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A COLD RIGHT-TO-DIE DECISION SKIPS PATIENT'S BEST INTEREST RULING SHOWS THE IMPORTANCE OF A LIVING WILL

IN ITS first excursion into the right-to-die thicket, the U.S. Supreme Court has both heightened the importance of living wills and proved depressingly cold-blooded in dealing with the specific case at hand.

Broadly, the court did signal that there is a constitutional right to have life-sustaining systems removed when the wishes of the patient have been clearly delineated.

But it also handed down bad news for people who care about victims like 32-year-old Nancy Cruzan, who has been in a vegetative state for seven years. In denying her parents permission to remove a feeding tube, the court has kept them from letting her take the final small step in her journey toward death.

The decision did a good job of spelling out the cold legal niceties. It ruled, 5-4, that the state of Missouri was not acting unconstitutionally in requiring the high standard of "clear and convincing evidence" that Nancy wouldn't want to be kept alive as a vegetable. It said states didn't have to set that standard.

Somewhere, though, there should have been room in this case for compassion, human understanding and plain good sense.

Ms. Cruzan is long past speaking for herself, so there can be no evidence that will satisfy Missouri. She cannot control her own medical care. But can there be any real doubt that she would choose to die if given a moment of lucidity to understand her state and express her will?

States have a proper interest in sustaining life. Indeed, Missouri is paying $130,000 a year to maintain Ms. Cruzan. But that interest should not be extended to the point of keeping people alive for no other reason than that it is technically possible to do so.

As Justice John Paul Stevens wisely said in a dissent, the court majority permitted Missouri's "abstract, undifferentiated interest in the preservation of life to overwhelm the best interests" of Ms. Cruzan.

In his more enlightened 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 court's ruling makes it clear that people who want to avoid Ms. Cruzan's fate should do something about it while they are competent. At least 35 states have laws safeguarding the wishes of the hopelessly ill. Sadly, New York is not one of them. One remedy would be a law to specify what would constitute an effective living will, allowing people to attest to what medical steps they will, or will not, accept to stay alive. Another way would be a law allowing people to designate friends or relatives as health-care proxies to make medical decisions for them if they become incompetent.

There is more to come, both in the courts and in state capitals. The question of whether a state can constitutionally require the highest sort of evidence is but one piece of the puzzle. The "more challenging task" is crafting appropriate procedures "for safeguarding incompetents' liberty interests," wrote Justice Sandra Day O'Connor in a concurring opinion. That, she said, is in the hands of the states in the initial instance.

New York has not been a player so far. It is long past time this state stopped dodging the right-to-die issue.

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