Linder v. United States

Summary

Charles O. Linder was a licensed physician in Spokane, Washington, registered under the Harrison Narcotic Act of 1914. In April 1922 he gave a woman named Ida Casey, whom he knew to be addicted to morphine and cocaine, one tablet of morphine and three of cocaine to take herself over a period of time. A federal grand jury indicted him on several counts; the jury acquitted him on all but one, and the Circuit Court of Appeals for the Ninth Circuit affirmed his conviction on that count, which charged a sale without the official order form required by section 2 of the act. The question was whether a registered physician who, in good faith, gave a known addict a small quantity of drugs to relieve the conditions of her addiction had committed a federal crime. The government relied on Webb v. United States (1919), Jin Fuey Moy v. United States (1920) and especially United States v. Behrman (1922), which it read as holding that any prescription to satisfy an addict's craving fell outside professional practice. Linder answered that the count did not allege bad faith or improper medicine and that the facts alleged did not amount to an offense against a revenue law. On 13 April 1925 a unanimous Court reversed. Justice McReynolds began from the premise that the Harrison Act was a revenue measure and could be sustained only as one. Citing McCulloch v. Maryland, he wrote that direct control of medical practice in the states is beyond federal power and that Congress could regulate it only as far as reasonably appropriate to collecting the tax. The act said nothing about addicts and did not prescribe their treatment; addicts, he wrote, are diseased and proper subjects for medical care. He then confined the earlier precedents to their facts: Webb involved thousands of orders sold for fifty cents, Jin Fuey Moy a doctor who charged by the dram, and Behrman an order for some three thousand doses. None of them, he held, meant that a physician acting in good faith and by fair medical standards could never give an addict moderate amounts for self-administration. Whether conduct was bona fide medical practice had to be decided on the evidence, and mere pretense would not shelter illegal sales. The library text gives McReynolds's opinion, including the grand jury's count, long extracts from the statute and the passages quoted from earlier cases, with notes left out. The decision did not end the debate. The Treasury's narcotics officers continued to treat maintenance prescribing as suspect, and later physicians and historians described Linder as a statement of principle that changed enforcement less than its words suggested. The Harrison Act remained in force until the Controlled Substances Act of 1970 replaced it, and the Court returned to the legal status of addiction in Robinson v. California (1962).

Plot or Argument

• The single surviving count

  McReynolds sets out Count II of the grand jury's 1922 charges, charging Linder with giving Ida Casey four tablets without an order form, and notes that the jury acquitted him on every other count.

• The statute in its own words

  The opinion quotes the Harrison Act's title, its registration and tax provisions, the order-form requirement of section 2 with the exemption for physicians in the course of professional practice, the possession rule of section 8 and the 1919 amendments.

• What the charge does and does not allege

  Read fairly, the count charges only that a registered physician gave four small tablets to a known addict to relieve her condition; it does not question his good faith or allege that he acted for other than medical purposes.

• A revenue measure and the limits of federal power

  Relying on McCulloch and the Child Labor Tax Case, McReynolds holds that Congress may touch medical practice only so far as is incidental to collecting the tax, and that addicts are proper subjects for medical treatment that the act does not attempt to prescribe.

• Webb, Jin Fuey Moy and Behrman confined

  Each earlier decision is reread in light of its facts: large-scale sales disguised as prescriptions. Their language must not be stretched to forbid every good-faith prescription of moderate amounts to relieve an addict's suffering.

• Reversal

  Finding nothing in the charge that threatened the orderly collection of revenue, the Court reverses and remands for further proceedings.

Characters

• Dr. Charles O. Linder, petitioner

  Spokane physician registered under the Harrison Act, convicted of giving four tablets to an addicted woman.

• Ida Casey, recipient named in the charge

  Woman known to Linder to be addicted to morphine and cocaine, to whom he gave the tablets.

• Justice James C. McReynolds, author of the unanimous opinion

  Tennessean who held that the act could not be stretched into federal control of medical practice.

• Chief Justice William Howard Taft, presiding justice

  Led the Court that joined McReynolds's opinion without dissent.

Lessons

• Enumerated powers and the practice of medicine

  McReynolds rests the decision on the structure of the Constitution: the national government has delegated powers only, and regulating the practice of medicine belongs to the states. A tax law may touch medicine only as needed to collect the tax. The lesson is that how a law is justified determines how far it can reach.

  • Why does McReynolds cite McCulloch v. Maryland in a case about four tablets of medicine?
  • What does it mean to say that federal power is delegated?
  • Should a desirable goal ever justify stretching a government's powers beyond their stated limits?

• Addiction as a condition for medical care

  The opinion describes addicts as diseased and proper subjects for treatment, and it treats a doctor's good-faith effort to relieve conditions incident to addiction as medicine rather than commerce. This was a significant statement at a time when enforcement officials regarded most such prescribing as unlawful.

  • What words does the Court use to describe persons addicted to drugs?
  • How does the Court distinguish relieving an addict's suffering from catering to an appetite?
  • Who is best placed to judge what treatment a person with an addiction should receive?

• Reading precedents by their facts

  Rather than overrule Webb, Jin Fuey Moy or Behrman, McReynolds limits each to its circumstances: fifty-cent orders by the thousand, fees charged by the dram, three thousand doses at once. Students can see here how a court narrows broad language in earlier opinions by asking what those cases actually decided.

  • What facts does McReynolds emphasize in each of the earlier cases?
  • Is limiting a precedent to its facts different in effect from overruling it?

• Good faith and evidence

  The Court insists that whether a physician acted in bona fide medical practice must be determined from evidence and circumstances, not presumed from the bare fact that the patient was addicted. At the same time it warns that pretense cannot legalize forbidden sales.

  • What kinds of evidence might show that a doctor was acting in good faith?
  • How does the trial judge's instruction to the jury, quoted in the opinion, frame the issue of good faith?
  • Why does the Court say mere pretense of medical practice gives no protection?

Context

After Webb (1919) and Behrman (1922), the Treasury Department's Narcotic Division prosecuted thousands of physicians and pharmacists for supplying addicted patients, and the municipal narcotic clinics that had opened around 1919 in cities such as New York and Shreveport were closed by 1923. Medical opinion was divided between those who saw maintenance as necessary for some patients and those who favored rapid withdrawal.

Composition

Linder was indicted in June 1922 in the Eastern District of Washington. After his conviction on a single count was affirmed by the Ninth Circuit, the Court granted review. McReynolds, who had dissented in Doremus and Webb, wrote the opinion for a Court that had since changed in membership.

Reception

Defenders of medical discretion hailed the decision, but enforcement officials treated it as limited to its small quantities, and in Boyd v. United States (1926) the Court upheld a conviction involving larger amounts. Historians of drug policy, among them David Musto and Rufus King, have described Linder as an important statement that had limited practical effect on federal enforcement in the following decades.

Comparisons

• webb-v-united-states

  The 1919 decision that Linder reread: there an order sold to sustain a habit was no prescription, here four tablets given in good faith were not shown to be a crime.

• robinson-v-california

  Justice Stewart's 1962 opinion, holding that California could not punish the status of addiction, rests on the same view of addiction as an illness that Linder had stated.

• mcculloch-v-maryland

  McReynolds cites Marshall's opinion for the rule that a measure ostensibly carrying out a delegated power but aimed solely at matters reserved to the states is invalid.

• the-federalist-papers

  Madison's assurance in No. 45 that federal powers are few and defined, while those of the states are numerous, matches the premise of McReynolds's reasoning.

• gonzales-v-raich

  Eighty years later the Court upheld federal drug control over medical use under the Commerce Clause, a broader basis than the taxing power that bounded the Harrison Act.

Quotes

For Students

A reading companion for classical Christian high school students. See the student guide.

Reading Guide

Watch for

• The count against Linder and the quantity of tablets involved.
• The trial judge's instruction to the jury about catering to an appetite versus relieving pain.
• The paragraph that cites McCulloch v. Maryland and the Child Labor Tax Case.
• The sentence calling addicts diseased and proper subjects for treatment.
• How McReynolds restates the facts of Webb, Jin Fuey Moy and Behrman.

Key terms and names

Revenue measure

A law whose constitutional basis is the power to tax; the Court held the Harrison Act could be applied only in ways reasonably related to collecting its tax.

Bona fide

Latin for in good faith: genuine, without intent to deceive.

Count

One separately numbered charge in a grand jury's formal accusation; Linder was convicted on Count II alone.

Reserved powers

Powers not delegated to the national government, which remain with the states or the people under the Tenth Amendment.

Self-administration

A patient's taking a drug on his or her own rather than under a physician's direct supervision.

Seminar Questions

1. Comprehension What exactly did the grand jury's count accuse Dr. Linder of doing?
2. Comprehension On what constitutional ground does McReynolds say the Harrison Act must be read narrowly?
3. Comprehension How much of the drugs was involved in Behrman's case, according to the opinion?
4. Interpretation How does McReynolds reconcile his decision with Webb without overruling it?
5. Interpretation What role does the small quantity of tablets play in the Court's reasoning?
6. Big Question If a good end can be achieved only by a government exceeding its delegated powers, should the government refrain?

Faith Connections

• Luke 5:31 (Scripture)

  Jesus says that those who are whole need not a physician, but those who are sick, a saying that bears on the Court's description of addicted persons as proper subjects for medical care.

• Romans 13:1-7 (Scripture)

  Paul's teaching on governing authorities and the paying of tribute invites reflection on the proper scope of a taxing power.

Logic and Rhetoric

Central argument: Because the Harrison Act rests on the taxing power, it may reach medical practice only as far as tax enforcement requires; four small tablets given in good faith to an addicted patient do not threaten the revenue, and the earlier cases involved large-scale sales, so the count alleges no offense.

Rhetorical device: distinguishing precedent. McReynolds retells the facts of Webb, Jin Fuey Moy and Behrman, stressing the thousands of orders and doses in each, so that their broad language yields to the modest facts of Linder (quote 4).

Debate: Resolved: that a physician's good-faith judgment about treating addiction should be beyond the reach of federal criminal law.

Memory Work

Federal power is delegated, and its prescribed limits must not be transcended even though the end seems desirable.

Obviously, direct control of medical practice in the states is beyond the power of the federal government.

Writing Prompts

Essay: Explain how McReynolds uses the principle of delegated powers to decide a question about medical treatment, and assess whether the opinion depends more on constitutional structure or on the small quantity of drugs involved.

Comparison with Robinson v. California: Compare how Linder in 1925 and Robinson in 1962 describe addiction, and explain the different constitutional provisions each case relies on.

Medical Lens

Linder is the Court's clearest early statement that addiction is a disease within the proper sphere of medical treatment, and that a physician's good-faith provision of moderate doses to relieve an addicted patient's condition is medical practice rather than an illicit sale. It is a key document in the history of opiate maintenance, the closing of the post-1919 narcotic clinics and the long dispute between physicians and federal enforcement over who defines legitimate treatment.

• Opinion of the Court, paragraph beginning: Obviously, direct control of medical practice in the states is beyond the power of the federal government.

  Justice McReynolds holds that the act does not prescribe methods of treating addicts, calls them diseased and proper subjects for treatment, and declines to treat four small tablets as improper medicine.

  Addiction Opium Laudanum
• Opinion of the Court, discussion of Behrman: The opinion cannot be accepted as authority for holding that a physician

  The Court confines the 1922 Behrman decision so that physicians acting by fair medical standards may give moderate amounts for self-administration to relieve conditions incident to addiction.

  Addiction
• Opinion of the Court, the trial judge's charge beginning: If you are satisfied beyond a reasonable doubt that defendant knew that this woman was addicted

  The jury instruction distinguishes catering to an addicted person's craving from relieving pain the physician believed in good faith arose from another illness, showing how the line was drawn at trial.

  Addiction

Creative Prompts

• Classroom

  Stage the 1925 argument: one student argues for Dr. Linder that the count states no crime, another for the United States relying on Behrman, and the class as the Court decides what the earlier cases really held.

• Essay

  Write a one-page memo from a Treasury narcotics officer in 1925 explaining to field agents what Linder does and does not change.

• Dialogue

  Write a conversation between two Spokane physicians in 1922, one who believes some addicted patients need steady doses and one who favors immediate withdrawal.

• Essay

  Trace the phrase in the course of his professional practice only through Webb, Behrman and Linder, explaining how each case interpreted it.

Further Reading

• The American Disease: Origins of Narcotic Control, David F. Musto

  Places Linder within the Treasury's enforcement campaign and the closing of the narcotic clinics.

• The Drug Hang-Up: America's Fifty-Year Folly, Rufus King

  A lawyer's account of the Harrison Act cases, including a close reading of Linder.

• Dark Paradise: A History of Opiate Addiction in America, David T. Courtwright

  Describes the patients and physicians affected by the narcotics decisions of the 1910s and 1920s.