The Supreme Court, in its first ruling in a "right-to-die" case, said Monday that states may bar the removal of life-sustaining treatment from comatose patients who have not made or cannot make their desires known.
By a 5-4 vote, the justices blocked the parents of a permanently unconscious Missouri woman, Nancy Cruzan, from ordering the removal of tubes that provide her with food and water.The court said Cruzan's rights were not violated by allowing the state's interest in preserving life to outweigh her parents' wishes.
But the court, indirectly supporting so-called "living will" laws, said the Constitution guarantees a competent person a right to refuse medical treatment. That issue was not presented squarely in the Cruzan case since she is incompetent to decide her future, the court said.
The parents, Joe and Joyce Cruzan, left a message on the answering machine at their Cartersville, Mo., home that the family will have no reaction until they have had time to analyze the ruling.
But Dick Kurtenbach, who has worked with the Cruzans as head of the Kansas City, Mo., office of the American Civil Liberties Union, commented:
"When we looked at it realistically, and with the recent history of the court, this is not that surprising.
"I'm sure the family is going to be extremely disappointed."
Speaking for the American Medical Association, Dr. Nancy Dickey, a Richmond, Texas, family physician and a trustee of the AMA, said of the decision:
"We feel it is an intrusion into the doctor-patient relationship and a step toward taking that decision away from the bedside. . . . We should not deliver unnecessary care and pay for unnecessary care."
Dickey spoke with reporters at an AMA policymaking conference in Chicago.
Doctors have said Cruzan, 32, could live for 30 more years in her current "persistent vegetative" condition.
Chief Justice William H. Rehnquist, writing for the court, said Missouri may require "clear and convincing" proof that Cruzan wants to die before allowing the withdrawal of life-sustaining treatment. Such evidence is lacking in Cruzan's case, he said.
He was joined by Justices Byron R. White, Sandra Day O'Connor, Antonin J. Scalia and Anthony M. Kennedy.
Dissenting were Justices William J. Brennan, Thurgood Marshall, Harry A. Blackmun and John Paul Stevens.
Brennan, in an opinion joined by Marshall and Blackmun, said, "Nancy Cruzan is entitled to choose to die with dignity."
Missouri and the Supreme Court "have displaced Nancy's own assessment of the processes associated with dying," Brennan said.
More Supreme Court decisions
In other decisions Monday, the court:
- Said the Barnwell Islands belong to South Carolina and not Georgia.
- Refused to free Communications Satellite Corp. from having to refund $38.8 million to its customers.
- Refused to revive a 14-year-old lawsuit by a Texas oil refinery's black employees who say they are victims of racial discrimination.
- Refused to exempt the mining industry from some federal environmental rules for treating, storing and disposing of hazardous waste.
- Agreed to decide who - the secretary of labor or a safety and health review board - has the last word on what federal regulations require for on-the-job safety.