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As a future school counselor, I will come across students who have suicidal thoughts and ideation. I view a big part of my job as forming relationships with students. As I form these relationships, I will begin to notice changes in students and will begin to notice if they could be at risk of suicide. It is also important for other teachers and staff on campus to know how to notice these changes in students, as well as peers. Therefore, the audience this is intended for is all campus members.

I chose this topic because suicide hits close to home. I have had a family commit suicide in the past. One never really knows how hard it is until it happens in your own family. Since I have became a teacher, it has also happened to a couple of students that I have known and I have personally talked with students who attempted suicide and felt worthless. This is a hard topic to talk about, but it is important.

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I interviewed the CIS coordinator, Mrs. Gonzales, on my campus. She sees students on a daily basis about suicide and other issues. There are professionals and counselors on campus who have more insight, but last year alone, we had a lot of students see Mrs. Gonzales, so I decided to interview her.

Her company sends her to trainings every year to learn about suicide prevention as well as other trainings that provide her with information about mental health issues. At the suicide prevention trainings, she has stated that she learns what to do and who to call in a situation when a student is expressing these thoughts.

When asked about the rules and policies, Mrs. Gonzales stated that if anyone in the counselor suite gets a referral that a student has been talking about suicide or if a student comes in to talk about it, they have a certain set of questions that needs to be asked. They need to see if the student already has a plan or see if they have a letter written out already. Once the questions are asked, the mental health deputy is notified, as well as the parents. The parents need to be contacted, no matter what. Any situation like this needs to be called in.

We also talked about how our campus saw a high rate of suicidal students last year alone, even if they did not attempt it. After a teacher is told that a student is in a mental hospital and will return at a later date, some teachers will say something along the line of "oh yeah, they did talk about stuff like that in class". Mrs. Gonzales stated that if there is any talk about suicide by a student, then it needs to get reported right away. Even if we think the student if joking around or if they always talk like that. This is nothing to mess with and needs to be dealt with immediately.

As far as court goes, our school personally has not had to deal with any court cases. However, there is a chance of it. If something is not handled correctly, then the school can go to court. Any current court cases out in the public do not affect us. The school district has their policies and that is what they go by.

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Link to resource: https://www.nea.org/advocating-for-change/new-from-nea/teen-suicide-rate-increases-states-look-schools-address-crisis

Summary: According to the CDC, the suicide rate among adolescents has increased 70% in 10 years. Untreated mental health conditions are among the leading cause of suicide and it happens more among girls ages 15-19. Academic pressure is one reason students may consider suicide and the school system has taken a huge weight into making sure students are safe and feel at home.

Citation: Walker, T. (2018, May 14). As teen suicide rate increases, states look to schools to address crisis. NEA. Retrieved from https://www.nea.org/advocating-for-change/new-from-nea/teen-suicide-rate-increases-states-look-schools-address-crisis

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In April 2018, the Centers for Disease Control (CDC) reported that the suicide rate among U.S. youth, ages 10 to 17, had increased by 70 percent between 2006 and 2016.

According to a separate study, the CDC found that among young girls, ages 15 to 19, the suicide rate doubled from 2007 to 2015, its highest point in 40 years. The suicide rate for boys increased by 30 percent over the same time period.

The numbers are staggering and profoundly disturbing - and probably a shock to most people, including those who may already be aware of the "suicide clusters" that shook schools and communities such as Palo Alto, CA.

Untreated mental health conditions are among the leading causes of suicide, and this alarming increase is more proof that young people are an increasingly vulnerable group when it comes to mental health, say experts. Teen depression rates are on the rise, yet obstacles prevent students of all age groups from getting the help they need.

Experts cite a number of reasons why teens are so susceptible. Bullying, academic pressure, family problems, and social media are all risk factors.

"Honestly, I've had more students this year hospitalized for anxiety, depression, and other mental-health issues than ever," said Kathy Reamy, school counselor at La Plata High School in southern Maryland and chair of the NEA School Counselor Caucus. "There's just so much going on in this day and age, the pressures to fit in, the pressure to achieve, the pressure of social media. And then you couple that with the fact that kids can't even feel safe in their schools-they worry genuinely about getting shot-and it all makes it so much harder to be a teenager."

Too many schools have become pressure cookers, says Denise Pope of Stanford University.

"I've spoken with many kids who tell me, 'I'm studying as hard as I can and my parents are saying I just need to study harder.' These kids stay up all night and focus 100 percent on schoolwork to get ahead," Pope says.

Many students don't want to disappoint their parents, adds Reamy. "It's so hard for the kids who are already maybe perfectionists, and they're getting the first B in their lives and they're fearful it's going to prevent them going to college, any college, never mind their dream college," she explains.

LGBTQ students face a particularly high suicide risk. In 2017, researchers analyzed the 2015 National Youth Risk Behavior Survey and found that 40 percent of high school students who identify as gay, lesbian or bisexual or questioning, -- were seriously considering suicide. Transgender youth - not included in this government survey - is a group that is clearly just as, if not more, vulnerable to the same risk factors, according to research.
Mandatory Suicide Prevention Policies
Although the increasing teen suicide rate is a national crisis, much of the media spotlight has been focused on California. Surveys have shown that one in five students in the state had seriously considered attempting suicide in the past year. Futhermore, suicidal thoughts are generally most prevalent among female students and among students from multiracial, Native American and Pacific Islander backgrounds. Males, however, account for three out of every four suicide deaths.

According to Kids Data, nearly two out of three counties in California had at least one person between ages 5 and 19 die by suicide in 2013.

"90 percent of the time there's a mental health condition," Dr. Shashank Joshi, a suicide prevention expert at Stanford University, told EdSource.

Palo Alto has a teen suicide rate more than four times the national average. This affluent community with high-achieving schools saw 10 teen suicides over seven years - six during the 2008-09 school year and four in 2014-15.

The "suicide cluster" in Palo Alto, which attracted national headlines, placed high-stress academic environments under the microscope.

Charles Shannon is in his 29th year of teaching in Orinda, another high-performing district about 40 miles northeast of Palo Alto. He sees similar trends at his school.

"There are lot of pressures. Teachers and parents all want students to achieve but we are all seeing signs of stress, substance abuse, addiction," say Shannon. A vocal advocate for creating friendlier and safer environments for LGBTQ students, Shannon stresses the importance of strong anti-bullying programs but also a more inclusive curriculum.
NEA School Crisis Guide
Knowing what to do in a crisis can be the difference between stability and upheaval. A new step-by-step resource created by educators for educators can make it easier for all educators, including union leaders, school district administrators, and principals, to keep schools safe-before, during, and after a crisis.
California is taking action to help safeguard the health and wellbeing of teenagers across the state. In 2013, the legislature passed AB2246 , a law that requires all public school districts and charter schools serving students in grades 7-12 develop a suicide prevention policy.

The law mandates that these new policies be in place by the 2017-18 school year and must be developed in consultation with school and community stakeholders, school-employed mental health professionals, and suicide prevention experts. The policies must provide strategies and guidelines and resources, not only to address suicide prevention, but also intervention and postvention. (A model school youth suicide prevention policy can be found at the California Department of Education's website: http://www.cde.ca.gov/ls/cg/mh/index.asp.)

The Heard Alliance, a community alliance of health care professionals in the San Francisco area, released a comprehensive resource that serves as the implementation tool for AB2246. The "Toolkit for Mental Health Promotion and Suicide Prevention" is designed to support school communities - parents, teachers, school personnel, counselors and health providers - in improving the well-being of their students. Originally published in 2013, the resource was updated in 2017 as schools began to deisgn their suicide prevention policies. Users can find a wide variety of tools. Although created to support suicide prevention in California, any school in any district in the nation can find valuable and accessible information in the guide.
Mary Ellen Flannery contributed to this story

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As Teen Suicide Rate Increases, States Look to Schools to Address Crisis | NEA

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In April 2018, the Centers for Disease Control (CDC) reported that the suicide rate among U.S. youth, ages 10 to 17, had increased by 70 percent between 2006 and 2016. According to a separate study, the CDC found that among young girls, ages 15 to 19, the suicide rate doubled from 2007 to 2015, its highest point in 40 years.

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Link: https://www.highereddive.com/news/former-student-athlete-sues-washington-and-lee-u-following-suicide-attempt/545837/

Summary: - A freshman in college spoke with a counselor and told her about his thoughts of feeling suicidal and that he did have a plan to take his own life. The counselor ended the conversation in less than 10 minutes after telling the student to go to class and football practice that day and then check himself into the health center for overnight observation. He never checked himself in, as that night he attempted suicide.
-The students issue is something we see common today. He was already dealing with anxiety and depression and then he injured himself and could not play football early in the season, adding to his depression. Today, we see many students who are struggling with anxiety and depression and then something else happens to add onto that depression.
-There is a very small amount of people who suffer from a mental health disorder that will actually get help. In this article, it mentions that 3 out of 10 college students struggling with mental health will seek help. The same goes for any age group, which is why we are seeing a doubled rate of suicide.

Citation: Busta, H. (2019, January 11). Former student-athlete sues Washington and Lee U following suicide attempt. Higher Ed Dive. Retrieved from https://www.highereddive.com/news/former-student-athlete-sues-washington-and-lee-u-following-suicide-attempt/545837/

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Dive Brief:

A former Washington and Lee University student-athlete is suing the university and one of its counselors for medical malpractice and negligence concerning events leading up to his attempted suicide in the fall of 2017. It seeks $12 million from each.

In documents filed Tuesday in a Virginia circuit court, Kionte Burnette said he met with a counselor, Rallie Snowden, to whom he disclosed suicidal thoughts and his plan to take his own life. He said Snowden ended the conversation after "five to ten minutes," telling him to attend classes and football practice and then check himself into the Student Health Center for overnight observation.

That evening, Burnette did not go to the center but instead attempted to take his own life, leading to significant injuries. The lawsuit alleges Snowden did not tell the center Burnette was having suicidal thoughts and instead made him promise not to harm himself, a decision that "deviated from the applicable standard of care and treatment" because the two didn't have a prior therapeutic relationship.

Dive Insight:

In a statement emailed to Education Dive, a university spokesperson said she couldn't comment on the lawsuit but that students' health and wellbeing are of the "utmost importance" to the university. "We continuously assess and strive to meet our students' complex and evolving needs in all areas of student life - including health and counseling services - and we are confident in the professionalism and compassion of our staff," she wrote.

The factors contributing to Burnette's attempted suicide aren't uncommon on college campuses. Burnette, a freshman and member of the university's football team, was sidelined from his sport due to a foot injury shortly after the school year began. His inability to play football compounded feelings of depression and anxiety that he was already experiencing, the lawsuit said.

About one-third of college students experience mental health issues such as depression and anxiety, and while three in 10 of those students seek help, just one in 10 student athletes do, according to a University of Michigan professor's survey . Black students, in particular, cited by USA Today are less likely to seek help for mental health issues.

College athletics is "a unique and demanding culture," where mental health issues are minimized "because of the expectations of strength, stability and 'mental toughness' inherent in sports culture," write psychologists Chris Carr and Jamie Davidson in for the NCAA. Many athletic departments don't invest as heavily in mental health resources as they do in athletic training support, the pair add, instead referring students to the college's counseling center or other providers who may not understand the "stressors, motivations and dynamics" of student-athlete life.

Injury can spur or add to feelings of isolation, sadness, disengagement and even depression.

One current and one former student athlete at Oregon State University, who each lost teammates to suicide, are looking to increase mental health awareness within athletic departments through their #DamWorthIt campaign, with an aim to have seminars, guest speakers and suicide prevention training. And at the University of Texas, Austin, a $20 million gift will establish a Center for Student-Athlete Brain & Behavioral Health to serve student-athletes' mental health needs as well as research brain and behavioral health outcomes for athletes.

Intercollegiate athletics' high profile means student-athletes' suicides tend to get national attention. Yet a study of NCAA student-athletes found their suicide rate is lower than that of the general population. (Within the student-athlete community, men have a higher suicide rate than women, and black athletes have a higher rate than white athletes, according to a review of NCAA data.)

College is often a period of major transition for students who matriculate straight from high school, and a time when mental health issues such as depression tend to manifest,. On-campus mental health resources experts say are in high demand, meaning students may not be able to receive as much individualized attention as they need. That's led some to suggest colleges partner with hospitals and private practices to ensure needs are met.

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Former student-athlete sues Washington and Lee U following suicide attempt

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A former Washington and Lee University student-athlete is suing the university and one of its counselors for medical malpractice and negligence concerning events leading up to his attempted suicide in the fall of 2017. It seeks $12 million from each.

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Link: https://www.edweek.org/policy-politics/federal-appeals-court-lets-lawsuit-proceed-against-educators-in-students-suicide/2020/12

Summary: - An 8 year old boy hung himself after being bullied multiple times at school. His parents sued the school for not reaching out to them when their son was being bullied and knocked on the school campus. The principal and assistant principal denied that bullying took place on their campus.
-As a current teacher and a future counselor, I know the number one thing on a school campus is to keep the students safe. If we see anything, we must respond. If we are told anything, we must respond. If something happens, the parents must know. I think we are seeing more and more, especially in court cases like this, that schools are not reaching out to parents like they should be. Parents need to know what is happening when their children is in our care.
- We do have an issue of bullying in today's society. It can be physical, cyber, or sexual- but it is happening. Every school is experiencing bullying. There is no one school that does not have this problem. It is who we are as a society. How the schools are handling it is different. If they are not handling it properly, then we will have students like this who choose suicide to make the pain stop. However, if we have schools that are handling it in a proper way, they could stop students from wanting to harm themselves.

Citation: Walsh, M. (2020, December 30). Federal Appeals Court lets lawsuit proceed against educators in student's suicide. Education Week. Retrieved from https://www.edweek.org/policy-politics/federal-appeals-court-lets-lawsuit-proceed-against-educators-in-students-suicide/2020/12

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A federal appeals court has allowed a wrongful death lawsuit brought by the parents of an 8-year-old Cincinnati boy who committed suicide after alleged severe bullying at school to proceed against two school administrators.

A unanimous three-judge panel of the U.S. Court of Appeals for the 6th Circuit, in Cincinnati, rejected a request by the former principal and assistant principal to throw out state-law claims that they acted recklessly in handling persistent bullying of Carson Elementary School student Gabriel Taye and allegedly failing to inform his parents about several incidents.

Taye hung himself with a necktie in his bedroom on Jan. 26, 2017, two days after a student had knocked him unconscious in a school bathroom in the most serious of a pattern of bullying incidents.

The lawsuit by the parents, Cornelia Reynolds and Benyam Tate, alleges that then-Principal Ruthenia Jackson and then-Assistant Principal Jeffrey McKenzie did not tell Taye's mother that a student had attacked him in the school bathroom. The suit also alleges that McKenzie stood over Taye but did not aid him or call 911, as district policy required when a student was unconscious for longer than a minute.

A school nurse called Taye's mother and said he had fainted, court papers say. Taye stayed home from school the next day, then was bullied again in the school bathroom when he returned the following day, the same day he committed suicide.

The 6th Circuit court, in its Dec. 29 decision in Meyers v. Cincinnati Board of Education, said the parents have sufficiently alleged that Jackson and McKenzie "failed to call 911 when Taye was unconscious for seven minutes after being knocked to the floor in the bathroom."

"They reported false information about the number of 'bullying instances' that occurred as required by Ohio law, and ultimately, prevented Taye's parents from fully understanding Taye's horrifying experience at Carson Elementary until it was too late," the 6th Circuit panel added. "This court finds their behavior, as alleged, to be egregious and clearly reckless, thus barring them from the shield of government immunity."

Federal and State Claims

Taye's parents, as well as the boy's estate, sued the Cincinnati school system along with some other individual defendants on federal civil-rights claims as well as state torts such as wrongful death, intentional infliction of serious emotional distress, and others.

Jackson and McKenzie sought to have the suit dismissed on the basis of state governmental immunity. In court papers, the two administrators deny that there was bullying at Carson Elementary and that Taye's suicide was not forseeable.

A federal district court rejected their motion to dismiss. The Cincinnati Board of Education and other defendants have raised similar defenses to the lawsuit's federal claims, but those were not at issue in this appeal.

The 6th Circuit's opinion describes in detail the pattern of bullying faced by Taye since he was in 1st grade and the alleged failures by school administrators to respond adequately or keep his parents informed.

The administrators "could have asked teachers to supervise the student bathrooms or limited the number of students allowed to use the bathroom at one time," the court said. "Instead, Jackson and McKenzie allowed the boys' bathroom to remain unsupervised. Jackson and McKenzie's behavior shows their failure to take this situation seriously and exemplifies the very definition of recklessness: they consciously disregarded the known or obvious risk of harm that students would engage in violent behavior in the unsupervised bathroom, and that disregard was unreasonable in light of the attack that took place there."

As to the administrators' argument that Taye's suicide was not foreseeable, the 6th Circuit panel said that assertion was undercut by a 2017 decision of their court. In that decision, Tumminello v. Father Ryan High School, a different 6th Circuit panel had written that "if a school is aware of a student being bullied but does nothing to prevent the bullying, it is reasonably foreseeable that the victim of the bullying might resort to self-harm, even suicide."

In Taye's case, the 6th Circuit said Jackson and McKenzie "knew the full extent to which Taye was subjected to aggression and violence by his classmates. ... [T]hey knew Taye was harassed and bullied at school and that a risk of bullying is suicide, and yet they utterly failed to take reasonable steps to protect Taye from that risk."

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Federal Appeals Court Lets Lawsuit Proceed Against Educators in Student's Suicide

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A federal appeals court has allowed a wrongful death lawsuit brought by the parents of an 8-year-old Cincinnati boy who committed suicide after alleged severe bullying at school to proceed against two school administrators. A unanimous three-judge panel of the U.S.

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Source of Law: Constitutional

Citation: Legal Information Institute. (n.d.). Washington, et al., petitioners, V. Harold Glucksberg et al.. Legal Information Institute. https://www.law.cornell.edu/supremecourt/text/521/702

Link: https://www.law.cornell.edu/supremecourt/text/521/702

Requirements: -The state of Washington has had it illegal to assist with a suicide. A group of physicians, terminally ill patients, and an organization, argued that the 14th amendment's due process clause gives a choice of physician assisted suicide.
- Aiding a suicide does not offend the 14th Amendment of the Constitution
- Washington's law states that it is a felony to promote a suicide attempt.
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WASHINGTON, et al., Petitioners,
v.
Harold GLUCKSBERG et al.

No. 96-110.

Supreme Court of the United States

It has always been a crime to assist a suicide in the State of Washington. The State's present law makes " [p]romoting a suicide attempt'' a felony, and provides: "A person is guilty of [that crime] when he knowingly causes or aids another person to attempt suicide.'' Respondents, four Washington physicians who occasionally treat terminally ill, suffering patients, declare that they would assist these patients in ending their lives if not for the State's assisted-suicide ban. They, along with three gravely ill plaintiffs who have since died and a nonprofit organization that counsels people considering physician-assisted suicide, filed this suit against petitioners, the State and its Attorney General, seeking a declaration that the ban is, on its face, unconstitutional. They assert a liberty interest protected by the Fourteenth Amendment's Due Process Clause which extends to a personal choice by a mentally competent, terminally ill adult to commit physician-assisted suicide. Relying primarily on Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833, 112 S.Ct. 2791, 120 L.Ed.2d 674, and Cruzan v. Director, Mo. Dept. of Health, 497 U.S. 261, 110 S.Ct. 2841, 111 L.Ed.2d 224, the Federal District Court agreed, concluding that Washington's assisted-suicide ban is unconstitutional because it places an undue burden on the exercise of that constitutionally protected liberty interest. The en banc Ninth Circuit affirmed.

Held: Washington's prohibition against "caus[ing]'' or "aid[ing]'' a suicide does not violate the Due Process Clause. Pp. ____-____.

(a) An examination of our Nation's history, legal traditions, and practices demonstrates that Anglo-American common law has punished or otherwise disapproved of assisting suicide for over 700 years; that rendering such assistance is still a crime in almost every State; that such prohibitions have never contained exceptions for those who were near death; that the prohibitions have in recent years been reexamined and, for the most part, reaffirmed in a number of States; and that the President recently signed the Federal Assisted Suicide Funding Restriction Act of 1997, which prohibits the use of federal funds in support of physician-assisted suicide. Pp. ____-____.

(b) In light of that history, this Court's decisions lead to the conclusion that respondents' asserted "right'' to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause. The Court's established method of substantive-due-process analysis has two primary features: First, the Court has regularly observed that the Clause specially protects those fundamental rights and liberties which are, objectively, deeply rooted in this Nation's history and tradition. E.g., Moore v. East Cleveland, 431 U.S. 494, 503, 97 S.Ct. 1932, 1937-1938, 52 L.Ed.2d 531 (plurality opinion). Second, the Court has required a "careful description'' of the asserted fundamental liberty interest. E.g., Reno v. Flores, 507 U.S. 292, 302, 113 S.Ct. 1439, 1447, 123 L.Ed.2d 1. The Ninth Circuit's and respondents' various descriptions of the interest here at stake- e.g., a right to "determin[e] the time and manner of one's death,'' the "right to die,'' a "liberty to choose how to die,'' a right to "control of one's final days,'' "the right to choose a humane, dignified death,'' and "the liberty to shape death''-run counter to that second requirement. Since the Washington statute prohibits "aid[ing] another person to attempt suicide,'' the question before the Court is more properly characterized as whether the "liberty'' specially protected by the Clause includes a right to commit suicide which itself includes a right to assistance in doing so. This asserted right has no place in our Nation's traditions, given the country's consistent, almost universal, and continuing rejection of the right, even for terminally ill, mentally competent adults. To hold for respondents, the Court would have to reverse centuries of legal doctrine and practice, and strike down the considered policy choice of almost every State. Respondents' contention that the asserted interest is consistent with this Court's substantive-due-process cases, if not with this Nation's history and practice, is unpersuasive. The constitutionally protected right to refuse lifesaving hydration and nutrition that was discussed in Cruzan, supra, at 279, 110 S.Ct., at 2851-2852, was not simply deduced from abstract concepts of personal autonomy, but was instead grounded in the Nation's history and traditions, given the common-law rule that forced medication was a battery, and the long legal tradition protecting the decision to refuse unwanted medical treatment. And although Casey recognized that many of the rights and liberties protected by the Due Process Clause sound in personal autonomy, 505 U.S., at 852, 112 S.Ct., at 2807, it does not follow that any and all important, intimate, and personal decisions are so protected, see San Antonio School Dist. v. Rodriguez, 411 U.S. 1, 33-34, 93 S.Ct. 1278, 1296-1297, 36 L.Ed.2d 16. Casey did not suggest otherwise. Pp. ____-____.

(c) The constitutional requirement that Washington's assisted-suicide ban be rationally related to legitimate government interests, see e.g., Heller v. Doe, 509 U.S. 312, 319-320, 113 S.Ct. 2637, 2642-2643, 125 L.Ed.2d 257, is unquestionably met here. These interests include prohibiting intentional killing and preserving human life; preventing the serious public-health problem of suicide, especially among the young, the elderly, and those suffering from untreated pain or from depression or other mental disorders; protecting the medical profession's integrity and ethics and maintaining physicians' role as their patients' healers; protecting the poor, the elderly, disabled persons, the terminally ill, and persons in other vulnerable groups from indifference, prejudice, and psychological and financial pressure to end their lives; and avoiding a possible slide towards voluntary and perhaps even involuntary euthanasia. The relative strengths of these various interests need not be weighed exactingly, since they are unquestionably important and legitimate, and the law at issue is at least reasonably related to their promotion and protection. Pp. ____-____.

79 F.3d 790 (C.A.9 1996), reversed and remanded.

REHNQUIST, C.J., delivered the opinion of the Court, in which O'CONNOR, SCALIA, KENNEDY, and THOMAS, JJ., joined. O'CONNOR, J., filed a concurring opinion, in which GINSBURG and BREYER, JJ., joined in part. STEVENS, J., SOUTER, J., GINSBURG, J., and BREYER, J., filed opinions concurring in the judgment.

William L. Williams, for petitioners.

Walter Dellinger, for the United States as amicus curiae, by special leave of the Court.

Kathryn L. Tucker, Seattle, WA, for respondents.

Chief Justice REHNQUIST delivered the opinion of the Court.

It has always been a crime to assist a suicide in the State of Washington. In 1854, Washington's first Territorial Legislature outlawed "assisting another in the commission of self-murder.'' 1 Today, Washington law provides: "A person is guilty of promoting a suicide attempt when he knowingly causes or aids another person to attempt suicide.'' Wash. Rev.Code 9A.36.060(1) (1994). "Promoting a suicide attempt'' is a felony, punishable by up to five years' imprisonment and up to a $10,000 fine. -§§9A.36.060(2) and 9A.20.021(1)(c). At the same time, Washington's Natural Death Act, enacted in 1979, states that the "withholding or withdrawal of life-sustaining treatment'' at a patient's direction "shall not, for any purpose, constitute a suicide.'' Wash. Rev.Code §70.122.070(1). 2

Petitioners in this case are the State of Washington and its Attorney General. Respondents Harold Glucksberg, M. D., Abigail Halperin, M. D., Thomas A. Preston, M. D., and Peter Shalit, M. D., are physicians who practice in Washington. These doctors occasionally treat terminally ill, suffering patients, and declare that they would assist these patients in ending their lives if not for Washington's assisted-suicide ban. 3 In January 1994, respondents, along with three gravely ill, pseudonymous plaintiffs who have since died and Compassion in Dying, a nonprofit organization that counsels people considering physician-assisted suicide, sued in the United States District Court, seeking a declaration that Wash Rev.Code 9A.36.060(1) (1994) is, on its face, unconstitutional. Compassion in Dying v. Washington, 850 F.Supp. 1454, 1459 (W.D.Wash.1994). 4

The plaintiffs asserted "the existence of a liberty interest protected by the Fourteenth Amendment which extends to a personal choice by a mentally competent, terminally ill adult to commit physician-assisted suicide.'' Id., at 1459. Relying primarily on Planned Parenthood v. Casey, 505 U.S. 833, 112 S.Ct. 2791, 120 L.Ed.2d 674 (1992), and Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261, 110 S.Ct. 2841, 111 L.Ed.2d 224 (1990), the District Court agreed, 850 F.Supp., at 1459-1462, and concluded that Washington's assisted-suicide ban is unconstitutional because it "places an undue burden on the exercise of [that] constitutionally protected liberty interest.'' Id., at 1465. 5 The District Court also decided that the Washington statute violated the Equal Protection Clause's requirement that ""all persons similarly situated . . . be treated alike.''' Id., at 1466 (quoting Cleburne v. Cleburne Living Center, Inc., 473 U.S. 432, 439, 105 S.Ct. 3249, 3253-3254, 87 L.Ed.2d 313 (1985)).

A panel of the Court of Appeals for the Ninth Circuit reversed, emphasizing that " [i]n the two hundred and five years of our existence no constitutional right to aid in killing oneself has ever been asserted and upheld by a court of final jurisdiction.'' Compassion in Dying v. Washington, 49 F.3d 586, 591 (1995). The Ninth Circuit reheard the case en banc, reversed the panel's decision, and affirmed the District Court. Compassion in Dying v. Washington, 79 F.3d 790, 798 (1996). Like the District Court, the en banc Court of Appeals emphasized our Casey and Cruzan decisions. 79 F.3d, at 813-816. The court also discussed what it described as "historical'' and "current societal attitudes'' toward suicide and assisted suicide, id., at 806-812, and concluded that "the Constitution encompasses a due process liberty interest in controlling the time and manner of one's death-that there is, in short, a constitutionally-recognized "right to die.''' Id., at 816. After " [w]eighing and then balancing'' this interest against Washington's various interests, the court held that the State's assisted-suicide ban was unconstitutional "as applied to terminally ill competent adults who wish to hasten their deaths with medication prescribed by their physicians.'' Id., at 836, 837. 6 The court did not reach the District Court's equal-protection holding. Id., at 838. 7 We granted certiorari, 519 U.S. ----, 117 S.Ct. 37, 135 L.Ed.2d 1128 (1996), and now reverse.

* We begin, as we do in all due-process cases, by examining our Nation's history, legal traditions, and practices. See, e.g., Casey, 505 U.S., at 849- 850, 112 S.Ct., at 2805-2806; Cruzan, 497 U.S., at 269- 279, 110 S.Ct., at 2846-2842; Moore v. East Cleveland, 431 U.S. 494, 503, 97 S.Ct. 1932, 1937-1938, 52 L.Ed.2d 531 (1977) (plurality opinion) (noting importance of "careful "respect for the teachings of history'''). In almost every State-indeed, in almost every western democracy-it is a crime to assist a suicide. 8 The States' assisted-suicide bans are not innovations. Rather, they are longstanding expressions of the States' commitment to the protection and preservation of all human life. Cruzan, 497 U.S., at 280, 110 S.Ct., at 2852 (" [T]he States-indeed, all civilized nations-demonstrate their commitment to life by treating homicide as a serious crime. Moreover, the majority of States in this country have laws imposing criminal penalties on one who assists another to commit suicide''); see Stanford v. Kentucky, 492 U.S. 361, 373, 109 S.Ct. 2969, 2977, 106 L.Ed.2d 306 (1989) (" [T]he primary and most reliable indication of [a national] consensus is . . . the pattern of enacted laws''). Indeed, opposition to and condemnation of suicide-and, therefore, of assisting suicide-are consistent and enduring themes of our philosophical, legal, and cultural heritages. See generally, Marzen, O'Dowd, Crone & Balch, Suicide: A Constitutional Right?, 24 Duquesne L.Rev. 1, 17-56 (1985) (hereinafter Marzen); New York State Task Force on Life and the Law, When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context 77-82 (May 1994) (hereinafter New York Task Force).

More specifically, for over 700 years, the Anglo-American common-law tradition has punished or otherwise disapproved of both suicide and assisting suicide. 9 Cruzan, 497 U.S., at 294- 295, 110 S.Ct., at 2859-2860 (SCALIA, J., concurring). In the 13th century, Henry de Bracton, one of the first legal-treatise writers, observed that " [j]ust as a man may commit felony by slaying another so may he do so by slaying himself.'' 2 Bracton on Laws and Customs of England 423 (f.150) (G. Woodbine ed., S. Thorne transl., 1968). The real and personal property of one who killed himself to avoid conviction and punishment for a crime were forfeit to the king; however, thought Bracton, "if a man slays himself in weariness of life or because he is unwilling to endure further bodily pain . . . [only] his movable goods [were] confiscated.'' Id., at 423-424 (f.150). Thus, " [t]he principle that suicide of a sane person, for whatever reason, was a punishable felony was . . . introduced into English common law.'' 10 Centuries later, Sir William Blackstone, whose Commentaries on the Laws of England not only provided a definitive summary of the common law but was also a primary legal authority for 18th and 19th century American lawyers, referred to suicide as "self-murder'' and "the pretended heroism, but real cowardice, of the Stoic philosophers, who destroyed themselves to avoid those ills which they had not the fortitude to endure . . . . '' 4 W. Blackstone, Commentaries *189. Blackstone emphasized that "the law has . . . ranked [suicide] among the highest crimes,'' ibid, although, anticipating later developments, he conceded that the harsh and shameful punishments imposed for suicide "borde[r] a little upon severity.'' Id., at *190.

For the most part, the early American colonies adopted the common-law approach. For example, the legislators of the Providence Plantations, which would later become Rhode Island, declared, in 1647, that " [s]elf-murder is by all agreed to be the most unnatural, and it is by this present Assembly declared, to be that, wherein he that doth it, kills himself out of a premeditated hatred against his own life or other humor: . . . his goods and chattels are the king's custom, but not his debts nor lands; but in case he be an infant, a lunatic, mad or distracted man, he forfeits nothing.'' The Earliest Acts and Laws of the Colony of Rhode Island and Providence Plantations 1647-1719, p. 19 (J. Cushing ed.1977). Virginia also required ignominious burial for suicides, and their estates were forfeit to the crown. A. Scott, Criminal Law in Colonial Virginia 108, and n. 93, 198, and n. 15 (1930).

Over time, however, the American colonies abolished these harsh common-law penalties. William Penn abandoned the criminal-forfeiture sanction in Pennsylvania in 1701, and the other colonies (and later, the other States) eventually followed this example. Cruzan, 497 U.S., at 294, 110 S.Ct., at 2859-2860 (SCALIA, J., concurring). Zephaniah Swift, who would later become Chief Justice of Connecticut, wrote in 1796 that

" [t]here can be no act more contemptible, than to attempt to punish an offender for a crime, by exercising a mean act of revenge upon lifeless clay, that is insensible of the punishment. There can be no greater cruelty, than the inflicting [of] a punishment, as the forfeiture of goods, which must fall solely on the innocent offspring of the offender . . . . -[Suicide] is so abhorrent to the feelings of mankind, and that strong love of life which is implanted in the human heart, that it cannot be so frequently committed, as to become dangerous to society. There can of course be no necessity of any punishment.'' 2 Z. Swift, A System of the Laws of the State of Connecticut 304 (1796).

This statement makes it clear, however, that the movement away from the common law's harsh sanctions did not represent an acceptance of suicide; rather, as Chief Justice Swift observed, this change reflected the growing consensus that it was unfair to punish the suicide's family for his wrongdoing. Cruzan, supra, at 294, 110 S.Ct., at 2859 (SCALIA, J., concurring). Nonetheless, although States moved away from Blackstone's treatment of suicide, courts continued to condemn it as a grave public wrong. See, e.g., Bigelow v. Berkshire Life Ins. Co., 93 U.S. 284, 286, 23 L.Ed. 918 (1876) (suicide is "an act of criminal self-destruction''); Von Holden v. Chapman, 87 A.D.2d 66, 70-71, 450 N.Y.S.2d 623, 626-627 (1982); Blackwood v. Jones, 111 Fla. 528, 532, 149 So. 600, 601 (1933) ("No sophistry is tolerated . . . which seek[s] to justify self-destruction as commendable or even a matter of personal right'').

That suicide remained a grievous, though nonfelonious, wrong is confirmed by the fact that colonial and early state legislatures and courts did not retreat from prohibiting assisting suicide. Swift, in his early 19th century treatise on the laws of Connecticut, stated that " [i]f one counsels another to commit suicide, and the other by reason of the advice kills himself, the advisor is guilty of murder as principal.'' 2 Z. Swift, A Digest of the Laws of the State of Connecticut 270 (1823). This was the well established common-law view, see In re Joseph G., 34 Cal.3d 429, 434-435, 194 Cal.Rptr. 163, 166, 667 P.2d 1176, 1179 (1983); Commonwealth v. Mink, 123 Mass. 422, 428 (1877) (""Now if the murder of one's self is felony, the accessory is equally guilty as if he had aided and abetted in the murder''') (quoting Chief Justice Parker's charge to the jury in Commonwealth v. Bowen, 13 Mass. 356 (1816)), as was the similar principle that the consent of a homicide victim is "wholly immaterial to the guilt of the person who cause[d] [his death],'' 3 J. Stephen, A History of the Criminal Law of England 16 (1883); see 1 F. Wharton, Criminal Law §§451-452 (9th ed. 1885); Martin v. Commonwealth, 184 Va. 1009, 1018-1019, 37 S.E.2d 43, 47 (1946) (""The right to life and to personal security is not only sacred in the estimation of the common law, but it is inalienable'''). And the prohibitions against assisting suicide never contained exceptions for those who were near death. Rather, " [t]he life of those to whom life ha[d] become a burden-of those who [were] hopelessly diseased or fatally wounded-nay, even the lives of criminals condemned to death, [were] under the protection of law, equally as the lives of those who [were] in the full tide of life's enjoyment, and anxious to continue to live.'' Blackburn v. State, 23 Ohio St. 146, 163 (1872); see Bowen, supra, at 360 (prisoner who persuaded another to commit suicide could be tried for murder, even though victim was scheduled shortly to be executed).

The earliest American statute explicitly to outlaw assisting suicide was enacted in New York in 1828, Act of Dec. 10, 1828, ch. 20, §4, 1828 N.Y. Laws 19 (codified at 2 N.Y.Rev.Stat. pt. 4, ch. 1, tit. 2, art. 1, §7, p. 661 (1829)), and many of the new States and Territories followed New York's example. Marzen 73-74. Between 1857 and 1865, a New York commission led by Dudley Field drafted a criminal code that prohibited "aiding'' a suicide and, specifically, "furnish[ing] another person with any deadly weapon or poisonous drug, knowing that such person intends to use such weapon or drug in taking his own life.'' Id., at 76-77. By the time the Fourteenth Amendment was ratified, it was a crime in most States to assist a suicide. See Cruzan, supra, at 294-295, 110 S.Ct., at 2859-2860 (SCALIA, J., concurring). The Field Penal Code was adopted in the Dakota Territory in 1877, in New York in 1881, and its language served as a model for several other western States' statutes in the late 19th and early 20th centuries. Marzen 76-77, 205-206, 212-213. California, for example, codified its assisted-suicide prohibition in 1874, using language similar to the Field Code's. 11 In this century, the Model Penal Code also prohibited "aiding'' suicide, prompting many States to enact or revise their assisted-suicide bans. 12 The Code's drafters observed that "the interests in the sanctity of life that are represented by the criminal homicide laws are threatened by one who expresses a willingness to participate in taking the life of another, even though the act may be accomplished with the consent, or at the request, of the suicide victim.'' American Law Institute, Model Penal Code §210.5, Comment 5, p. 100 (Official Draft and Revised Comments 1980).

Though deeply rooted, the States' assisted-suicide bans have in recent years been reexamined and, generally, reaffirmed. Because of advances in medicine and technology, Americans today are increasingly likely to die in institutions, from chronic illnesses. President's Comm'n for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment 16-18 (1983). Public concern and democratic action are therefore sharply focused on how best to protect dignity and independence at the end of life, with the result that there have been many significant changes in state laws and in the attitudes these laws reflect. Many States, for example, now permit "living wills,'' surrogate health-care decisionmaking, and the withdrawal or refusal of life-sustaining medical treatment. See Vacco v. Quill, --- U.S. ----, ---------, 117 S.Ct. 2293, ---------, --- L.Ed.2d ----; 79 F.3d, at 818-820; People v. Kevorkian, 447 Mich. 436, 478-480, and nn. 53-56, 527 N.W.2d 714, 731-732, and nn. 53-56 (1994). At the same time, however, voters and legislators continue for the most part to reaffirm their States' prohibitions on assisting suicide.

California voters rejected an assisted-suicide initiative similar to Washington's in 1993. On the other hand, in 1994, voters in Oregon enacted, also through ballot initiative, that State's "Death With Dignity Act,'' which legalized physician-assisted suicide for competent, terminally ill adults. 14 Since the Oregon vote, many proposals to legalize assisted-suicide have been and continue to be introduced in the States' legislatures, but none has been enacted. 15 And just last year, Iowa and Rhode Island joined the overwhelming majority of States explicitly prohibiting assisted suicide. See Iowa Code Ann. §§707A.2, 707A.3 (Supp.1997); R.I. Gen. Laws §§11-60-1, 11-60-3 (Supp.1996). Also, on April 30, 1997, President Clinton signed the Federal Assisted Suicide Funding Restriction Act of 1997, which prohibits the use of federal funds in support of physician-assisted suicide. Pub.L. 105-12, 111 Stat. 23 (codified at 42 U.S.C. §14401 et seq). 16

Thus, the States are currently engaged in serious, thoughtful examinations of physician-assisted suicide and other similar issues. For example, New York State's Task Force on Life and the Law-an ongoing, blue-ribbon commission composed of doctors, ethicists, lawyers, religious leaders, and interested laymen-was convened in 1984 and commissioned with "a broad mandate to recommend public policy on issues raised by medical advances.'' New York Task Force vii. Over the past decade, the Task Force has recommended laws relating to end-of-life decisions, surrogate pregnancy, and organ donation. Id., at 118-119. After studying physician-assisted suicide, however, the Task Force unanimously concluded that " [l]egalizing assisted suicide and euthanasia would pose profound risks to many individuals who are ill and vulnerable . . . . -[T]he potential dangers of this dramatic change in public policy would outweigh any benefit that might be achieved.'' Id., at 120.

Attitudes toward suicide itself have changed since Bracton, but our laws have consistently condemned, and continue to prohibit, assisting suicide. Despite changes in medical technology and notwithstanding an increased emphasis on the importance of end-of-life decisionmaking, we have not retreated from this prohibition. Against this backdrop of history, tradition, and practice, we now turn to respondents' constitutional claim.

II

The Due Process Clause guarantees more than fair process, and the "liberty'' it protects includes more than the absence of physical restraint. Collins v. Harker Heights, 503 U.S. 115, 125, 112 S.Ct. 1061, 1068-1069, 117 L.Ed.2d 261 (1992) (Due Process Clause "protects individual liberty against "certain government actions regardless of the fairness of the procedures used to implement them''') (quoting Daniels v. Williams, 474 U.S. 327, 331, 106 S.Ct. 662, 665, 88 L.Ed.2d 662 (1986)). The Clause also provides heightened protection against government interference with certain fundamental rights and liberty interests. Reno v. Flores, 507 U.S. 292, 301-302, 113 S.Ct. 1439, 1446-1447, 123 L.Ed.2d 1 (1993); Casey, 505 U.S., at 851, 112 S.Ct., at 2806-2807. In a long line of cases, we have held that, in addition to the specific freedoms protected by the Bill of Rights, the "liberty'' specially protected by the Due Process Clause includes the rights to marry, Loving v. Virginia, 388 U.S. 1, 87 S.Ct. 1817, 18 L.Ed.2d 1010 (1967); to have children, Skinner v. Oklahoma ex rel. Williamson, 316 U.S. 535, 62 S.Ct. 1110, 86 L.Ed. 1655 (1942); to direct the education and upbringing of one's children, Meyer v. Nebraska, 262 U.S. 390, 43 S.Ct. 625, 67 L.Ed. 1042 (1923); Pierce v. Society of Sisters, 268 U.S. 510, 45 S.Ct. 571, 69 L.Ed. 1070 (1925); to marital privacy, Griswold v. Connecticut, 381 U.S. 479, 85 S.Ct. 1678, 14 L.Ed.2d 510 (1965); to use contraception, ibid; Eisenstadt v. Baird, 405 U.S. 438, 92 S.Ct. 1029, 31 L.Ed.2d 349 (1972); to bodily integrity, Rochin v. California, 342 U.S. 165, 72 S.Ct. 205, 96 L.Ed. 183 (1952), and to abortion, Casey, supra. We have also assumed, and strongly suggested, that the Due Process Clause protects the traditional right to refuse unwanted lifesaving medical treatment. Cruzan, 497 U.S., at 278- 279, 110 S.Ct., at 2851-2852.

But we "ha[ve] always been reluctant to expand the concept of substantive due process because guideposts for responsible decisionmaking in this unchartered area are scarce and open-ended.'' Collins, 503 U.S., at 125, 112 S.Ct., at 1068. By extending constitutional protection to an asserted right or liberty interest, we, to a great extent, place the matter outside the arena of public debate and legislative action. We must therefore "exercise the utmost care whenever we are asked to break new ground in this field,'' ibid, lest the liberty protected by the Due Process Clause be subtly transformed into the policy preferences of the members of this Court, Moore, 431 U.S., at 502, 97 S.Ct., at 1937 (plurality opinion).

Our established method of substantive-due-process analysis has two primary features: First, we have regularly observed that the Due Process Clause specially protects those fundamental rights and liberties which are, objectively, "deeply rooted in this Nation's history and tradition,'' id., at 503, 97 S.Ct., at 1938 (plurality opinion); Snyder v. Massachusetts, 291 U.S. 97, 105, 54 S.Ct. 330, 332, 78 L.Ed. 674 (1934) ("so rooted in the traditions and conscience of our people as to be ranked as fundamental''), and "implicit in the concept of ordered liberty,'' such that "neither liberty nor justice would exist if they were sacrificed,'' Palko v. Connecticut, 302 U.S. 319, 325, 326, 58 S.Ct. 149, 152, 82 L.Ed. 288 (1937). Second, we have required in substantive-due-process cases a "careful description'' of the asserted fundamental liberty interest. Flores, supra, at 302, 113 S.Ct., at 1447; Collins, supra, at 125, 112 S.Ct., at 1068; Cruzan, supra, at 277-278, 110 S.Ct., at 2850-2851. Our Nation's history, legal traditions, and practices thus provide the crucial "guideposts for responsible decisionmaking,'' Collins, supra, at 125, 112 S.Ct., at 1068, that direct and restrain our exposition of the Due Process Clause. As we stated recently in Flores, the Fourteenth Amendment "forbids the government to infringe . . . "fundamental' liberty interests at all, no matter what process is provided, unless the infringement is narrowly tailored to serve a compelling state interest.'' 507 U.S., at 302, 113 S.Ct., at 1447.

Justice SOUTER, relying on Justice Harlan's dissenting opinion in Poe v. Ullman, would largely abandon this restrained methodology, and instead ask "whether [Washington's] statute sets up one of those "arbitrary impositions' or "purposeless restraints' at odds with the Due Process Clause of the Fourteenth Amendment,'' post, at __ (quoting Poe, 367 U.S. 497, 543, 81 S.Ct. 1752, 1776-1777, 6 L.Ed.2d 989 (1961) (Harlan, J., dissenting)). 17 In our view, however, the development of this Court's substantive-due-process jurisprudence, described briefly above, supra, at __, has been a process whereby the outlines of the "liberty'' specially protected by the Fourteenth Amendment-never fully clarified, to be sure, and perhaps not capable of being fully clarified-have at least been carefully refined by concrete examples involving fundamental rights found to be deeply rooted in our legal tradition. This approach tends to rein in the subjective elements that are necessarily present in due-process judicial review. In addition, by establishing a threshold requirement-that a challenged state action implicate a fundamental right-before requiring more than a reasonable relation to a legitimate state interest to justify the action, it avoids the need for complex balancing of competing interests in every case.

Turning to the claim at issue here, the Court of Appeals stated that " [p]roperly analyzed, the first issue to be resolved is whether there is a liberty interest in determining the time and manner of one's death,'' 79 F.3d, at 801, or, in other words, " [i]s there a right to die?,'' id., at 799. Similarly, respondents assert a "liberty to choose how to die'' and a right to "control of one's final days,'' Brief for Respondents 7, and describe the asserted liberty as "the right to choose a humane, dignified death,'' id., at 15, and "the liberty to shape death,'' id., at 18. As noted above, we have a tradition of carefully formulating the interest at stake in substantive-due-process cases. For example, although Cruzan is often described as a "right to die'' case, see 79 F.3d, at 799; --- U.S., at ----, 117 S.Ct., at 2307 (STEVENS, J., concurring in judgment) ( Cruzan recognized "the more specific interest in making decisions about how to confront an imminent death''), we were, in fact, more precise: we assumed that the Constitution granted competent persons a "constitutionally protected right to refuse lifesaving hydration and nutrition.'' Cruzan, 497 U.S., at 279, 110 S.Ct., at 2843; id., at 287, 110 S.Ct., at 2856 (O'CONNOR, J., concurring) (" [A] liberty interest in refusing unwanted medical treatment may be inferred from our prior decisions''). The Washington statute at issue in this case prohibits "aid[ing] another person to attempt suicide,'' Wash. Rev.Code §9A.36.060(1) (1994), and, thus, the question before us is whether the "liberty'' specially protected by the Due Process Clause includes a right to commit suicide which itself includes a right to assistance in doing so. 18

We now inquire whether this asserted right has any place in our Nation's traditions. Here, as discussed above, supra, at __-__, we are confronted with a consistent and almost universal tradition that has long rejected the asserted right, and continues explicitly to reject it today, even for terminally ill, mentally competent adults. To hold for respondents, we would have to reverse centuries of legal doctrine and practice, and strike down the considered policy choice of almost every State. See Jackman v. Rosenbaum Co., 260 U.S. 22, 31, 43 S.Ct. 9, 9-10, 67 L.Ed. 107 (1922) ("If a thing has been practiced for two hundred years by common consent, it will need a strong case for the Fourteenth Amendment to affect it''); Flores, 507 U.S., at 303, 113 S.Ct., at 1447 ("The mere novelty of such a claim is reason enough to doubt that "substantive due process' sustains it'').

Respondents contend, however, that the liberty interest they assert is consistent with this Court's substantive-due-process line of cases, if not with this Nation's history and practice. Pointing to Casey and Cruzan, respondents read our jurisprudence in this area as reflecting a general tradition of "self-sovereignty,'' Brief of Respondents 12, and as teaching that the "liberty'' protected by the Due Process Clause includes "basic and intimate exercises of personal autonomy,'' id., at 10; see Casey, 505 U.S., at 847, 112 S.Ct., at 2804-2805 ("It is a promise of the Constitution that there is a realm of personal liberty which the government may not enter''). According to respondents, our liberty jurisprudence, and the broad, individualistic principles it reflects, protects the "liberty of competent, terminally ill adults to make end-of-life decisions free of undue government interference.'' Brief for Respondents 10. The question presented in this case, however, is whether the protections of the Due Process Clause include a right to commit suicide with another's assistance. With this "careful description'' of respondents' claim in mind, we turn to Casey and Cruzan.

In Cruzan, we considered whether Nancy Beth Cruzan, who had been severely injured in an automobile accident and was in a persistive vegetative state, "ha[d] a right under the United States Constitution which would require the hospital to withdraw life-sustaining treatment'' at her parents' request. Cruzan, 497 U.S., at 269, 110 S.Ct., at 2846-2847. We began with the observation that " [a]t common law, even the touching of one person by another without consent and without legal justification was a battery.'' Ibid. We then discussed the related rule that "informed consent is generally required for medical treatment.'' Ibid. After reviewing a long line of relevant state cases, we concluded that "the common-law doctrine of informed consent is viewed as generally encompassing the right of a competent individual to refuse medical treatment.'' Id., at 277, 110 S.Ct., at 2851. Next, we reviewed our own cases on the subject, and stated that " [t]he principle that a competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment may be inferred from our prior decisions.'' Id., at 278, 110 S.Ct., at 2851. Therefore, "for purposes of [that] case, we assume[d] that the United States Constitution would grant a competent person a constitutionally protected right to refuse lifesaving hydration and nutrition.'' Id., at 279, 110 S.Ct., at 2852; see id., at 287, 110 S.Ct., at 2856 (O'CONNOR, J., concurring). We concluded that, notwithstanding this right, the Constitution permitted Missouri to require clear and convincing evidence of an incompetent patient's wishes concerning the withdrawal of life-sustaining treatment. Id., at 280-281, 110 S.Ct., at 2852-2853.

Respondents contend that in Cruzan we "acknowledged that competent, dying persons have the right to direct the removal of life-sustaining medical treatment and thus hasten death,'' Brief for Respondents 23, and that "the constitutional principle behind recognizing the patient's liberty to direct the withdrawal of artificial life support applies at least as strongly to the choice to hasten impending death by consuming lethal medication,'' id., at 26. Similarly, the Court of Appeals concluded that " Cruzan, by recognizing a liberty interest that includes the refusal of artificial provision of life-sustaining food and water, necessarily recognize[d] a liberty interest in hastening one's own death.'' 79 F.3d, at 816.

Respondents also rely on Casey. There, the Court's opinion concluded that "the essential holding of Roe v. Wade should be retained and once again reaffirmed.'' Casey, 505 U.S., at 846, 112 S.Ct., at 2804. We held, first, that a woman has a right, before her fetus is viable, to an abortion "without undue interference from the State''; second, that States may restrict post-viability abortions, so long as exceptions are made to protect a woman's life and health; and third, that the State has legitimate interests throughout a pregnancy in protecting the health of the woman and the life of the unborn child. Ibid. In reaching this conclusion, the opinion discussed in some detail this Court's substantive-due-process tradition of interpreting the Due Process Clause to protect certain fundamental rights and "personal decisions relating to marriage, procreation, contraception, family relationships, child rearing, and education,'' and noted that many of those rights and liberties "involv[e] the most intimate and personal choices a person may make in a lifetime.'' Id., at 851, 112 S.Ct., at 2807.

"Like the decision of whether or not to have an abortion, the decision how and when to die is one of "the most intimate and personal choices a person may make in a lifetime,' a choice "central to personal dignity and autonomy.''' 79 F.3d, at 813-814.

Brief for Respondents 12. By choosing this language, the Court's opinion in Casey described, in a general way and in light of our prior cases, those personal activities and decisions that this Court has identified as so deeply rooted in our history and traditions, or so fundamental to our concept of constitutionally ordered liberty, that they are protected by the Fourteenth Amendment. 19 The opinion moved from the recognition that liberty necessarily includes freedom of conscience and belief about ultimate considerations to the observation that "though the abortion decision may originate within the zone of conscience and belief, it is more than a philosophic exercise. '' Casey, 505 U.S., at 852, 112 S.Ct., at 2807 (emphasis added). That many of the rights and liberties protected by the Due Process Clause sound in personal autonomy does not warrant the sweeping conclusion that any and all important, intimate, and personal decisions are so protected, San Antonio Independent School Dist. v. Rodriguez, 411 U.S. 1, 33-35, 93 S.Ct. 1278, 1296-1298, 36 L.Ed.2d 16 (1973), and Casey did not suggest otherwise.

The history of the law's treatment of assisted suicide in this country has been and continues to be one of the rejection of nearly all efforts to permit it. That being the case, our decisions lead us to conclude that the asserted "right'' to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause. The Constitution also requires, however, that Washington's assisted-suicide ban be rationally related to legitimate government interests. See Heller v. Doe, 509 U.S. 312, 319-320, 113 S.Ct. 2637, 2642-2643, 125 L.Ed.2d 257 (1993); Flores, 507 U.S., at 305, 113 S.Ct., at 1448-1449. This requirement is unquestionably met here. As the court below recognized, 79 F.3d, at 816-817, 20 Washington's assisted-suicide ban implicates a number of state interests. 21 See 49 F.3d, at 592-593; Brief for State of California et al. as Amici Curiae 26-29; Brief for United States as Amicus Curiae 16-27.

First, Washington has an "unqualified interest in the preservation of human life.'' Cruzan, 497 U.S., at 282, 110 S.Ct., at 2853. The State's prohibition on assisted suicide, like all homicide laws, both reflects and advances its commitment to this interest. See id., at 280, 110 S.Ct., at 2852; Model Penal Code §210.5, Comment 5, at 100 (" [T]he interests in the sanctity of life that are represented by the criminal homicide laws are threatened by one who expresses a willingness to participate in taking the life of an other''). 22 This interest is symbolic and aspirational as well as practical:

"While suicide is no longer prohibited or penalized, the ban against assisted suicide and euthanasia shores up the notion of limits in human relationships. It reflects the gravity with which we view the decision to take one's own life or the life of another, and our reluctance to encourage or promote these decisions.'' New York Task Force 131-132.

Respondents admit that " [t]he State has a real interest in preserving the lives of those who can still contribute to society and enjoy life.'' Brief for Respondents 35, n. 23. The Court of Appeals also recognized Washington's interest in protecting life, but held that the "weight'' of this interest depends on the "medical condition and the wishes of the person whose life is at stake.'' 79 F.3d, at 817. Washington, however, has rejected this sliding-scale approach and, through its assisted-suicide ban, insists that all persons' lives, from beginning to end, regardless of physical or mental condition, are under the full protection of the law. See United States v. Rutherford, 442 U.S. 544, 558, 99 S.Ct. 2470, 2478-2479, 61 L.Ed.2d 68 (1979) (". . . Congress could reasonably have determined to protect the terminally ill, no less than other patients, from the vast range of self-styled panaceas that inventive minds can devise''). As we have previously affirmed, the States "may properly decline to make judgments about the "quality' of life that a particular individual may enjoy,'' Cruzan, 497 U.S., at 282, 110 S.Ct., at 2853. This remains true, as Cruzan makes clear, even for those who are near death.

Relatedly, all admit that suicide is a serious public-health problem, especially among persons in otherwise vulnerable groups. See Washington State Dept. of Health, Annual Summary of Vital Statistics 1991, pp. 29-30 (Oct.1992) (suicide is a leading cause of death in Washington of those between the ages of 14 and 54); New York Task Force 10, 23-33 (suicide rate in the general population is about one percent, and suicide is especially prevalent among the young and the elderly). The State has an interest in preventing suicide, and in studying, identifying, and treating its causes. See 79 F.3d, at 820; id., at 854 (Beezer, J., dissenting) ("The state recognizes suicide as a manifestation of medical and psychological anguish''); Marzen 107-146.

Next, the State has an interest in protecting vulnerable groups-including the poor, the elderly, and disabled persons-from abuse, neglect, and mistakes. The Court of Appeals dismissed the State's concern that disadvantaged persons might be pressured into physician-assisted suicide as "ludicrous on its face.'' 79 F.3d, at 825. We have recognized, however, the real risk of subtle coercion and undue influence in end-of-life situations. Cruzan, 497 U.S., at 281, 110 S.Ct., at 2852. Similarly, the New York Task Force warned that " [l]egalizing physician-assisted suicide would pose profound risks to many individuals who are ill and vulnerable . . . . The risk of harm is greatest for the many individuals in our society whose autonomy and well-being are already compromised by poverty, lack of access to good medical care, advanced age, or membership in a stigmatized social group.'' New York Task Force 120; see Compassion in Dying, 49 F.3d, at 593 (" [A]n insidious bias against the handicapped-again coupled with a cost-saving mentality-makes them especially in need of Washington's statutory protection''). If physician-assisted suicide were permitted, many might resort to it to spare their families the substantial financial burden of end-of-life health-care costs.

Finally, the State may fear that permitting assisted suicide will start it down the path to voluntary and perhaps even involuntary euthanasia. The Court of Appeals struck down Washington's assisted-suicide ban only "as applied to competent, terminally ill adults who wish to hasten their deaths by obtaining medication prescribed by their doctors.'' 79 F.3d, at 838. Washington insists, however, that the impact of the court's decision will not and cannot be so limited. Brief for Petitioners 44-47. If suicide is protected as a matter of constitutional right, it is argued, "every man and woman in the United States must enjoy it.'' Compassion in Dying, 49 F.3d, at 591; see Kevorkian, 447 Mich., at 470, n. 41, 527 N.W.2d, at 727-728, n. 41. The Court of Appeals' decision, and its expansive reasoning, provide ample support for the State's concerns. The court noted, for example, that the "decision of a duly appointed surrogate decision maker is for all legal purposes the decision of the patient himself,'' 79 F.3d, at 832, n. 120; that "in some instances, the patient may be unable to self-administer the drugs and . . . administration by the physician . . . may be the only way the patient may be able to receive them,'' id., at 831; and that not only physicians, but also family members and loved ones, will inevitably participate in assisting suicide. Id., at 838, n. 140. Thus, it turns out that what is couched as a limited right to "physician-assisted suicide'' is likely, in effect, a much broader license, which could prove extremely difficult to police and contain. 23 Washington's ban on assisting suicide prevents such erosion.

We need not weigh exactingly the relative strengths of these various interests. They are unquestionably important and legitimate, and Washington's ban on assisted suicide is at least reasonably related to their promotion and protection. We therefore hold that Wash. Rev.Code §9A.36.060(1) (1994) does not violate the Fourteenth Amendment, either on its face or "as applied to competent, terminally ill adults who wish to hasten their deaths by obtaining medication prescribed by their doctors.'' 79 F.3d, at 838. 24

Throughout the Nation, Americans are engaged in an earnest and profound debate about the morality, legality, and practicality of physician-assisted suicide. Our holding permits this debate to continue, as it should in a democratic society. The decision of the en banc Court of Appeals is reversed, and the case is remanded for further proceedings consistent with this opinion.

Justice SOUTER, concurring in the judgment.

Three terminally ill individuals and four physicians who sometimes treat terminally ill patients brought this challenge to the Washington statute making it a crime "knowingly . . . [to] ai[d] another person to attempt suicide,'' Wash. Rev.Code §9A.36.060 (1994), claiming on behalf of both patients and physicians that it would violate substantive due process to enforce the statute against a doctor who acceded to a dying patient's request for a drug to be taken by the patient to commit suicide. The question is whether the statute sets up one of those "arbitrary impositions'' or "purposeless restraints'' at odds with the Due Process Clause of the Fourteenth Amendment. Poe v. Ullman, 367 U.S. 497, 543, 81 S.Ct. 1752, 1776-1777, 6 L.Ed.2d 989 (1961) (Harlan, J., dissenting). I conclude that the statute's application to the doctors has not been shown to be unconstitutional, but I write separately to give my reasons for analyzing the substantive due process claims as I do, and for rejecting this one.

* Although the terminally ill original parties have died during the pendency of this case, the four physicians who remain as respondents here 1 continue to request declaratory and injunctive relief for their own benefit in discharging their obligations to other dying patients who request their help. 2 See, e.g., Southern Pacific Terminal Co. v. ICC, 219 U.S. 498, 515, 31 S.Ct. 279, 283, 55 L.Ed. 310 (1911) (question was capable of repetition yet evading review). The case reaches us on an order granting summary judgment, and we must take as true the undisputed allegations that each of the patients was mentally competent and terminally ill, and that each made a knowing and voluntary choice to ask a doctor to prescribe "medications . . . to be self-administered for the purpose of hastening . . . death.'' Complaint ¶2.3. The State does not dispute that each faced a passage to death more agonizing both mentally and physically, and more protracted over time, than death by suicide with a physician's help, or that each would have chosen such a suicide for the sake of personal dignity, apart even from relief from pain. Each doctor in this case claims to encounter patients like the original plaintiffs who have died, that is, mentally competent, terminally ill, and seeking medical help in "the voluntary self-termination of life.'' Id., at ¶2.5-2.8. While there may be no unanimity on the physician's professional obligation in such circumstances, I accept here respondents' representation that providing such patients with prescriptions for drugs that go beyond pain relief to hasten death would, in these circumstances, be consistent with standards of medical practice. Hence, I take it to be true, as respondents say, that the Washington statute prevents the exercise of a physician's "best professional judgment to prescribe medications to [such] patients in dosages that would enable them to act to hasten their own deaths.'' Id., at ¶2.6; see also App. 35-37, 49-51, 55-57, 73-75.

In their brief to this Court, the doctors claim not that they ought to have a right generally to hasten patients' imminent deaths, but only to help patients who have made "personal decisions regarding their own bodies, medical care, and, fundamentally, the future course of their lives,'' Brief for Respondents 12, and who have concluded responsibly and with substantial justification that the brief and anguished remainders of their lives have lost virtually all value to them. Respondents fully embrace the notion that the State must be free to impose reasonable regulations on such physician assistance to ensure that the patients they assist are indeed among the competent and terminally ill and that each has made a free and informed choice in seeking to obtain and use a fatal drug. Complaint ¶3.2; App. 28-41.

First, the State argues that the right could not be confined to the terminally ill. Even assuming a fixed definition of that term, the State observes that it is not always possible to say with certainty how long a person may live. Id., at 34. It asserts that " [t]here is no principled basis on which [the right] can be limited to the prescription of medication for terminally ill patients to administer to themselves'' when the right's justifying principle is as broad as ""merciful termination of suffering.''' Id., at 45 (citing Y. Kamisar, Are Laws Against Assisted Suicide Unconstitutional?, Hastings Center Report 32, 36-37 (May-June 1993)). Second, the State argues that the right could not be confined to the mentally competent, observing that a person's competence cannot always be assessed with certainty, Brief for Petitioners 34, and suggesting further that no principled distinction is possible between a competent patient acting independently and a patient acting through a duly appointed and competent surrogate, id., at 46. Next, according to the State, such a right might entail a right to or at least merge in practice into "other forms of life-ending assistance,'' such as euthanasia. Id., at 46-47. Finally, the State believes that a right to physician assistance could not easily be distinguished from a right to assistance from others, such as friends, family, and other health-care workers. Id., at 47. The State thus argues that recognition of the substantive due process right at issue here would jeopardize the lives of others outside the class defined by the doctors' claim, creating risks of irresponsible suicides and euthanasia, whose dangers are concededly within the State's authority to address.

II

When the physicians claim that the Washington law deprives them of a right falling within the scope of liberty that the Fourteenth Amendment guarantees against denial without due process of law, 3 they are not claiming some sort of procedural defect in the process through which the statute has been enacted or is administered. Their claim, rather, is that the State has no substantively adequate justification for barring the assistance sought by the patient and sought to be offered by the physician. Thus, we are dealing with a claim to one of those rights sometimes described as rights of substantive due process and sometimes as unenumerated rights, in view of the breadth and indeterminacy of the "due process'' serving as the claim's textual basis. The doctors accordingly arouse the skepticism of those who find the Due Process Clause an unduly vague or oxymoronic warrant for judicial review of substantive state law, just as they also invoke two centuries of American constitutional practice in recognizing unenumerated, substantive limits on governmental action. Although this practice has neither rested on any single textual basis nor expressed a consistent theory (or, before Poe v. Ullman, a much articulated one), a brief overview of its history is instructive on two counts. The persistence of substantive due process in our cases points to the legitimacy of the modern justification for such judicial review found in Justice Harlan's dissent in Poe, 4 on which I will dwell further on, while the acknowledged failures of some of these cases point with caution to the difficulty raised by the present claim.

Before the ratification of the Fourteenth Amendment, substantive constitutional review resting on a theory of unenumerated rights occurred largely in the state courts applying state constitutions that commonly contained either due process clauses like that of the Fifth Amendment (and later the Fourteenth) or the textual antecedents of such clauses, repeating Magna Carta's guarantee of "the law of the land.'' 5 On the basis of such clauses, or of general principles untethered to specific constitutional language, state courts evaluated the constitutionality of a wide range of statutes.

Thus, a Connecticut court approved a statute legitimating a class of previous illegitimate marriages, as falling within the terms of the "social compact,'' while making clear its power to review constitutionality in those terms. Goshen v. Stonington, 4 Conn. 209, 225-226 (1822). In the same period, a specialized court of equity, created under a Tennessee statute solely to hear cases brought by the state bank against its debtors, found its own authorization unconstitutional as "partial'' legislation violating the state constitution's "law of the land'' clause. Bank of the State v. Cooper, 10 Tenn. 599, 2 Yerg. 599, 602-608 (1831) (Green, J.); id., 2 Yer., at 613-615 (Peck, J.); id., at 618-623 (Kennedy, J.). And the middle of the 19th century brought the famous Wynehamer case, invalidating a statute purporting to render possession of liquor immediately illegal except when kept for narrow, specified purposes, the state court finding the statute inconsistent with the state's due process clause. Wynehamer v. People, 13 N.Y. 378, 486-487 (1856). The statute was deemed an excessive threat to the "fundamental rights of the citizen'' to property. Id., at 398 (Comstock, J.). See generally, E. Corwin, Liberty Against Government 58-115 (1948) (discussing substantive due process in the state courts before the Civil War); T. Cooley, Constitutional Limitations *85-*129, *351-*397.

Even in this early period, however, this Court anticipated the developments that would presage both the Civil War and the ratification of the Fourteenth Amendment, by making it clear on several occasions that it too had no doubt of the judiciary's power to strike down legislation that conflicted with important but unenumerated principles of American government. In most such instances, after declaring its power to invalidate what it might find inconsistent with rights of liberty and property, the Court nevertheless went on to uphold the legislative acts under review. See, e.g., Wilkinson v. Leland, 2 Pet. 627, 656-661, 7 L.Ed. 542 (1829); Calder v. Bull, 3 Dall. 386, 386-395, 1 L.Ed. 648 (1798) (opinion of Chase, J.); see also Corfield v. Coryell, 6 F. Cas. 546, 550-552, No. 3,230 (1823). But in Fletcher v. Peck, 6 Cranch 87, 3 L.Ed. 162 (1810), the Court went further. It struck down an act of the Georgia legislature that purported to rescind a sale of public land ab initio and reclaim title for the State, and so deprive subsequent, good-faith purchasers of property conveyed by the original grantees. The Court rested the invalidation on alternative sources of authority: the specific prohibitions against bills of attainder, ex post facto laws, laws impairing contracts in Article I, §10 of the Constitution; and "general principles which are common to our free institutions,'' by which Chief Justice Marshall meant that a simple deprivation of property by the State could not be an authentically "legislative'' act. Fletcher, 6 Cranch, at 135-139, 3 L.Ed. 162.

Fletcher was not, though, the most telling early example of such review. For its most salient instance in this Court before the adoption of the Fourteenth Amendment was, of course, the case that the Amendment would in due course overturn, Dred Scott v. Sandford, 19 How. 393, 15 L.Ed. 691 (1857). Unlike Fletcher, Dred Scott was textually based on a due process clause (in the Fifth Amendment, applicable to the national government), and it was in reliance on that clause's protection of property that the Court invalidated the Missouri Compromise. 19 How., at 449-452. This substantive protection of an owner's property in a slave taken to the territories was traced to the absence of any enumerated power to affect that property granted to the Congress by Article I of the Constitution, id., at 451-452, the implication being that the government had no legitimate interest that could support the earlier congressional compromise. The ensuing judgment of history needs no recounting here.

After the ratification of the Fourteenth Amendment, with its guarantee of due process protection against the States, interpretation of the words "liberty'' and "property'' as used in due process clauses became a sustained enterprise, with the Court generally describing the due process criterion in converse terms of reasonableness or arbitrariness. That standard is fairly traceable to Justice Bradley's dissent in the Slaughter-House Cases, 16 Wall. 36, 21 L.Ed. 394 (1873), in which he said that a person's right to choose a calling was an element of liberty (as the calling, once chosen, was an aspect of property) and declared that the liberty and property protected by due process are not truly recognized if such rights may be "arbitrarily assailed,'' id., 16 Wall., at 116. 6 After that, opinions comparable to those that preceded Dred Scott expressed willingness to review legislative action for consistency with the Due Process Clause even as they upheld the laws in question. See, e.g., Bartemeyer v. Iowa, 18 Wall. 129, 133-135, 21 L.Ed. 929 (1874); Munn v. Illinois, 94 U.S. 113, 123-135, 24 L.Ed. 77 (1877); Railroad Comm'n Cases, 116 U.S. 307, 331, 6 S.Ct. 1191, 29 L.Ed. 636 (1886); Mugler v. Kansas, 123 U.S. 623, 659-670, 8 S.Ct. 273, 295-302, 31 L.Ed. 205 (1887). See generally Corwin, Liberty Against Government, at 121-136 (surveying the Court's early Fourteenth Amendment cases and finding little dissent from the general principle that the Due Process Clause authorized judicial review of substantive statutes).

The theory became serious, however, beginning with Allgeyer v. Louisiana, 165 U.S. 578, 17 S.Ct. 427, 41 L.Ed. 832 (1897), where the Court invalidated a Louisiana statute for excessive interference with Fourteenth Amendment liberty to contract, id., at 588-593, 17 S.Ct., at 430-433, and offered a substantive interpretation of "liberty,'' that in the aftermath of the so-called Lochner Era has been scaled back in some respects, but expanded in others, and never repudiated in principle. The Court said that Fourteenth Amendment liberty includes "the right of the citizen to be free in the enjoyment of all his faculties; to be free to use them in all lawful ways; to live and work where he will; to earn his livelihood by any lawful calling; to pursue any livelihood or avocation; and for that purpose to enter into all contracts which may be proper, necessary and essential to his carrying out to a successful conclusion the purposes above mentioned.'' Id., at 589, 17 S.Ct., at 431. " [W]e do not intend to hold that in no such case can the State exercise its police power,'' the Court added, but " [w]hen and how far such power may be legitimately exercised with regard to these subjects must be left for determination to each case as it arises.'' Id., at 590, 17 S.Ct., at 432.

Although this principle was unobjectionable, what followed for a season was, in the realm of economic legislation, the echo of Dred Scott. Allgeyer was succeeded within a decade by Lochner v. New York, 198 U.S. 45, 25 S.Ct. 539, 49 L.Ed. 937 (1905), and the era to which that case gave its name, famous now for striking down as arbitrary various sorts of economic regulations that post-New Deal courts have uniformly thought constitutionally sound. Compare, e.g., id., at 62, 25 S.Ct., at 545 (finding New York's maximum-hours law for bakers "unreasonable and entirely arbitrary'') and Adkins v. Children's Hospital of D.C., 261 U.S. 525, 559, 43 S.Ct. 394, 401-402, 67 L.Ed. 785 (1923) (holding a minimum wage law "so clearly the product of a naked, arbitrary exercise of power that it cannot be allowed to stand under the Constitution of the United States'') with West Coast Hotel Co. v. Parrish, 300 U.S. 379, 391, 57 S.Ct. 578, 581-582, 81 L.Ed. 703 (1937) (overruling Adkins and approving a minimum-wage law on the principle that "regulation which is reasonable in relation to its subject and is adopted in the interests of the community is due process''). As the parentheticals here suggest, while the cases in the Lochner line routinely invoked a correct standard of constitutional arbitrariness review, they harbored the spirit of Dred Scott in their absolutist implementation of the standard they espoused.

Even before the deviant economic due process cases had been repudiated, however, the more durable precursors of modern substantive due process were reaffirming this Court's obligation to conduct arbitrariness review, beginning with Meyer v. Nebraska, 262 U.S. 390, 43 S.Ct. 625, 67 L.Ed. 1042 (1923). Without referring to any specific guarantee of the Bill of Rights, the Court invoked precedents from the Slaughter-House Cases through Adkins to declare that the Fourteenth Amendment protected "the right of the individual to contract, to engage in any of the common occupations of life, to acquire useful knowledge, to marry, establish a home and bring up children, to worship God according to the dictates of his own conscience, and generally to enjoy those privileges long recognized at common law as essential to the orderly pursuit of happiness by free men.'' Id., at 399, 43 S.Ct., at 626. The Court then held that the same Fourteenth Amendment liberty included a teacher's right to teach and the rights of parents to direct their children's education without unreasonable interference by the States, id., at 400, 43 S.Ct., at 627, with the result that Nebraska's prohibition on the teaching of foreign languages in the lower grades was, "arbitrary and without reasonable relation to any end within the competency of the State,'' id., at 403, 43 S.Ct., at 628. See also Pierce v. Society of Sisters, 268 U.S. 510, 534-536, 45 S.Ct. 571, 573-574, 69 L.Ed. 1070 (1925) (finding that a statute that all but outlawed private schools lacked any "reasonable relation to some purpose within the competency of the State''); Palko v. Connecticut, 302 U.S. 319, 327-328, 58 S.Ct. 149, 152-153, 82 L.Ed. 288 (1937) ("even in the field of substantive rights and duties the legislative judgment, if oppressive and arbitrary, may be overridden by the courts''; "Is that [injury] to which the statute has subjected [the appellant] a hardship so acute and shocking that our polity will not endure it? Does it violate those fundamental principles of liberty and justice which lie at the base of all our civil and political institutions?'') (citation and internal quotation marks omitted).

After Meyer and Pierce, two further opinions took the major steps that lead to the modern law. The first was not even in a due process case but one about equal protection, Skinner v. Oklahoma ex rel. Williamson, 316 U.S. 535, 62 S.Ct. 1110, 86 L.Ed. 1655 (1942), where the Court emphasized the "fundamental'' nature of individual choice about procreation and so foreshadowed not only the later prominence of procreation as a subject of liberty protection, but the corresponding standard of "strict scrutiny,'' in this Court's Fourteenth Amendment law. See id., at 541, 62 S.Ct., at 1113. Skinner, that is, added decisions regarding procreation to the list of liberties recognized in Meyer and Pierce and loosely suggested, as a gloss on their standard of arbitrariness, a judicial obligation to scrutinize any impingement on such an important interest with heightened care. In so doing, it suggested a point that Justice Harlan would develop, that the kind and degree of justification that a sensitive judge would demand of a State would depend on the importance of the interest being asserted by the individual. Poe, 367 U.S., at 543, 81 S.Ct., at 1776-1777.

The second major opinion leading to the modern doctrine was Justice Harlan's Poe dissent just cited, the conclusion of which was adopted in Griswold v. Connecticut, 381 U.S. 479, 85 S.Ct. 1678, 14 L.Ed.2d 510 (1965), and the authority of which was acknowledged in Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833, 112 S.Ct. 2791, 120 L.Ed.2d 674 (1992). See also n. 4, supra. The dissent is important for three things that point to our responsibilities today. The first is Justice Harlan's respect for the tradition of substantive due process review itself, and his acknowledgement of the Judiciary's obligation to carry it on. For two centuries American courts, and for much of that time this Court, have thought it necessary to provide some degree of review over the substantive content of legislation under constitutional standards of textual breadth. The obligation was understood before Dred Scott and has continued after the repudiation of Lochner's progeny, most notably on the subjects of segregation in public education, Bolling v. Sharpe, 347 U.S. 497, 500, 74 S.Ct. 693, 694-695, 98 L.Ed. 884 (1954), interracial marriage, Loving v. Virginia, 388 U.S. 1, 12, 87 S.Ct. 1817, 1823-1824, 18 L.Ed.2d 1010 (1967), marital privacy and contraception, Carey v. Population Services Int'l, 431 U.S. 678, 684-691, 97 S.Ct. 2010, 2015-2019, 52 L.Ed.2d 675 (1977), Griswold v. Connecticut, supra, at 481-486, 85 S.Ct., at 1679-1683, abortion, Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833, 849, 869-879, 112 S.Ct. 2791, 2805-2806, 2816-2822, 120 L.Ed.2d 674 (1992) (joint opinion of O'CONNOR, KENNEDY, and SOUTER, JJ.), Roe v. Wade, 410 U.S. 113, 152-166, 93 S.Ct. 705, 726-733, 35 L.Ed.2d 147 (1973), personal control of medical treatment, Cruzan v. Director, Mo. Dept. of Health, 497 U.S. 261, 287-289, 110 S.Ct. 2841, 2856-2857, 111 L.Ed.2d 224 (1990) (O'CONNOR, J., concurring); id., at 302, 110 S.Ct., at 2863-2864 (Brennan, J., dissenting); id., at 331, 110 S.Ct., at 2879 (STEVENS, J., dissenting); see also id., at 278, 110 S.Ct., at 2851 (majority opinion), and physical confinement, Foucha v. Louisiana, 504 U.S. 71, 80-83, 112 S.Ct. 1780, 1785-1787, 118 L.Ed.2d 437 (1992). This enduring tradition of American constitutional practice is, in Justice Harlan's view, nothing more than what is required by the judicial authority and obligation to construe constitutional text and review legislation for conformity to that text. See Marbury v. Madison, 1 Cranch 137, 2 L.Ed. 60 (1803). Like many judges who preceded him and many who followed, he found it impossible to construe the text of due process without recognizing substantive, and not merely procedural, limitations. "Were due process merely a procedural safeguard it would fail to reach those situations where the deprivation of life, liberty or property was accomplished by legislation which by operating in the future could, given even the fairest possible procedure in application to individuals, nevertheless destroy the enjoyment of all three.'' Poe, 367 U.S., at 541, 81 S.Ct., at 1775. 7 The text of the Due Process Clause thus imposes nothing less than an obligation to give substantive content to the words "liberty'' and "due process of law.''

III

My understanding of unenumerated rights in the wake of the Poe dissent and subsequent cases avoids the absolutist failing of many older cases without embracing the opposite pole of equating reasonableness with past practice described at a very specific level. See Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833, 847-849, 112 S.Ct. 2791, 2804-2806, 120 L.Ed.2d 674 (1992). That understanding begins with a concept of "ordered liberty,'' Poe, 367 U.S., at 549, 81 S.Ct., at 1780 (Harlan, J.); see also Griswold, 381 U.S., at 500, 85 S.Ct., at 1690, comprising a continuum of rights to be free from "arbitrary impositions and purposeless restraints,'' Poe, 367 U.S., at 543, 81 S.Ct., at 1777 (Harlan, J., dissenting).

See also Moore v. East Cleveland, 431 U.S. 494, 503, 97 S.Ct. 1932, 1937-1938, 52 L.Ed.2d 531 (1977) (plurality opinion of Powell, J.) ("Appropriate limits on substantive due process come not from drawing arbitrary lines but rather from careful "respect for the teachings of history [and] solid recognition of the basic values that underlie our society''') (quoting Griswold, 381 U.S., at 501, 85 S.Ct., at 1691 (Harlan, J., concurring)).

After the Poe dissent, as before it, this enforceable concept of liberty would bar statutory impositions even at relatively trivial levels when governmental restraints are undeniably irrational as unsupported by any imaginable rationale. See, e.g., United States v. Carolene Products Co., 304 U.S. 144, 152, 58 S.Ct. 778, 783, 82 L.Ed. 1234 (1938) (economic legislation "not . . . unconstitutional unless . . . facts . . . preclude the assumption that it rests upon some rational basis''); see also Poe, 367 U.S., at 545, 548, 81 S.Ct., at 1778, 1779-1780 (Harlan, J., dissenting) (referring to usual "presumption of constitutionality'' and ordinary test "going merely to the plausibility of [a statute's] underlying rationale''). Such instances are suitably rare. The claims of arbitrariness that mark almost all instances of unenumerated substantive rights are those resting on "certain interests requir[ing] particularly careful scrutiny of the state needs asserted to justify their abridgment. Cf. Skinner v. Oklahoma [ ex rel. Williamson, 316 U.S. 535, 62 S.Ct. 1110, 86 L.Ed. 1655 (1942)]; Bolling v. Sharpe, [ 347 U.S. 497, 74 S.Ct. 693, 98 L.Ed. 884 (1954)],'' id., at 543, 81 S.Ct., at 1777; that is, interests in liberty sufficiently important to be judged "fundamental,'' id., at 548, 81 S.Ct., at 1779-1780; see also id., at 541, 81 S.Ct., at 1775-1776 (citing Corfield v. Coryell, 4 Wash. C.C. 371, 380 (C.C.E.D.Pa.1823)). In the face of an interest this powerful a State may not rest on threshold rationality or a presumption of constitutionality, but may prevail only on the ground of an interest sufficiently compelling to place within the realm of the reasonable a refusal to recognize the individual right asserted. Poe, supra, at 548, 81 S.Ct., at 1779-1780 (Harlan, J., dissenting) (an "enactment involv[ing] . . . a most fundamental aspect of "liberty' . . . [is] subjec[t] to "strict scrutiny''') (quoting Skinner v. Oklahoma ex rel. Williamson, 316 U.S., at 541, 62 S.Ct., at 1113); 8 Reno v. Flores, 507 U.S. 292, 301-302, 113 S.Ct. 1439, 1446-1447, 123 L.Ed.2d 1 (1993) (reaffirming that due process "forbids the government to infringe certain "fundamental' liberty interests . . . unless the infringement is narrowly tailored to serve a compelling state interest''). 9

This approach calls for a court to assess the relative "weights'' or dignities of the contending interests, and to this extent the judicial method is familiar to the common law. Common law method is subject, however, to two important constraints in the hands of a court engaged in substantive due process review. First, such a court is bound to confine the values that it recognizes to those truly deserving constitutional stature, either to those expressed in constitutional text, or those exemplified by "the traditions from which [the Nation] developed,'' or revealed by contrast with "the traditions from which it broke.'' Poe, 367 U.S., at 542, 81 S.Ct., at 1776 (Harlan, J., dissenting). ""We may not draw on our merely personal and private notions and disregard the limits . . . derived from considerations that are fused in the whole nature of our judicial process . . . [,] considerations deeply rooted in reason and in the compelling traditions of the legal profession.''' Id., at 544-545, 81 S.Ct., at 1778 (quoting Rochin v. California, 342 U.S. 165, 170-171, 72 S.Ct. 205, 208-209, 96 L.Ed. 183 (1952)); see also Palko v. Connecticut, 302 U.S., at 325, 58 S.Ct., at 152 (looking to ""principle[s] of justice so rooted in the traditions and conscience of our people as to be ranked as fundamental''') (quoting Snyder v. Massachusetts, 291 U.S. 97, 105, 54 S.Ct. 330, 332, 78 L.Ed. 674 (1934)).

The second constraint, again, simply reflects the fact that constitutional review, not judicial lawmaking, is a court's business here. The weighing or valuing of contending interests in this sphere is only the first step, forming the basis for determining whether the statute in question falls inside or outside the zone of what is reasonable in the way it resolves the conflict between the interests of state and individual. See, e.g., Poe, supra, at 553, 81 S.Ct., at 1782 (Harlan, J., dissenting); Youngberg v. Romeo, 457 U.S. 307, 320-321, 102 S.Ct. 2452, 2460-2461, 73 L.Ed.2d 28 (1982). It is no justification for judicial intervention merely to identify a reasonable resolution of contending values that differs from the terms of the legislation under review. It is only when the legislation's justifying principle, critically valued, is so far from being commensurate with the individual interest as to be arbitrarily or pointlessly applied that the statute must give way. Only if this standard points against the statute can the individual claimant be said to have a constitutional right. See Cruzan v. Director, Mo. Dept. of Health, 497 U.S., at 279, 110 S.Ct., at 2851-2852 (" [D]etermining that a person has a "liberty interest' under the Due Process Clause does not end the inquiry; "whether [the individual's] constitutional rights have been violated must be determined by balancing his liberty interests against the relevant state interests''') (quoting Youngberg v. Romeo, supra, at 321, 102 S.Ct., at 2461). 10

The Poe dissent thus reminds us of the nature of review for reasonableness or arbitrariness and the limitations entailed by it. But the opinion cautions against the repetition of past error in another way as well, more by its example than by any particular statement of constitutional method: it reminds us that the process of substantive review by reasoned judgment, Poe, 367 U.S., at 542-544, 81 S.Ct., at 1776-1778, is one of close criticism going to the details of the opposing interests and to their relationships with the historically recognized principles that lend them weight or value.

Although the Poe dissent disclaims the possibility of any general formula for due process analysis (beyond the basic analytic structure just described), see id., at 542, 544, 81 S.Ct., at 1776, 1777-1778, Justice Harlan of course assumed that adjudication under the Due Process Clauses is like any other instance of judgment dependent on common-law method, being more or less persuasive according to the usual canons of critical discourse. See also Casey, 505 U.S., at 849, 112 S.Ct., at 2805-2806 ("The inescapable fact is that adjudication of substantive due process claims may call upon the Court in interpreting the Constitution to exercise that same capacity which by tradition courts always have exercised: reasoned judgment''). When identifying and assessing the competing interests of liberty and authority, for example, the breadth of expression that a litigant or a judge selects in stating the competing principles will have much to do with the outcome and may be dispositive. As in any process of rational argumentation, we recognize that when a generally accepted principle is challenged, the broader the attack the less likely it is to succeed. The principle's defenders will, indeed, often try to characterize any challenge as just such a broadside, perhaps by couching the defense as if a broadside attack had occurred. So the Court in Dred Scott treated prohibition of slavery in the Territories as nothing less than a general assault on the concept of property. See Dred Scott v. Sandford, 19 How., at 449-452.

Just as results in substantive due process cases are tied to the selections of statements of the competing interests, the acceptability of the results is a function of the good reasons for the selections made. It is here that the value of common-law method becomes apparent, for the usual thinking of the common law is suspicious of the all-or-nothing analysis that tends to produce legal petrification instead of an evolving boundary between the domains of old principles. Common-law method tends to pay respect instead to detail, seeking to understand old principles afresh by new examples and new counterexamples. The "tradition is a living thing,'' Poe, 367 U.S., at 542, 81 S.Ct., at 1776 (Harlan, J., dissenting), albeit one that moves by moderate steps carefully taken. "The decision of an apparently novel claim must depend on grounds which follow closely on well-accepted principles and criteria. The new decision must take its place in relation to what went before and further [cut] a channel for what is to come.'' Id., at 544, 81 S.Ct., at 1777 (Harlan, J., dissenting) (internal quotation marks omitted). Exact analysis and characterization of any due process claim is critical to the method and to the result.

So, in Poe, Justice Harlan viewed it as essential to the plaintiffs' claimed right to use contraceptives that they sought to do so within the privacy of the marital bedroom. This detail in fact served two crucial and complementary functions, and provides a lesson for today. It rescued the individuals' claim from a breadth that would have threatened all state regulation of contraception or intimate relations; extramarital intimacy, no matter how privately practiced, was outside the scope of the right Justice Harlan would have recognized in that case. See id., at 552-553, 81 S.Ct., at 1781-1782. It was, moreover, this same restriction that allowed the interest to be valued as an aspect of a broader liberty to be free from all unreasonable intrusions into the privacy of the home and the family life within it, a liberty exemplified in constitutional provisions such as the Third and Fourth Amendments, in prior decisions of the Court involving unreasonable intrusions into the home and family life, and in the then-prevailing status of marriage as the sole lawful locus of intimate relations. Id., at 548, 551, 81 S.Ct., at 1779-1780, 1781. 11 The individuals' interest was therefore at its peak in Poe, because it was supported by a principle that distinguished of its own force between areas in which government traditionally had regulated (sexual relations outside of marriage) and those in which it had not (private marital intimacies), and thus was broad enough to cover the claim at hand without being so broad as to be shot-through by exceptions.

On the other side of the balance, the State's interest in Poe was not fairly characterized simply as preserving sexual morality, or doing so by regulating contraceptive devices. Just as some of the earlier cases went astray by speaking without nuance of individual interests in property or autonomy to contract for labor, so the State's asserted interest in Poe was not immune to distinctions turning (at least potentially) on the precise purpose being pursued and the collateral consequences of the means chosen, see id., at 547-548, 81 S.Ct., at 1779-1780. It was assumed that the State might legitimately enforce limits on the use of contraceptives through laws regulating divorce and annulment, or even through its tax policy, ibid., but not necessarily be justified in criminalizing the same practice in the marital bedroom, which would entail the consequence of authorizing state enquiry into the intimate relations of a married couple who chose to close their door, id., at 548-549, 81 S.Ct., at 1779-1780. See also Casey, 505 U.S., at 869, 112 S.Ct., at 2816 (strength of State's interest in potential life varies depending on precise context and character of regulation pursuing that interest).

IV

* Respondents claim that a patient facing imminent death, who anticipates physical suffering and indignity, and is capable of responsible and voluntary choice, should have a right to a physician's assistance in providing counsel and drugs to be administered by the patient to end life promptly. Complaint ¶3.1. They accordingly claim that a physician must have the corresponding right to provide such aid, contrary to the provisions of Wash. Rev.Code §9A.36.060 (1994). I do not understand the argument to rest on any assumption that rights either to suicide or to assistance in committing it are historically based as such. Respondents, rather, acknowledge the prohibition of each historically, but rely on the fact that to a substantial extent the State has repudiated that history. The result of this, respondents say, is to open the door to claims of such a patient to be accorded one of the options open to those with different, traditionally cognizable claims to autonomy in deciding how their bodies and minds should be treated. They seek the option to obtain the services of a physician to give them the benefit of advice and medical help, which is said to enjoy a tradition so strong and so devoid of specifically countervailing state concern that denial of a physician's help in these circumstances is arbitrary when physicians are generally free to advise and aid those who exercise other rights to bodily autonomy.

PCS1

The dominant western legal codes long condemned suicide and treated either its attempt or successful accomplishment as a crime, the one subjecting the individual to penalties, the other penalizing his survivors by designating the suicide's property as forfeited to the government. See 4 W. Blackstone, Commentaries *188-*189 (commenting that English law considered suicide to be "ranked . . . among the highest crimes'' and deemed persuading another to commit suicide to be murder); see generally Marzen, O'Dowd, Crone, & Balch, Suicide: A Constitutional Right?, 24 Duquense L.Rev. 1, 56-63 (1985). While suicide itself has generally not been considered a punishable crime in the United States, largely because the common-law punishment of forfeiture was rejected as improperly penalizing an innocent family, see id., at 98-99, most States have consistently punished the act of assisting a suicide as either a common-law or statutory crime and some continue to view suicide as an unpunishable crime. See generally id., at 67-100, 148-242. 13 Criminal prohibitions on such assistance remain widespread, as exemplified in the Washington statute in question here. 14

The principal significance of this history in the State of Washington, according to respondents, lies in its repudiation of the old tradition to the extent of eliminating the criminal suicide prohibitions. Respondents do not argue that the State's decision goes further, to imply that the State has repudiated any legitimate claim to discourage suicide or to limit its encouragement. The reasons for the decriminalization, after all, may have had more to do with difficulties of law enforcement than with a shift in the value ascribed to life in various circumstances or in the perceived legitimacy of taking one's own. See, e.g., Kamisar, Physician-Assisted Suicide: The Last Bridge to Active Voluntary Euthanasia, in Euthanasia Examined 225, 229 (J. Keown ed.1995); CeloCruz, Aid-in-Dying: Should We Decriminalize Physician-Assisted Suicide and Physician-Committed Euthanasia?, 18 Am. J.L. & Med. 369, 375 (1992); Marzen, O'Dowd, Crone, & Balch 24 Duquesne L.Rev. supra, at __-__. Thus it may indeed make sense for the State to take its hands off suicide as such, while continuing to prohibit the sort of assistance that would make its commission easier. See, e.g., American Law Institute, Model Penal Code §210.5, Comment 5 (1980). Decriminalization does not, then, imply the existence of a constitutional liberty interest in suicide as such; it simply opens the door to the assertion of a cognizable liberty interest in bodily integrity and associated medical care that would otherwise have been inapposite so long as suicide, as well as assisting a suicide, was a criminal offense.

This liberty interest in bodily integrity was phrased in a general way by then-Judge Cardozo when he said, " [e]very human being of adult years and sound mind has a right to determine what shall be done with his own body'' in relation to his medical needs. Schloendorff v. Society of New York Hospital, 211 N.Y. 125, 129, 105 N.E. 92, 93 (1914). The familiar examples of this right derive from the common law of battery and include the right to be free from medical invasions into the body, Cruzan v. Director, Mo. Dept. of Health, 497 U.S., at 269- 279, 110 S.Ct., at 2846-2852, as well as a right generally to resist enforced medication, see Washington v. Harper, 494 U.S. 210, 221-222, 229, 110 S.Ct. 1028, 1036-1037, 1040-1041, 108 L.Ed.2d 178 (1990). Thus " [i]t is settled now . . . that the Constitution places limits on a State's right to interfere with a person's most basic decisions about . . . bodily integrity.'' Casey, 505 U.S., at 849, 112 S.Ct., at 2806 (citations omitted); see also Cruzan, 497 U.S., at 278, 110 S.Ct., at 2851; id., at 288, 110 S.Ct., at 2856-2857 (O'CONNOR, J., concurring); Washington v. Harper, supra, at 221-222, 110 S.Ct., at 1036-1037; Winston v. Lee, 470 U.S. 753, 761-762, 105 S.Ct. 1611, 1617-1618, 84 L.Ed.2d 662 (1985); Rochin v. California, 342 U.S., at 172, 72 S.Ct., at 209-210. Constitutional recognition of the right to bodily integrity underlies the assumed right, good against the State, to require physicians to terminate artificial life support, Cruzan, supra, at 279, 110 S.Ct., at 2851-2852 ("we assume that the United States Constitution would grant a competent person a constitutionally protected right to refuse lifesaving hydration and nutrition''), and the affirmative right to obtain medical intervention to cause abortion, see Casey, supra, at 857, 896, 112 S.Ct., at 2810, 2830; cf. Roe v. Wade, 410 U.S., at 153, 93 S.Ct., at 726-727.

It is, indeed, in the abortion cases that the most telling recognitions of the importance of bodily integrity and the concomitant tradition of medical assistance have occurred. In Roe v. Wade, the plaintiff contended that the Texas statute making it criminal for any person to "procure an abortion,'' id., at 117, 93 S.Ct., at 709, for a pregnant woman was unconstitutional insofar as it prevented her from "terminat[ing] her pregnancy by an abortion "performed by a competent, licensed physician, under safe, clinical conditions,''' id., at 120, 93 S.Ct., at 710, and in striking down the statute we stressed the importance of the relationship between patient and physician, see id., at 153, 156, 93 S.Ct., at 726-727, 728.

The analogies between the abortion cases and this one are several. Even though the State has a legitimate interest in discouraging abortion, see Casey, 505 U.S., at 871, 112 S.Ct., at 2817 (joint opinion of O'CONNOR, KENNEDY, and SOUTER, JJ.) Roe, 410 U.S., at 162, 93 S.Ct., at 731, the Court recognized a woman's right to a physician's counsel and care. Like the decision to commit suicide, the decision to abort potential life can be made irresponsibly and under the influence of others, and yet the Court has held in the abortion cases that physicians are fit assistants. Without physician assistance in abortion, the woman's right would have too often amounted to nothing more than a right to self-mutilation, and without a physician to assist in the suicide of the dying, the patient's right will often be confined to crude methods of causing death, most shocking and painful to the decedent's survivors.

PCS2

The argument supporting respondents' position thus progresses through three steps of increasing forcefulness. First, it emphasizes the decriminalization of suicide. Reliance on this fact is sanctioned under the standard that looks not only to the tradition retained, but to society's occasional choices to reject traditions of the legal past. See Poe v. Ullman, 367 U.S., at 542, 81 S.Ct., at 1776 (Harlan, J., dissenting). While the common law prohibited both suicide and aiding a suicide, with the prohibition on aiding largely justified by the primary prohibition on self-inflicted death itself, see, e.g., American Law Institute, Model Penal Code §210.5, Comment 1, pp. 92-93, and n. 7 (1980), the State's rejection of the traditional treatment of the one leaves the criminality of the other open to questioning that previously would not have been appropriate. The second step in the argument is to emphasize that the State's own act of decriminalization gives a freedom of choice much like the individual's option in recognized instances of bodily autonomy. One of these, abortion, is a legal right to choose in spite of the interest a State may legitimately invoke in discouraging the practice, just as suicide is now subject to choice, despite a state interest in discouraging it. The third step is to emphasize that respondents claim a right to assistance not on the basis of some broad principle that would be subject to exceptions if that continuing interest of the State's in discouraging suicide were to be recognized at all. Respondents base their claim on the traditional right to medical care and counsel, subject to the limiting conditions of informed, responsible choice when death is imminent, conditions that support a strong analogy to rights of care in other situations in which medical counsel and assistance have been available as a matter of course. There can be no stronger claim to a physician's assistance than at the time when death is imminent, a moral judgment implied by the State's own recognition of the legitimacy of medical procedures necessarily hastening the moment of impending death.

B

The State has put forward several interests to justify the Washington law as applied to physicians treating terminally ill patients, even those competent to make responsible choices: protecting life generally, Brief for Petitioners 33, discouraging suicide even if knowing and voluntary, id., at 37-38, and protecting terminally ill patients from involuntary suicide and euthanasia, both voluntary and nonvoluntary, id., at 34-35.

It is not necessary to discuss the exact strengths of the first two claims of justification in the present circumstances, for the third is dispositive for me. That third justification is different from the first two, for it addresses specific features of respondents' claim, and it opposes that claim not with a moral judgment contrary to respondents', but with a recognized state interest in the protection of nonresponsible individuals and those who do not stand in relation either to death or to their physicians as do the patients whom respondents describe. The State claims interests in protecting patients from mistakenly and involuntarily deciding to end their lives, and in guarding against both voluntary and involuntary euthanasia. Leaving aside any difficulties in coming to a clear concept of imminent death, mistaken decisions may result from inadequate palliative care or a terminal prognosis that turns out to be error; coercion and abuse may stem from the large medical bills that family members cannot bear or unreimbursed hospitals decline to shoulder. Voluntary and involuntary euthanasia may result once doctors are authorized to prescribe lethal medication in the first instance, for they might find it pointless to distinguish between patients who administer their own fatal drugs and those who wish not to, and their compassion for those who suffer may obscure the distinction between those who ask for death and those who may be unable to request it. The argument is that a progression would occur, obscuring the line between the ill and the dying, and between the responsible and the unduly influenced, until ultimately doctors and perhaps others would abuse a limited freedom to aid suicides by yielding to the impulse to end another's suffering under conditions going beyond the narrow limits the respondents propose. The State thus argues, essentially, that respondents' claim is not as narrow as it sounds, simply because no recognition of the interest they assert could be limited to vindicating those interests and affecting no others. The State says that the claim, in practical effect, would entail consequences that the State could, without doubt, legitimately act to prevent.

The mere assertion that the terminally sick might be pressured into suicide decisions by close friends and family members would not alone be very telling. Of course that is possible, not only because the costs of care might be more than family members could bear but simply because they might naturally wish to see an end of suffering for someone they love. But one of the points of restricting any right of assistance to physicians, would be to condition the right on an exercise of judgment by someone qualified to assess the patient's responsible capacity and detect the influence of those outside the medical relationship.

But at least at this moment there are reasons for caution in predicting the effectiveness of the teeth proposed. Respondents' proposals, as it turns out, sound much like the guidelines now in place in the Netherlands, the only place where experience with physician-assisted suicide and euthanasia has yielded empirical evidence about how such regulations might affect actual practice. Dutch physicians must engage in consultation before proceeding, and must decide whether the patient's decision is voluntary, well considered, and stable, whether the request to die is enduring and made more than once, and whether the patient's future will involve unacceptable suffering. See C. Gomez, Regulating Death 40-43 (1991). There is, however, a substantial dispute today about what the Dutch experience shows. Some commentators marshall evidence that the Dutch guidelines have in practice failed to protect patients from involuntary euthanasia and have been violated with impunity. See, e.g., H. Hendin, Seduced By Death 75-84 (1997) (noting many cases in which decisions intended to end the life of a fully competent patient were made without a request from the patient and without consulting the patient); Keown, Euthanasia in the Netherlands: Sliding Down the Slippery Slope?, in Euthanasia Examined 261, 289 (J. Keown ed.1995) (guidelines have "proved signally ineffectual; non-voluntary euthanasia is now widely practised and increasingly condoned in the Netherlands''); Gomez, supra, at 104-113. This evidence is contested. See, e.g., R. Epstein, Mortal Peril 322 (1997) ("Dutch physicians are not euthanasia enthusiasts and they are slow to practice it in individual cases''); R. Posner, Aging and Old Age 242, and n. 23 (1995) (noting fear of "doctors' rushing patients to their death'' in the Netherlands "has not been substantiated and does not appear realistic''); Van der Wal, Van Eijk, Leenen, & Spreeuwenberg, Euthanasia and Assisted Suicide, 2, Do Dutch Family Doctors Act Prudently?, 9 Family Practice 135 (1992) (finding no serious abuse in Dutch practice). The day may come when we can say with some assurance which side is right, but for now it is the substantiality of the factual disagreement, and the alternatives for resolving it, that matter. They are, for me, dispositive of the due process claim at this time.

I take it that the basic concept of judicial review with its possible displacement of legislative judgment bars any finding that a legislature has acted arbitrarily when the following conditions are met: there is a serious factual controversy over the feasibility of recognizing the claimed right without at the same time making it impossible for the State to engage in an undoubtedly legitimate exercise of power; facts necessary to resolve the controversy are not readily ascertainable through the judicial process; but they are more readily subject to discovery through legislative factfinding and experimentation. It is assumed in this case, and must be, that a State's interest in protecting those unable to make responsible decisions and those who make no decisions at all entitles the State to bar aid to any but a knowing and responsible person intending suicide, and to prohibit euthanasia. How, and how far, a State should act in that interest are judgments for the State, but the legitimacy of its action to deny a physician the option to aid any but the knowing and responsible is beyond question.

The capacity of the State to protect the others if respondents were to prevail is, however, subject to some genuine question, underscored by the responsible disagreement over the basic facts of the Dutch experience. This factual controversy is not open to a judicial resolution with any substantial degree of assurance at this time. It is not, of course, that any controversy about the factual predicate of a due process claim disqualifies a court from resolving it. Courts can recognize captiousness, and most factual issues can be settled in a trial court. At this point, however, the factual issue at the heart of this case does not appear to be one of those. The principal enquiry at the moment is into the Dutch experience, and I question whether an independent front-line investigation into the facts of a foreign country's legal administration can be soundly undertaken through American courtroom litigation. While an extensive literature on any subject can raise the hopes for judicial understanding, the literature on this subject is only nascent. Since there is little experience directly bearing on the issue, the most that can be said is that whichever way the Court might rule today, events could overtake its assumptions, as experimentation in some jurisdictions confirmed or discredited the concerns about progression from assisted suicide to euthanasia.

Legislatures, on the other hand, have superior opportunities to obtain the facts necessary for a judgment about the present controversy. Not only do they have more flexible mechanisms for factfinding than the Judiciary, but their mechanisms include the power to experiment, moving forward and pulling back as facts emerge within their own jurisdictions. There is, indeed, good reason to suppose that in the absence of a judgment for respondents here, just such experimentation will be attempted in some of the States. See, e.g., Ore.Rev.Stat. Ann. §§127.800 et seq. -(Supp.1996); App. to Brief for State Legislators as Amici Curiae 1a (listing proposed statutes).

I do not decide here what the significance might be of legislative foot-dragging in ascertaining the facts going to the State's argument that the right in question could not be confined as claimed. Sometimes a court may be bound to act regardless of the institutional preferability of the political branches as forums for addressing constitutional claims. See, e.g., Bolling v. Sharpe, 347 U.S. 497, 74 S.Ct. 693, 98 L.Ed. 884 (1954). Now, it is enough to say that our examination of legislative reasonableness should consider the fact that the Legislature of the State of Washington is no more obviously at fault than this Court is in being uncertain about what would happen if respondents prevailed today. We therefore have a clear question about which institution, a legislature or a court, is relatively more competent to deal with an emerging issue as to which facts currently unknown could be dispositive. The answer has to be, for the reasons already stated, that the legislative process is to be preferred. There is a closely related further reason as well.

One must bear in mind that the nature of the right claimed, if recognized as one constitutionally required, would differ in no essential way from other constitutional rights guaranteed by enumeration or derived from some more definite textual source than "due process.'' An unenumerated right should not therefore be recognized, with the effect of displacing the legislative ordering of things, without the assurance that its recognition would prove as durable as the recognition of those other rights differently derived. To recognize a right of lesser promise would simply create a constitutional regime too uncertain to bring with it the expectation of finality that is one of this Court's central obligations in making constitutional decisions. See Casey, 505 U.S., at 864- 869, 112 S.Ct., at 2813-2816.

Legislatures, however, are not so constrained. The experimentation that should be out of the question in constitutional adjudication displacing legislative judgments is entirely proper, as well as highly desirable, when the legislative power addresses an emerging issue like assisted suicide. The Court should accordingly stay its hand to allow reasonable legislative consideration. While I do not decide for all time that respondents' claim should not be recognized, I acknowledge the legislative institutional competence as the better one to deal with that claim at this time.

# data[].attributes.attachment_link.title
WASHINGTON, et al., Petitioners, v. Harold GLUCKSBERG et al.

# data[].attributes.attachment_link.description
WASHINGTON, et al., Petitioners,v.Harold GLUCKSBERG et al. No. 96-110. Supreme Court of the United States It has always been a crime to assist a suicide in the State of Washington.

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Source of Law: Statutory
Tex. Health & Safety Code § 62.052 (a)(3)(D)

Citation:

Link: https://statutes.capitol.texas.gov/Docs/HS/htm/HS.62.htm

Requirements:

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HEALTH AND SAFETY CODE CHAPTER 62. CHILD HEALTH PLAN FOR CERTAIN LOW-INCOME CHILDREN

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HEALTH AND SAFETY CODE TITLE 2. HEALTH SUBTITLE C. PROGRAMS PROVIDING HEALTH CARE BENEFITS AND SERVICES CHAPTER 62. CHILD HEALTH PLAN FOR CERTAIN LOW-INCOME CHILDREN SUBCHAPTER A. GENERAL PROVISIONS Sec. 62.001. OBJECTIVE OF THE STATE CHILD HEALTH PLAN.

# data[].attributes.body
Source of Law: Administrative

Citation:

Link: https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=37&pt=11&ch=351&rl=13

Requirements:

# data[].attributes.attachment_link.description
(c) Medication. In accordance with Texas Human Resources Code Section 142.005, the juvenile board shall adopt a policy concerning the administration of medication to residents. The policy shall include which facility employees are authorized to administer medication to residents.

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Source of Law: Judicial

Citation:

Link: http://jaapl.org/content/46/4/521

Requirements:

# data[].attributes.attachment_link.provider_name
Journal of the American Academy of Psychiatry and the Law

# data[].attributes.attachment_link.title
Commonwealth v. Carter and Legal Interpretations of Facilitated Suicide

# data[].attributes.attachment_link.description
In June 2017, a media frenzy ensued after Michelle Carter was convicted of involuntary manslaughter in the state of Massachusetts for facilitating the suicide of Conrad Roy. The verdict stirred controversy and cast a spotlight on facilitation of suicide, i.e., a person’s act(s) done with the purpose…

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Brazosport ISD has implemented programs to address the following mental health and substance abuse concerns:
-Suicide prevention, intervention, and postvention (interventions after a suicide);

Link: https://cdn5-ss10.sharpschool.com/UserFiles/Servers/Server_415374/File/Resources/Code%20of%20Conduct/Student_Code_of_Conduct.pdf

Summary: I chose this out of the code of conducts from my campus. It shows for the public to see that we do have a counseling program here on campus for students who are suicidal. We can start early or we even have a plan set if there is a suicide.

# data[].attributes.body
A.9.b "Recognize the level of suicide risk (e.g., low, medium, high) is difficult to accurately quantify. If required to use a risk assessment, it must be completed with the realization that it is an information-gathering tool and only one element in the risk-assessment process. When reporting risk-assessment results to parents/guardians, school counselors do not negate the risk of students’ potential harm to self even if the assessment reveals a low risk, as students may minimize risk to avoid further scrutiny and/or parental/guardian notification. The purpose of reporting any risk-assessment results to parents/guardians is to underscore the need for parents/guardians to act, not to report a judgment of risk."

Link: https://www.schoolcounselor.org/getmedia/44f30280-ffe8-4b41-9ad8-f15909c3d164/EthicalStandards.pdf

Summary: All students going through suicidal ideation will be assessed by a counselor. While there is confidentiality among counselors and students, this type of things is one of the topics that gets shared. When a student is assessed, no matter if they are at low risk or high risk, the parents/guardians need to be informed so that they can get the student the proper help.

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Personal Connection to the Legal and Ethical Standards

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Personal Connection to the Legal and Ethical Standards

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Identify your personal connection to legal and ethical standards by providing an overview of how the context allowed you to understand the application of the law to your personal educational journey (3 sentences). Include three (3) sentences points regarding your feelings about these connections to the law and how this paved a way for your education goals.