## Facts

- Washington criminalized “promoting a suicide attempt,” making it a felony to knowingly cause or aid another person to attempt suicide.
- Plaintiffs included a nonprofit organization, three terminally ill patients using pseudonyms, and physicians who treated terminally ill patients.
- The physicians alleged they were deterred from prescribing life-ending medication to competent, terminally ill adults who wished to hasten death because of felony liability.
- Plaintiffs alleged some terminally ill patients face severe suffering and a prolonged dying process and sought physician assistance to hasten death in limited, medically supervised circumstances.
- The district court held the statute unconstitutional as applied to physicians prescribing life-ending medication for competent, terminally ill adults.
- A Ninth Circuit panel reversed, but the Ninth Circuit granted rehearing en banc and reconsidered the constitutional questions.

## Issues

1. Whether the Fourteenth Amendment Due Process Clause protects a competent, terminally ill adult’s liberty interest in determining the time and manner of death by obtaining physician-prescribed medication to hasten death.
2. Whether Washington may, consistent with due process, categorically criminalize physicians’ prescribing of life-ending medication in that setting.

## Decision

- The en banc Ninth Circuit reversed the prior panel decision and affirmed the district court’s judgment in relevant part.
- The court held that a constitutionally protected liberty interest exists in determining the time and manner of one’s death for competent, terminally ill adults.
- After weighing that liberty interest against Washington’s asserted interests, the court held the statute unconstitutional as applied insofar as it prohibited physicians from prescribing life-ending medication for use by competent, terminally ill adults who sought to hasten their own deaths.
- The court emphasized the narrow scope of the holding and did not recognize a general right to suicide.

## Legal Principles

- Substantive due process protects certain intimate and bodily decisions; identifying the protected interest requires careful description of the specific context, not an abstract formulation.
- A competent, terminally ill adult has a protected liberty interest in determining the time and manner of death, subject to balancing against legitimate state interests.
- State interests in preserving life, preventing suicide, protecting vulnerable persons, and maintaining medical ethics are legitimate but may carry less weight when the patient is competent, terminally ill, and acting voluntarily in the face of imminent death and suffering.
- The constitutional analysis may consider the relationship between physician-assisted dying and the recognized right to refuse or withdraw life-sustaining treatment, where physician involvement is permitted and death is an expected result.
- A categorical criminal ban may be unconstitutional as applied when it broadly prohibits physician conduct in circumstances where the protected liberty interest is implicated and the state’s concerns can be addressed through safeguards.

## Conclusion

The Ninth Circuit held that due process protects a competent, terminally ill adult’s liberty interest in hastening death with physician-prescribed medication and that Washington’s felony prohibition on aiding suicide was unconstitutional as applied to physicians who prescribe life-ending medication for such patients acting voluntarily and competently.


Compassion in Dying v. State of Washington, 79 F.3d 790 (9th Cir. 1996) (en banc)