A doctor who provides life-ending medication to a patient can be prosecuted for manslaughter, the state’s highest court ruled Monday, declaring that the state constitution does not protect a right to what justices termed “physician-assisted suicide.”
The unanimous decision by the Supreme Judicial Court sets the stage for a new legislative push on Beacon Hill. The ruling left the door open for action on the contentious issue, and lawmakers are preparing to reintroduce bills next month that would legalize doctor-prescribed lethal drugs to hasten the death of terminally ill patients who are suffering in the final months of their lives.
“These questions are best left to the democratic process, where their resolution can be informed by robust public debate and thoughtful research by experts in the field,” Justice Frank M. Gaziano wrote.
State voters narrowly rejected a “death with dignity” ballot question in 2012, following a well-funded opposition campaign led in part by the Catholic church. Bills that would give the terminally ill the option to obtain lethal drugs have been filed in every legislative session since then but have never been brought to a vote in the full state House or Senate.
Proponents hoping the state’s high court would clear the way for doctors to prescribe lethal drugs without legislative action, as the Montana Supreme Court did in 2009, were disappointed by the SJC’s ruling Monday, even as right-to-die adversaries applauded the court’s decision.
The long-awaited ruling cited society’s “long-standing opposition to suicide in all its forms, and the absence of modern precedent supporting an affirmative right to medical intervention that causes death.
“We cannot conclude that physician-assisted suicide ranks among those fundamental rights protected by the Massachusetts Declaration of Rights,’’ Gaziano wrote. “We conclude as well that the law of manslaughter may prohibit physician-assisted suicide, and does so, without offending constitutional protections.”
Governor-elect Maura Healey, whose office argued against a so-called right to die in the SJC case, has suggested she would favor legislative action to allow what proponents call “medical aid-in-dying” if there were proper safeguards for patients and doctors.
Healey, choosing her words carefully in a Boston Globe interview Monday, said she was pleased the court affirmed her office’s position, but called it a “tough issue” and again said the issue should be decided on Beacon Hill.
“It’s a sensitive issue, and my heart goes out to those who find themselves or their loved ones in a position of needing to think through and make some of these decisions,” the governor-elect said.
Healey said she is open to reviewing any legislation that springs from the Legislature, but she did not commit to filing her own bill.
After the court ruling, state Senator Joanne Comerford, a Democrat from Northampton, said she would submit a medical aid-in-dying bill in the Senate next month. State Representative James O’Day, a Worcester Democrat, said he would file one in the House.
Comerford said the high court “has given us real clarity” that any relief for Massachusetts residents who are suffering and want to hasten their deaths will have to come from lawmakers.
“It’s a priority bill for me,” she said.
“We would have been pleasantly surprised if the (SJC) outcome was different, but it doesn’t change our approach,” O’Day said Monday. “We always thought this was going to take an act of the Legislature.”
The case was brought by Roger M. Kligler, a Falmouth doctor who has stage 4 prostate cancer. Kligler contended he should have the right to choose, with the help of a physician, how to end his life. But the justices determined Kligler lacked the legal standing to bring the issue before the high court because his health has not yet deteriorated to the point where doctors have said has only six months to live.
Joining Kligler in the case was Dr. Alan Steinbach, who is not treating Kligler but has expressed a desire to help end his patients’ suffering, provided he would not be criminally prosecuted for his actions. The justices decided he did have standing to bring his case, allowing them to rule on the overall issue.
Kligler, in an interview Monday, said he was disappointed by the ruling and will shift his attention to the Legislature in hopes of legalizing medical aid-in-dying. “Basically they’re saying the courts don’t want to help people who need help in an expeditious way,” Kligler said.
The court made it clear that Steinbach could be criminally prosecuted if he provided medication that a patient used to end their lives.
“I’m disappointed, but I’m not without hope,” Steinbach said, noting that he will continue to support legislative efforts on behalf of patients.
John Kappos, the lead attorney for Steinbach and Kligler, said, “This is not the end of the war. We view this as a setback.”
Cape and Islands District Attorney Michael O’Keefe, who helped bring about the litigation by declaring he’d prosecute a doctor for physician-assisted suicide, applauded the court for shifting the debate to the Legislature. “These are decisions that should be made by the people’s elected representatives and not by unelected judges,’' he said Monday.
Last May, in a Boston Globe/Suffolk University poll, 77 percent of respondents said they favored a right-to-die law, up from 70 percent in a 2019 poll.
Legislatures have legalized the right-to-die option in Vermont and Maine. It’s also legal in Oregon, Washington state, California, Colorado, Hawaii, New Jersey, New Mexico, and Washington, D.C.
But the practice remains relatively rare, with only 5,171 people in those states taking drugs to end their lives over the past two decades. Many more fill prescriptions for the medicines but never take them.
Opponents hailed Monday’s court decision, promising to keep working against legislative efforts to allow doctors to prescribe lethal drugs.
Jim Driscoll, executive director of the Massachusetts Catholic Conference, the public policy arm of the state’s Catholic bishops, said church leaders will continue to advocate with other organizations to keep the prohibition against doctor-prescribed lethal drugs in place.
Driscoll said in a statement the conference “is prepared to join a diverse group of individuals and organizations in opposing any future legislation that would legalize Physician Assisted Suicide.”
John Kelly, director of Second Thoughts Massachusetts, a disability rights group, hailed the court’s decision as a “victory for disability rights.”
“Everyone who is terminally ill is already or will soon be disabled and deserves the same level of suicide prevention as everyone else,” he said. “This is a case of people not wanting to take responsibility for suicide.”
Monday’s ruling was unanimous, with Justice Scott L. Kafker not taking part. But Justice Dalila A. Wendlandt, who was joined by Chief Justice Kimberly S. Budd, argued that because Kligler is terminally ill, he deserved to have his case answered by the SJC, not dismissed because he didn’t have a six-month prognosis.
Doctors do not face criminal charges in palliative care situations where terminally ill patients are sedated to unconsciousness and consequently dehydration and starvation contribute to their deaths, Wendlandt noted.
“In such a moment, there is no meaningful distinction between physician-assisted suicide and palliative sedation to unconsciousness followed by withdrawal of nutrients so as to cause dehydration and starvation,” Wendlandt wrote. “Allowing this subset of patients to choose to die with dignity as their final act while death is looming and inevitable would not result in harm to the public welfare.”
But she agreed with her colleagues that there is “no fundamental right” in the state constitution to allow terminally ill people obtain a prescription drug to end their lives.
Gaziano also expressed sympathy to patients and doctors who confront medical conditions that will invariably end with the patient’s death.
“Our decision today does not diminish the critical nature of these interests, but rather recognizes the limits of our Constitution, and the proper role of the judiciary in a functioning democracy,” he wrote.
Matt Stout of the Globe staff contributed to this story.