Justices Grapple With 1st ‘Right-to-Die’ Case : Supreme Court: Conservatives doubt Constitution applies. Missouri decision could undercut state rulings.

For the first time, the Supreme Court grappled Wednesday with a disturbing question that thousands of family members, doctors and nurses face each year: Under what conditions can a profoundly ill or comatose person be allowed to die?

Since a 1983 auto accident, Nancy Beth Cruzan has lain unconscious and been fed through a surgically inserted tube. Her parents are asking that the tube be removed and that their daughter, now 32 years old, be allowed to die.

Attorneys for Missouri have sought to block her death, asserting the state’s “unqualified interest . . . in preserving life.”

During an unusually philosophical and wide-ranging argument, the justices peppered both sides with questions and, as usual, provided only clues as to how they would decide the issue.

The court’s conservative members, who frown on newly minted constitutional rights, expressed doubts that the Constitution gives persons an unquestioned “right to die.”

However, Justice Sandra Day O’Connor, the fifth and pivotal member of the conservative majority, appeared to be seeking a narrower ruling that would balance the interests of parents and the state through a court proceeding.

In several comments, O’Connor suggested that even though Cruzan’s parents deserve a chance to speak for the wishes of their unconscious daughter, a judge should make the final decision on whether terminating her treatment reflects the “best interest” of the patient.

The Cruzan case has attracted intense interest because her family’s plight is both tragic and, as a result of medical advances, relatively common.

Cruzan’s life was saved by the quick action of paramedics and emergency room doctors, but she suffered irreparable brain damage from the car crash. Like about 10,000 Americans, she is characterized as being in a “persistent vegetative state,” with no hope of recovery.

Moreover, studies have estimated that of the 1.3 million persons who die each year in medical centers, 70% expire after a decision is made either to halt or not to undertake extraordinary treatment.

Beginning with the 1976 case of Karen Ann Quinlan in New Jersey, state courts across the nation have declared that the Constitution provides a right to be free from unwanted medical care. Typically, these rulings have relied on high court statements about a “right to privacy” in matters such as birth control, marriage and abortion.

The Supreme Court has never addressed the issue of whether a person has a right to die. A broadly written decision in the Cruzan case, if fashioned by the high court’s conservatives, could undercut all those state court rulings.

However, a narrow decision could be limited only to Missouri. That state’s Supreme Court, in breaking with other state courts, said that the young woman cannot be allowed to die unless her parents could furnish “clear and convincing evidence” that she wishes all treatment to end.

Nancy Cruzan once had told friends that she would not like to exist on life-sustaining equipment in a hospital but the Missouri court said that evidence was not enough. Citing the same “right-to-life” philosophy that was at issue in the Missouri abortion case before the high court in the last term, the state judges said that they prefer to “err on the side of life” and keep the comatose woman alive.

On Wednesday, a lawyer for the Cruzans told the Supreme Court that state officials have intervened in the tragedy and blocked the wishes of the young woman and her family.

“The question is whether the state is going to decide this, or the person’s family is going to make the decision,” said William Colby, a lawyer from Kansas City.

Missouri Assistant Atty. Gen. Robert Presson countered: “This is not a situation of the state intruding into someone’s privacy. The question is: How do you decide for someone who can’t decide for herself?”

The Bush Administration’s top courtroom lawyer, Kenneth W. Starr, urged the justices to avoid a clear ruling on whether the Constitution creates a “right to die.” Rather, he said, the court should give the states “wide latitude” to make their own policies in this area.

Despite obvious disagreement among the justices, they appeared to be in accord on some points. The conservative members of the court--Chief Justice William H. Rehnquist and Justice Antonin Scalia--seemed to agree that a suffering or terminally ill patient has a right to die if she had earlier stated--perhaps in writing--her wish not to have extraordinary medical treatment.

At the same time, the court’s liberals did not object to the notion that the state could use a judicial proceeding to make sure that the decision to end medical treatment was in the “best interest” of the unconscious patient.

Throughout the argument, O’Connor kept probing for a middle ground, asking if the Constitution requires the state to let the nearest relative decide whether an unconscious patient can be allowed to die.

If the relatives need not make the decision alone, the state could create a judicial forum to hear evidence and decide whether a patient’s medical treatment or food can be removed.

Left unmentioned Wednesday was the fact that a judge had considered Nancy Cruzan’s plight during a trial. After hearing testimony from her family, her friends and a series of medical experts, Judge Charles Teel Jr. said that the young woman had no hope of recovery and would have wanted to die. In May, 1987, he issued an order allowing her feeding tube to be removed.

But the state Supreme Court, on a 4-3 vote, ignored the judge’s conclusions and overruled his order.

The Supreme Court likely will issue a ruling in the case (Cruzan vs. Missouri Dept. of Health, 88-1503) in the spring.