We begin, as we do in all due-process cases, by examining our
Nation's history, legal traditions, and practices.
Protection and preservation of ALL human life
The States' assisted-suicide bans are not innovations. Rather,
they are longstanding expressions of the States' commitment to
the protection and preservation of all human life.
Focused on protecting dignity and independence at the end of
Public concern and democratic action are therefore sharply
focused on how best to protect dignity and independence at the
end of life, with the result that there have been many
significant changes in state laws and in the attitudes these
Many States, for example, now permit "living wills," surrogate
health-care decision making, and the withdrawal or refusal of
life-sustaining medical treatment.
Legislators reaffirmed prohibitions on assisting suicide
At the same time, however, voters and legislators continue for
the most part to reaffirm their States' prohibitions on
Substantive-due-process analysis two primary features
First, we have regularly observed that the Due Process Clause
Those fundamental rights and liberties which are, objectively,
"deeply rooted in this Nation's history and tradition,
"implicit in the concept of ordered liberty," such that "neither
liberty nor justice would exist if they were sacrificed."
Second, we have required in substantive-due-process cases a "careful
description" of the
asserted fundamental liberty interest.
Our Nation's history, legal traditions, and practices thus
provide the crucial "guideposts
for responsible decisionmaking," that
direct and restrain our
exposition of the Due Process Clause.
Analysis: Whether this asserted right has any place in our
Here we are confronted with a
consistent and almost universal
tradition that has long rejected the asserted right,
and continues explicitly to reject
it today, even for terminally ill, mentally competent
To hold for respondents, we
would have to reverse centuries of legal doctrine and
practice, and strike down the considered policy choice of almost
Respondents contend - Consistent with substantive due process
line of cases
The liberty interest they assert is consistent with this Court's
substantive-due-process line of cases, if not with this Nation's
history and practice.
Respondents Point to Casey and Cruzan - General tradition of
Pointing to Casey and Cruzan, respondents read our jurisprudence
in this area as reflecting a general tradition of
"self-sovereignty," and as teaching that the "liberty" protected
by the Due Process Clause includes "basic and intimate exercises
of personal autonomy.
"It is a promise of the Constitution that there is a realm of
personal liberty which the government may not enter.
According to respondents,
Our liberty jurisprudence, and the broad, individualistic
principles it reflects, protects the "liberty of competent,
terminally ill adults to make end-of-life decisions free of
undue government interference."
- Refusing medical treatment CANNOT be transmuted to assisting
in committing suicide
The right assumed in Cruzan, however, was not simply deduced
from abstract concepts of personal autonomy.
The decision to commit suicide with the assistance of another
may be just as personal and profound as the decision to refuse
unwanted medical treatment, but it has never enjoyed similar
In Cruzan itself, we recognized that most States outlawed
assisted suicide--and even more do today--and
we certainly gave no intimation
that the right to refuse unwanted medical treatment could
be somehow transmuted into a right to assistance in committing
- the right to assistance in committing suicide is not a
fundamental liberty interest
The history of the law's treatment of assisted suicide in this
country has been and continues to be one of the rejection of
nearly all efforts to permit it.
That being the case, our decisions lead us to conclude that the
asserted "right" to assistance
in committing suicide is not a fundamental liberty interest
protected by the Due Process Clause.
Rational Basis: Rationally related to a legitimate government
The Constitution also requires, however, that Washington's
assisted-suicide ban be rationally related to legitimate
This requirement is unquestionably
- Rational Basis Interests
Washington has an "unqualified interest in the preservation of
The ban against assisted suicide and euthanasia shores up the
notion of limits in human relationships.
Interest in protecting the integrity and ethics of the medical
Time honored tradition between healing and harming.
Interest in protecting vulnerable groups - including the poor,
the elderly, and disable persons - from abuse, neglect, and
The is a real risk of subtle coercion and undue influence in
The lives of the terminal ill and elderly must be no less valued
than lives of the young and healthy.
Fear in permitting assisted suicide will start it down the path
to voluntary and perhaps even involuntary euthanasia.
Netherlands allows euthanasia and sees a lot of cases.
Banning assisted suicide does NOT violate the Fourteenth
Concurring - Justice OConnor
Whether a mentally competent person who is experiencing great
suffering has a constitutionally cognizable interest in
controlling the circumstances of his or her imminent death.
Patient can obtain palliative [to reduce severity] care that
hastens their death.
Concurring - Justice Stevens
The Court holds that the Washington law is not invalid on its
However, it might be invalid in certain circumstances.
Specifically, it might be invalid with respect to an individual
who is not victimized by abuse, who is not suffering from
depression, and who makes a rational and voluntary decision to
seek assistance in dying.
Concurring - Justice Souter
Substantive due process evolves as competing interests evolve.
The present case is like the abortion cases.
The state has a legitimate interest in discouraging abortion,
but the Court has recognized a woman's right to a physician's
assistance in obtaining an abortion.
The state interest that is dispositive to me is the state's
interest in protecting terminally ill patients from involuntary
suicide and voluntary and involuntary euthanasia.
It is too difficult to draw the line between voluntary and
For example, family members might pressure a patient because of
the high costs of care or simply because they wish to see their
loved one's suffering end.
Relying on physicians to make this determination is inadequate.
Physicians may not know whether a patient is making a knowing
and voluntary choice.
Also, physicians may not be acting purely objectively.
They may act out of compassion or under financial incentives.
Glucksberg's proposal to rewrite the law sounds like the law in
However, the evidence regarding the success of the Dutch system
Concurring - Justice Ginsburg
Concurs for the same reasons as Justice OConnors
Concurring - Justice Breyer
law regarding the right to die with dignity might be upheld.
However, I do not believe that the Court must decide whether
this right is fundamental.
There is palliative care for a dying person who is suffering
from severe pain.
If the law prevented such palliative care, the law's impact on
serious and unavoidable pain would be more at issue.