The highest court in Massachusetts said in a decision Monday that allowing doctors to prescribe a lethal dose of medication to mentally competent patients with terminal illnesses is not protected by the state constitution.

“Although we recognize the paramount importance and profound significance of all end-of-life decisions, after careful consideration, we conclude that the Massachusetts Declaration of Rights does not reach so far as to protect physician-assisted suicide,” the Supreme Judicial Court wrote in its decision. “We conclude as well that the law of manslaughter may prohibit physician-assisted suicide, and does so, without offending constitutional protections.”

The high court, while noting the sensitive nature of the case, said the ultimate decision on physician assisted suicide — also known as medical aid in dying — lies with the state Legislature.

The court said “every one of us is free to vote and encourage our legislators to enact laws, and to craft appropriate procedural safeguards, with respect to one of the only human experiences that will affect us all.”

The suit was originally filed in 2016 by Dr. Roger Kligler, a retired physician with stage 4 prostate cancer, and another doctor who feared prosecution on manslaughter charges if he prescribed end-of-life medications to terminally ill patients.