With the ever-increasing power of medical science to prolong life, even in the face of what would otherwise be terminal illness, the States have had to strike a balance between the rights of the individual and the demands of organized society. That balance is grounded in the States' recognition of their responsibility to protect both individual rights and, at the same time, the lives of those who wish to live no matter what their circumstances. In striking that balance, the States have drawn a line between an individual's "right to be let alone",(17) on the one hand, and intentionally killing oneself, with or without assistance, on the other. That balance, now a national consensus, is represented by statutes in a majority of states which both codify an individual's right to refuse unwanted medical treatment and, in the same legislation, reject any affirmative act to end life. The exercise of the right to refuse life-sustaining medical treatment permits an individual to determine, at least to some extent, when he or she will die. The exercise of this right does not, however, condemn such an individual to suffer either an undignified death or excruciating pain. Rather, at the same time an individual elects to forego life-sustaining treatment, he or she may choose to accept palliative care which will help insure both a dignified death and well-controlled symptoms. (18)

Whether this balance should be abandoned and the line redrawn to permit an individual to commit suicide without state interference, and then redrawn yet again to permit assisted suicide, is a matter appropriately left for the people to decide, through their duly elected representatives or by initiative ballot.(19) The principles of federalism embodied in our Constitution require no less. Simply put, as Justice Scalia noted in the right to refuse treatment context,"...the federal courts have no business in this field..." Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261, 293 (1990) (Scalia, J., concurring). In addition, as the Missouri Supreme Court has observed, the courts are simply not an appropriate forum for resolution of broad questions of public policy.

        "Broad policy questions bearing on life and death

        issues are more properly addressed by representa-

        tive assemblies. These have vast fact and opinion

        gathering and synthesizing powers unavailable to

        courts; the exercise of these powers is particularly

        appropriate where issues invoke the concerns of

        medicine, ethics, morality, philosophy, theology, and 

        law. Assuming change is appropriate, this issue

        demands a comprehensive resolution which courts

        cannot provide." Cruzan v. Harmon, 760 S.W.2d 

        408, 426 (Mo. banc 1988), aff'd sub nom. Cruzan v.

        Director, Missouri Dept. of Health, 497 U.S. 261

        (1990).

As the States continue to grapple with the difficult questions presented by the ever-increasing ability of medical technology to prolong life, the corresponding need to allow the States to serve as laboratories for change becomes paramount. Indeed, as this Court has recognized, "[t]he science of government,...." Garcia v. San Antonio Metro., 469 U.S. 528, 546 (1985) (citation and internal quotes omitted).

                "To stay experimentation in things social and

        economic is a grave responsibility. Denial of the 

        right to experiment may be fraught with serious

        consequences to the Nation. It is one of the happy

        incidents of the federal system that a single coura-

        geous State may, if its citizens choose, serve as a 

        laboratory; and try novel social and economic

        experiments without risk to the rest of the coun-

        try...." New State Ice Co. v. Liebmann, 285 U.S.

        262, 311 (1932) (Brandeis, J., dissenting).

If allowed to stand, the Second Circuit's opinion in Quill will effectively extinguish the power of the States to continue to serve as laboratories for change on an issue that arguably will affect more lives than any other issue the States will face in the forseeable future. If allowed to stand, it will also "...invite an elected federal judiciary to make decisions about which state policies it favors and which ones it dislikes." Garcia v. San Antonio Metro., 469 U.S. 528, 546 (1985). At the same time, it will "...relegate the States to precisely the trivial role that opponents of the Constitution feared they would occupy." Garcia, supra, 469 U.S. at 575 (Powell, J., dissenting) (footnote omitted).

       "The founding Fathers did not establish the United

       States as a democratic republic so that elected offi-

       cials would decide trivia, while all great questions

       would be decided by the judiciary." Compassion in

       Dying v. State of Washington, 79 F.3d 790, 858 (9th

       Cir. 1996) (Kleinfeld, C.J., dissenting).

17.) Olmstead v. United States, 277 U.S. 438, 478 (1928) (Brandeis, J., dissenting), overruled by Katz v. United States, 389 U.S. 347, 352-353 (1967).
18.) Palliative care is designed to relieve distressing symptoms in dying patients and includes measures to alleviate pain and suffering, together with the provisions of emotional, social and spiritual support for the patient. The Hastings Center, Guidelines on the Termination of Life-Sustaining Treatment and the Care of Dying, 71-73 (1987). See also, American Medical Association, Council on Ethical and Judicial Affairs, Code of Medical Ethics Reports, Vol. V, No.2 (July 1994), Report 59, Physician Assisted Suicide, 269, 272-273 (describing advances in hospice care).
19.) See People v. Kevorkian, 447 Mich. 436, 481-482, 527 N.W.2d 714, 733 (1994), cert. denied, 115 S.Ct. 1795 (1995), and Donaldson v. Lungren, 2 Cal.App.4th 1614, 1623, 4 Cal.Rptr.2d 59, 64 (1992).