Politics and Your Practice: The High Court Got It Right

One of the first political surprises of 2006 came from the Supreme Court.

In a January ruling, the justices told federal officials that they could not interfere with Oregon physicians who want to treat patients under the state's unique assisted-suicide law.

The ruling is narrow: It applies only to Oregon physicians and their terminally ill patients, and may be nothing more than a symbolic victory of sorts for physicians.

But in politics, symbols can carry a lot of weight, if used effectively.

The Supreme Court's opinion in Gonzales v. Oregon is just such a symbol: a positive note for the large number of physician advocates who were reeling from other negative ones.

However you feel about the values implicit in physician-assisted suicide, physicians should be glad that the court said to the federal government: "Butt out." Unless Congress says differently, regulating the practice of medicine is a state matter, explained the court.

For one day, someone in power in Washington seemed to get it: Physicians should be able to practice medicine and determine the treatments their patients receive, without federal interference.

Gonzales was a major rebuke to the Justice Department and former Attorney General John Ashcroft, a long-time foe of the Oregon law and physician-assisted suicide.

Nine years ago, the high court ruled in another case, 9-0, that there is no Constitutional right to physician-assisted suicide. Thus, state laws could be enacted that either banned or prohibited the practice. Later that same year, in a statewide referendum, Oregon voters overwhelmingly approved the Death With Dignity Act. The law says that if two physicians confirm that a patient has less than six months to live, and is mentally competent, a physician may prescribe a lethal dose of medicine for a patient to self-administer.

As a senator from Missouri, Ashcroft tried and failed to block the law. When he became Attorney General, he directed the Justice Department to declare that assisting suicide is not a "legitimate medical purpose" for dispensing drugs. The Justice Department threatened to revoke the medical licenses of physicians who assisted in a suicide.

Lower federal court action blocked Ashcroft: Because the regulation of medical practices is a state matter, the courts ruled that he had exceeded his authority.

One of Ashcroft's final acts before resigning as Attorney General in 2004 was to direct the Justice Department to file an appeal of the Oregon case to the U.S. Supreme Court.

The 6-3 Gonzales ruling, written by Justice Anthony Kennedy, explained that the administration had no authority to interfere with Oregon's law.

The court chided what seemed like a big power play by Ashcroft, describing it as an attempted "radical shift of authority from the [s]tates to the [f]ederal [g]overnment to define general standards of medical practice in every locality."

The immediate impact of the ruling is straightforward: DEA officials won't be showing up in physicians' offices to take away their prescription pads. The decision was a surprise because less than a year earlier the court had ruled that federal laws supersede California laws that allow citizens to grow marijuana to treat pain associated with cancer. In that instance, Congress had passed a law that precluded citizens from growing marijuana, even for medical treatment; federal law will always trump state laws. But there is no federal law that bans physician-assisted suicide.

The Gonzales case is about raw political power: Who gets to decide how physicians can care for their terminally ill patients - the Justice Department, Congress, or individual states? For at least one day, the Supreme Court was keeping the federal government honest.

What do you think? Write to me at kkarpay@physicianspractice.com. The views expressed here are my own, and do not necessarily reflect those of Physicians Practice.

This article originally appeared in the March 2006 issue of Physicians Practice.