Ruan's Hippocratic Hegemony: Physician Idiosyncrasy Should Not Determine Criminality

This Note advocates for congressional and state action to remedy the Supreme Court’s flawed 2022 decision in Ruan v. United States. This approach includes a modified return to the objective good faith defense established by the Controlled Substances Act of 1970 (CSA) and United States v. Moore, the 1975 seminal case that established that physicians could be prosecuted under 21 U.S.C. § 841. Ruan requires that the government show a defendant physician subjectively knew their conduct in issuing controlled substances was unlawful. This permits the substitution of an individual physician’s conception of acceptable medical practice in place of a generally agreed upon standard when a jury decides whether the physician prescribed in good faith. The Ruan decision is inconsistent with the text and intent of the CSA and the objective good faith defense standard established in Moore. Further, it is incongruous with the Supreme Court’s 2006 decision in Gonzales v. Oregon, which delegated authority to the states, not individual physicians, to determine the bounds of acceptable medical practice. Additionally, Ruan had the unintended consequence of exacerbating a treatment disparity between low-level drug couriers and physicians charged under the CSA. This Note argues that a comprehensive, uniform amendment to the CSA, state prescribing statutes, and federal agency prescribing guidelines clearly defining what constitutes lawful prescribing would fulfill the Ruan Court’s aims and maintain consistency with the CSA and the Supreme Court’s prior holdings. Simultaneously, it would prevent the inequity between drug couriers and physicians from intensifying.