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Back to the Quill Case: The Unpleasantness of Gray-Area Cases

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On April 2, I very briefly discussed the U.S. Supreme Court decision of Vacco v. Quill (1997).  I promised more. So here, at least, is a bit more.

To resume where I left off: the court's opinion, by Chief Justice Rehnquist, said this:

"[W]e disagree with respondents' claim that the distinction between refusing lifesaving medical treatment and assisted suicide is 'arbitrary' and 'irrational.' ... Granted, in some cases, the line between the two may not be clear, but certainty is not required, even were it possible. Logic and contemporary practice support New York's judgment that the two acts are different, and New York may therefore, consistent with the Constitution, treat them differently."

It had by then become customary for some patients to carry the "do not resuscitate" tag with them. The decision to so label a patient was NOT treated as murder. Providing the patient (a mature, rational patient in a lot of pain) with a pill than would enable him to end his own life: THAT was prohibited.  The question is whether this distinction makes sense.

Judging from their comments in oral argument, the Justices in Quill seem to have worried most about slippery slopes. At the bottom of the slope, one can imagine a doctor prescribing a lethal dose of a pill to a teenager who was suffering from the pangs of unrequited love, or dealing with a bad break-up with his/her first love. Imagine this person of majority age but still young enough (and perhaps sheltered enough) to have had little experience of the ups and downs and eventual recovery and new ups in such matters. The strong intuition is that assisting THAT suicide is wrong. Though that hypothetical sounds very different from the actual facts of Quill, the Justices wanted and failed to receive assurances of a firm conceptual distinction somewhere that would serve better than the simple seeming distinction between killing and not-keeping-alive.

What then were the facts in Quill? Dr, Dennis Quill sued New York on behalf of mentally competent terminally ill patients. Crucially, though the pathology was well advanced in the case of each patient involved (and three of them died while the matter was pending before SCOTUS) they were NOT on life sustaining equipment, Thus, there was no "plug" to "pull." That was their equal protection argument: they were being denied the same right to hasten death as would be available to someone who WAS on a respirator or the like, who COULD effectively ask that the plug be pulled.

Personally, I sympathize with the Justices' concern about the slipperiness here. But I have to wonder whether a sort of institutional self-interest plays a part. The Justices don't want to hear a string of heart-breaking cases in various gray areas and to have to make difficult calls. Nor do they want their colleagues in black robes on lower courts to have to do the same. Is that in part simply because it is an agonizing thing to have to do, and they want their own jobs and those of their colleagues to be shielded from that agony?

If it IS their job, then they should be willing to bear it. Nobody should have to, well ... give them a pill to enable them to avoid it!


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