WASHINGTON -- The Constitution gives no one the right to have a doctor's help in committing suicide, a unanimous Supreme Court ruled yesterday.
The historic ruling was perhaps the most significant one on individual rights in decades. It did leave the terminally ill the option of obtaining pain-easing drugs in doses that could hasten death, so long as the drugs are not prescribed explicitly to cause death.
Speaking in bland, mostly legalistic terms on a deeply emotional issue, the court rejected any claim that the Constitution includes "a right to commit suicide which includes a right to assistance in doing so." Seldom changing tone, Chief Justice William H. Rehnquist read the ruling to a small, hushed courtroom audience.
The court declared: "Opposition to and condemnation of suicide -- and, therefore, of assisting suicide -- are consistent and enduring themes of our philosophical, legal, and cultural heritages."
It traced that history back more than 700 years, to the 13th century.
"Throughout the nation," Rehnquist wrote, "Americans are engaged in an earnest and profound debate about the morality, legality, and practicality of physician-assisted suicide."
These decisions, he added, permit "this debate to continue, as it should in a democratic society."
Dr. Timothy E. Quill, a doctor in Rochester, N.Y., who filed the lawsuit challenging New York's assisted-suicide law and who has gained prominence as an outspoken advocate of the "death with dignity" movement, said the ruling was "on the surface a big defeat." But he added that it "left a lot of room for exceptional cases."
Quill noted that the court spoke in terms not of "prohibition" but of the "need for more creative solutions" to the treatment of the dying patient.
President Clinton applauded the decision, saying that assisted suicide "is wrong." Clinton called the ruling "a victory for all Americans -- it prevents us from going down a very dangerous and troubling path on this difficult and often agonizing issue."
The court made clear that it was not prepared at this point to go beyond a 1990 ruling, which said that terminally ill patients do have a constitutional right to reject life-support. That right, the court said yesterday, was clearly different from a right to assisted suicide.
"A patient who commits suicide with a doctor's aid necessarily has the specific intent to end his or her own life, while a patient who refuses or discontinues treatment might not," the chief justice wrote in one of the two rulings.
The states, Rehnquist made clear, are free to draw that distinction, and to bar any patient from receiving a lethal drug from a doctor that the patient could take to hasten death. Forty-four states already do so. Maryland has no such law, but the state attorney general's office considers assisted suicide to be a common-law crime.
At the same time, the ruling left states with the option of legalizing physician-assisted suicide if they wish. So far, Oregon is the only state to have done so, although voters there will be asked to repeal the law in an election next fall.
The ruling yesterday -- upholding state laws in New York and Washington that make physician-assisted suicide a crime -- did not entirely block terminally ill patients from alternative ways to avoid suffering.
Most of the justices, writing in separate opinions, stressed that the ruling would not allow states to bar someone from receiving pain-easing medicine that might be taken in doses strong enough to hasten death. The justices said such a case would raise a constitutional issue about individual rights separate from the right to a doctor's aid in committing suicide.
Justice Sandra Day O'Connor said the court might later have to decide a claim to a constitutional right "in obtaining relief from the suffering that they may experience in the last days of their lives" -- relief that might include pain-control care that "would hasten their deaths."
Rehnquist said the new decisions do not "absolutely foreclose such a claim."
The court stressed that it was upholding the two state bans on assisted suicide only as those laws were written, leaving to future decisions the constitutionality of how prosecutors could actually apply the laws to control the treatment given to individual patients.
Several of the justices' comments seemed almost to invite a new lawsuit, should a state ban doctors from prescribing pain medication with the knowledge that it could hasten death.
The ruling made no mention -- except in referring to lower-court opinions -- of Dr. Jack Kevorkian, the Michigan doctor known for his crusade on behalf of assisted suicide. Kevorkian's assistance in the suicides of more than 40 patients has led to repeated, but unsuccessful, prosecutions.
Kevorkian's lawyer, Geoffrey Fieger, said his client would continue his efforts.
Fieger added: "Dr. Kevorkian is going to continue to do what's right. There is no law against assisted suicide here in this state."