In effect, the respondents argued that refusing treatment and requesting that their doctor assist them in ending their life were "the same thing."

The District Court said that this was a matter of legislation, and, if the ban were to be repealed, it would take an act of New York's legislature (or a binding referendum by the voters) to do so.

It agreed with the contention that removing life support devices was identical to requesting physician-assisted euthanasia, and thereby reversed the lower court's finding.

In the Court's own words, from Heller v. Doe, 509 U.S. 312 (1993), laws such as those enacted by New York were entitled to a "strong presumption of validity."

To this effect the Court quoted a House Judiciary Committee hearing, stating that a physician performing an assisted suicide, "must, necessarily and indubitably, intend primarily that the patient be made dead."

Furthermore, in another repudiation of the respondents' argument, the Court noted that a patient removing life support might not actually intend to die, and that death without such a device may not be a certainty.

Looking to New York's intent behind the ban, the Court noted that the law plainly recognized the difference between "killing" and "letting die."

It also recognized that the State of New York had, as a matter of policy, a compelling interest in forbidding assisted suicide, while allowing a patient to refuse life support was simply an act of protecting a common-law right.

In closing, the Court said that it fully rejected the respondents' argument that the statutory difference between assisted suicide and refusing lifesaving treatment was "arbitrary" and "irrational."

Justice O'Connor stated that, in the context of the questions presented in this case, the Court did not need to address whether a patient had a constitutionally cognizable interest in controlling the circumstances of his or her imminent death."

Stevens notes that the Court construed the challenge to the statute as one of facial validity; i.e., that the respondents asserted that the law was invalid in all or most cases it might be applied.

Stevens agreed with the Court in rejecting this idea, believing that "liberty" as defined by the Due Process Clause didn't include such a right, because "The value to others of a person's life is far too precious to allow the individual to claim a constitutional entitlement to complete autonomy in making a decision to end that life."

Justice Souter issued a short clarifying concurrence, noting that he agreed with the ruling, but also stressing that he felt the claims raised were significant enough to warrant further justification.

He cited his own concurrence in Washington v. Glucksberg 521 U.S. 702 (1997), reiterating that he felt the distinction between the permitted refusal of treatment and the prohibited assisted suicide was not an arbitrary one.

He believed that there could be cases in the future with similar yet substantially different circumstances in which the Court may be forced to reconsider the terms used in this decision.