Should the state make life-or-death medical decisions?

The case of Terri Schiavo, which the Florida high court hears Tuesday, will help establish procedures in future cases.

A six-year legal dispute over whether to terminate the life support of a severely brain-damaged Florida woman has placed the state's highest court at the center of a bitter clash between the right to live - and the right die.

Ultimately at issue in the case of Terri Schiavo is whether the nutrition tube that sustains her life should remain connected. But what will occupy a lion's share of the argument Tuesday as her case is considered by the Florida Supreme Court is whether state lawmakers and Gov. Jeb Bush overstepped their constitutional authority last fall when they intervened to reattach Mrs. Schiavo's nutrition tube after a state judge had ordered it disconnected.

More precisely, the justices must consider competing provisions of the Florida Constitution. On one hand, the constitution recognizes a strong government interest in preserving life. On the other hand, the same document guarantees that Floridians may make private healthcare decisions - including the refusal of medical treatment - without facing government interference.

Schiavo's case resides at the turbulent intersection of faith, ethics, the law, and medicine. It has attracted national attention in part because the life-or-death issues break along the same ideological fault lines that divide the nation over legalized abortion.

But the case is also important because it will help establish procedures to be used in future life-or-death cases involving individuals who are unable to communicate a desire to live or die. "Everybody has their own ideological ax to grind in this case," says Jon Eisenberg, an Encino, Calif., lawyer who filed a friend-of-the-court brief on behalf of 55 bioethicists.

The case pits death-with-dignity supporters against pro-life advocates. It pits the Florida judiciary against Governor Bush and conservative state lawmakers. And it pits Schiavo's husband, Michael, against her parents, Mary and Robert Schindler.

Mrs. Schiavo was in her 20s when a medical emergency left her in her current condition. For 14 years she has been fed by way of a nutrition tube. It is surgically implanted in her stomach.

She did not have a living will and is unable to communicate whether she wants to continue living. But Florida law allows the courts to make a determination of her intent based on the testimony of others.

Mr. Schiavo and two other witnesses testified that Terri had earlier indicated she would never want to be kept artificially alive. Mr. Schiavo favors removing the nutrition tube and allowing his wife to pass away.

Mrs. Schiavo's parents want to take over her care and increase the level of treatment she receives. They ask whether Mr. Schiavo has a conflict of interest since he is the sole beneficiary of her estate and lives with a longtime girlfriend with whom he has two children.

Nonetheless, during six years of litigation, the Florida courts (both at the trial and appeals court level) have consistently ruled in Mr. Schiavo's favor, finding that Terri wants to end her life.

Scott Solkoff, chairman of the elder-law section of the Florida Bar, filed a friend-of-the-court brief objecting to the last-minute intervention of the Legislature and governor. He says the governor's action violates the separation of powers by usurping a role reserved for judges.

"I trust the judicial system," he says. "The judge in this case heard all the facts and heard from all sides. We have to defer to that system," Mr. Solkoff says.

William Saunders, director of the Center for Human Life and Bioethics at the Family Research Council in Washington, takes a different view. "If Terri's intent had been clear in a living will, that would be the end of it," he says. "But without a written document, I think an extra layer of review is appropriate."

Under special legislation adopted last fall called "Terri's Law," the Schiavo case would be reopened.

"When the consequence is death, we have to do all we can to determine intent," says Mr. Saunders. "[Terri's Law] doesn't prejudge the outcome. It just requires another level of review of her intent."

Others see it as a stalling tactic and an abuse of power by elected officials trying to undermine a difficult and controversial judicial decision.

"There is no doubt on the part of the Florida judiciary how this case should be resolved," says Mr. Eisenberg. "I understand it is very painful for the Schindlers, but that is not a basis for turning our back on the way we resolve tough questions in this country."

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