Life, Death, and the Law: The Ongoing Debate on Assisted Suicide

Written by Evie Diffloth on March 1st, 2025

On Saturday, as they have done for the past two years, Megan and her family of seven load into the minivan and suffer through the silent, two hour-long drive to the hospital. When they finally arrive, the family trudges through the harsh, fluorescently lit hallways and take the elevator up to the sixth floor. The sole of Megan’s shoe makes a flapping sound as she walks, her old Converse broken but her family financially incapable of affording a new pair. Every Saturday she thinks it will be different, that the shock of seeing her grandma in her debilitated state will be less of a blow, but every week she is faced with the same pain in her chest, the same struggle to hold back tears. Her grandma, unable to speak, to move, to think, lies motionless in the hospital bed as she has since the accident, in what Megan has heard the doctors call a ‘vegetative state.’ “Why can’t we just let her go, let her finally pass in peace?” Megan hears her mom ask every week. “I’m afraid we can’t do that,” the doctor replies each time. At the moment, 10,000 to 25,000 adult patients are in a persistent vegetative state in the United States, with some families wanting to keep their ailing family member on life support. However, many others would rather end their treatment, but are unable to due to strict laws regarding assisted suicide that currently exist in many states.

The morality and legality of assisted suicide laws is a long-debated topic in the US with multiple perspectives, initial discussions dating back to the beginning of the early 20th century. However, this issue first received significant attention from the American people in 1976 with the case of Karen Ann Quinlan. When Karen fell unconscious due to a lack of oxygen, she was saved by medical intervention but was left in a vegetative state due to the absence of oxygen. Karen’s parents requested that their daughter’s ventilator, a medical device that helps a person breathe when they are unable to do so on their own, be removed after her condition did not alter over several months. In the In re Quinlan case, the Quinlan family filed a lawsuit in order to gain permission to end Karen’s life without anyone involved, including the hospital and Karen’s doctors, being charged with a crime. On March 31st the New Jersey State Supreme Court unanimously decided that privacy rights protected a person’s freedom to refrain from medical treatment that would sustain their life, and that Quinlan’s parents could make the decision for her in this situation. This ruling was a landmark decision that would determine the nature of assisted suicide laws for years to come, setting precedent that assisted suicide is a matter governed by states. While referring to cases such as Karen Ann Quinlan case as ‘suicide’ may be confusing, the case is labeled in this way because it concerns the debate over the right to refuse medical treatment, which is intertwined with assisted suicide law.

Another fundamental case in the issue of assisted suicide was Cruzan v. Director, Missouri Department of Health in which Nancy Beth Cruzan was involved in a car accident that put her in a persistent vegetative state. After Cruzan’s life was maintained for multiple weeks through artificial feeding, her family wanted to take her off life-support. However, the hospital refused to take this action without court approval, leading the Missouri Supreme Court to take up the case. This lawsuit questioned whether the Fourteenth Amendment, which declares that states cannot deny a person of life, liberty, or property without due process of law, allowed Cruzan’s parents to act on their daughter’s behalf in terminating her life-support. In the end, the court ruled 5-to-4 that the state’s existing policy on the preservation of human life was constitutional, allowing Cruzan’s parents to cease her life-sustaining treatment. The court justified the decision by citing the Fourteenth Amendment, which grants due process, meaning that people are granted certain legal rights and a fair procedure, people who were incompetent could not invoke this right. In the context of the law, incompetency is defined as a person’s inability to understand legal proceedings or make decisions due to mental illness, disability, or other conditions, in this case referring to Cruzan’s persistent vegetative state. Applying this reasoning to the decision made in Cruzan’s situation, the justices came to this verdict due to a lack of evidence that Cruzan desired her life-support to be ended. This 1990 case established important legal principles surrounding the right to refuse medical treatment.

One significant case that followed Cruzan in the debate over assisted suicide was Gonzales v. Oregon, which addressed the conflict between federal authority and state laws regarding end-of-life decisions. The Death with Dignity Act was passed by Oregon in 1994 and was the first state law to allow physicians to prescribe substances to terminally ill patients for the purpose of ending their lives prematurely. However, in 2001 Attorney General John Ashcroft, head of the U.S. Department of Justice and the chief lawyer for the federal government, declared that suicide assisted by a physician violated the Controlled Substances Act (CSA). The Attorney General of the United States holds the power to authorize federal prosecutions, provide legal opinions to the President and federal agencies, and challenge state laws. Ashcroft threatened to revoke the medical licenses of physicians who administered lethal doses to patients, resulting in the state of Oregon suing Ashcroft in federal district court, a court that handles civil and criminal cases under federal law at the trial level. This lawsuit concluded with a 6-to-3 ruling stating that the purpose of the CSA was to prevent physicians from being involved in illegal drug dealing, rather than govern state medical practices. The court also decided that the CSA did not allow the Attorney General to assert a medical practice governed by state law to be illegal. Gonzales v. Oregon upheld Orgeon’s Death with Dignity Act and confirmed that states have the power to regulate medical practices, including assisted suicide, without federal interference.

These landmark cases set the groundwork for future lawsuits surrounding assisted suicide, and have influenced recent debates over this issue, including the Glassman v. Grewal case of 2021, in which the New Jersey Supreme Court rejected an appeal attempting to overturn the state's Aid in Dying for the Terminally Ill Act. The precedent set in early cases also impacted the introduction of the 118th Congress bill in April of 2024, which aims to improve access for patients to care options by providing exceptions for the restrictions mandated by the Assisted Suicide Funding Restriction Act of 1997. Recently, fourteen additional states introduced bills to legalize suicide assisted by a physician, expanding the existing fourteen states that currently authorize this practice.

Assisted suicide law broadly addresses the moral questions of what we consider to be a life, and what determines whether a person is living. This is the same question that is considered in the debate on the legality of abortions, as well as a number of other pressing issues, including organ donation, the death penalty, and genetic engineering. The unresolved debate surrounding assisted suicide raises fundamental ethical and philosophical questions about the value of life and individual autonomy, making it a topic that will continue to challenge our legal and moral frameworks.