Gonzales v. Oregon
546 U.S. 243 (2006)
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Rule of Law:
The Controlled Substances Act (CSA) does not grant the U.S. Attorney General the authority to unilaterally declare a medical practice authorized by state law, such as physician-assisted suicide, to be an illegitimate medical purpose. The CSA is intended to regulate illicit drug trafficking and abuse, not the general practice of medicine, which is a field traditionally regulated by the states.
Facts:
- In 1994, Oregon voters enacted the Death With Dignity Act (ODWDA), which permits state-licensed physicians to prescribe lethal doses of drugs to terminally ill adult residents who meet specific, strict criteria.
- The drugs prescribed under ODWDA are federally regulated under the Controlled Substances Act (CSA), and physicians must be registered with the federal Drug Enforcement Administration (DEA) to prescribe them.
- In 1998, then-Attorney General Janet Reno concluded that the CSA did not authorize the federal government to take punitive action against Oregon physicians who complied with the ODWDA.
- In 2001, Attorney General John Ashcroft reversed this position and issued an Interpretive Rule.
- The Interpretive Rule declared that using controlled substances to assist suicide was not a 'legitimate medical purpose' under the CSA.
- The rule further stated that prescribing such substances was unlawful and could lead to the suspension or revocation of a physician's federal registration to dispense controlled substances.
Procedural Posture:
- The State of Oregon, along with a physician, a pharmacist, and terminally ill patients, challenged the Attorney General's Interpretive Rule in the U.S. District Court for the District of Oregon.
- The District Court, as the court of first instance, granted a permanent injunction against the enforcement of the rule.
- The U.S. Attorney General, as the appellant, appealed the decision to the U.S. Court of Appeals for the Ninth Circuit.
- A divided panel of the Ninth Circuit, an intermediate appellate court, affirmed the District Court's judgment, holding the Interpretive Rule invalid.
- The U.S. Attorney General, as the petitioner, petitioned the U.S. Supreme Court for a writ of certiorari, which was granted.
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Issue:
Does the Controlled Substances Act authorize the U.S. Attorney General to prohibit physicians from prescribing federally regulated drugs for use in physician-assisted suicide, when such conduct is permitted by state law?
Opinions:
Majority - Justice Kennedy
No. The Controlled Substances Act does not grant the Attorney General the authority to issue a rule prohibiting physicians from prescribing drugs for assisted suicide as permitted by state law. The CSA was enacted to combat illicit drug dealing and trafficking, not to regulate the general practice of medicine, which has traditionally been overseen by the states. The statute's text, structure, and legislative history show that Congress did not delegate to the Attorney General, a law enforcement official, the power to make broad, quintessentially medical judgments. Where the CSA does address medical standards, it delegates that authority to the Secretary of Health and Human Services, not the Attorney General. To find such a sweeping power to define medical standards in the CSA's registration provisions would be to 'hide elephants in mouseholes,' as it would fundamentally alter the federal-state balance in regulating medicine without a clear statement from Congress.
Dissenting - Justice Scalia
Yes. The Attorney General acted within his authority. The CSA requires prescriptions to be issued for a 'legitimate medical purpose,' and the Attorney General’s interpretation that this phrase excludes assisted suicide is a reasonable interpretation of his own regulation and the statute, deserving of deference. The CSA grants the Attorney General authority to make rules for the 'control' of regulated substances and to deny or revoke a physician's registration if it is 'inconsistent with the public interest,' which includes protecting 'public health and safety.' Historically and professionally, 'medicine' has been understood as the art of healing, not of intentionally causing death, making the Attorney General's interpretation not only permissible but the most natural one.
Dissenting - Justice Thomas
Yes. The majority’s narrow interpretation of the Controlled Substances Act is inconsistent with the Court's recent decision in Gonzales v. Raich, which held that the CSA was a comprehensive regulatory scheme that could override state laws authorizing medical marijuana. In Raich, the Court adopted an expansive view of the CSA's power, but here it adopts a restrictive view based on principles of federalism that it rejected in Raich. This inconsistency is perplexing. The Attorney General’s interpretation that the CSA prohibits physician-assisted suicide is reasonable and, under the precedent of Raich, should be upheld.
Analysis:
This decision significantly reinforces the principle that the regulation of medical practice is a traditional state function, limiting the federal executive branch's ability to interfere without a clear congressional mandate. It prevents the Attorney General, as a law enforcement officer, from setting national medical standards under the guise of enforcing the Controlled Substances Act. The ruling thereby preserves state authority to act as 'laboratories of democracy' in creating and implementing controversial medical policies, like physician-assisted suicide, protecting such state laws from being nullified by federal executive action.
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