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Legal and Political Timeline in Oregon
In the early-1990s, a group of Oregonians came together to develop a law allowing dying patients to control their own end-of-life care. The group was comprised of citizens, scholars and legal and medical experts, many of whom today serve on our board of directors. Below is a full legal and political timeline of the law from the 1994 Ballot Measure 16 to the current Supreme Court case of Gonzales v. Oregon.
Learn more about ballot initiatives at the Initiative and Referendum Institute.
Oregon Ballot Measure 16 (1994)
(From Wikipedia): Measure 16 of 1994 established Oregon's Death with Dignity Act, which legalizes physician-assisted suicide with certain restrictions, making Oregon the first U.S. state and one of the first jurisdictions in the world to officially do so. The measure was approved in the 8 November 1994 general election in a tight race. The final tally showed 627,980 votes (51.3%) in favor, and 596,018 votes (48.7%) against.
Under the law, a capable adult Oregon resident who has been diagnosed with a terminal illness by a physician may request in writing, from his or her physician, a prescription for a lethal dose of medication for the purpose of ending the patient's life. The request must be confirmed by two witnesses, one of whom cannot be related to the patient, be entitled to any portion of the patient's estate, be the patient's physician, or be an employee of a health care facility caring for the patient. After the request is made, another physician must examine the patient's medical records and confirm the diagnosis. The patient must be determined to not suffer from a mental condition impairing judgment. If the request is authorized, the patient must wait at least fifteen days and make a second oral request before the prescription may be written. The patient has a right to rescind the request at any time.
The law protects doctors from liability for participating in assisted suicide. Furthermore, no doctor is required to participate. Also, the law specifies that a patient's decision to end his or her life shall not "have an effect upon a life, health, or accident insurance or annuity policy."
Controversy and Aftermath
Measure 16 is regarded as one of the most controversial ballot measures in Oregon's history. In addition to the standard arguments, opponents also feared that terminally ill people throughout the nation would flock to Oregon to take advantage of the law, a fear that proved to be ungrounded.
Despite the measure's passage, implementation was tied up in the courts for several years. The Oregon Legislative Assembly also tried to repeal the law, sending Measure 51 to the people in 1997 (see below); the measure failed by a larger margin (60%) than the margin by which Measure 16 passed. Some members of Congress tried to block implementation of Measure 16, but failed.
In 2003, a federal judge blocked a move by U.S. Attorney General John Ashcroft to suspend the license for prescribing drugs covered in the Controlled Substances Act of doctors who prescribed life-ending medications under the Oregon law. The Ninth Circuit Court of Appeals affirmed the block, stating that the "Attorney General lacked Congress' requisite authorization". F.9a 9913 (2004).
According to the Oregon Department of Human Resources' most recent annual report (1998-2004), 208 people have taken their lives under the law.
In October, 2005, the U.S. Supreme Court heard arguments in the case of Oregon v. Gonzales which will determine the fate of the Death with Dignity law. Arguing on behalf of the state was Oregon Senior Assistant Attorney General Robert Atkinson. U.S. Solicitor General Paul Clement argued on behalf of the Bush administration, which is challenging Oregon's right to regulate the practice of medicine when that practice entails prescribing federally banned substances. The issue, which will be decided by the end of 2005, is whether federal drug laws trump state laws regulating physicians.
Read the language of the law (revised by legislature in 1999).
In December, 1994, the case Lee v. State of Oregon became the Oregon law's first legal challenge in which U.S. District Court Judge Michael R. Hogan placed a temporary injunction on the implementation of ODWDA. The plaintiffs in the case were doctors and patients who contended that the Oregon law violated the Constitution's First and Fourteenth Amendments. Lee v. State of Oregon eventually made its way to the U.S. Supreme Court, which refused to hear the case. The Appellate Court vacated the claims and instructed the lower court to dismiss.
In August, District Judge Hogan made the injunction permanent, ruling that ODWDA violates the U.S. Constitution's Equal Protection clause. The ruling was immediately appealed to the U.S. Circuit Court of Appeals.
In the related case Washington v. Glucksberg, the Ninth Circuit Court of Appeals ruled on March 6 that Washington State's ban on doctor-assisted dying was unconstitutional. The case was the first of its kind to be decided by a full federal appeals court. Read the Ninth Circuit decision. Read selected quotations from the case.
In February, a three-judge panel of the Ninth Circuit Appeals Court dismissed the District Court's challenge to Oregon's Death with Dignity law. Read the Ninth Circuit Court of Appeals' decision. Read selected quotations from the case.
In two related June rulings -- Vacco v. Quill and Washington v. Glucksberg -- the U.S. Supreme Court ruled in assisted suicide was not a Constitutional right. However, the Court also instructed that the issue would be best addressed in the "laboratory of the states," which are free to prohibit or legalize physician-assisted dying. In Vacco v. Quill, the Supreme Court ruled that New York's prohibition on physician-assisted dying does not violate the Equal Protection Clause. Read the Supreme Court decision. Read selected quotations. In Washington v. Glucksberg, the Supreme Court ruled that the asserted "right" to assistance in committing suicide is not a fundamental liberty interest protected by the Constitution's Due Process Clause. Read the Supreme Court decision. Read selected quotations from the case.
Oregon Ballot Measure 51 (1997)
(From Wikipedia): Measure 51 of 1997 would have repealed Oregon's Death with Dignity Act (also known as Measure 16), which legalized doctor-assisted death. It was sent to the ballot by the Oregon Legislative Assembly. The measure was defeated in the 4 November 1997 special election with 445,830 votes in favor, and 666,275 votes against.
The three years after Oregonians passed the Death with Dignity Act were marked with controversy. Opponents of the Death with Dignity Act, seeking to repeal the law, got the legislature to refer Measure 51 to the voters, hoping that the voters would have changed their mind in the intervening years.
The debate over Measure 51 found a re-hashing of the standard arguments about assisted death. Proponents of Measure 51 also argued that the Death with Dignity Law suffered from several flaws, including a lack of a mandatory counseling provision, a family notification provision, strong reporting requirements, or a strong residency requirement. Measure 51 opponents argued that sending the measure back to voters was disrespectful considering they had already passed Measure 16 via the initiative process. They also felt that the safeguards in the Death with Dignity Act were adequate.
Read the full language of Oregon Ballot Measure 51, from the Oregon Voter's Guide, including arguments for and against
Immediately, U.S. Senator Orin Hatch (R-UT) and U.S. Representative Henry Hyde (R-IL) urged the U.S. Drug Enforcement Administration (DEA) to investigate and penalize doctors who prescribe federally controlled drugs for dying patients to hasten their death. In December, DEA chief Thomas Constantine said that Oregon physicians participating under the law's guidelines would be in violation of the Controlled Substances Act (CSA). U.S. Attorney General Janet Reno agreed to review the matter.
Through an April 2 letter to Representative Hyde, Attorney General Reno issued a reversal of the DEA's position, saying that the Department of Justice would not prosecute physicians who had assisted their patients's deaths in compliance with the Oregon law. Reno argued that:
- The Controlled Substances Act was designed to prevent the illegal sale and diversion of drugs,
- The CSA was not intended to supplant individual states as the regulators of medical practice, and
- The Oregon Death with Digntiy Act, as written, was well beyond the regulatory purview of the Controlled Substances Act.
Congressional opponents to physician-assisted dying introduced the Lethal Drug Abuse Prevention Act (HR 4006/S 2151), designed to overturn the Oregon law, and Senator Don Nickles (R-OK) introduced it as an amendment to the 1998 Omnibus Spending Bill. President Bill Clinton said he would not sign the bill, and Senator Ron Wyden (D-OR) threatened to filibuster the bill.
Editorials throughout the country attacked Congress' attempt to overturn the will of Oregon voters. In addition, a coalition of 57 healthcare organizations opposed the Lethal Drug Abuse Prevention Act on grounds that it would harm patients. The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) helped lead the lobby against the Lethal Drug Abuse Prevention Act. Harold C. Sox, their president, wrote: "Ideology inspired this bill, and its chief sponsors didn't seem to understand our concerns about the harm it might cause. But we could also see its defeat as an uplifting civics lesson: Many legislators changed their minds when they realized that the bill could put their constituents at risk."
As legislators backed away, some of the bill's co-sponsors dropped their support, and Senator Nickles withdrew his plan as the session came to a close.
The U.S. House of Representatives passed the Pain Relief Promotion Act to bar physicians from prescribing medications as allowed by the Oregon Death with Dignity Act.
National organizations like the American Bar Association, the American Cancer Society and the American Pain Foundation came out against the legislation, national editorial boards lambasted Congress' assault on pain management, and President Clinton, an historic opponent of physician aid-in-dying, expressed reservations about the PRPA's negative impact.
In October, the PRPA passed the U.S. House 271 to 156.
At the beginning of the 2000 Congressional session, passage of the PRPA appeared imminent; but opponents pressed for an honest examination of the bill's true costs and intentions, and the PRPA failed to reach the Senate floor for a full vote before adjournment.
On November 6, new U.S. Attorney General John Ashcroft attempted to block the Oregon Death with Dignity Act by issuing his "Ashcroft Directive" authorizing DEA agents to investigate and prosecute doctors who prescribe federally controlled drugs to help terminally ill patients die. Read the transcript of the Ashcroft Directive. Two days later, U.S. District Court Judge Robert Jones issued an injunction against the Attorney General's order until April 2002, when arguments would be heard.
In March, arguments regarding the Ashcroft Directive were heard in U.S. District Court. Read the hearing transcript.
On April 17, Judge Robert Jones ruled that the U.S. Justice Department lacks the authority to overturn an Oregon law allowing physician-assisted deaths. Read Judge Jones' ruling.
On September 23, Attorney General Ashcroft filed an appeal with the U.S. 9th Circuit Court of Appeals. Read Attorney General Ashcroft's appeal.
On May 7, oral arguments were heard in the Ninth Circuit Court of Appeals in Oregon v. Ashcroft.
On May 26, a three-judge panel of the Circuit Court ruled in favor of ODWDA, asserting: "We hold that the Ashcroft Directive is unlawful and unenforceable because it violates the plain language of the CSA, contravenes Congress' express legislative intent, and oversteps the bounds of the Attorney General's statutory authority."
On July 12, Attorney General John Ashcroft appealed the ruling and requested that an 11-member panel rehearing of Oregon v. Ashcroft. On August 11, the Circuit Court rejected Ashcroft's request.
On November 9, the deadline for an appeal, Attorney General Ashcroft filed his petition with the U.S. Supreme Court. Later that day, Ashcroft announced his retirement from the Department of Justice.
Read the DDNC brief opposing the Department of Justice's petition for Writ of Certiorari filed with the United States Supreme Court. A petition for Writ of Certiorari ("Cert Petition") is a document a losing party files with the Supreme Court asking the Court to review a lower court's decision. It includes arguments why the Supreme Court should grant the writ.
In February, the U.S. Supreme Court granted the Department of Justice's request for a hearing in Gonzales v. Oregon, No. 04-623 (formerly Oregon v. Ashcroft). Oral arguments were heard on October 5, 2005. The legal question in Gonzales v. Oregon is: "Whether the Attorney General has permissibly construed the Controlled Substances Act, 21 U.S.C. 801 et seq., and its implementing regulations to prohibit the distribution of federally controlled substances for the purpose of facilitating an individual's suicide, regardless of a state law purporting to authorize such distribution."
On January 17, 2006, the Supreme Court voted 6-3 to uphold an Oregon physician-assisted suicide law in the case Gonzales v. Oregon, ruling that former Attorney General John Ashcroft overstepped his authority in seeking to punish doctors who prescribed drugs to help terminally ill patients end their lives. In the decision, the Supreme Court said that the Oregon law supersedes federal authority to regulate physicians and that the Bush administration improperly attempted to use the CSA to prosecute Oregon physicians who assist in patient suicides.
In the majority opinion -- also supported by Justices Sandra Day O'Connor, John Paul Stevens, David Souter, Ruth Bader Ginsburg and Stephen Breyer -- Justice Anthony Kennedy wrote that the federal government can regulate prescriptions through CSA but only in relation to prohibiting doctors from engaging in illegal drug dealing. "Beyond this, the statute manifests no intent to regulate the practice of medicine generally," Kennedy wrote. Kennedy wrote that the "authority claimed by [Ashcroft] is both beyond his expertise and incongruous with the statutory purposes and design." He wrote that had the Bush administration's position been upheld, it would have "delegate[d] to a single Executive officer the power to effect a radical shift of authority from the states to the federal government to define the medical practice in every locality." He added that when Congress passed CSA, it "did not have this far-reaching intent to alter the federal-state balance."
On Friday, August 4, 2006 U.S. Senator Sam Brownback introduced the Assisted Suicide Prevention Act, which would prohibit doctors from prescribing federally-controlled substances for the purpose of physician-assisted suicide.
Oregon Sen. Ron Wyden moved September 6 to block Senator brownback's attempt to derail Oregon's landmark law allowing doctor-assisted suicide, the first legislative assault since the U.S. Supreme Court upheld Oregon's law. Wyden announce he would block the bill indefinitely through a legislative hold. The bill was withdrawn.
Defend dignity. Take action.
You are the key to ensuring well-crafted Death with Dignity laws for all Americans. With your financial and volunteer help, the Death with Dignity National Center, a 501(c)(3), non-partisan, nonprofit organization, has been the leading advocate in the Death with Dignity movement. Individual contributions helped us pass new Death with Dignity laws in Washington and Vermont, defend the Oregon law, and provide education and outreach programs for the vitality of the Death with Dignity movement.