between the two may not be clear, but certainty is not required, even were it possible.[12] Logic and contemporary practice support New York's judgment that the two acts are different, and New York may therefore, consistent with the Constitution, treat them differently. By permitting everyone to refuse unwanted medical treatment while prohibiting anyone from assisting a suicide, New York law follows a longstanding and rational distinction.

New York's reasons for recognizing and acting on this distinction—including prohibiting intentional killing and preserving life; preventing suicide; maintaining physicians' role as their patients' healers; protecting vulnerable people from *809 indifference, prejudice, and psychological and financial pressure to end their lives; and avoiding a possible slide towards euthanasia—are discussed in greater detail in our opinion in Glucksberg, ante. These valid and important public interests easily satisfy the constitutional requirement that a legislative classification bear a rational relation to some legitimate end.[13]

The judgment of the Court of Appeals is reversed.

It is so ordered.

[For concurring opinion of Justice O'Connor, see ante, p. 736; for opinions concurring in the judgments of Justice Stevens, see ante, p. 738, Justice Ginsburg, see ante, p. 789, and Justice Breyer, see ante, p. 789.]

Justice Souter, concurring in the judgment.

Even though I do not conclude that assisted suicide is a fundamental right entitled to recognition at this time, I accord the claims raised by the patients and physicians in this case and Washington v. Glucksberg a high degree of importance, requiring a commensurate justification. See Washington v. Glucksberg, ante, at 782 (Souter, J., concurring in judgment). The reasons that lead me to conclude in Glucksberg that the prohibition on assisted suicide is not arbitrary under the due process standard also support the distinction between assistance to suicide, which is banned, and *810 practices such as termination of artificial life support and death-hastening pain medication, which are permitted. I accordingly concur in the judgment of the Court.

NOTES

[*] Briefs of amici curiae urging reversal were filed for the State of California et al. by Daniel E. Lungren, Attorney General of California, Robert L. Mukai, Chief Assistant Attorney General, Alvin J. Korobkin, Senior Assistant Attorney General, and Thomas S. Lazar, Deputy Attorney General, and by the Attorneys General for their respective jurisdictions as follows: Jeff Sessions of Alabama, Gale A. Norton of Colorado, Robert A. Butterworth of Florida, Michael J. Bowers of Georgia, James E. Ryan of Illinois, Thomas J. Miller of Iowa, Richard P. Ieyoub of Louisiana, J. Joseph Curran, Jr., of Maryland, Frank J. Kelley of Michigan, Mike Moore of Mississippi, Joseph P. Mazurek of Montana, Don Stenberg of Nebraska, Jeffrey R. Howard of New Hampshire, Drew Edmondson of Oklahoma, Pedro R. Pierluisi of Puerto Rico, Charles Molony Condon of South Carolina, Mark W. Barnett of South Dakota, Charles W. Burson of Tennessee, James S. Gilmore III of Virginia, and Christine O. Gregoire of Washington; for Wayne County, Michigan, by John D. O'Hair and Timothy A. Baughman; for Agudath Israel of America by David Zwiebel and Morton M. Avigdor; for the American Association of Homes and Services for the Aging et al. by Joel G. Chefitz and Robert K. Niewijk; for the American Center for Law and Justice by Jay Alan Sekulow, James M. Henderson, Sr., Walter M. Weber, Keith A. Fournier, John G. Stepanovich, and Thomas P. Monaghan; for the American Geriatrics Society by John H. Pickering and Joseph E. Schmitz; for the American Hospital Association by Michael K. Kellogg and Margaret J. Hardy; for the American Medical Association et al. by Carter G. Phillips, Mark E. Haddad, Paul E. Kalb, Katherine L. Adams, Newton N. Minow, Jack R. Bierig, Kirk B. Johnson, and Michael L. Ile; for the Catholic Health Association of the United States by James A. Serritella, James C. Geoly, Kevin R. Gustafson, Thomas C. Shields, Peter M. Leibold, and Charles S. Gilham; for the Catholic Medical Association by Joseph J. Frank, Sergio Alvarez-Mena III, and Peter Buscemi; for the Christian Legal Society et al. by Edward J. Larson, Kimberlee Wood Colby, and Steven T. McFarland; for the Clarendon Foundation by Ronald D. Maines; for the Evangelical Lutheran Church in America by Edward McGlynn Gaffney, Jr., Susan D. Reece Martyn, Henry J. Bourguignon, and Phillip H. Harris; for the Family Research Council by Cathleen A. Cleaver, Mark A. Rothe, and Edward R. Grant; for the Institute for Public Affairs of the Union of Orthodox Jewish Congregations of America et al. by Richard B. Stone; for the Medical Society of New Jersey by Paul W. Armstrong and R. Bruce Crelin; for the National Association of Prolife Nurses et al. by Jacqulyn Kay Hall; for the National Catholic Office for Persons with Disabilities et al. by James Bopp, Jr., Thomas J. Marzen, Daniel Avila, and Jane E. T. Brockmann; for the National Hospice Organization by E. Barrett Prettyman, Jr.; for the National Legal Center for the Medically Dependent & Disabled, Inc., et al. by James Bopp, Jr., Thomas J. Marzen, Daniel Avila, and Jane E. T. Brockmann; for the Project on Death in America et al. by Robert A. Burt; for the United States Catholic Conference et al. by Mark E. Chopko; for Senator Orrin Hatch et al. by Michael W. McConnell; for Members of the New York and Washington State Legislatures by Paul Benjamin Linton and Clarke D. Forsythe; for Bioethics Professors by George J. Annas; for Jerome J. De Cosse et al. by Michael P. Tierney; for Gary Lee, M. D., et al. by James Bopp, Jr., Bary A. Bostrom, and Richard E. Coleson; and for Richard Thompson by Mr. Thompson, pro se, and Richard H. Browne.

Briefs of amici curiae urging affirmance were filed for the American Civil Liberties Union et al. by Cameron Clark, Karen E. Boxx, and Steven R. Shapiro; for Americans for Death with Dignity et al. by John R. Reese and Page R. Barnes; for the American Medical Student Association et al. by John H. Hall; for the Coalition of Hospice Professionals by Gerald A. Rosenberg and Frances Kulka Browne; for Gay Men's Health Crisis et al. by Andrew I. Batavia; for the National Women's Health Network et al. by Sylvia A. Law; for 36 Religious Organizations, Leaders, and Scholars by Barbara McDowell and Gregory A. Castanias; for the Washington State Psychological Association et al. by Edward C. DuMont; for Bioethicists by Martin R. Gold and Robert P. Mulvey; for Law Professors by Charles H. Baron, David A. Hoffman, and Joshua M. Davis; for State Legislators by Sherry F. Colb; and for Julian M. Whitaker, M. D., by Jonathan W. Emord.

Briefs of amici curiae were filed for the American College of Legal Medicine by Miles J. Zaremski, Bruce C. Nelson, and Ila S. Rothschild; for the American Life League, Inc., by Charles E. Rice; for Choice in Dying, Inc., by Henry Putzel III; for the International Anti-Euthanasia Task Force by Wesley J. Smith; for Not Dead Yet et al. by Stephen F. Gold; for Surviving Family Members in Support of Physician-Assisted Dying by Katrin E. Frank, Robert A. Free, and Kathleen Wareham; and for Ronald Dworkin et al. by Mr. Dworkin, pro se, Peter L. Zimroth, Philip H. Curtis, Kent A. Yalowitz, Anand Agneshwar, and Abe Krash.

[1] New York Penal Law § 125.15 (McKinney 1987) ("Manslaughter in the second degree") provides: "A person is guilty of manslaughter in the second degree when . . . (3) He intentionally causes or aids another person to commit suicide. Manslaughter in the second degree is a class C felony." Section 120.30 ("Promoting a suicide attempt") states: "A person is guilty of promoting a suicide attempt when he intentionally causes or aids another person to attempt suicide. Promoting a suicide attempt is a class E felony." See generally Washington v. Glucksberg, ante, at 710-719.

[2] "It is established under New York law that a competent person may refuse medical treatment, even if the withdrawal of such treatment will result in death." Quill v. Koppell, 870 F. Supp. 78, 84 (SDNY 1994); see N. Y. Pub. Health Law, §§ 2960-2979 (McKinney 1993 and Supp. 1997) ("Orders Not to Resuscitate") (regulating right of "adult with capacity" to direct issuance of orders not to resuscitate); id., §§ 2980-2994 ("Health Care Agents and Proxies") (allowing appointment of agents "to make . . . health care decisions on the principal's behalf," including decisions to refuse lifesaving treatment).

[3] Declaration of Timothy E. Quill, M. D., App. 42-49; Declaration of Samuel C. Klagsbrun, M. D., id., at 68-74; Declaration of Howard A. Grossman, M. D., id., at 84-89; 80 F.3d 716, 719 (CA2 1996).

[4] These three patients stated that they had no chance of recovery, faced the "prospect of progressive loss of bodily function and integrity and increasing pain and suffering," and desired medical assistance in ending their lives. App. 25-26; Declaration of William A. Barth, id., at 96-98; Declaration of George A. Kingsley, id., at 99-102; Declaration of Jane Doe, id., at 105-109.

[5] The court acknowledged that because New York's assisted-suicide statutes "do not impinge on any fundamental rights [or] involve suspect classifications," they were subject only to rational-basis judicials crutiny. 80 F. 3d, at 726-727.

[6] The American Medical Association emphasizes the "fundamental difference between refusing life-sustaining treatment and demanding a lifeending treatment." American Medical Association, Council on Ethical and Judicial Affairs, Physician-Assisted Suicide, 10 Issues in Law & Medicine 91, 93 (1994); see also American Medical Association, Council on Ethical and Judicial Affairs, Decisions Near the End of Life, 267 JAMA 2229, 2230-2231, 2233 (1992) ("The withdrawing or withholding of life-sustaining treatment is not inherently contrary to the principles of beneficence and nonmaleficence," but assisted suicide "is contrary to the prohibition against using the tools of medicine to cause a patient's death"); New York State Task Force on Life and the Law, When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context 108 (1994) ("[Professional organizations] consistently distinguish assisted suicide and euthanasia from the withdrawing or withholding of treatment, and from the provision of palliative treatments or other medical care that risk fatal side effects"); Brief for American Medical Association et al. as Amici Curiae 18-25. Of course, as respondents' lawsuit demonstrates, there are differences of opinion within the medical profession on this question. See New York Task Force, supra, at 104-109.

[7] Thus, the Second Circuit erred in reading New York law as creating a "right to hasten death"; instead, the authorities cited by the court recognize a right to refuse treatment, and nowhere equate the exercise of this right with suicide. Schloendorff v. Society of New York Hospital, 211 N.Y. 125, 129-130,  105 N.E. 92, 93 (1914), which contains Justice Cardozo's famous statement that "[e]very human being of adult years and sound mind has a right to determine what shall be done with his own body," was simply an informed-consent case. See also Rivers v. Katz, 67 N.Y. 2d 485, 495, 495 N.E.2d 337, 343 (1986) (right to refuse antipsychotic medication is not absolute, and may be limited when "the patient presents a danger to himself"); Matter of Storar, 52 N.Y. 2d 363, 377, n. 6, 420 N.E.2d 64, 71, n. 6, cert. denied, 454 U.S. 858 (1981).

[8] Many courts have recognized this distinction. See, e. g., Kevorkian v. Thompson, 947 F. Supp. 1152, 1178, and nn. 20-21 (ED Mich. 1997); In re Fiori, 543 Pa. 592, 602, 673 A.2d 905, 910 (1996); Singletary v. Costello,  665 So. 2d 1099, 1106 (Fla. App. 1996); Laurie v. Senecal, 666 A.2d 806, 808-809 (R. I. 1995); State ex rel. Schuetzle v. Vogel, 537 N.W.2d 358, 360 (N. D. 1995); Thor v. Superior Court, 5 Cal. 4th 725, 741-742, 855 P.2d 375, 385-386 (1993); DeGrella v. Elston, 858 S.W.2d 698, 707 (Ky. 1993); People v. Adams, 216 Cal. App. 3d 1431, 1440, 265 Cal. Rptr. 568, 573-574 (1990); Guardianship of Jane Doe, 411 Mass. 512, 522-523, 583 N.E.2d 1263, 1270, cert. denied sub nom. Doe v. Gross, 503 U.S. 950 (1992); In re L. W., 167 Wis. 2d 53, 83, 482 N.W.2d 60, 71 (1992); In re Rosebush, 195 Mich. App. 675, 681, n. 2, 491 N.W.2d 633, 636, n. 2 (1992); Donaldson v. Van de Kamp, 2 Cal. App. 4th 1614, 1619-1625, 4 Cal. Rptr. 2d 59, 61-64 (1992); In re Lawrance, 579 N.E.2d 32, 40, n. 4 (Ind. 1991); McKay v. Bergstedt, 106 Nev. 808, 822-823, 801 P.2d 617, 626-627 (1990); In re Browning, 568 So. 2d 4, 14 (Fla. 1990); McConnell v. Beverly EnterprisesConnecticut, Inc., 209 Conn. 692, 710, 553 A.2d 596, 605 (1989); State v. McAfee, 259 Ga. 579, 581, 385 S.E.2d 651, 652 (1989); In re Grant, 109 Wash. 2d 545, 563, 747 P.2d 445, 454-455 (1987); In re Gardner, 534 A.2d 947, 955-956 (Me. 1987); Matter of Farrell, 108 N. J. 335, 349-350, 529 A.2d 404, 411 (1987); Rasmussen v. Fleming, 154 Ariz. 207, 218, 741 P.2d 674, 685 (1987); Bouvia v. Superior Court, 179 Cal. App. 3d 1127, 1144— 1145, 225 Cal. Rptr. 297, 306 (1986); Von Holden v. Chapman, 87 A.D. 2d 66, 70, 450 N. Y. S. 2d 623, 627 (1982); Bartling v. Superior Court, 163 Cal. App. 3d 186, 196-197, 209 Cal. Rptr. 220, 225-226 (1984); Foody v. Manchester Memorial Hospital, 40 Conn. Supp. 127, 137, 482 A.2d 713, 720 (1984); In re P. V. W., 424 So. 2d 1015, 1022 (La. 1982); Leach v. Akron General Medical Center, 68 Ohio Misc. 1, 10, 426 N.E.2d 809, 815 (Ohio Comm. Pleas 1980); In re Severns, 425 A.2d 156, 161 (Del. Ch. 1980); Satz v. Perlmutter, 362 So. 2d 160, 162-163 (Fla. App. 1978); Application of the President and Directors of Georgetown College, 331 F.2d 1000, 1009 (CADC), cert. denied, 377 U.S. 978 (1964); Brophy v. New England Sinai Hospital, 398 Mass. 417, 439, 497 N.E.2d 626, 638 (1986). The British House of Lords has also recognized the distinction. Airedale N. H. S. Trust v. Bland, 2 W. L. R. 316, 368 (1993).

[9] See Ala. Code § 22-8A-10 (1990); Alaska Stat. Ann. §§ 18.12.080(a), (f) (1996); Ariz. Rev. Stat. Ann. § 36-3210 (Supp. 1996); Ark. Code Ann. §§ 20— 13-905(a), (f), XX-XX-XXX(a), (g) (1991 and Supp. 1995); Cal. Health & Safety Code Ann. §§ 7191.5(a), (g) (West Supp. 1997); Cal. Prob. Code Ann. § 4723 (West Supp. 1997); Colo. Rev. Stat. §§ 15-14-504(4), 15-18-112(1), 15-18.5— 101(3), 15-18.6-108 (1987 and Supp. 1996); Conn. Gen. Stat. § 19a—575 (Supp. 1996); Del. Code Ann., Tit. 16, § 2512 (Supp. 1996); D. C. Code Ann. §§ 6-2430, 21-2212 (1995 and Supp. 1996); Fla. Stat. §§ 765.309(1), (2) (Supp. 1997); Ga. Code Ann. §§ 31-32-11(b), 31-36-2(b) (1996); Haw. Rev. Stat. § 327D-13 (1996); Idaho Code § 39-152 (Supp. 1996); Ill.Comp. Stat., ch. 755, §§ 35/9(f), 40/5, 40/50, 45/2-1 (1992); Ind. Code §§ 16-36-1—13, 16-36— 4-19, 30-5—5-17 (1994 and Supp. 1996); Iowa Code §§ 144A.11.1-144A.11.6, 144B.12.2 (1989 and Supp. 1997); Kan. Stat. Ann. § 65-28,109 (1985); Ky. Rev. Stat. Ann. § 311.638 (Baldwin Supp. 1992); La. Rev. Stat. Ann. §§ 40:1299.58.10(A), (B) (West 1992); Me. Rev. Stat. Ann., Tit. 18—A, §§ 5— 813(b), (c) (Supp. 1996); Md. Health Code Ann. § 5-611(c) (1994); Mass. Gen. Laws 201D, § 12 (Supp. 1997); Mich. Comp. Laws Ann. § 700.496(20) (West 1995); Minn. Stat. §§ 145B.14, 145C.14 (Supp. 1997); Miss. Code Ann. §§ 41— 41-117(2), 41-41-119(1) (Supp. 1992); Mo. Rev. Stat. §§ 459.015.3, 459.055(5) (1992); Mont. Code Ann. §§ 50-9—205(1), (7), 50-10-104(1), (6) (1995); Neb. Rev. Stat. §§ 20-412(1), (7), 30-3401(3) (1995); Nev. Rev. Stat. § 449.670(2) (1996); N. H. Rev. Stat. Ann. §§ 137—H:10, 137—H:13, 137—J:1 (1996); N. J. Stat. Ann. §§ 26:2H-54(d), (e), 26:2H-77 (West 1996); N. M. Stat. Ann. §§ 24-7A-13(B)(1), (C) (Supp. 1995); N. Y. Pub. Health Law § 2989(3) (McKinney 1993); N. C. Gen. Stat. §§ 90-320(b), 90-321(f) (1993); N. D. Cent. Code §§ 23-06.4-01, 23-06.5-01 (1991); Ohio Rev. Code Ann. §§ 2133.12(A), (D) (Supp. 1996); Okla. Stat., Tit. 63, §§ 3101.2(C), 3101.12(A), (G) (1997); 20 Pa. Cons. Stat. § 5402(b) (Supp. 1996); R. I. Gen. Laws §§ 23-4.10-9(a), (f), 23-4.11-10(a), (f) (1996); S. C. Code Ann. §§ 44-77-130, 44-78-50(A), (C), 62-5—504(O) (Supp. 1996); S. D. Codified Laws §§ 34-12D-14, 34-12D-20 (1994); Tenn. Code Ann. §§ 32-11-110(a), 39-13-216 (Supp. 1996); Tex. Health & Safety Code Ann. §§ 672.017, 672.020, 672.021 (1992); Utah Code Ann. §§ 75-2—1116, 75-2—1118 (1993); Vt. Stat. Ann., Tit. 18, § 5260 (1987); Va. Code Ann. § 54.1-2990 (1994); V. I. Code Ann., Tit. 19, §§ 198(a), (g) (1995); Wash. Rev. Code §§ 70.122.070(1), 70.122.100 (Supp. 1997); W. Va. Code §§ 16-30-10, 16-30A-16(a), 16-30B-2(b), 16-30B-13, 16-30C-14 (1995); Wis. Stat. §§ 154.11(1), (6), 154.25(7), 155.70(7) (Supp. 1996); Wyo. Stat. §§ 3-5—211, 35-22-109, 35-22-208 (1994 and Supp. 1996). See also 42 U.S. C. §§ 14402(b)(1), (2), (4) (1994 ed., Supp. III) ("Assisted Suicide Funding Restriction Act of 1997").

[10] It has always been a crime, either by statute or under the common law, to assist a suicide in New York. See Marzen, O'Dowd, Crone, & Balch, Suicide: A Constitutional Right?, 24 Duquesne L. Rev. 1, 205-210 (1985) (App.).

[11] Respondents also argue that the State irrationally distinguishes between physician-assisted suicide and "terminal sedation," a process respondents characterize as "induc[ing] barbiturate coma and then starv[ing] the person to death." Brief for Respondents 48-50; see 80 F. 3d, at 729. Petitioners insist, however, that "`[a]lthough proponents of physician-assisted suicide and euthanasia contend that terminal sedation is covert physician-assisted suicide or euthanasia, the concept of sedating pharmacotherapy is based on informed consent and the principle of double effect.' " Reply Brief for Petitioners 12 (quoting P. Rousseau, Terminal Sedation in the Care of Dying Patients, 156 Archives Internal Med. 1785, 1785-1786 (1996)). Just as a State may prohibit assisting suicide while permitting patients to refuse unwanted lifesaving treatment, it may permit palliative care related to that refusal, which may have the foreseen but unintended "double effect" of hastening the patient's death. See New York Task Force, When Death is Sought, supra n. 6, at 163 ("It is widely recognized that the provision of pain medication is ethically and professionally acceptable even when the treatment may hasten the patient's death, if the medication is intended to alleviate pain and severe discomfort, not to cause death").

[12] We do not insist, as Justice Stevens suggests, ante, at 750 (opinion concurring in judgments), that "in all cases there will in fact be a significant difference between the intent of the physicians, the patients, or the families [in withdrawal-of-treatment and physician-assisted-suicide cases]." See supra, at 801-802 ("[A] physician who withdraws, or honors a patient's refusal to begin, life-sustaining medical treatment purposefully intends, or may so intend, only to respect his patient's wishes . . . . The same is true when a doctor provides aggressive palliative care; . . . the physician's purpose and intent is, or may be, only to ease his patient's pain" (emphasis added)). In the absence of omniscience, however, the State is entitled to act on the reasonableness of the distinction.

[13] Justice Stevens observes that our holding today "does not foreclose the possibility that some applications of the New York statute may impose an intolerable intrusion on the patient's freedom." Ante, at 751-752 (opinion concurring in judgments). This is true, but, as we observe in Glucksberg, ante, at 735, n. 24, a particular plaintiff hoping to show that New York's assisted-suicide ban was unconstitutional in his particular case would need to present different and considerably stronger arguments than those advanced by respondents here.

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text: therefore

text: entitled

text: to

text: a

text: strong

text: presumption

text: of

text: validity

text: Heller

text: v

text: Doe

text: U

text: S

text: On

text: their

text: faces

text: neither

text: New

text: York

text: s

text: ban

text: on

text: assisting

text: suicide

text: nor

text: its

text: statutes

text: permitting

text: patients

text: to

text: refuse

text: medical

text: treatment

text: treat

text: anyone

text: differently

text: from

text: anyone

text: else

text: or

text: draw

text: any

text: distinctions

text: between

text: persons

text: Everyone

text: regardless

text: of

text: physical

text: condition

text: is

text: entitled

text: if

text: competent

text: to

text: refuse

text: unwanted

text: life

text: saving

text: medical

text: treatment

text: no

text: one

text: is

text: permitted

text: to

text: assist

text: a

text: suicide

text: Generally

text: speaking

text: laws

text: that

text: apply

text: evenhandedly

text: to

text: all

text: unquestionably

text: comply

text: with

text: the

text: Equal

text: Protection

text: Clause

text: New

text: York

text: City

text: Transit

text: Authority

text: v

text: Beazer

text: U

text: S

text: see

text: Personnel

text: Administrator

text: of

text: Mass

text: v

text: Feeney

text: U

text: S

text: M

text: any

text: laws

text: affect

text: certain

text: groups

text: unevenly

text: even

text: though

text: the

text: law

text: itself

text: treats

text: them

text: no

text: differently

text: from

text: all

text: other

text: members

text: of

text: the

text: class

text: described

text: by

text: the

text: law

text: The

text: Court

text: of

text: Appeals

text: however

text: concluded

text: that

text: some

text: terminally

text: ill

text: people

text: those

text: who

text: are

text: on

text: life

text: support

text: systems

text: are

text: treated

text: differently

text: from

text: those

text: who

text: are

text: not

text: in

text: that

text: the

text: former

text: may

text: hasten

text: death

text: by

text: ending

text: treatment

text: but

text: the

text: latter

text: may

text: not

text: hasten

text: death

text: through

text: physician

text: assisted

text: suicide

text: F

text: d

text: at

text: This

text: conclusion

text: depends

text: on

text: the

text: submission

text: that

text: ending

text: or

text: refusing

text: life

text: saving

text: medical

text: treatment

text: is

text: nothing

text: more

text: nor

text: less

text: than

text: assisted

text: suicide

text: Ibid

text: Unlike

text: the

text: Court

text: of

text: Appeals

text: we

text: think

text: the

text: distinction

text: between

text: assisting

text: suicide

text: and

text: withdrawing

text: life

text: sustaining

text: treatment

text: a

text: distinction

text: widely

text: recognized

text: and

text: endorsed

text: in

text: the

text: medical

text: profession

text: and

text: in

text: our

text: legal

text: traditions

text: is

text: both

text: important

text: and

text: logical

text: it

text: is

text: certainly

text: rational

text: See

text: Feeney

text: supra

text: at

text: When

text: the

text: basic

text: classification

text: is

text: rationally

text: based

text: uneven

text: effects

text: upon

text: particular

text: groups

text: within

text: a

text: class

text: are

text: ordinarily

text: of

text: no

text: constitutional

text: concern

text: The

text: distinction

text: comports

text: with

text: fundamental

text: legal

text: principles

text: of

text: causation

text: and

text: intent

text: First

text: when

text: a

text: patient

text: refuses

text: lifesustaining

text: medical

text: treatment

text: he

text: dies

text: from

text: an

text: underlying

text: fatal

text: disease

text: or

text: pathology

text: but

text: if

text: a

text: patient

text: ingests

text: lethal

text: medication

text: prescribed

text: by

text: a

text: physician

text: he

text: is

text: killed

text: by

text: that

text: medication

text: See

text: e

text: g

text: People

text: v

text: Kevorkian

text: Mich

text: N

text: W

text: d

text: cert

text: denied

text: U

text: S

text: Matter

text: of

text: Conroy

text: N

text: J

text: A

text: d

text: when

text: feeding

text: tube

text: is

text: removed

text: death

text: result

text: s

text: from

text: the

text: patient

text: s

text: underlying

text: medical

text: condition

text: In

text: re

text: Colyer

text: Wash

text: d

text: P

text: d

text: D

text: eath

text: which

text: occurs

text: after

text: the

text: removal

text: of

text: life

text: sustaining

text: systems

text: is

text: from

text: natural

text: causes

text: American

text: Medical

text: Association

text: Council

text: on

text: Ethical

text: and

text: Judicial

text: Affairs

text: PhysicianAssisted

text: Suicide

text: Issues

text: in

text: Law

text: Medicine

text: When

text: a

text: life

text: sustaining

text: treatment

text: is

text: declined

text: the

text: patient

text: dies

text: primarily

text: because

text: of

text: an

text: underlying

text: disease

text: Furthermore

text: a

text: physician

text: who

text: withdraws

text: or

text: honors

text: a

text: patient

text: s

text: refusal

text: to

text: begin

text: life

text: sustaining

text: medical

text: treatment

text: purposefully

text: intends

text: or

text: may

text: so

text: intend

text: only

text: to

text: respect

text: his

text: patient

text: s

text: wishes

text: and

text: to

text: cease

text: doing

text: useless

text: and

text: futile

text: or

text: degrading

text: things

text: to

text: the

text: patient

text: when

text: the

text: patient

text: no

text: longer

text: stands

text: to

text: benefit

text: from

text: them

text: Assisted

text: Suicide

text: in

text: the

text: United

text: States

text: Hearing

text: before

text: the

text: Subcommittee

text: on

text: the

text: Constitution

text: of

text: the

text: House

text: Committee

text: on

text: the

text: Judiciary

text: th

text: Cong

text: d

text: Sess

text: testimony

text: of

text: Dr

text: Leon

text: R

text: Kass

text: The

text: same

text: is

text: true

text: when

text: a

text: doctor

text: provides

text: aggressive

text: palliative

text: care

text: in

text: some

text: cases

text: pain

text: killing

text: drugs

text: may

text: hasten

text: a

text: patient

text: s

text: death

text: but

text: the

text: physician

text: s

text: purpose

text: and

text: intent

text: is

text: or

text: may

text: be

text: only

text: to

text: ease

text: his

text: patient

text: s

text: pain

text: A

text: doctor

text: who

text: assists

text: a

text: suicide

text: however

text: must

text: necessarily

text: and

text: indubitably

text: intend

text: primarily

text: that

text: the

text: patient

text: be

text: made

text: dead

text: Id

text: at

text: Similarly

text: a

text: patient

text: who

text: commits

text: suicide

text: with

text: a

text: doctor

text: s

text: aid

text: necessarily

text: has

text: the

text: specific

text: intent

text: to

text: end

text: his

text: or

text: her

text: own

text: life

text: while

text: a

text: patient

text: who

text: refuses

text: or

text: discontinues

text: treatment

text: might

text: not

text: See

text: e

text: g

text: Matter

text: of

text: Conroy

text: supra

text: at

text: A

text: d

text: at

text: patients

text: who

text: refuse

text: life

text: sustaining

text: treatment

text: may

text: not

text: harbor

text: a

text: specific

text: intent

text: to

text: die

text: and

text: may

text: instead

text: fervently

text: wish

text: to

text: live

text: but

text: to

text: do

text: so

text: free

text: of

text: unwanted

text: medical

text: technology

text: surgery

text: or

text: drugs

text: Superintendent

text: of

text: Belchertown

text: State

text: School

text: v

text: Saikewicz

text: Mass

text: n

text: N

text: E

text: d

text: n

text: I

text: n

text: refusing

text: treatment

text: the

text: patient

text: may

text: not

text: have

text: the

text: specific

text: intent

text: to

text: die

text: The

text: law

text: has

text: long

text: used

text: actors

text: intent

text: or

text: purpose

text: to

text: distinguish

text: between

text: two

text: acts

text: that

text: may

text: have

text: the

text: same

text: result

text: See

text: e

text: g

text: United

text: States

text: v

text: Bailey

text: U

text: S

text: T

text: he

text: common

text: law

text: of

text: homicide

text: often

text: distinguishes

text: between

text: a

text: person

text: who

text: knows

text: that

text: another

text: person

text: will

text: be

text: killed

text: as

text: the

text: result

text: of

text: his

text: conduct

text: and

text: a

text: person

text: who

text: acts

text: with

text: the

text: specific

text: purpose

text: of

text: taking

text: another

text: s

text: life

text: Morissette

text: v

text: United

text: States

text: U

text: S

text: distinctions

text: based

text: on

text: intent

text: are

text: universal

text: and

text: persistent

text: in

text: mature

text: systems

text: of

text: law

text: M

text: Hale

text: Pleas

text: of

text: the

text: Crown

text: If

text: A

text: with

text: an

text: intent

text: to

text: prevent

text: a

text: gangrene

text: beginning

text: in

text: his

text: hand

text: doth

text: without

text: any

text: advice

text: cut

text: off

text: his

text: hand

text: by

text: which

text: he

text: dies

text: he

text: is

text: not

text: thereby

text: felo

text: de

text: se

text: for

text: tho

text: it

text: was

text: a

text: voluntary

text: act

text: yet

text: it

text: was

text: not

text: with

text: an

text: intent

text: to

text: kill

text: himself

text: Put

text: differently

text: the

text: law

text: distinguishes

text: actions

text: taken

text: because

text: of

text: a

text: given

text: end

text: from

text: actions

text: taken

text: in

text: spite

text: of

text: their

text: unintended

text: but

text: foreseen

text: consequences

text: Feeney

text: U

text: S

text: at

text: Compassion

text: in

text: Dying

text: v

text: Washington

text: F

text: d

text: CA

text: Kleinfeld

text: J

text: dissenting

text: When

text: General

text: Eisenhower

text: ordered

text: American

text: soldiers

text: onto

text: the

text: beaches

text: of

text: Normandy

text: he

text: knew

text: that

text: he

text: was

text: sending

text: many

text: American

text: soldiers

text: to

text: certain

text: death

text: His

text: purpose

text: though

text: was

text: to

text: liberate

text: Europe

text: from

text: the

text: Nazis

text: Given

text: these

text: general

text: principles

text: it

text: is

text: not

text: surprising

text: that

text: many

text: courts

text: including

text: New

text: York

text: courts

text: have

text: carefully

text: distinguished

text: refusing

text: life

text: sustaining

text: treatment

text: from

text: suicide

text: See

text: e

text: g

text: Fosmire

text: v

text: Nicoleau

text: N

text: Y

text: d

text: and

text: n

text: N

text: E

text: d

text: and

text: n

text: M

text: erely

text: declining

text: medical

text: care

text: is

text: not

text: considered

text: a

text: suicidal

text: act

text: In

text: fact

text: the

text: first

text: state

text: court

text: decision

text: explicitly

text: to

text: authorize

text: withdrawing

text: life

text: saving

text: treatment

text: noted

text: the

text: real

text: distinction

text: between

text: the

text: self

text: infliction

text: of

text: deadly

text: harm

text: and

text: a

text: self

text: determination

text: against

text: artificial

text: life

text: support

text: In

text: re

text: Quinlan

text: N

text: J

text: and

text: n

text: A

text: d

text: and

text: n

text: cert

text: denied

text: sub

text: nom

text: Garger

text: v

text: New

text: Jersey

text: U

text: S

text: And

text: recently

text: the

text: Michigan

text: Supreme

text: Court

text: also

text: rejected

text: the

text: argument

text: that

text: the

text: distinction

text: between

text: acts

text: that

text: artificially

text: sustain

text: life

text: and

text: acts

text: that

text: artificially

text: curtail

text: life

text: is

text: merely

text: a

text: distinction

text: without

text: constitutional

text: significance

text: a

text: meaningless

text: exercise

text: in

text: semantic

text: gymnastics

text: insisting

text: that

text: the

text: Cruzan

text: majority

text: disagreed

text: and

text: so

text: do

text: we

text: Kevorkian

text: Mich

text: at

text: N

text: W

text: d

text: at

text: Similarly

text: the

text: overwhelming

text: majority

text: of

text: state

text: legislatures

text: have

text: drawn

text: a

text: clear

text: line

text: between

text: assisting

text: suicide

text: and

text: withdrawing

text: or

text: permitting

text: the

text: refusal

text: of

text: unwanted

text: life

text: saving

text: medical

text: treatment

text: by

text: prohibiting

text: the

text: former

text: and

text: permitting

text: the

text: latter

text: Glucksberg

text: ante

text: at

text: And

text: nearly

text: all

text: states

text: expressly

text: disapprove

text: of

text: suicide

text: and

text: assisted

text: suicide

text: either

text: in

text: statutes

text: dealing

text: with

text: durable

text: powers

text: of

text: attorney

text: in

text: health

text: care

text: situations

text: or

text: in

text: living

text: will

text: statutes

text: Kevorkian

text: supra

text: at

text: and

text: nn

text: N

text: W

text: d

text: at

text: and

text: nn

text: Thus

text: even

text: as

text: the

text: States

text: move

text: to

text: protect

text: and

text: promote

text: patients

text: dignity

text: at

text: the

text: end

text: of

text: life

text: they

text: remain

text: opposed

text: to

text: physician

text: assisted

text: suicide

text: New

text: York

text: is

text: a

text: case

text: in

text: point

text: The

text: State

text: enacted

text: its

text: current

text: assisted

text: suicide

text: statutes

text: in

text: Since

text: then

text: New

text: York

text: has

text: acted

text: several

text: times

text: to

text: protect

text: patients

text: commonlaw

text: right

text: to

text: refuse

text: treatment

text: Act

text: of

text: Aug

text: ch

text: N

text: Y

text: Laws

text: Do

text: Not

text: Resuscitate

text: Orders

text: codified

text: as

text: amended

text: at

text: N

text: Y

text: Pub

text: Health

text: Law

text: McKinney

text: and

text: Supp

text: Act

text: of

text: July

text: ch

text: N

text: Y

text: Laws

text: Health

text: Care

text: Agents

text: and

text: Proxies

text: codified

text: as

text: amended

text: at

text: N

text: Y

text: Pub

text: Health

text: Law

text: McKinney

text: and

text: Supp

text: In

text: so

text: doing

text: however

text: the

text: State

text: has

text: neither

text: endorsed

text: a

text: general

text: right

text: to

text: hasten

text: death

text: nor

text: approved

text: physician

text: assisted

text: suicide

text: Quite

text: the

text: opposite

text: The

text: State

text: has

text: reaffirmed

text: the

text: line

text: between

text: killing

text: and

text: letting

text: die

text: See

text: N

text: Y

text: Pub

text: Health

text: Law

text: McKinney

text: This

text: article

text: is

text: not

text: intended

text: to

text: permit

text: or

text: promote

text: suicide

text: assisted

text: suicide

text: or

text: euthanasia

text: New

text: York

text: State

text: Task

text: Force

text: on

text: Life

text: and

text: the

text: Law

text: LifeSustaining

text: Treatment

text: Making

text: Decisions

text: and

text: Appointing

text: a

text: Health

text: Care

text: Agent

text: July

text: Do

text: Not

text: Resuscitate

text: Orders

text: The

text: Proposed

text: Legislation

text: and

text: Report

text: of

text: the

text: New

text: York

text: State

text: Task

text: Force

text: on

text: Life

text: and

text: the

text: Law

text: Apr

text: More

text: recently

text: the

text: New

text: York

text: State

text: Task

text: Force

text: on

text: Life

text: and

text: the

text: Law

text: studied

text: assisted

text: suicide

text: and

text: euthanasia

text: and

text: in

text: unanimously

text: recommended

text: against

text: legalization

text: When

text: Death

text: is

text: Sought

text: Assisted

text: Suicide

text: and

text: Euthanasia

text: in

text: the

text: Medical

text: Context

text: vii

text: In

text: the

text: Task

text: Force

text: s

text: view

text: allowing

text: decisions

text: to

text: forgo

text: life

text: sustaining

text: treatment

text: and

text: allowing

text: assisted

text: suicide

text: or

text: euthanasia

text: have

text: radically

text: different

text: consequences

text: and

text: meanings

text: for

text: public

text: policy

text: Id

text: at

text: This

text: Court

text: has

text: also

text: recognized

text: at

text: least

text: implicitly

text: the

text: distinction

text: between

text: letting

text: a

text: patient

text: die

text: and

text: making

text: that

text: patient

text: die

text: In

text: Cruzan

text: v

text: Director

text: Mo

text: Dept

text: of

text: Health

text: U

text: S

text: we

text: concluded

text: that

text: t

text: he

text: principle

text: that

text: a

text: competent

text: person

text: has

text: a

text: constitutionally

text: protected

text: liberty

text: interest

text: in

text: refusing

text: unwanted

text: medical

text: treatment

text: may

text: be

text: inferred

text: from

text: our

text: prior

text: decisions

text: and

text: we

text: assumed

text: the

text: existence

text: of

text: such

text: a

text: right

text: for

text: purposes

text: of

text: that

text: case

text: id

text: at

text: But

text: our

text: assumption

text: of

text: a

text: right

text: to

text: refuse

text: treatment

text: was

text: grounded

text: not

text: as

text: the

text: Court

text: of

text: Appeals

text: supposed

text: on

text: the

text: proposition

text: that

text: patients

text: have

text: a

text: general

text: and

text: abstract

text: right

text: to

text: hasten

text: death

text: F

text: d

text: at

text: but

text: on

text: well

text: established

text: traditional

text: rights

text: to

text: bodily

text: integrity

text: and

text: freedom

text: from

text: unwanted

text: touching

text: Cruzan

text: U

text: S

text: at

text: id

text: at

text: O

text: Connor

text: J

text: concurring

text: In

text: fact

text: we

text: observed

text: that

text: the

text: majority

text: of

text: States

text: in

text: this

text: country

text: have

text: laws

text: imposing

text: criminal

text: penalties

text: on

text: one

text: who

text: assists

text: another

text: to

text: commit

text: suicide

text: Id

text: at

text: Cruzan

text: therefore

text: provides

text: no

text: support

text: for

text: the

text: notion

text: that

text: refusing

text: life

text: sustaining

text: medical

text: treatment

text: is

text: nothing

text: more

text: nor

text: less

text: than

text: suicide

text: For

text: all

text: these

text: reasons

text: we

text: disagree

text: with

text: respondents

text: claim

text: that

text: the

text: distinction

text: between

text: refusing

text: lifesaving

text: medical

text: treatment

text: and

text: assisted

text: suicide

text: is

text: arbitrary

text: and

text: irrational

text: Brief

text: for

text: Respondents

text: Granted

text: in

text: some

text: cases

text: the

text: line

text: between

text: the

text: two

text: may

text: not

text: be

text: clear

text: but

text: certainty

text: is

text: not

text: required

text: even

text: were

text: it

text: possible

text: Logic

text: and

text: contemporary

text: practice

text: support

text: New

text: York

text: s

text: judgment

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text: organizations

text: consistently

text: distinguish

text: assisted

text: suicide

text: and

text: euthanasia

text: from

text: the

text: withdrawing

text: or

text: withholding

text: of

text: treatment

text: and

text: from

text: the

text: provision

text: of

text: palliative

text: treatments

text: or

text: other

text: medical

text: care

text: that

text: risk

text: fatal

text: side

text: effects

text: Brief

text: for

text: American

text: Medical

text: Association

text: et

text: al

text: as

text: Amici

text: Curiae

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text: course

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text: demonstrates

text: there

text: are

text: differences

text: of

text: opinion

text: within

text: the

text: medical

text: profession

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text: this

text: question

text: See

text: New

text: York

text: Task

text: Force

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text: at

text: Thus

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text: Second

text: Circuit

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text: New

text: York

text: law

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text: a

text: right

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text: hasten

text: death

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text: authorities

text: cited

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text: court

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text: a

text: right

text: to

text: refuse

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text: and

text: nowhere

text: equate

text: the

text: exercise

text: of

text: this

text: right

text: with

text: suicide

text: Schloendorff

text: v

text: Society

text: of

text: New

text: York

text: Hospital

text: N

text: Y

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text: Justice

text: Cardozo

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text: famous

text: statement

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text: human

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text: adult

text: years

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text: sound

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text: a

text: right

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text: determine

text: what

text: shall

text: be

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text: his

text: own

text: body

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text: simply

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text: informed

text: consent

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text: Rivers

text: v

text: Katz

text: N

text: Y

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text: refuse

text: antipsychotic

text: medication

text: is

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text: when

text: the

text: patient

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text: a

text: danger

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text: himself

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text: Storar

text: N

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text: III

text: Assisted

text: Suicide

text: Funding

text: Restriction

text: Act

text: of

text: It

text: has

text: always

text: been

text: a

text: crime

text: either

text: by

text: statute

text: or

text: under

text: the

text: common

text: law

text: to

text: assist

text: a

text: suicide

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text: New

text: York

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text: Dowd

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text: Constitutional

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text: Duquesne

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text: the

text: State

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text: physician

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text: suicide

text: and

text: terminal

text: sedation

text: a

text: process

text: respondents

text: characterize

text: as

text: induc

text: ing

text: barbiturate

text: coma

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text: ing

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text: person

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text: d

text: at

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text: a

text: lthough

text: proponents

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text: physician

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text: and

text: euthanasia

text: contend

text: that

text: terminal

text: sedation

text: is

text: covert

text: physician

text: assisted

text: suicide

text: or

text: euthanasia

text: the

text: concept

text: of

text: sedating

text: pharmacotherapy

text: is

text: based

text: on

text: informed

text: consent

text: and

text: the

text: principle

text: of

text: double

text: effect

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text: Petitioners

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text: P

text: Rousseau

text: Terminal

text: Sedation

text: in

text: the

text: Care

text: of

text: Dying

text: Patients

text: Archives

text: Internal

text: Med

text: Just

text: as

text: a

text: State

text: may

text: prohibit

text: assisting

text: suicide

text: while

text: permitting

text: patients

text: to

text: refuse

text: unwanted

text: lifesaving

text: treatment

text: it

text: may

text: permit

text: palliative

text: care

text: related

text: to

text: that

text: refusal

text: which

text: may

text: have

text: the

text: foreseen

text: but

text: unintended

text: double

text: effect

text: of

text: hastening

text: the

text: patient

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text: death

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text: New

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text: Death

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text: Sought

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text: n

text: at

text: It

text: is

text: widely

text: recognized

text: that

text: the

text: provision

text: of

text: pain

text: medication

text: is

text: ethically

text: and

text: professionally

text: acceptable

text: even

text: when

text: the

text: treatment

text: may

text: hasten

text: the

text: patient

text: s

text: death

text: if

text: the

text: medication

text: is

text: intended

text: to

text: alleviate

text: pain

text: and

text: severe

text: discomfort

text: not

text: to

text: cause

text: death

text: We

text: do

text: not

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text: as

text: Justice

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text: in

text: judgments

text: that

text: in

text: all

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text: there

text: will

text: in

text: fact

text: be

text: a

text: significant

text: difference

text: between

text: the

text: intent

text: of

text: the

text: physicians

text: the

text: patients

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text: the

text: families

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text: withdrawal

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text: treatment

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text: physician

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text: physician

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text: refusal

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text: begin

text: life

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text: medical

text: treatment

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text: wishes

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text: same

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text: doctor

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text: aggressive

text: palliative

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text: purpose

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text: absence

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text: State

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text: act

text: on

text: the

text: reasonableness

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text: the

text: distinction

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text: Stevens

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text: our

text: holding

text: today

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text: not

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text: possibility

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text: applications

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text: the

text: New

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text: intolerable

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text: the

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text: freedom

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text: at

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text: n

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text: assisted

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text: was

text: unconstitutional

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text: his

text: particular

text: case

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text: need

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text: present

text: different

text: and

text: considerably

text: stronger

text: arguments

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text: those

text: advanced

text: by

text: respondents

text: here