Case Name: Barry KRISCHER, Appellant, v. Cecil McIVER, M.D., et al., Appellees
Court: Florida Supreme Court
Jurisdiction: Florida
Decision Date: 1997-07-17
Citations: 697 So. 2d 97
Docket Number: No. 89837
Parties: Barry KRISCHER, Appellant, v. Cecil McIVER, M.D., et al., Appellees.
Judges: SHAW and WELLS, JJ., concur.
Reporter: Southern Reporter, Second Series
Volume: 697
Pages: 97–115

Head Matter:
Barry KRISCHER, Appellant, v. Cecil McIVER, M.D., et al., Appellees.
No. 89837.
Supreme Court of Florida.
July 17, 1997.
Robert A. Butterworth, Attorney General; Michael A. Gross, Assistant Attorney General, Tallahassee; Charles M. Fahlbuseh, Assistant Attorney General, Fort Lauderdale; and Parker D. Thomson and Carol A. Licko, Special Assistant Attorneys General of Thomson, Muraro, Razook & Hart, P.A., Miami, for Appellant.
Robert Rivas of Rivas & Rivas, Boca Ra-ton, for Appellees.
Paul X. McMenaman, Steubenville, OH, for Amicus Curiae, International Anti-Euthanasia Task Force.
Steven T. McFarland, Center for Law and Religious Freedom Christian Legal Society, Annandale, VA, for Amici Curiae, Christian Legal Society, Christian Medical & Dental Society, Christian Pharmacists Fellowship International, Fellowship of Christian Physician Assistants, and Nurses Christian Fellowship.
Gary L. Printy, Tallahassee, for Amici Curiae, Not Dead Yet and American Disabled for Attendant Programs Today (ADAPT).
James Bopp, Jr. and Barry A. Bostrom of Bopp, Coleson & Bostrom, Terre Haute, IN, for Amici Curiae, The National Right to Life Committee, Inc. and Florida Right to Life, Inc.
David J. Busch, Tallahassee, for a BiPartisan Group of Florida State Legislators, Amici Curiae.
Marcia Beach, Executive Director and Wayne Hampton Basford, Senior Attorney, Advocacy Center for Persons with Disabilities; and Linda G. Miklowitz, Tallahassee, for Amicus Curiae, Advocacy Center for Persons with Disabilities, Inc.
James Bopp, Jr., Thomas J. Marzen, Daniel Avila and Jane Elizabeth Therese Broek-mann, Indianapolis, IN, for, Amici Curiae, The Commission on Aging with Dignity; The National Legal Center for the Medically Dependent & Disabled, Inc., on behalf of its client population, especially those in Florida; Lorraine Banks, L.P.N.; Sally Beach, R.N., individually and on behalf of her patients ■with terminal conditions; John Connors; John Thomas “Jack” Doucette, by and through his guardian, Margaret Doucette; Kathleen Lumbra; Jose Rodriguez, R. Ph.; and Dr. David L. Vastóla, D.O., individually and on behalf of his patients with terminal conditions, Amici Curiae; and The National Catholic Office for Persons with Disabilities and its Florida Network, and the Knights of Columbus and its Florida Members.
John M. Knight, Florida Medical Association, Tallahassee; Christopher L. Nuland, The Winicki & Nuland Law Firm, Jacksonville; Morton J. Morris, The Florida Osteopathic Medical Association, Tallahassee; and Casey J. Gluckman, Gluckman & Gluckman, Crawfordville, for Amici Curiae, The Florida Medical Association, The American Medical Association, Florida Society of Internal Medicine, Florida Society of Thoracic and Cardiovascular Surgeons, The Florida Osteopathic Medical Association, Florida Hospices, Inc., and The Florida Nurses Association.
Thomas A. Horkan, Jr., Victoria H. Pfiug and Thomas J. Schulte, Tallahassee, for Ami-cus Curiae, Florida Catholic Conference.
Tamar Feder, New York City, for Amici Curiae, The Florida Coalition of Mental Health Professionals.
Andrew I. Batavia, Marina L. Fontani and Susan F. Dournaux of McDermott, Will & Emery, Miami, for Amici Curiae, a Coalition of Floridians and Other Americans With Disabilities.
David Allen Buck, Spring Hill, for Amicus Curiae, The Florida Silver Haired Legislature, Inc.
Rosemarie Richard, Advocates for Disability Rights, Inc., Palm City, for Amici Curiae, 25 Religious Organizations, Leaders and Scholars.
Lynn G. Waxman of Lynn G. Waxman, P.A., West Palm Beach, for Amici Curiae, The American Medical Student Association and a Coalition of Florida Medical Professionals.

Opinion:
GRIMES, Justice.
We have on appeal a judgment of the trial court certified by the Fourth District Court of Appeal to be of great public importance and to require immediate resolution by this Court. We have jurisdiction under article V, section 3(b)(5) of the Florida Constitution.
Charles E. Hall and his physician, Cecil Mclver, M.D., filed suit for a declaratory judgment that section 782.08, Florida Statutes (1995), which prohibits assisted suicide, violated the Privacy Clause of the Florida Constitution and the Due Process and Equal Protection Clauses of the Fourteenth Amendment to the United States Constitution. They sought an injunction against the state attorney from prosecuting the physician for giving deliberate assistance to Mr. Hall in committing suicide. After a six-day bench trial, the trial court issued a final declaratory judgment and injunctive decree responding to the "question of whether a competent adult, who is terminally ill, immediately dying and acting under no undue influence, has a constitutional right to hasten his own death by seeking and obtaining from his physician a fatal dose of prescription drugs and then subsequently administering such drugs to himself." The court concluded that section 782.08 could not be constitutionally enforced against the appellees and enjoined the state attorney from enforcing it against Dr. Melver should he assist Mr. Hall in committing suicide. The court based its conclusion on Florida's privacy provision and the federal Equal Protection Clause but held that there was no federal liberty interest in assisted suicide guaranteed by the federal Due Process Clause.
Mr. Hall is thirty-five years old and suffers from acquired immune deficiency syndrome (AIDS) which he contracted from a blood transfusion. The court found that Mr. Hall was mentally competent and that he was in obviously deteriorating health, clearly suffering, and terminally ill. The court also found that it was Dr. Mclver's professional judgment that it was medically appropriate and ethical to provide Mr. Hall with the assistance he requests at some time in the future.
Dr. Melver had testified that he would assist Mr. Hall in committing suicide by intravenous means. In granting the relief sought by the respondents, the court held that "the lethal medication must be self administered only after consultation and determination by both physician and patient that Mr. Hall is (1) competent, (2) imminently dying, and (3) prepared to die." The court explained that Mr. Hall must state that he subjectively believes that his time to die has come because he has no hope for further life of satisfactory quality and would die soon in any event "and that at that time, Dr. Melver must conclude that Mr. Hall's belief — and his chosen option — is objectively reasonable at the time."
The state attorney appealed. The trial court then set aside the automatic stay imposed by Florida Rule of Appellate Procedure 9.310(b)(2). When this Court assumed jurisdiction of the case, we reinstated the stay and provided for expedited review.
At the outset, we note that the United States Supreme Court recently issued two decisions on the subject of whether there is a right to assisted suicide under the United States Constitution. In Washington v. Glucksberg, — U.S. -, 117 S.Ct. 2258, 138 L.Ed.2d 772 (1997), the Court reversed a decision of the Ninth Circuit Court of Appeals which had held that the State of Washington's prohibition against assisted suicide violated the Due Process Clause. Like the trial court's decision in the instant case, the Court reasoned that the asserted "right" to assistance in committing suicide was not a fundamental liberty interest protected by the Due Process Clause.
In the second decision, the Court upheld New York's prohibition on assisted suicide against the claim that it violated the Equal Protection Clause. Vacco v. Quill, — U.S. -, 117 S.Ct. 2293, 138 L.Ed.2d 834 (1997). In reversing the Second Circuit Court of Appeals, the Court held that there was a logical and recognized distinction between the right to refuse medical treatment and assisted suicide and concluded that there were valid and important public interests which easily satisfied the requirement that a legislative classification bear a rational relation to some legitimate end. Thus, the Court's decision in Vacco rejected one of the two bases for the trial court's ruling in the instant case.
The remaining issue is whether Mr. Hall has the right to have Dr. Melver assist him in committing suicide under Florida's guarantee of privacy contained in our constitution's declaration of rights. Art. I, § 23, Fla. Const. Florida has no law against committing suicide. However, Florida imposes criminal responsibility on those who assist others in committing suicide. Section 782.08, Florida Statutes (1995), which was first enacted in 1868, provides in pertinent part that "every person deliberately assisting another in the commission of self murder shall be guilty of manslaughter." See also § 765.309, 458.326(4), Fla. Stat. (1995) (disapproving mercy killing and euthanasia). Thus, it is clear that the public policy of this state as expressed by the legislature is opposed to assisted suicide.
Florida's position is not unique. Forty-five states that recognize the right to refuse treatment or unwanted life support have expressed disapproval of assisted suicide. Edward R. Grant & Paul Benjamin Linton, Relief or Reproach?: Euthanasia Rights in the Wake of Measure 16, 74 Or. L.Rev. 449, 462-63 (1995). As of 1994, thirty-four jurisdictions had statutes which criminalized such conduct. People v. Kevorkian, 447 Mich. 436, 527 N.W.2d 714 (1994). Since that date, at least seventeen state legislatures have rejected proposals to legalize assisted suicide. Washington.
The only case in the nation in which a court has considered whether assisted suicide is a protected right under the privacy provi sion of its state's constitution is Donaldson v. Lungren, 2 Cal.App.4th 1614, 4 Cal.Rptr.2d 59, 63 (1992), which held: "We cannot expand the nature of Donaldson's right of privacy to provide a protective shield for third persons who end his life." The court reasoned:
In such a case, the state has a legitimate competing interest in protecting society against abuses. This interest is more significant than merely the abstract interest in preserving life no matter what the quality of that life is. Instead, it is the interest of the state to maintain social order through enforcement of the criminal law and to protect the lives of those who wish to live no matter what their circumstances. This interest overrides any interest Donaldson possesses in ending his life through the assistance of a third person in violation of the state's penal laws.
Id. See Kevorkian v. Arnett, 939 F.Supp. 725 (C.D.Cal.1996) (there is no persuasive authority to believe that the California Supreme Court would hold contrary to Donaldson when directly presented with the issue).
In 1984, Governor Mario Cuomo convened the New York State Task Force on Life and the Law, a blue ribbon commission composed of doctors, ethieists, lawyers, religious leaders, and interested laypersons, with a mandate to develop public policy on a number of issues arising from medical advances. With respect to assisted suicide and euthanasia, the task force concluded as follows:
In this report, we unanimously recommend that New York laws prohibiting assisted suicide and euthanasia should not be changed. In essence, we propose a clear line for public policies and medical practice between forgoing medical interventions and assistance to commit suicide or euthanasia. Decisions to forgo treatment are an integral part of medical practice; the use of many treatments would be inconceivable without the ability to withhold or to stop the treatments in appropriate cases. We have identified the wishes and interests of patients as the primary guideposts for those decisions.
Assisted suicide and euthanasia would carry us into new terrain. American society has never sanctioned assisted suicide or mercy killing. We believe that the practices would be profoundly dangerous for large segments of the population, especially in light of the widespread failure of American medicine to treat pain adequately or to diagnose and treat depression in many eases. The risks would extend to all individuals who are ill. They would be most severe for those whose autonomy and well-being are already compromised by poverty, lack of access to good medical care, or membership in a stigmatized social group. The risks of legalizing assisted suicide and euthanasia for these individuals, in a health care system and society that cannot effectively protect against the impact of inadequate resources and ingrained social disadvantage, are likely to be extraordinary.
When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context, vi-vii (May 1994).
The task force addressed the issue again in a supplement to the report dated April 1997 and reaffirmed this position. The task force outlined the primary risks associated with legalization as follows: (1) undiagnosed or untreated mental illness; (2) improperly managed physical symptoms; (3) insufficient attention to the suffering and fears of dying patients; (4) vulnerability of socially marginalized groups; (5) devaluation of the lives of the disabled; (6) sense of obligation; (7) patient deference to physician recommendations; (8) increasing financial incentives to limit care; (9) arbitrariness of proposed limits; and (10) impossibility of developing effective regulation. When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context, 4-5 (Supplement to Report April 1997). Even those on the task force who believed that assisted suicide could be ethically appropriate in extraordinary cases concluded that legalizing it would pose serious and unsurmountable risks of mistake and abuse that would greatly outweigh any benefit that might be achieved.
One would expect persons with serious disabilities to have a vital interest in the subject of assisted suicide. The Advocacy Center for Persons With Disabilities, Inc., is a Florida nonprofit corporation organized pursuant to Executive Order of the Governor which is charged with the responsibility of carrying out the federally mandated and funded protection and advocacy system for persons with disabilities in the State of Florida. In its amicus brief filed herein, the Center states:
To give someone, including a physician, the right to assist a person with a severe disability in killing himself or herself is discrimination based on a disability. It lessens the value of a person's life based on health status and subjects persons with severe physical and mental disabilities to undue pressure to which they may be especially vulnerable.
The Advocacy Center for Persons with Disability, Inc., opposes the legalization of assisted suicide, either by judicial decision negating its prohibition or by legislative enactment. If assisted suicide is permitted in Florida, Floridians will be put on the so-called slippery slope of determining the relative value of life. Floridians with severe physical and mental disabilities, who are particularly vulnerable to being devalued as burdens of society, would be at grave risk.
The American Disabled for Attendant Programs Today, Not Dead Yet, and the National Legal Center for the Medically Dependent and Disabled, Inc., three national organizations composed primarily of persons with serious disabilities, also strongly oppose assisted suicide.
We have previously refused to allow the state to prohibit affirmative medical intervention, such as the case with the right to an abortion before viability of the fetus, only because the state's interests in preventing the intervention were not compelling. In re T.W., 551 So.2d 1186 (Fla.1989) (state's interest in prohibiting abortion is compelling after fetus reaches viability). This is because, under our privacy provision, once a privacy right has been implicated, the state must establish a compelling interest to justify intruding into the privacy rights of an individual. Winfield v. Division of Pari-Mutuel Wagering, 477 So.2d 544 (Fla.1985).
This Court has also rendered several prior decisions declaring in various contexts that there is a constitutional privacy right to refuse medical treatment. Those cases recognized the state's legitimate interest in (1) the preservation of life, (2) the protection of innocent third parties, (3) the prevention of suicide, and (4) the maintenance of the ethical integrity of the medical profession. However, we held that these interests were not sufficiently compelling to override the patient's right of self-determination to forego life-sustaining medical treatment.
The respondents successfully convinced the trial court that there was no meaningful difference between refusing medical treatment and obtaining a physician's assistance in committing suicide. We cannot agree that there is no distinction between the right to refuse medical treatment and the right to commit physician-assisted suicide through self-administration of a lethal dose of medication. The assistance sought here is not treatment in the traditional sense of that term. It is an affirmative act designed to cause death — no matter how well-grounded the reasoning behind it. Each of our earlier decisions involved the decision to refuse medical treatment and thus allow the natural course of events to occur. In re Dubreuil, 629 So.2d 819 (Fla.1993) (due to religious beliefs, individual wanted to refuse blood transfusion); In re Guardianship of Browning, 568 So.2d 4 (Fla.1990) (surrogate asserted right of woman who was vegetative but not terminally ill to remove nasogastric feeding tube); Public Health Trust v. Wons, 541 So.2d 96 (Fla.1989) (same facts as Dubreuil); Satz v. Perlmutter, 379 So.2d 359 (Fla.1980) (individual suffering from Lou Gehrig's disease sought to remove artificial respirator needed to keep him alive).
In the instant case, Mr. Hall seeks affirmative medical intervention that will end his life on his timetable and not in the natural course of events. There is a significant difference between these two situations. As explained by the American Medical Association:
When a life-sustaining treatment is declined, the patient dies primarily because of an underlying disease. The illness is simply allowed to take its natural course. With assisted suicide, however, death is hastened by the taking of a lethal drug or other agent. Although a physician cannot force a patient to accept a treatment against the patient's will, even if the treatment is life-sustaining, it does not follow that a physician ought to provide a lethal agent to the patient. The inability of physicians to prevent death does not imply that physicians are free to help cause death.
AMA Council on Ethical and Judicial Affairs, Report 1-93-8, at 2.
Measured by the criteria employed in orn-eases addressing the right to refuse medical treatment, three of the four recognized state interests are so compelling as to clearly outweigh Mr. Hall's desire for assistance in committing suicide. First, the state has an unqualified interest in the preservation of life. Cruzan v. Director, Missouri Department of Health, 497 U.S. 261, 110 S.Ct. 2841, 111 L.Ed.2d 224 (1990). The opinion we adopted in Perlmutter included the caveat that suicide was not at issue because the discontinuation of life support would "merely result in [the patient's] death, if at all, from natural causes." Satz v. Perlmutter, 362 So.2d 160, 162 (Fla. 4th DCA 1978); accord Brouming, 568 So.2d at 14. Although the constitutional privacy provision was not involved, in Mr. Perlmutter's case a sharp distinction was drawn between disconnecting a respirator that would result in his death from "natural causes" (i.e., the inability to breathe on his own) and an "unnatural death by means of a 'death producing agent.' " Perlmutter, 362 So.2d at 162. It is the second scenario that we encounter in the instant case. Mr. Hall will not die from the complications of his illness. Rather, a physician will assist him in administering a "death producing agent" with the intent of causing certain death. The state has a compelling interest in preventing such affirmative destructive act and in preserving Mr. Hall's life.
The state also has a compelling interest in preventing suicide. As the United States Supreme Court explained in Washington:
Those who attempt suicide — terminally ill or not — often suffer from depression or other mental disorders. See New York Task Force 13-22,126-128 (more than 95% of those who commit suicide had a major psychiatric illness at the time of death; among the terminally ill, uncontrolled pain is a "risk factor" because it contributes to depression); Physician-Assisted Suicide and Euthanasia in the Netherlands: A Report of Chairman Charles T. Canady to the Subcommittee on the Constitution of the House Committee on the Judiciary, 104th Cong., 2d Sess., 10-11 (Comm. Print 1996); cf. Back, Wallace, Starts, & Pearlman, Physician-Assisted Suicide and Euthanasia in Washington State, 275 JAMA 919, 924 (1996) ("[I]ntolerable physical symptoms are not the reason most patients request physician-assisted suicide or euthanasia"). Research indicates, however, that many people who request physician-assisted suicide withdraw that request if their depression and pain are treated. H. Hendin, Seduced by Death: Doctors, Patients and the Dutch Cure 24-25 (1997) (suicidal, terminally ill patients "usually respond well to treatment for depressive illness and pain medication and are then grateful to be alive"); New York Task Force 177-178. The New York Task Force, however, expressed its concern that, because depression is difficult to diagnose, physicians and medical professionals often fail to respond adequately to seriously ill patients' needs. Id., at 175. Thus, legal physician-assisted suicide could make it more difficult for the State to protect depressed or mentally ill persons, or those who are suffering from untreated pain, from suicidal impulses.
Washington, — U.S. at-, 117 S.Ct. at 2273.
Finally, the state also has a compelling interest in maintaining the integrity of the medical profession. While not all health care providers agree on the issue, the leading health care organizations are unanimous in their opposition to legalizing assisted suicide. The American Medical Association, which represents 290,000 physicians, as late as June of 1996 overwhelmingly endorsed a recom mendation to reaffirm the ethical ban on physician-assisted suicide. American Medical Association, Press Release, "AMA Soundly Reaffirms Policy Opposing Physician-Assisted Suicide" (June 24, 1996). The same position is endorsed by the Florida Medical Association, the Florida Society of Internal Medicine, the Florida Society of Thoracic and Cardiovascular Surgeons, the Florida Osteopathic Medical Association, the Florida Hospices, Inc., and the Florida Nurses Association. Who would have more knowledge of the dangers of legalizing assisted suicide than those intimately charged with maintaining the patient's well-being?
In addition, the Code of Medical Ethics, § 2.211, states that physician-assisted suicide is "fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks." Even the Hippocratic Oath itself states that a physician "will neither give a deadly drug to anybody if asked for it, nor . make a suggestion to this effect." Physician-assisted suicide directly contradicts these ethical standards and compromises the integrity of the medical profession and the role of hospitals in caring for patients.
We do not hold that a carefully crafted statute authorizing assisted suicide would be unconstitutional. Nor do we discount the sincerity and strength of the respondents' convictions. However, we have concluded that this case should not be decided on the basis of this Court's own assessment of the weight of the competing moral arguments. By broadly construing the privacy amendment to include the right to assisted suicide, we would run the risk of arrogating to ourselves those powers to make social policy that as a constitutional matter belong only to the legislature. See art. II, § 3, Fla. Const, (separation of powers).
We reverse the judgment of the trial court and uphold the constitutionality of section 782.08.
It is so ordered.
SHAW and WELLS, JJ., concur.
OVERTON and HARDING, JJ., concur with an opinion.
KOGAN, C.J., dissents with an opinion.
ANSTEAD, J., recused.
. Three patient-plaintiffs originally joined in the action but two died before the trial.
. At common law committing suicide was a criminal offense which resulted in the forfeiture of the suicide's goods and chattels. These sanctions were later abolished in recognition of the unfairness of penalizing the suicide's family. See Washington.
. Iowa and Rhode Island have subsequently enacted statutes against assisted suicide. Iowa Code Ann. § 707A.2, 707A.3 (Supp.1997); R.I. Gen. Laws § 11-60-1, 11-60-3 (Supp.1996).
. There was no evidence introduced to demonstrate the effect of Mr. Hail's suicide upon innocent third parties.
. In Shands Teaching Hospital & Clinics, Inc. v. Smith, 497 So.2d 644, 646 (Fla.1986), we acknowledged that:
[O]f the three branches of government, the judiciary is the least capable of receiving public input and resolving broad public policy questions based on a societal consensus.