Instead, lawyers for the federal government and for Oregon, the only state to have authorized physician-assisted suicide, argued over a single question: whether John Ashcroft acted within his authority as attorney general when he decided in 2001 that doctors would lose their federal prescription privileges if they followed the Oregon law's procedures and prescribed lethal doses of lawful medications for terminally ill patients who wanted to end their own lives.
This is a straightforward question of federal administrative law, the bread and butter of the Supreme Court's docket. A federal appeals court ruled last year that in enacting the Controlled Substances Act in 1970, Congress did not give the attorney general the unilateral authority to penalize doctors who follow state law in prescribing federally regulated medications. The case, now known as Gonzales v. Oregon, No. 04-623, is the Bush administration's appeal.
Chief Justice John G. Roberts Jr. was an active participant in the questioning. He asked Solicitor General Paul D. Clement, who was defending the Ashcroft action, for "the closest analogy you have, other than this case," in which the attorney general had "impinged on" a state regulation of medical practice.
When Mr. Clement began to describe the Food and Drug Administration's effort some years ago to stop the use of laetrile, an anticancer drug that was permitted in 17 states, Chief Justice Roberts cut him off. "That's the F.D.A.," he said. "I'm talking about the attorney general under this statute."
Mr. Clement, an admired Supreme Court advocate who speaks without notes, at first said he could not think of an example. Then he offered the government's prohibition against using marijuana for medical purposes, which the Supreme Court upheld in June.
This drew an objection from Justice David H. Souter, who said that Congress's desire to stop "drug pushing and drug abuse in the conventional sense" did not support the government's position on assisted suicide.
Despite the clearly confined scope of the issue before the court, it was equally clear that there was background music to this case, deep questions of social policy and of federal-state relations that attracted dozens of briefs for both sides from medical professionals, elected officials, and religious and policy organizations.
Justice Antonin Scalia sparred with Robert M. Atkinson, Oregon's senior assistant attorney general, over how to interpret the Congressional silence on assisted suicide. Congress did not mention it, Justice Scalia said, because "I would have thought that a doctor using drugs to kill a patient was unthinkable" when the Controlled Substances Act was passed. His point was that the Congressional silence left room for administrative regulation.
Mr. Atkinson said that to the contrary, Congress passed the law against the "backdrop of 200 years of responsible regulation of the practice of medicine" by the states and should be understood as having left to the states the aspects of drug use that it did not address directly.
Congress expected in 1970 that medical practice would continue to evolve, Mr. Atkinson said, noting that acupuncture and the use of Botox, among other medical practices, are regulated by the states without federal intervention.
"Assisting people to die is totally different," Justice Scalia objected.
"I disagree," Mr. Atkinson said, adding that there was growing attention to "end-of-life issues," including living wills and "do not resuscitate" orders. Congress assumed that "states were to be trusted to act responsibly, and that's what Oregon has done here," he said.
The Death With Dignity Act was approved twice by Oregon's voters and took effect in 1997. It requires patients who want to end their lives, and doctors who want to help them, to follow particular procedures. Patients must have a life expectancy of less than six months, as determined by two doctors; must be mentally competent and not suffering from impaired judgment due to depression or another psychiatric disorder; must make an initial request to the doctor and then wait 15 days before making a written request that is witnessed by two people; and must be advised of all alternatives, like hospice care and pain management. The doctor prescribes the drugs but may not administer them.
As of the last reporting period in 2004, 326 patients had received prescriptions and 208 actually used the medications to end their lives. The law's supporters maintain that the law is beneficial even to those terminally ill people who do not use the drugs, because they gain peace of mind from knowing that the end of life is under their control.
Mr. Clement's argument had barely begun before Justice Sandra Day O'Connor asked him to explain why, given his position, the attorney general does not punish doctors who use lethal drugs to carry out death sentences.
"Would it be open to a new attorney general who had a very different view of the death penalty" to adopt a regulation subjecting those doctors to losing their prescription privileges, she wanted to know.
Mr. Clement replied that use of lethal drugs for executions had been "effectively ratified" by Congress in a federal death penalty law it enacted in 1994, leading Justice Souter to observe that the federal law did not specifically authorize doctors to administer lethal drugs.
The justices' questions about a change of mind by the attorney general reflected the history of the administration's current policy. In 1998, a group of members of Congress, including Mr. Ashcroft, who was then a senator from Missouri, asked Janet Reno, the Clinton administration's attorney general, to use federal enforcement power to block the new Oregon law.
She replied that she lacked the authority to do so, because "the federal government's pursuit of adverse actions against Oregon physicians who fully comply with that state's Death With Dignity Act would be beyond the purpose of the C.S.A.," the Controlled Substances Act. Senator Ashcroft then helped sponsor a bill to prohibit assisted suicide, which did not pass.
Acknowledging the history, Mr. Clement said to Justice O'Connor: "This is an area where there are different approaches."
Justice Ruth Bader Ginsburg asked the solicitor general how he could reconcile the government's current position with the Supreme Court's view eight years ago that the states could appropriately innovate with physician-assisted suicide. In that case, Washington v. Glucksberg, the court refused to find a constitutional right to a doctor's assistance in dying, but left the door open for states to develop their own policies.
The administration's brief in that case, Justice Ginsburg noted, invited such a result. "Now you are rejecting that position," she said.
"We stand by the brief in Glucksberg," Mr. Clement said.
Just before the argument began, a fleeting moment in the courtroom underscored the inherent drama in the chain of events that had lifted Chief Justice Roberts into the Supreme Court's center chair. A member of the Supreme Court bar approached the bench to move for the admission of a dozen graduates of Pepperdine Law School.
It was Kenneth W. Starr, the former solicitor general, whom Chief Justice Roberts had served as principal deputy. Mr. Starr, who was a federal appeals court judge while in his 30's, was once widely considered a leading candidate for a Supreme Court seat. Now he is dean of a law school that overlooks the Pacific Ocean in Malibu, Calif., about as far from the center of action as it is possible to be.
"Dean Starr," Chief Justice Roberts said in acknowledgment, as their eyes met briefly.
"Mr. Chief Justice and may it please the court," Mr. Starr began.