On June 26, 1997, the United States Supreme Court considered a constitutional challenge to a Washington statute that criminalized acts of deliberate assistance of another in committing suicide. (1) The Court ruled that an asserted right to physician assisted suicide was not a fundamental liberty interest protected by the Fourteenth Amendment of the United States Constitution. (2) Chief Justice Rehnquist, writing for the Court, concluded the influential decision with a strong statement: "the opinion should not restrict the continuation of the open debate in our society about all aspects of physician assisted suicide." (3)
The issue of how to care for the terminally ill patient, whether by use of palliative care techniques, a medical treatment process placing the relief of pain as the primary care goal, or by allowing the patient to voluntarily end their life, has been enriched by the far-reaching implications of the court's decision. (4) Timothy Quill, M.D., published an influential article in the New England Journal of Medicine which frames the issue of physician assisted suicide. (5) Dr. Quill wrote about his patient Diane who had recovered from several difficult life circumstances only to discover that she had acute myelomonocytic leukemia(6) Dr. Quill described the woman as an "incredibly clear, at times brutally honest thinker and communicator" who had finally taken complete control of her life with a strong sense of independence and self-esteem. (7) Faced with the prospect of a fifty percent survival rate involving extensive chemotherapy treatments and other considerably intrusive and complicated medical care, Diane, with the support of her family, decided not to undergo the recommended therapy. (8) Dr. Quill stated that she wanted to live her remaining time with her family outside of the hospital. (9)
After considerable discussions between Dr. Quill and Diane about her care, Diane expressed the importance of the need and value of maintaining control of herself and her dignity over the upcoming months. (10) Dr. Quill wrote "that Diane expressed that when the time came, she wanted to take her life in the least painful way possible." (11) A short time later, Dr. Quill prescribed barbiturates after carefully considering the brief conversation between the two about Diane's trouble sleeping. (12) Dr. Quill noted that it was evident to him that Diane then felt secure knowing that if the time came she would be able to voluntarily end the suffering at her moment of choice. (13) Diane did take the medications and quietly passed away at home with her family one hour after ingesting the drugs. (14) Dr. Quill wrote: "[s]uffering can be lessened to some extent, but in no way eliminated or made benign, by careful intervention of a competent, caring physician, given current social constraints." (15)
This Note will examine current issues pertaining to the medical care of the terminally ill individual, particularly with respect to palliative care and how the continuum of medical care incorporates the voluntary termination of a patient's life. Part II of this Note will look at the decision reached in Washington v. Glucksberg and how the Supreme Court has contributed to the molding of care for the terminally ill. Part III will review relevant aspects of end of life care concepts and their relationship and impact upon the assisted suicide alternative. Any analysis of physician assisted suicide must include the evolution of Oregon's legislative approach to the topic. (16) Oregon is the only state which provides terminally ill citizens the option of assisted suicide by legislative initiative, viz., the Death with Dignity Act. (17) The Act will be reviewed at length in Part IV.
The final portion of this note will take a hard look at how the United States Congress has addressed the issue of care of the terminally ill with such initiatives as the Lethal Drug Abuse Prevention Act of 1998. …