Header, the Administration of the Honorable Lincoln C. Almond
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August 5, 1996

TO THE HONORABLE, THE SENATE:

I am transmitting to the Secretary of State, with my signature, 96-S-2558, Substitute A, As Amended, "An Act Relating to Criminal Offenses - Assisted Suicide."

This Act criminalizes assisted suicide by providing that "any individual or licensed health care practitioner who with the purpose of assisting another person to commit suicide knowingly: (a) provides the physical means by which another person commits or attempts to commit suicide, or (b) participates in a physical act by which another person commits or attempts to commit suicide" is guilty of a felony. Punishment upon conviction is imprisonment of up to ten (10) years and/or a fine of up to ten thousand dollars ($10,000). The Act also contains a specific exemption for a licensed health care professional "who administers, prescribes, or dispenses medications or procedures to relieve another person's pain or discomfort, even if the medication or procedure may hasten or increase the risk of death" so long as the medication or procedure is not "knowingly administered, prescribed, or dispensed to cause death." The Act also exempts from its purview the withholding or withdrawing of life-sustaining procedures as provided for in R.I. Gen. Laws § 23-4.10-1 et seq. Finally, the Act provides the Attorney General with authority to obtain injunctive relief against any person who is reasonably believed to be, or is in the course of, assisting in a suicide.

1 write in support of this Act, which passed by overwhelming majorities in both the House and the Senate. Criminalizing assisted suicide by statute serves the State's fundamental interest in preserving human life by deterring suicide. As explained below, we believe that the Act will likely withstand constitutional challenge (it certainly will with respect to persons who are not terminally ill) and that it will not, in practice, adversely affect the quality of patient care. The Act supplies a guideline to the medical profession, a safeguard for patients and a reaffirmation of the State's opposition to suicide and euthanasia. The Act will prevent Kevorkian-type assisted suicides in Rhode Island and protect the vulnerable.

I. Is the Act Constitutional?

It is important to note that the Act criminalizes all assisted suicides in Rhode Island whether or not the patient is terminally ill. The two United States Circuit Court cases invalidating state prohibitions on assisted-suicide did so only to the extent that they prevented terminally ill patients from seeking such assistance. No court has questioned the authority of a state to outlaw suicide or assisted suicide of persons not terminally ill. Moreover, it is extremely unlikely that the United States Supreme Court would-so rule. As such, there is no question that this Act is constitutional when applied to assisted suicides of persons who are not terminally ill.

Today, thirty-four states outlaw assisted suicide by statute. In another ten, including Rhode Island, assisted suicide is a common law offense. Suicide has always been illegal under the common law of Rhode Island. In re Marlene B., 540 A.2d 1028 (R.I. 1988). The Supreme Court of Michigan upheld the constitutionality of its law and the United States Supreme Court refused to hear an appeal of that ruling.

Both the Second and Ninth Circuit Courts of Appeals have held such statutes unconstitutional. See Quill v. Vacco, 80 F.3d 716 (2nd. Cir. 1996) (New York statute );

Compassion in Dying v. State of Washington, 79 F.3d 790 (9th Cir. 1996) (en bane) (Washington statute). Both Circuit rulings are presently on appeal and do not govern Rhode Island- The United States Supreme Court has never ruled on whether anti-assisted suicide laws violate the United States Constitution, but is likely to do so within the next year. The Court has, however, affirmed that a state has an undeniable interest in the protection and preservation of human life. See Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990).

Both the Second and Ninth Circuit decisions share a fundamental premise - that there is no constitutionally or ethically valid distinction between the withdrawal or refusal of lifesaving medical treatment (which remains legal) and active intervention with the intent to cause death. That line, however, is no less rational than the line between allowance of assisted suicide for only the terminally ill and no-one else. If the principle is, as assisted suicide advocates argue, personal autonomy, self-determination and/or a generalized "right to die," then what logically prevents that principle from being applied to anyone who repeatedly requests assistance to take their own life? How could that "right" be withheld from the severely depressed, the infirm, a quadriplegic, or someone who has lost her family in a plane crash? I would suggest that the line that Rhode Island and dozens of other states have drawn is no less valid than the line with which it would be replaced. See, e.g., Kamisar, Are Laws Against Assisted Suicide Unconstitutional? Hastings Center Law Report, 32-41(May-June 1993) (assisted suicide represents the current and appropriate "stopping point" of legally recognized personal autonomy); People v. Kevorkian, 527 N.W.2d 714 (Mich. 1994), cert. denied 115 S. Ct. 1795 (1995). If that line is not respected, voluntary and involuntary euthanasia are not far behind. Sadly, such is already the case in the Netherlands.

I believe that this Act prohibiting assisted suicide ultimately will be found to be constitutional by the courts.

II. Does the Act Impair the Physician/Patient Relationship?

Several Rhode Island physicians and physician groups have opposed this bill based upon concern that physicians will be prosecuted for assisted suicide by prescribing pain medication which may result in, but is not intended to cause a patient's death. They also contend that the Act could adversely affect the quality of patient care. It is highly unlikely that either will come to pass.

First, it is significant that despite the fact that the nearly all states outlaw assisted suicide, there is no recorded instance to our knowledge of a prosecution based upon a physician's administration of pain relieving medication. The only case of a threatened prosecution that we know of was in 1990 in Minnesota. That case was never prosecuted and resulted in an amendment to Minnesota's anti-assisted suicide law to clarify that administration of pain relieving medication or procedures, even if they may hasten or increase the risk of death, do not violate the law unless they are knowingly administered to cause death. Importantly, the identical physician-protection provision is contained in this Act. Moreover, the provision is properly considered an exemption from the law and not an affirmative defense. Thus, in prosecuting any offense under the Act, the Attorney General must prove that a physician's action was knowingly intended to cause death. With these safeguards, I am satisfied that physicians practicing medically-responsibly pain control will face no increased liability.

As for whether the Act will negatively impact the quality of patient care, apparently the American Medical Association does not agree. In fact, to allow assisted suicide could change that relationship. Very recently, the AMA reaffirmed, by a nearly unanimous vote, its policy opposing physician-assisted suicide. Dr. Nancy W. Dickey, Chair of the AMA's Board of Trustees, summed up the AMA position: "To allow or force physicians to participate in actively ending the lives of patients would so dramatically and fundamentally change the entire patient/physician relationship that it would undermine the principles we, as a society, hold most dear. We must never lose sight of the caveat that physicians are healers, and where we cannot heal, our role is to comfort." AMA News Release, June 25, 1996.

For the foregoing reasons, I sign this bill into law.


Sincerely,

Lincoln Almond
Governor