In Gonzales et al., v. Oregon, et al. (2018), the Supreme Court considered whether a state law that allowed assisted suicide through physician-prescribed doses of controlled substances violated a federal controlled-substances law.
In 1994, Oregon enacted the Oregon Death With Dignity Act (ODWDA), becoming the first state law to allow physicians to prescribe lethal doses of controlled substances to terminally ill patients. The drugs that Oregon physicians would prescribe under the law were regulated by the federal Controlled Substances Act of 1970 (CSA). In 2001, the U.S. Justice Department issued an Interpretive Rule addressing the implementation of the CSA with respect to ODWDA. The rule declared that the use of controlled substances to assist suicide was not a legitimate medical practice. The department threatened to revoke the license of any physician who administered lethal doses of controlled substances under ODWDA.
Oregon and a group of other interested parties challenged the Interpretive Rule. On appeal, the Supreme Court focused on whether the Attorney General had the authority to decide whether a particular activity by a physician was, in the words of the CSA, done “for a legitimate medical purpose.”
The court noted that under the CSA, the Attorney General’s rulemaking authority was limited to issuing rules relating to the registration and control of the manufacture, distribution, and dispensing of controlled substances. The Court ruled that this delegation of authority did not extend to the Justice Department’s attempt to define standards of medical practice.
The Court also examined the Attorney General’s authority based upon the CSA’s requirement that physicians wishing to prescribe controlled substances must register with the Justice Department. In its Interpretive Rule, the Attorney General declared that the department had the authority to refuse registration – or to deregister – physicians who participated in assisted suicide. In considering whether the Attorney General indeed had that authority, the Court pointed out that the Interpretive Rule declared that the ODWDA violated the CSA. Such a violation would be a felony. The Court held that, in purporting to declare the actions allowed by the ODWDA a crime, the Attorney General exceeded his authority to register or deregister physicians. The Court noted that to hold otherwise would offer the Attorney General “unrestrained” powers far beyond those that Congress had “painstakingly described” in outlining the department’s registration-related authority.
The Court continued that, with the CSA, Congress regulated medical practice only in regard to barring doctors from using their prescription-writing powers to engage in drug dealing and trafficking. The statute did not attempt to regulate medical practice generally. This silence, the Court pointed out, “is understandable given the structure and limitations of federalism.” The Court stated that regulating medical practice is something within the police power of the states rather than the federal government.
In rejecting the conclusions of the Justice Department’s Interpretive Rule, the Court concluded that “Congress did not have this far-reaching intent to alter the federal-state balance and the congressional role in maintaining it.”