Oct. 7 (Bloomberg) -- Scott Rice traveled 2,000 miles to hear a case argued at the U.S. Supreme Court this week. Once there, he had a hard time sitting still.

``I wanted to stand up and scream,'' he said.

Specifically, he wanted to yell at the justices for getting it all wrong.

Rice is no lawyer, but he knows about Oregon's Death with Dignity Act, which the court is deciding whether to let live. His wife, Colleen, used it to end her losing fight with cancer five years ago.

Approved twice by voters, the law makes Oregon the only state that allows doctors to prescribe lethal drugs to terminally ill patients who want them.

Whether suicide is moral or whether suffering people should be offered a peaceful exit are not the issues the court is pondering.

The legal question is who gets to decide whether dying patients can get medical help to end their lives. Do individual states, which have always regulated medical practices? Or does the country's chief law enforcer, the attorney general of the U.S.?

Put another way, does the federal anti-drug-abuse law give the attorney general the right to halt a medical practice a state has approved?

Who's In Charge?

It sounds like a legalistic, bloodless debate for an issue that ignites passions. And yet the question of who is in charge bears upon emotional and spiritual concerns, too. Who, indeed, gets to say how we end our lives?

The answer seemed clear back in 2001, after then-Attorney General John Ashcroft reached into Oregon to try to choke the state law, only to be blocked by a lawsuit.

``To allow the attorney general -- an appointed executive whose tenure depends entirely on whatever administration occupies the White House -- to determine the legitimacy of a particular medical practice without a specific congressional grant of such authority would be unprecedented and extraordinary,'' ruled U.S. District Judge Robert E. Jones of Portland, an appointee of President George H.W. Bush.

With that unequivocal start, the case has been getting muddier ever since. A panel of the 9th U.S. Circuit Court of Appeals affirmed Jones' decision, 2 to 1.

The Slope

Now, at the highest court, clarity is getting obscured by that ubiquitous feature of legal landscape, the slippery slope.

Would letting the Oregon law stand mean states could legalize other kinds of drug use that federal law enforcement opposes, like steroids for body building, justices wanted to know.

Ashcroft claimed authority under the U.S. Controlled Substances Act, the central weapon in the nation's long-running war on drugs. It lists drugs that are always forbidden, such as marijuana, and drugs that can be prescribed, such as the barbiturates that Colleen Rice took.

Doctors can prescribe drugs only for ``legitimate medical practices,'' the law says. And that's where Ashcroft stepped in.

He and his successor, Alberto Gonzales, say there's nothing medically legitimate about helping someone die. They say the attorney general can lift prescription-writing licenses of any physician who does so, regardless of state law.

Justice Sandra Day O'Connor clearly disagreed when the case was argued this week.

``Certainly the practice of medicine by physicians is an area traditionally regulated by states, is it not?'' she asked U.S. Solicitor General Paul Clement.

``It absolutely is,'' he acknowledged.

Morphine and Steroids

But he went on to add the feds aren't looking to take over the regulation of medicine. All they want is to enforce U.S. drug laws.

When Oregon's lawyer stood to argue, O'Connor asked what would happen if a state were to allow doctors to prescribe morphine for depression or steroids for bodybuilding. ``Could the attorney general say that's drug abuse?''

O'Connor, openly friendly to Oregon's position in the case, was probably looking for a yes answer to discourage whatever trips onto the slippery slope her colleagues were considering. That isn't what she got.

``If it was regulated by state law,'' the U.S. attorney general could not declare such a prescription to be drug abuse, replied Robert Atkinson, Oregon senior assistant attorney general. This was a play for broader state authority than even friendly justices appeared willing to grant.

Slipping on the Slope

Justice Stephen Breyer, also seemingly pro-Oregon, invited Atkinson to argue for something narrower, to give states authority over something like assisted suicide without stretching it into more abusive drug use, which would bring in the feds. Atkinson wouldn't go for it.

This led the court to worry further about that slippery slope.

``If one state can say it's legal for doctors to prescribe morphine to make people feel better, or to prescribe steroids for body building, doesn't that undermine the uniformity of federal law and make enforcement impossible?'' asked Chief Justice John G. Roberts Jr.

All that talk of morphine and steroids is what got to Rice, who had come to Washington from Portland, Oregon.

No Tour de France

``This was not about recreational narcotics,'' Rice said he wanted to scream at the bench.

His 67-year-old, ailing wife was hardly planning to dance the night away on Ecstasy, nor was she training for the Tour de France when she took the barbiturates her doctor had prescribed at her request. All she wanted was to die peacefully and not struggle each day simply to breathe.

Rice hopes the justices can see the difference.

He's no lawyer but Rice correctly sensed that that line defines the difference between a state law that lets Oregonians ease their own dying and some federal official in Washington saying they can't.

To contact the writer of this column: Ann Woolner in Atlanta at awoolner@bloomberg.net.

Last Updated: October 7, 2005 09:33 EDT