The decision by the Supreme Court that individuals don't have a constitutional "right to die" - one of the most contentious moral issues of the day - will likely slow the national movement toward doctor-assisted suicide in the US.
The ruling does not prevent advocates from passing right-to-die laws in any of the 50 states, which they vow to do, most immediately in Florida and Oregon.
Indeed, beneath a deceptively unanimous 9 to 0 ruling by the high court is a clear message that the issue of assisted suicide is a troubling one that won't go away and needs to be debated further by society.
In its decision, which appeared to be as wrenching for many of the justices as for those desiring a right to die, the court ruled there is no constitutional right to use a physician, or anyone, to assist in a suicide under any circumstances. It struck down federal courts in Washington and New York, which last year granted a right to die for the first time in US history.
Chief Justice William Rehnquist, who wrote for the court in two separate opinions, was only able to garner five votes for an absolute ban on any due process rights for assisted suicide. Four justices, led by Sandra Day O'Connor, concurred about the difficulty of deciding the issue.
"Beneath both sets of opinions are concurrences about how hard this question is, and about not foreclosing challenges that individuals may make," says Mark Tushnet, a scholar at Georgetown University Law School in Washington.
The larger debate over assisted suicide weighs the emotional claims of individuals in serious pain against a wider concern about damage to the health of society, should suicide become an easy legal process that could cheapen life or even entrap those most vulnerable.
No federal court has ever allowed a physician's assistance in suicide until two courts did last spring. Polls show half of Americans would consider allowing euthanasia in extreme cases of pain or illness, though figures are fuzzy.
Much early support of euthanasia during the peak media coverage of Jack Kevorkian, the controversial Michigan physician who has helped many people kill themselves, has waned. When put to a vote, a "right to die" law has been defeated every time except in Oregon, where it passed by 51 percent. Some 59 percent of senior citizens were opposed in a recent Gallop poll.
The two cases brought to the high court this year, Vacco v. Quill from New York, and Washington v. Glucksberg, presented two very different issues.
Until yesterday the closest the high court has come to spelling out the legality of life-ending procedures was the 1990 Cruzan opinion. In Cruzan, a case concerning a woman on a respirator, the justices agreed that persons can refuse medical treatment or stop medical care that is intrusive, even if the outcome of that decision is expected to be life-ending.
IN the New York case, a challenge to antisuicide laws by Dr. Timothy Quill on behalf of two AIDS patients, lawyers argued there is no essential legal difference between ending a life by terminating medical treatment, as allowed under Cruzan, and a doctor who pro-actively administers life-ending drugs, since the intended outcome is the same. The US Second Circuit Court of Appeals agreed.
But the US high court drew a sharp line between ending life by refusing treatment and ending life by assisted suicide. Justice Rehnquist, writing for the court, stated, "... we think the distinction between assisting suicide and withdrawing life-sustaining treatment, a distinction widely recognized and endorsed in the medical profession and in our legal traditions, is both important and logical; it is certainly rational."
The rationale for assisted suicide from the West coast's Ninth Circuit Court of Appeals was more radical and sweeping. In a 9 to 3 decision, the court found a fundamental right to end one's life at anytime regardless of medical condition. Using concepts of expansive liberty from the Roe v. Wade abortion ruling, the court reasoned the privacy right of intrusive medical procedure like abortion that ended an unborn life should be also allowed for those deciding to end their lives.
Yet Rehnquist's opinion states that the Ninth Circuit ignored American history and legal tradition, as well as 700 years of common law, which denied suicide as a right.
Still, the issue is certain to persist. Assisted suicide exists at the crossroads of a number of contemporary issues, including medical technology, problems of health-care funding, confidence in those entrusted to care, religious and spiritual convictions, even the way people look after each other as family and friends.
Yale University professor Robert Burt argues the case is not "ripe" in public thought. Euthanasia needs a history of moral, political, and legal debate, he says.