521 U.S. 793 (1997)
New York, like most states, criminalizes aiding another to commit or attempt suicide.1 Patients may nevertheless refuse even lifesaving medical treatment.2 Petitioners are New York public officials responsible for enforcing state law.3 Respondents Timothy E. Quill, Samuel C. Klagsbrun, and Howard A. Grossman are physicians practicing in New York.4
The physicians assert that prescribing lethal medication for mentally competent, terminally ill patients suffering great pain would be consistent with their medical standards.5 They are deterred by the state's ban.6 Along with three gravely ill patients who later died, the physicians sued the State's Attorney General in the United States District Court for the Southern District of New York.7 They argued that the ban violates equal protection because New York allows refusal of life-sustaining treatment, which they claim is essentially the same as physician-assisted suicide.8 The District Court disagreed with their position.9
The Court of Appeals for the Second Circuit reversed in 1996.10 It held that New York law unequally treats competent persons in the final stages of fatal illness who wish to hasten death.11 Those on life-support may direct removal, but others may not self-administer prescribed drugs.12 The Supreme Court granted certiorari in 1996.13
New York enacted its assisted-suicide statutes in 1965.14 It later protected the right to refuse treatment through 1987 do-not-resuscitate legislation and 1990 health care proxy laws, both in the Public Health Law.15 In 1994, a state task force unanimously recommended against legalizing assisted suicide.16
Whether New York’s prohibition on assisting suicide violates the Equal Protection Clause of the Fourteenth Amendment?17
The Equal Protection Clause commands that no State shall deny to any person within its jurisdiction the equal protection of the laws.18 This provision creates no substantive rights.19 Instead, it embodies a general rule that States must treat like cases alike but may treat unlike cases accordingly.20 If a legislative classification or distinction neither burdens a fundamental right nor targets a suspect class, we will uphold it so long as it bears a rational relation to some legitimate end.21
No. The facts establish that New York maintains statutes that criminalize aiding another to commit or attempt suicide while allowing patients to refuse even lifesaving medical treatment.22 The physicians assert that prescribing lethal medication for mentally competent, terminally ill patients is consistent with their medical practice but are deterred by the ban.23 The distinction drawn by the Court of Appeals between patients on life-support and those not is not supported because the acts are different in causation and intent.24 When a patient refuses life-sustaining medical treatment, he dies from an underlying fatal disease or pathology.25
In contrast, if a patient ingests lethal medication prescribed by a physician, he is killed by that medication.26 A physician who withdraws life-sustaining treatment intends only to respect his patient’s wishes and to cease doing useless and futile things.27 However, a doctor who assists a suicide must intend primarily that the patient be made dead.28 The law has long used actors’ intent or purpose to distinguish between two acts that may have the same result.29
New York has acted to protect patients’ right to refuse treatment but has reaffirmed the line between killing and letting die through its task force recommendations against legalization.30
The prohibition does not violate the Equal Protection Clause.31 New York may, consistent with the Constitution, treat the refusal of treatment and assisted suicide differently because the distinction is rational and supported by legitimate state interests in preserving life and preventing suicide.32
Related opinions on this issue
Justice Souter wrote a concurring opinion in the judgment.33 He does not conclude that assisted suicide is a fundamental right entitled to recognition at this time.34 He accords the claims raised by the patients and physicians a high degree of importance requiring a commensurate justification.35
The reasons that lead him to conclude in the related case that the prohibition on assisted suicide is not arbitrary under the due process standard also support the distinction between assistance to suicide, which is banned, and practices such as termination of artificial life support and death-hastening pain medication, which are permitted.36 He accordingly concurs in the judgment of the Court.37