updated 3/23/2005 4:57:04 PM ET 2005-03-23T21:57:04

The Supreme Court ruled in 1990 that a terminally ill person in a “persistent vegetative state” has a constitutional right to decline life-sustaining treatment.

But the 5-4 opinion written by Chief Justice William H. Rehnquist also held that the right was not absolute, saying a state may impose a higher legal burden on a family to show a patient had actually consented by “clear and convincing evidence.”

The ruling returned the case of Nancy Cruzan to Missouri state court, which eventually determined the comatose woman indeed had indicated she wanted to die. She died 12 days after her feeding tube was removed at her family’s request. Five of the nine justices in that case remain on the court. Here are excerpts from their opinions, concurring and dissenting:

Chief Justice Rehnquist
Rehnquist: “Close family members may have a strong feeling, a feeling not at all ignoble or unworthy, but not entirely disinterested, either, that they do not wish to witness the continuation of the life of a loved one which they regard as hopeless, meaningless, and even degrading.

“But there is no automatic assurance that the view of close family members will necessarily be the same as the patient’s would have been had she been confronted with the prospect of her situation while competent.”

Sandra Day O’Connor
“Today we decide only that one state’s practice does not violate the Constitution; the more challenging task of crafting appropriate procedures for safeguarding incompetents’ liberty interests is entrusted to the ’laboratory’ of the states in the first instance.”

Antonin Scalia
“While I agree with the court’s analysis today, and therefore join in its opinion, I would have preferred that we announce, clearly and promptly, that the federal courts have no business in this field, that American law has always accorded the state the power to prevent, by force if necessary, suicide. ... The point at which life becomes ’worthless,’ and the point at which the means necessary to preserve it become ’extraordinary’ or ’inappropriate,’ are neither set forth in the Constitution nor known to the nine justices of this court any better than they are known to nine people picked at random from the Kansas City telephone directory.”

John Paul Stevens
“In my view, the Constitution requires the state to care for Nancy Cruzan’s life in a way that gives appropriate respect to her own best interests. ... The meaning and completion of (Cruzan’s) life should be controlled by persons who have her best interests at heart — not by a state legislature concerned only with the ’preservation of human life.’

“However commendable may be the state’s interest in human life, it cannot pursue that interest by appropriating Nancy Cruzan’s life as a symbol for its own purposes.

“Because Nancy Beth Cruzan did not have the foresight to preserve her constitutional right in a living will, or some comparable ’clear and convincing’ alternative, her right is gone forever and her fate is in the hands of the state legislature instead of in those of her family, her independent neutral guardian ad litem, and an impartial judge.”

Justice Anthony Kennedy joined the majority opinion without comment.

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