ORANGE COUNTY VOICES : Look at Instructions on Prolonging Life as Empowering Your Family : The Missouri right-to-die case makes clear communication on a person’s preferences even more vital.

When the U.S. Supreme Court recently handed down its opinion in the Nancy Cruzan case, I thought of my friend, Carson Milligan of Costa Mesa. In some ways, Nancy and Carson are similar: both in an irreversible coma, both sustained by a feeding tube inserted into their stomachs and both with loving, devoted families. Both had their fates decided for them, and it is here that the differences are striking.

Carson died on Father’s Day after his feeding tube was removed by the hospital and doctors, who agreed with his family that the tube met none of the proper goals of medicine: cure, comfort or care. It was merely prolonging his death, not enhancing his life.

Those who loved Carson knew he would not have wanted that. Carson had the good fortune to have talked about his wishes with his family before a ruptured aneurysm snuffed out his vibrant life. He also lived in California, a state that allows families to make decisions for incompetent patients based on their previously expressed wishes, or in their best interests if their wishes are unknown.

Things are different in Missouri, where Nancy Cruzan still lies in the dark space between life and death. There, the state Supreme Court has ruled that the state is in a better position to decide what Nancy would want than her parents because she left no “clear and convincing evidence” of her wishes. The U.S. Supreme Court found no constitutional right of Nancy or her parents that would forbid Missouri from holding this position.

The Missouri opinion is contrary to that of about all the other states that have ruled on this matter. It also seems extremely counterintuitive because most people say they would not want to be kept alive with a feeding tube if there were no hope for their return to consciousness. But such is the problem of deciding these issues in the courts: human needs get lost in legal structures.

What can we do to avoid similar problems? There are no guarantees, but I offer some suggestions.

For individuals:

* Think about it. Are there limits to the treatment you would want? Do you have some general guidelines that you want followed? Under what circumstances would you want or not want your life prolonged?

* Talk about it. We need to move conversations about death and dying from a taboo subject to a part of every family’s agenda. If a loved one has to make critical decisions for someone else, it is a comfort and empowerment to know what they want.

* Fill out a durable power of attorney for health care. This legal document enables us to express our wishes and name a person to make medical decisions on our behalf. California Health Decisions, a grass-roots organization, conducts workshops and has forms available. Their number is: (714) 647-4925.

For health professionals:

* Take the initiative to ask patients about their wishes before a crisis.

* Have materials available in doctors’ offices, hospitals and nursing homes to assist patients and families in thinking about the range of choices that are available to them.

* Develop policies and guidelines governing the use of life-sustaining procedures and make them known.

* Establish an ethics committee to help patients and health professionals resolve difficult cases.

For public officials:

* Ensure that the bonds of family and familiarity remain the gauge of patients’ wishes and best interests. Sensitive matters about when and how a patient dies are ordinarily best made at the bedside, not in the courtroom.

Carson Milligan’s family had the great comfort of knowing that they did what he would have wanted. They were able to grieve within the supportive circle of their many friends.

Nancy Cruzan’s parents bear the double tragedy of losing her and of being prevented from carrying out what they know would be her wishes. They are also forced to deal with their grief in public and with the devastating accusation from some quarters that they are trying to kill their daughter.

In this litigious, death-denying culture, it is getting harder to remember that dying is a natural part of the human story. Once we get that straight, we’ll be better able to recognize the transition that comes for each patient: the time when what they need far more than life-prolonging technology is our caring presence.