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A Case of Federalism

The U.S. Supreme Court recently upheld a controversial law in the state of Oregon that allows physicians to prescribe lethal doses of drugs to help terminally ill patients end their lives. While the issue involves matters of life and death, the high court did not decide the morality of assisted suicide, but rather a technicality related to the distribution of power in the United States.

Since the adoption of Oregon's Death With Dignity Act in 1997, about 200 residents of the state have chosen to die from an overdose of drugs legally prescribed by their physicians.

"I don't want to have to die in diapers," says Char Andrews. Oregonian Char Andrews is an elderly woman with breast cancer. She has already lost all of her hair to chemotherapy and faces the likelihood of severe pain and disability. Ms. Andrews is glad that Oregonians voted twice in favor of the assisted suicide law and welcomes the Supreme Court decision in its favor.

Ms. Andrews says, "The U.S. Supreme Court did justice in recognizing the feelings and the needs of the people who have this terminal illness to be able to use that process in a compassionate and dignified manner."

Opponents of Oregon's Death with Dignity Act

Opposing the Oregon law was U.S. Attorney General Alberto Gonzales and his predecessor John Ashcroft who asked the Supreme Court to overturn the measure. Both officials said that a federal law, The Controlled Substances Act, prohibits the use of narcotics nationwide for any reason other than legitimate medical purposes. The attorneys general argued that assisted suicide is not a legitimate practice because physicians traditionally help people live, not die.

However, the 10th Amendment to the U.S. Constitution grants the states all powers, which the document does not specifically delegate to the federal government. Determining medical policy is considered to be one such power.

Mark Moller, a constitutional expert at the Cato Institute think tank in Washington, says that the morality of assisted suicide was not an issue in the Oregon case. He says, "What was at issue is whether a federal drug law, the Controlled Substances Act, gives the Attorney General the power to second guess states' assisted suicide policies. And the court said that the congressional drug law didn't clearly give the Attorney General that authority."

Some legislators in Washington state, Oregon's neighbor to the north, are also considering an assisted suicide law, though voters rejected the practice in a referendum in the early 1990s. It remains a crime in 44 states, and a civil offense in Virginia. Four states have no position.

While Oregon is out of step with the rest of the nation, Mark Moller says states have always experimented with social policy.

According to Mr. Moller, "This is the idea of the Framers i.e., the authors of the Constitution, that we don't have one government, but we have multiple governments, each that can try different policies, and see if they work. We can learn from that."

This means that the Supreme Court, in its six to three vote, decided not on morality, but procedure -- whether the Attorney General was authorized to override a particular state law.

Catholic University politics professor David Coyne says this is important for the rule of law. He says, "While sticking to a procedure may seem somewhat amoral, like it's skipping the important question, that in itself is somewhat of a moral judgment, to trust in the rule of law as a positive good. Now at some point, the moral question has a very appropriate role.

Professor Coyne says the U.S. Congress could enter the morality debate by amending the Controlled Substances Act with a definition of legitimate medical practice that excludes assisted suicide. However, he notes that the states could argue in court that Congress would be usurping their right to determine medical policy.

Meanwhile, in Oregon, opponents of assisted suicide are expressing disappointment with the Supreme Court decision on the Death With Dignity Act.

William Toffler is a member of Physicians for Compassionate Care, a Portland-based group that opposes assisted suicide. He says, "I think we'll continue to do what we've done for the last decade, which is to try to educate others to provide the best in end of life care, so we live until we die. At the same time we'll educate other states, so we won't have other states caught off guard as we were here in Oregon with the promoters of assisted suicide."

Dr. Toffler says the solution to suffering should not be to end the life of the sufferer. He adds that government approval of assisted suicide sends the wrong message.

According to Dr. Toffler, "It sends an imprimatur, a stamp of approval if you will, on the idea that some people's lives are not valuable, they're not worth giving the investment of time and energy to allow them to really die with true dignity and to get palliative care and appropriate care."

Abuses of Assisted Suicide?

Some critics say assisted suicide could eventually lead to abuses in which patients are killed because they are too expensive to maintain.

In Washington state, however, lawmaker Hans Dunshee rejects that argument as a scare tactic. Mr. Dunshee, who is considering sponsorship of a bill to legalize assisted suicide in his state, says government should not decide the fate of the terminally ill. He says, "I think liberty means you get to make your own decisions. It hasn't been abused in Oregon and it's very rare, very rare, very rare. But I think you ought to have that option. You know it's a basic human liberty to be able to control your own destiny."

The principle of federalism often allows contentious issues to be decided by the states, which avoids a centralized solution that could spark resentment in some parts of the country. If assisted suicide reaches the courts again, federalism is likely to figure in the deliberations.

This story was first broadcast on the English news program,VOA News Now. For other Focus reports click here.