Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1410_1an2.pdf
Page Number: 28.0

8 

XIULU RUAN v. UNITED STATES 

ALITO, J., concurring
ALITO, J., concurring in judgment 

person  who  acts  under  duress  is  not  “morally  blamewor-
thy”—that is part of what it means to say that duress ex-
cuses  otherwise-criminal  conduct.  Similarly,  individuals
who kill or wound another person in self-defense to prevent 
their own death or serious injury are not considered morally
blameworthy.  No one supposes that these defenses are hy-
brids, or that the mens rea canon is a guide to their content.
It is unclear why the Court thinks that §841(a)’s affirma-
tive  defense  is  different.  There  are  hints  in  the  Court’s 
opinion that it has crafted a special rule for doctors—for ex-
ample,  the  Court  describes  their  conduct  in  writing  pre-
scriptions  as  not  just  “innocent,”  but  “socially  beneficial”
and “socially necessary.”  Ante, at 6, 12.  But §841(a) is not 
a doctor-specific provision.  Section 841(a)’s proviso presum-
ably applies in the same way for all §841(a) defendants—
whether they are drug dealers accused of selling heroin or 
are physicians charged with abusing their authority to pre-
scribe painkillers. 

“[T]he serious nature of the crime and its penalties.”  The 
Court also suggests that authorization is “like an element” 
because dispensing or distributing a controlled substance is
a felony that carries a substantial sentence.  But would all 
felonies  qualify?    If  not,  where  would  the  Court  draw  the 
line?  The Court provides no answers. 

“[T]he  vague,  highly  general  language  of  the  regulation 
defining prescribing authority.”  As the Court explains, the
regulation defining the authority of physicians to prescribe
controlled  substances  allows  them  to  issue  a  prescription
“for a legitimate medical purpose . . . in the usual course of 
. . . professional practice.”  21 CFR §1306.04(a) (2021).  But 
§841(a) applies to many other types of violations and many
other categories of defendants.  Is the proviso a hybrid ele-
ment/defense only for doctors?  Would its status change if 
the regulation were reframed in more specific terms?  How 
can the status of a phrase in a statute depend upon an im-
plementing  regulation?  The  Court  provides  no  answer  to