The Supreme Judicial Court ruled today that the state constitution does not allow a physician to help a terminally ill patient die, that, in fact, it could be considered a form of manslaughter.
The ruling comes in a lawsuit by two Cape Cod physicians - one who has metastatic prostate cancer and wants to be able to end his life with the help of a doctor should he become terminally ill, the other a doctor who wants to offer the procedure to his patients.
The two doctors sued both the state Attorney General and the Cape and Islands District Attorney's office. Neither have flat out said they would prosecute the doctors, but, the court noted, neither have the two ruled out prosecuting them should they actually attempt such a death.
In its ruling, the state's highest court said it could not allow the practice under current state law. The court noted that in 2012 voters rejected a ballot question that would have allowed physician-assisted suicide, and that:
Additionally, although lawmakers have introduced over a dozen bills to legalize physician-assisted suicide in the Commonwealth, none has advanced to a vote. To the contrary, the Legislature has adopted a stance against physician-assisted suicide.
Kligler and Steinbach argued that the Massachusetts Declaration of Rights, roughly our equivalent of the Bill of Rights, protects doctors who help their patients die and that any prosecution would violate their equal protection and due process rights - and that doctors have a free-speech right to discuss physician-assisted suicide with their terminally ill patients.
The court first dismissed Kligler's claims entirely, because he has not yet gotten the six-month prognosis he says would trigger his request to a doctor for help in dying. In fact, his doctor said that based on his type of cancer and treatments available, he could still be around in ten years, so his case is predicated on what might happen to him, not what is happening to him, and is legally premature, the court said.
In contrast, Steinbach said he would immediately begin discussing physician-assisted suicide with terminally ill patients, so an actual legal "controversy" exists on which the court can rule.
Steinbach argues that the law of involuntary manslaughter is per se inapplicable to physician-assisted suicide because a doctor's participation in physician-assisted suicide is not wanton, reckless, or the proximate cause of death. Steinbach maintains that the determination whether a doctor acted wantonly or recklessly turns on genuine issues of material fact regarding the doctor's decision-making process. In Steinbach's view, a doctor who follows general medical standards in prescribing lethal medication for the purpose of physician-assisted suicide is not acting wantonly or recklessly; rather, he or she is making an informed and deliberate medical judgment calculated "to help a terminally ill patient obtain peace of mind, rather than causing harm or death of the patient."
The court disagreed:
[P]hysician-assisted suicide could constitute wanton or reckless conduct. Our case law demonstrates that knowingly providing someone who has expressed an interest in ending his or her life with the means to do so may be considered wanton or reckless behavior. See, e.g., Persampieri v. Commonwealth, 343 Mass. 19, 23 (1961) (husband acted recklessly or wantonly in providing his wife, who was emotionally distraught and threatening to commit suicide, with loaded weapon and instructions on how she could use it to kill herself). That a doctor's intent in providing the lethal medication was to alleviate a patient's suffering is irrelevant, as conduct may be wanton or reckless even where the actor "meant no harm to the victim."
The court also rejected the doctor's argument that it's the terminal condition that would kill the patient, not the pills the doctors might prescribe:
Steinbach argues that, regardless, doctors who provide physician-assisted suicide cannot be the proximate cause of a patient's death because the patient's decision to ingest the medication is a superseding event that extinguishes proximate cause. We do not agree. It is entirely foreseeable that a terminally ill patient who requests medication intended to bring about death may use the medication for such a purpose. See Catalina, 407 Mass. at 791 ("Intervening conduct that is reasonably foreseeable will not relieve the defendant of criminal responsibility"). Indeed, the majority of patients who receive a prescription for lethal medication pursuant to physician-assisted suicide ultimately die by ingesting the medication.
In sum, under our existing law, doctors who engage in physician-assisted suicide may risk liability for involuntary manslaughter.
But is physician-assisted suicide involved a right to privacy protected by the state constitution? The court first noted that while suicide or suicide attempts are no longer considered illegal, society in general and Massachusetts in particular has long been opposed to them. But as with such things as abortion and same-sex marriage, has the law evolved to the point where it might be considered a protected activity?
In Steinbach's view, the right to physician-assisted suicide is a natural outgrowth of the right to refuse medical treatment recognized in Saikewicz, 373 Mass. at 736, and Brophy v. New England Sinai Hosp., 398 Mass. 417, 419 (1986).
The court, however, concluded that the right against being subjected to unwanted medical procedures enumerated in those cases does not extend so far as to encompass physician-assisted suicide, that it involves neither the common-law right to be 'free of nonconsensual invasion of one's bodily integrity' nor the right to privacy."
Steinbach asserts that if the right to privacy includes the right to refuse unwanted medical care, it also necessarily must include the right to physician-assisted suicide, because there is no meaningful distinction between the two. We do not agree, but, rather, recognize an important distinction between the refusal of medical treatment and physician-assisted suicide, which lies in fundamental legal principles of cause and effect; whereas withdrawing or withholding medical care is not the primary cause of a patient's death, physician-assisted suicide is.
These principles are not new; to the contrary, they have been invoked explicitly in the very cases upon which Steinbach relies.
In sum, given our long-standing opposition to suicide in all its forms, and the absence of modern precedent supporting an affirmative right to medical intervention that causes death, we cannot conclude that physician-assisted suicide ranks among those fundamental rights protected by the Massachusetts Declaration of Rights. Thus, application of the law of manslaughter to physician-assisted suicide would not impinge on an individual's right to substantive due process.