In a 6-3 vote, justices ruled that a federal drug law could not be used to prosecute Oregon doctors who prescribed overdoses intended to facilitate the deaths of terminally ill patients. The Bush administration in 2001 sought to go after Oregon doctors who invoked the law, saying that induced suicide was not a "legitimate medical purpose."
But during oral arguments last November, several justices seemed skeptical of the government's position. Justice Sandra Day O'Connor pointed out that doctors participate in the administration of lethal injections to death row inmates.
Writing for the majority, Justice Anthony Kennedy chided former Attorney General John Ashcroft, who tried to lock horns with Oregon over the law. Kennedy wrote that the "authority claimed by the attorney general is both beyond his expertise and incongruous with the statutory purposes and design."
Kennedy said that both Ashcroft and the current attorney general, Alberto Gonzales, were overstepping their bounds in trying to impede Oregon's legislature and the U.S. Congress. The attorneys general had argued that the federal Controlled Substances Act (CSA) gave them the power to override the Oregon assisted suicide law.
"The CSA explicitly contemplates a role for the states in regulating controlled substances," Kennedy noted.
Moreover, when Ashcroft said that assisted suicide was not a "legitimate medical purpose," he was seeking to define that term, which was not spelled out in the CSA. If anyone is going to define what a legitimate medical purpose is, Kennedy wrote, it should not be the attorney general, whose job description does not include making health and medical policy.
"He is not authorized to make a rule declaring illegitimate a medical standard for care and treatment of patients that is specifically authorized under state law," Kennedy wrote. He was joined in the majority opinion by Justices O'Connor, John Paul Stevens, David Souter, Ruth Bader Ginsburg and Stephen Breyer.
Peg Sandeen, executive director of the Death With Dignity National Center, said she was pleased but hardly surprised by Tuesday's outcome.
"We're pretty convinced states are going to go forward with similar legislation," Sandeen told FOXNews.com, citing pending legislation in Vermont and California. "We really believe the American people want this."
The court did not make a bold statement about the right to die, however. It merely said that the attorney general could not use the CSA to prosecute physicians who prescribe deadly doses to terminally ill patients — meaning, Congress could explicitly grant or deprive the attorney general of that power in new legislation.
"It's a rebuke to the Bush administration, but it's not any great victory for one side or the other," said Neil Siegel, a constitutional law professor at Duke Law School.
"The decision did not [address] the merits of assisted suicide," said Bradford Short, staff attorney for the Culture of Life Foundation. "At the most what it said is that the Controlled Substances Act as it was passed by Congress either does not enable the federal government to prevent Oregon from cleaving out for itself its own zone to have controlled substances legally used for assisted suicide, or it accused Ashcroft of not taking enough time" before trying to block the law.
Chief Justice John Roberts and Justices Antonin Scalia and Clarence Thomas dissented from Tuesday's ruling. Scalia wrote that the so-called Ashcroft Directive, which the attorney general issued to block implementation of the Oregon law, did not violate the separation of powers.
"Because the regulation was promulgated by the attorney general, and because the directive purported to interpret the language of the regulation ... this case calls for the straightforward application of our rule that an agency's interpretation of its own regulations is 'controlling unless plainly erroneous or inconsistent with the regulation,'" Scalia wrote.
While Scalia scoffed at the notion that helping someone die might fall under the rubric of "legitimate medical purpose," he also acknowledged the highly personal nature of the debate.
"The court's decision today is perhaps driven by a feeling that the subject of assisted suicide is none of the federal government's business. It is easy to sympathize with that position," he wrote.
The right-to-die debate came to a boil last year during a protracted and anguished legal battle over Terri Schiavo, a Florida woman who died after the feeding tube that had kept her alive for 15 years was removed. Most Americans disapproved of the unorthodox measures taken by members of the House and President Bush to defy repeated court rulings allowing Schiavo's husband to order the tube removed.
Groups that opposed the removal of Schiavo's feeding tube were disappointed by the court's ruling.
"It is important that the traditional understanding of the medical role as one of healing not be confused by licensing doctors to kill. Assisted suicide is a perversion of the medical profession because it violates a fundamental ethical principle of medicine, 'first, do no harm,'" said Tony Perkins, president of the Family Research Council.
While Roberts seemed to approach the Oregon law with skepticism during oral arguments, his decision to side with the Bush administration feeds suspicions that he is sympathetic toward the broad powers arguments of the executive branch. If Supreme Court nominee Samuel Alito is indeed more to the right of Roberts on separation of powers, as is widely believed, then a visible shift on the court could be seen as early as this year, pending Alito's almost certain confirmation.
"I think there is the expectation that one of things Alito and Roberts have in common is a healthy — or perhaps unhealthy — respect for strong executive power," said Vikram Amar of the University of California Hastings College of Law.
"If this case was a clash between executive power and state power, the fact that Roberts leans toward executive power would indicate Alito would as well. And that places so much more weight on Anthony Kennedy, who in some ways replaces O'Connor as the sole fulcrum of the court," Amar told FOXNews.com.
"These kinds of cases are tricky because it's not entirely clear what it means to be a conservative," Siegel said. "You can have strong views about assisted suicide and drug use but also strong views about federalism. My guess is Alito would have come out with Roberts, Scalia and Thomas."
Siegel noted that conservatives Kennedy and O'Connor sided with the liberals on the court in part because of their strong federalist views.
"That shows how critical Kennedy's vote is going to be in the short run," he said of O'Connor's pending retirement, "whether he stays where he's been or moves in response to the court becoming more conservative."
The Oregon Death With Dignity Act was passed by ballot initiative in 1994, but because of legal conflicts, it did not go into effect until 1997. The act made self-administration mandatory, barred lethal injection, forced participatory doctors to report to the state and applied only to terminally ill patients with less than six months to live.
More than 200 people in the state have opted for legal assisted suicide under the law.
Oregon's law is the only one of its kind in the country, but other states, including Hawaii and California, have made moves toward similar legislation, and may be emboldened to go further in their efforts after Tuesday's ruling.
In a somewhat ironic twist, then-Chief Justice William H. Rehnquist, who succumbed to thyroid cancer last year, presciently left the door open for Tuesday's ruling eight years ago, even though he may have been in the minority had he lived to weigh in on Gonzales v. Oregon.
In 1997, the court ruled unanimously that people have no constitutional right to end their lives, upholding state bans on physician-assisted suicide. But Rehnquist concluded in the opinion he authored that states could choose to permit the practice.
"Throughout the nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide. Our holding permits this debate to continue, as it should in an democratic society," he wrote.
Tuesday's case is the first highly controversial one to be decided by the newly minted Roberts court. Other decisions in which the Bush administration has claimed high stakes, including a contested law restricting abortion for minors and a battle over military recruiters on school campuses, are pending. The outcomes for those decisions are very much in the air, as O'Connor may no longer be on the court when they are decided.
O'Connor, who announced she would retire last June, will leave the court upon Alito's confirmation. Had O'Connor's vote not been counted in this case, it would not have changed the outcome of the ruling.