Gonzales vs. Oregon Case Analysis

Gonzales vs. Oregon

Case Analysis

The objective of this work is to submit a written analysis of a closed case or issue pertaining to health care law. The chosen topic is the case of Gonzales vs. Oregon which is currently being debated at the Supreme Court level. This case stems from the 1994 passage of the death with Dignity Act, which allows terminally ill and mentally competent individuals to obtain drugs that could be utilized in the state of Oregon. The current debate questions administrative law and whether the former Attorney General John Ashcroft interpretation of the Federal Control Substance Act to outlaw these drugs is valid and is the Justice department overstepping their boundaries.

Introduction

Oregon voters approved the legalization of physician-assisted suicide (PAS) in November, 1994. After being legally challenged the Oregon PAS law became effective in the latter part of 1987. Since 1998 and through 2004 there have been a total of 208 PAS deaths in the State of Oregon. There are existing concerns with the legalization of physician-assisted suicide and there has been a great debate about the legality and morality of this practice. All levels of American society look harshly upon the thought of the use of drugs or other means to hasten the death of someone even though they may be in excruciating terminal pain however, healthcare modernization has changed the very "character of death and dying." (Pew Forum on Religion & Public Life, 2005) The case of Gonzales v. Oregon has arisen out of the debate which is one that is morally charged in nature as well as being the focus of lawsuits in relation to end-of-life decisions. However, this case has been subject to technical legalities and statutory interpretation.

Facts Surrounding the Case of Gonzales vs. Oregon

The concerns which center around the legalization of assisted suicide are stated by Kenneth R. Stevens, Jr. M.D. (2005) as being first of all that "suicide devalues human life, and results in a loss of protection for terminally ill patients against doctors writing a prescription for the sole purpose of causing their death.

(Stevens, 2005) Secondly, a false message is sent that "doctors can do a better job of assisting in a patient's suicide that they can of caring for their medical needs." (Stevens, 2005) Third, "the legalization of assisted suicide and euthanasia can inhibit the progress of medical advances, and tends to result in fewer efforts by the doctor to find a solution to the patient's distress." (Stevens, 2005) Fourth, "once a patient has the means to take their own life, there can be increased incentive to care for the patient's symptoms and needs." Fifth, "the immunity offered to physicians under the Oregon assisted-suicide law requires only 'good-faith compliance' with the law.

This is not a medical-legal standard of care, and is not applicable to any legitimate medical treatment." (Stevens, 2005) Other concerns are that the 'safeguards' for Oregon's assisted suicide are not being followed and that doctors are writing lethal drug prescriptions for patients for whom they have not provide care. Finally "there is no real monitoring of Oregon's assisted suicides." (Stevens, 2005)

Background and Historical Case Facts

The Controlled Substances Act outlaws an individual in the "manufacturing, distribution, or dispensation" of a controlled substance except they conform with the specified conditions which have been established by law. Further, the Controlled Substances Act makes it a requirement that physicians register with the attorney general in order to legally prescribed controlled substances which are those "issued for a legitimate medical purpose." (Pew Forum on Religion & Public Life, 2005) The attorney general is given authority under this act to revoke the license of a physician found in violation of the CSA or for any acts deemed "inconsistent with the public interest."

Following the re-approval of the Death with Dignity Act in 1997 by Oregon voters Thomas Constantine, who was then DEA administrator made the determination that the use of controlled substances for lethal dose was prohibited by the CSA and that this practice did not constitute a "legitimate medical purpose" however, Attorney General at the time, Reno overruled the determination made by the DEA concluding that "congress enacted the CSA to address the traffic in illegal and unauthorized drugs and to address problems of abuse of substances. According to Reno congress had not intention "to displace the states as the primary regulators of the medical profession and as not to override a states' determination of that which "constitutes legitimate medical practice in the absence of a prohibitive federal law.

In November of 2001 Attorney-General Ashcroft "issued an interpretive rule, known as the Ashcroft Directive that reversed his predecessor's legal analysis of the conflict between the DWDA and the CSA." (Pew Forum on Religion & Public Life, 2005) The Ashcroft Directive "asserts the authority of the attorney general to identify and establish a uniform national definition of 'legitimate medical purpose' as used in the CSA and its implementing regulations" (Pew Forum on Religion & Public Life, 2005)

That very same year the Supreme Court made a decision in the case United States v. Oakland Cannabis Buyers' Coop. (2001) which gives weight to the Directive. Furthermore, the Office of Legal Counsel opinion on which the Directive is based, asserts that "the Oregon law represent a significant departure from the legal and ethical norms governing medical care." Also, the Directive states the intention of the attorney general to "sanction non-complying practitioners and instructs DEA officials to monitor compliance in Oregon" stating that the legalization of physician-assisted suicide in Oregon is not a defense to those in violation of the terms of the CSA through prescribing or dispensing drugs for assisting patients in suicide.

The following day after issuance of the Directive the state of Oregon filed a federal district court suit for the purpose of blocking the Directive being enforced. This suit was soon joined by terminally ill patients and health care providers. The district court granted the motion but had no jurisdiction and the case was transferred to the U.S. Court of Appeals for the Ninth Circuit. The Ninth Circuit Court "asserted jurisdiction over the case and continued the injunction." (Pew Forum on Religion & Public Life, 2005)