Cruzan v. Director, Missouri Department of Health

Brief Fact Summary.

Petitioner was rendered incompetent as a result of severe injuries sustained during an automobile accident. Her parents sought a court order directing the withdrawal of their daughter’s artificial feeding and hydration equipment after it became apparent that she had virtually no chance of recovering her cognitive faculties.

Synopsis of Rule of Law.

The Due Process Clause protects an interest in life as well as an interest in refusing life-sustaining medical treatment.

Facts.

Nancy Cruzan lost control of her car and she was found to have permanent brain damage. It is estimated that Cruzan was deprived of oxygen from 12 to 14 minutes. Surgeons implanted a gastrostomy feeding and hydration tube in Cruzan with the consent of her husband. Subsequent rehabilitative efforts proved unavailing. She lies in a Missouri state hospital. There is no indication of significant cognitive function in her. After it had become apparent that Nancy had virtually no chance of regaining her mental faculties her parents asked hospital employees to terminate the artificial nutrition and hydration procedures. The employees refused to honor the request without court approval. The parents then sought and received authorization from the state trial court for termination. The Supreme Court of Missouri reversed.

Issue.

May a State court refuse to allow individuals to terminate their life?

Held.

No, an incompetent person is not able to make an informed and voluntary choice to exercise a hypothetical right to refuse treatment or any other right. Such a right must be exercised for her by some sort of surrogate. Here, Missouri has established a procedural safeguard to assure that the action of the surrogate conforms as best it may to the wishes expressed by the patient while competent. This state establishment of procedural requirement is constitutional.

Dissent.

Justice Brennan

Nancy is entitled to choose to die with dignity. Though the right to be free of unwanted medical intervention may not be absolute, no State interest could outweigh the rights of an individual in Nancy’s position.

Concurrence.

Justice Scalia

The federal courts have no business in the field at issue. American law has always accorded the State the power to prevent, by force if necessary, suicide including suicide by refusing to take appropriate measures necessary to preserve one’s life. It is up to the citizens of Missouri to decide, through their elected representatives, whether the choice will be honored. It is quite impossible that those citizens will decide upon a line less lawful than the one the Court would choose and it is unlikely that they will decide upon a line less reasonable.

Discussion.

Missouri may legitimately seek to safeguard the personal element of the choice through the imposition of heightened evidentiary requirements. The Due Process Clause protects an interest in life as well as an interest in refusing life-sustaining medical treatment. Not all incompetent patients will have loved ones available to serve as surrogate decision-makers. Even where family members are present, there will be some unfortunate situations in which family members will not act to protect a patient. A State is entitled to guard against potential abuses in such situations. A State is also entitled to consider that a judicial proceeding to make a determination regarding an incompetent’s wishes may not be an adversarial one, with the added guarantee of accurate fact-finding that the adversary process brings with it. Finally, a State may properly decline to make judgments about the quality of life that a particular individual may enjoy and simply assert an unqualified interest in the preservation of human life to be weighed against the constitutionally protected interests of the individual.