[January 17, 2006]
Justice Kennedy delivered the opinion of the Court.
The question before us is whether the Controlled Substances Act allows the United States Attorney General to prohibit doctors from prescribing regulated drugs for use in physician-assisted suicide, notwithstanding a state law permitting the procedure. As the Court has observed, “Americans are engaged in an earnest and profound debate about the morality, legality, and practicality of physician-assisted suicide.” The dispute before us is in part a product of this political and moral debate, but its resolution requires an inquiry familiar to the courts: interpreting a federal statute to determine whether Executive action is authorized by, or otherwise consistent with, the enactment.
In 1994, Oregon became the first State to legalize assisted suicide when voters approved a ballot measure enacting the Oregon Death With Dignity Act (ODWDA). ODWDA, which survived a 1997 ballot measure seeking its repeal, exempts from civil or criminal liability state-licensed physicians who, in compliance with the specific safeguards in ODWDA, dispense or prescribe a lethal dose of drugs upon the request of a terminally ill patient.
The drugs Oregon physicians prescribe under ODWDA are regulated under a federal statute, the Controlled Substances Act (CSA or Act). The CSA allows these particular drugs to be available only by a written prescription from a registered physician. In the ordinary course the same drugs are prescribed in smaller doses for pain alleviation.
A November 9, 2001 Interpretive Rule issued by the Attorney General addresses the implementation and enforcement of the CSA with respect to ODWDA. It determines that using controlled substances to assist suicide is not a legitimate medical practice and that dispensing or prescribing them for this purpose is unlawful under the CSA. The Interpretive Rule’s validity under the CSA is the issue before us.
We turn first to the text and structure of the CSA. Enacted in 1970 with the main objectives of combating drug abuse and controlling the legitimate and illegitimate traffic in controlled substances, the CSA creates a comprehensive, closed regulatory regime criminalizing the unauthorized manufacture, distribution, dispensing, and possession of substances classified in any of the Act’s five schedules. The Act places substances in one of five schedules based on their potential for abuse or dependence, their accepted medical use, and their accepted safety for use under medical supervision. Schedule I contains the most severe restrictions on access and use, and Schedule V the least. Congress classified a host of substances when it enacted the CSA, but the statute permits the Attorney General to add, remove, or reschedule substances. He may do so, however, only after making particular findings, and on scientific and medical matters he is required to accept the findings of the Secretary of Health and Human Services (Secretary)....III
As we have noted before,
“repealed most of the earlier antidrug laws in favor of a
comprehensive regime to combat the international and interstate
traffic in illicit drugs.” In doing so, Congress sought to
“conquer drug abuse and to control the legitimate and
illegitimate traffic in controlled substances.” Ibid. It comes
as little surprise, then, that we have
not considered the extent to which the CSA regulates medical
practice beyond prohibiting a doctor from acting as a drug
In deciding whether the CSA can be read
as prohibiting physician-assisted suicide, we look to the
statute’s text and design. 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. Beyond this,
however, the statute manifests no intent to
regulate the practice of medicine generally. The silence is
understandable given the structure and limitations of
federalism, which allow the States “
Further cautioning against the
the CSA effectively displaces the States’ general
regulation of medical practice is the Act’s pre-emption
provision, which indicates that, absent a positive conflict,
none of the Act’s provisions should be “construed as
indicating an intent on the part of the Congress to occupy the
field in which that provision operates … to the exclusion
of any State law on the same subject matter which would
otherwise be within the authority of the State.”
Oregon’s regime is an
the state regulation of medical practice that the CSA
presupposes. Rather than simply decriminalizing assisted
suicide, ODWDA limits its exercise to the attending physicians
of terminally ill patients, physicians who must be licensed by
Oregon’s Board of Medical Examiners....
Even though regulation of health and safety is “primarily, and historically, a matter of local concern,” there is no question that the Federal Government can set uniform national standards in these areas. In connection to the CSA, however, we find only one area in which Congress set general, uniform standards of medical practice. Title I of the Comprehensive Drug Abuse Prevention and Control Act of 1970, of which the CSA was Title II, provides that
“[The Secretary], after consultation with the Attorney
General and with national organizations representative of
persons with knowledge and experience in the treatment of
narcotic addicts, shall determine the appropriate methods of
professional practice in the medical treatment of the narcotic
addiction of various classes of narcotic addicts, and shall
report thereon from time to time to the Congress.”
This provision strengthens the understanding of the CSA as a statute combating recreational drug abuse, and also indicates that when Congress wants to regulate medical practice in the given scheme, it does so by explicit language in the statute.
In the face of the CSA’s
on the practice of medicine generally and its recognition of
state regulation of the medical profession it is difficult to
defend the Attorney General’s declaration that the statute
impliedly criminalizes physician-assisted suicide....
The Government, in the end, maintains that the prescription requirement delegates to a single Executive officer the power to effect a radical shift of authority from the States to the Federal Government to define general standards of medical practice in every locality. The text and structure of the CSA show that Congress did not have this far-reaching intent to alter the federal-state balance and the congressional role in maintaining it.