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The United States attorney general overstepped his bounds when he tried to stop the state of Oregon from implementing its 1997 physician-assisted suicide bill, the Supreme Court ruled Tuesday in a 6-3 decision.

In 2001, Attorney General John Ashcroft issued a directive "that assisting suicide is not a 'legitimate medical purpose' … and that prescribing, dispensing, or administering federally controlled substances to assist suicide violates the CSA [Controlled Substances Act]."

Using such drugs to assist with suicide could lead to "suspension or revocation" of a doctor's medical license, Ashcroft wrote.

Writing for the majority, Supreme Court Justice Anthony M. Kennedy said the Controlled Substances Act did not give Ashcroft "such broad and unusual authority." The attorney general, the Court said, has no expertise in medical matters.

"The statute and our case law amply support the conclusion that Congress regulates medical practice insofar as it bars doctors from using their prescription-writing powers as a means to engage in illicit drug dealing and trafficking as conventionally understood," Kennedy wrote. "Beyond this, however, the statute manifests no intent to regulate the practice of medicine generally."

In his dissent, Justice Antonin Scalia argued that the CSA's "legitimate medical purpose" clause is not limited to the regulation of illicit drugs.

"If the term 'legitimate medical purpose' has any meaning, it surely excludes the prescription of drugs to produce death," Scalia wrote.

Scalia was joined by Justice Clarence Thomas and Chief Justice John Roberts, for whom this was his first dissent.

Thomas wrote an additional dissent, noting that last year's Gonzales v. Raich decision, which allowed Congress to ban the medical use of marijuana, gave the federal government precedence over states in regulating controlled substances.

"The Court's reliance upon the constitutional principles that it rejected in Raich … is perplexing to say the least," Thomas wrote.

Thomas had dissented in the Raich case on the basis that since the marijuana in the case never crossed state lines and wasn't part of a commercial transaction, it didn't violate the Constitution's commerce clause. "In the early days of the Republic, it would have been unthinkable that Congress could prohibit the local cultivation, possession, and consumption of marijuana."

Scalia, on the other hand, had filed a concurring opinion in the Raich case. "The commerce power permits Congress not only to devise rules for the governance of commerce between states but also to facilitate interstate commerce by eliminating potential obstructions, and to restrict it by eliminating potential stimulants."

Scalia's dissent in the suicide case makes a similar argument:

The prohibition or deterrence of assisted suicide is certainly not among the enumerated powers conferred on the United States by the Constitution, and it is within the realm of public morality traditionally addressed by the so-called police power of the states. But then, neither is prohibiting the recreational use of drugs or discouraging drug addiction among the enumerated powers. From an early time in our national history, the federal government has used its enumerated powers, such as its power to regulate interstate commerce, for the purpose of protecting public morality—for example, by banning the interstate shipment of lottery tickets, or the interstate transport of women for immoral purposes. Unless we are to repudiate a long and well-established principle of our jurisprudence, using the federal commerce power to prevent assisted suicide is unquestionably permissible. The question before us is not whether Congress can do this, or even whether Congress should do this, but simply whether Congress has done this in the CSA. I think there is no doubt that it has.

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January (Web-only) 2006, Vol. 50