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Cruzan v. Director, Missouri Dept. of Health

Citation. 497 U.S. 261, 110 S. Ct. 2841, 111 L. Ed. 2d 224, 1990 U.S.
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Brief Fact Summary.

Nancy Cruzan’s (Ms. Cruzan) parents sought to withhold medical treatment from their vegetative daughter, but were denied because of insufficient evidence of Nancy’s intent. Ms. Cruzan’s parents now bring suit on her behalf, alleging she has a liberty interest in withdrawal of treatment.

Synopsis of Rule of Law.

States are given wide latitude in determining how they give rights to patient surrogates.


Missouri denied the withdrawal of treatment request because Ms. Cruzan’s parents could not establish Ms. Cruzan’s wishes regarding such withdrawal by clear and convincing evidence. Ms. Cruzan had a discussion with a friend who testified in court that she said she would not want to be on life support, but this was the only evidence of her personal wishes.


Does Missouri have a legitimate state interest in tempering the liberty interests of incompetent patients?


Yes. Appeals Court ruling affirmed.
Chief Justice William Rehnquist (J. Rehnquist) notes that unwanted medical treatment is considered a battery at common law. Hence, it is clear that there must be a liberty interest to refuse medical treatment. However, the treatment must be unwanted by the patient.
Missouri is free to choose whether or not they will accept a surrogate for an incompetent’s medical decisions, but they are free to establish the standard by which they do so. That is a legislative, not judicial choice.


Justice William Brennan (J. Brennan) dissents, arguing that the State interest cannot outweigh Ms. Cruzan’s liberty interest in having treatment withheld.
Justice Sandra Day O’Connor (J. O’Connor) concurs, emphasizing that the Supreme Court of the United States (Supreme Court) did not have to decide whether a State must abide by the decisions of a medical surrogate.
Justice Antonin Scalia (J. Scalis) concurs, but writes separately to state his opinion that the federal courts have no place making substantive decisions in this area, that this police power has always been afforded to the States.


While the Supreme Court decides there is a liberty interest in requesting to withdraw treatment, the Ms. Cruzan’s family is not afforded the remedy they hoped for, as the Supreme Court also ruled that Missouri has a state interest in determining how that liberty interest is to be applied in the case of an incompetent.

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