Opinion ID: 2514118
Heading Depth: 5
Heading Rank: 3

Heading: The manslaughter statute's ban on physician-assisted suicide bears a close and substantial relationship to a legitimate state interest.

Text: Sampson and Doe next contend that, even if the privacy and liberty clauses do not incorporate a fundamental right to physician-assisted suicide, the manslaughter statute's ban on physician-assisted suicide nonetheless amounts to an impermissible interference with their general right to privacy and liberty. To the extent that the manslaughter statute's general prohibition of assisted suicide prevents terminally ill patients from seeking a physician's help in ending their lives, we agree that the provision substantially interferes with Sampson and Doe's general privacy and liberty interests, as guaranteed by the Alaska Constitution. As previously stated, when state action limits non-fundamental privacy or liberty interests, the state must identify a legitimate governmental purpose and show that the challenged limitation bears a close and substantial relationship to that purpose. [55] There can be little doubt that substantial state interests underlie the manslaughter statute's general ban of assisted suicide. Other courts have recognized state interests in preserving human life, [56] protecting vulnerable persons, [57] protecting the integrity of the medical profession, [58] regulating dangerous substances and activities in the state, [59] and preventing suicide. [60] In this case, the state emphasizes its strong interest in protecting potentially vulnerable Alaskans, including terminally ill persons, from undue influence. Sampson and Doe do not seriously dispute the legitimacy of this interest as a general proposition. Indeed, by arguing that we should recognize a right to physician-assisted suicide that could be exercised only by mentally competent, terminally ill adults who are capable of self-administering lethal drugs prescribed by their physicians, Sampson and Doe tacitly acknowledge both that assisted suicide generally poses a significant risk of harm to potentially vulnerable persons and that a corresponding need exists for state regulation except in the narrow class of cases that they view to be relatively risk-free. The chief point of dispute, then, is whether, in the absence of a particularized exception for physicians assisting terminally ill patients, the manslaughter statute's assisted-suicide provision bears a close and substantial relationship to the state's legitimate interest in protecting vulnerable persons. Sampson and Doe posit that, without an exception for physicians, the assisted-suicide ban does not bear a close and substantial relationship to the state's interests. The state forcefully refutes this position. It insists that the terminally ill are a class of persons who need protection from family, social, and economic pressures, and who are often particularly vulnerable to such pressures because of chronic pain, depression, and the effects of medication. In support of its position, the state cites a New York task force report that unanimously rejected a narrowly tailored exemption similar to the one proposed by Sampson and Doe: The moral claim to autonomy is weakened by both the overall risks of the practice and the extraordinary nature of the remedy sought. Moreover, if assisted suicide and euthanasia are legalized, the autonomy of some patients would be extended while the autonomy of others would be compromised by the pressures to exercise these new options. [61] The task force concluded that public policy considerations of assisted suicide must include a recognition that our society is one that, despite legal and social declarations to the contrary, frequently judges others on the basis of physical and mental disabilities, race, ethnicity, social-standing, and other factors unacceptable in life-valuing decision-making: [I]t must be recognized that assisted suicide and euthanasia will be practiced through the prism of social inequality and prejudice that characterizes the delivery of services in all segments of society, including health care. Those who will be most vulnerable to abuse, error, or indifference are the poor, minorities, and those who are least educated and least empowered.... ... [T]here [is no] reason to believe that the practices, whatever safeguards are erected, will be unaffected by the broader social and medical context in which they will be operating. This assumption is naive and unsupportable.[ [62] ] In our view, the state's argument is persuasive. We note that there appears to be no consensus within the medical community about the adequacy of protective measures such as those proposed by Sampson and Doe. Indeed, some medical associations, including two amici to this case, have voiced concerns that physician-assisted suicide is fundamentally incompatible with the physician's role as healer and, if adopted, might erode the doctor-patient relationship. [63] As an expression of views currently held by a sizable segment of the medical community, these concerns reinforce the state's position: they illustrate that, even in its application to the relationship between physicians and terminally ill patients, Alaska's assisted-suicide provision furthers the state's protective interests by promoting the integrity of the medical profession and fostering healthy physician-patient relationships. We note, additionally, that the specifics of Sampson and Doe's proposed physician-assisted suicide exemption are problematic in their own right. A physician-assisted suicide exemption that narrowly restricts the right to mentally competent, terminally ill patients raises many unexamined and potentially troubling issues. For example, Sampson and Doe would have us draw a constitutional line between terminally ill patients who can self-administer lethal drugs and those who cannot. Yet this would arguably amount to discrimination based upon physical disability. Furthermore, by proposing to restrict physician-assisted suicide to mentally competent adults, Sampson and Doe would hinge the exercise of that right on a vague, unverifiable, and subjective standard. While mental competency is certainly well accepted as a measure for determining when physicians may render life-prolonging medical treatment, [64] it is potentially far more controversial as a measure for determining when a physician is entitled to terminate a patient's life. This is so not only because the prescription of life-ending medication is a unique and absolute form of medical treatment, but also because the mental competency of terminally ill patients is uniquely difficult to determine. [65] Sampson and Doe's proposal to extend physician-assisted suicide only to patients who are near death raises similar problems. To define an eligible class of terminally ill persons would be a daunting enterprise especially for a court of law. And even if a general medical consensus allowed us to resolve the difficult question of how near death a terminally ill patient must be before becoming eligible to request assistance in committing suicide, this resolution would not be particularly helpful, since physicians' predictions of expected remaining life are generally inaccurate. [66] In highlighting these difficulties, we do not mean to suggest that they are necessarily insurmountable. Nor do we mean to disparage Sampson and Doe's proposed exemption or to suggest that their arguments lack merit. To the contrary, we recognize that Sampson and Doe have raised close and difficult issues. But these issues flow quickly away from questions of the law and lapse seamlessly into questions of morality, medical ethics, and contemporary social norms. Because the controversy surrounding physician-assisted suicide is so firmly rooted in questions of social policy, rather than constitutional tradition, it is a quintessentially legislative matter. Accordingly, we hold that the right to physician-assisted suicide is not implicit in text, context, or history of the Alaska Constitution's liberty and privacy clauses. While these guarantees encompass a broad range of autonomy, they do not require an exemption to Alaska's manslaughter statute that would provide for physician-assisted suicide. As another court said in reaching the same conclusion: 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. [67]