Citation. 22 Ill.497 U.S. 261, 110 S. Ct. 2841, 111 L. Ed. 2d 224 (1990)
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Nancy Cruzan (Cruzan) was in a vehicular accident, which left her in a persistent vegetative state. When it became clear she would have no chance of regaining her mental faculties, Cruzan’s parents asked the hospital to terminate artificial nutrition and hydration procedures. After the hospital refused to honor this request, authorization was obtained from the state trial court. Thereafter, the Supreme Court of Missouri reversed the decision.
Synopsis of Rule of Law.
An individual has a constitutionally protected right to refuse or direct the withdrawal of death prolonging procedures. When determining whether this right has been violated, the court must balance the constitutional right against the relevant state interests.
Facts.
In January of 1983, Cruzan lost control of her vehicle and was discovered without detectable respiratory or cardiac function. She was placed in a Missouri hospital and remained in a persistent vegetative state in which she exhibited motor reflexes, but no indications of significant cognitive function. The State of Missouri bore the cost of her care. When it became apparent she would not regain use of her mental faculties, Cruzan’s parents asked hospital employees to withdraw life-sustaining procedures. After the hospital refused the request, the state trial court gave authorization for termination finding that a person in Cruzan’s condition had a fundamental right under the State and Federal Constitutions to refuse or direct the withdrawal of death prolonging procedures. The court also found that Cruzan had expressed to a friend that if she were sick or injured she would not wish to continue her life unless she could live at least halfway normally. The Missouri Supreme Court reversed the lower court’s decision by a divided vote. The court found Cruzan’s statements to her friend unreliable for the purpose of determining her intent and thus insufficient to support her co-guardians’ claim to substitute judgment on her behalf.
Issue.
a. Does an incompetent person via a surrogate have a Constitutional right to refuse or direct the withdrawal of death prolonging procedures? b. Does the State of Missouri’s requirement that an incompetent’s wishes as to the withdrawal of life-saving treatment be proven by clear and convincing evidence violate the United States Constitution (Constitution)?
Held.
Chief Justice William H. Rehnquist (J. Rehnquist) delivered the opinion of the Supreme Court.
Yes, an incompetent individual via a surrogate has a Constitutional right of privacy and a liberty interest under the Due Process clause to refuse or direct the withdrawal of death prolonging procedures.
No. The Constitution does not forbid this procedural requirement. When determining whether a person’s liberty interest under the Due Process clause has been violated, the court must balance the constitutional right against the relevant state interests. The State of Missouri relies on its interest in the protection and preservation of human life.
Concurrence.
Justice Antonin Scalia (J. Scalia) concurring. The test of the Due Process clause does not protect individuals against deprivations of liberty alone. It protects individuals against deprivations of liberty “without due process of law.” Starving yourself to death is no different than committing suicide as far as the common-law definition of suicide is concerned. It has always been lawful for private citizens and for the state to interfere with bodily integrity to prevent a felony.
Discussion.
The Supreme Court assumes for the purposes of this case that the Constitution grants a competent person a protected right to refuse lifesaving hydration and nutrition. However, an incompetent person (e.g., one in a persistent vegetative state) is not able to make an informed and voluntary choice to exercise this right or any other right. Therefore, the right to refuse lifesaving procedures has to be exercised through a surrogate. The State of Missouri’s evidentiary requirement has to be balanced against the constitutional right. The interest the State of Missouri has in its protection and preservation of human life cannot be undermined.
