Cruzan v. Missouri, 497 U.S. 261 (1990)

Nancy Cruzan is the first case in which the Supreme Court of the United States (the Court) had to decide on the issue of ‘‘right to die’’ under the U.S. Constitution. In a five to four decision, the Court struggled to balance individual rights with state interests.

In January 1983, Nancy Cruzan lost control of her car in a serious accident. Her breathing and heartbeat were recovered; however, she remained in a coma for approximately three weeks before she progressed to an unconscious state. Surgeons implanted a gastrostomy feeding and hydration tube to ease feeding, but subsequent rehabilitative efforts failed to recover her from the so-called persistent vegetative state, in which she ‘‘exhibits motor reflexes but evinces no indications of significant cognitive function.’’ Seeing no chance of regaining her mental faculties, Cruzan’s parents asked a court authorization to terminate the artificial nutrition and hydration.Recognizing her medical condition, the trial court believed that Nancy Cruzan had a fundamental right under bothMissouri and U.S. Constitutions to ‘‘refuse or direct the withdrawal of ‘death prolonging procedures.’’’ The trial court also found reliableCruzan’s conversation with a housemate friend, in which Nancy Cruzan expressed her unwillingness to continue her life if she could not ‘‘live at least halfway normally.’’ The Missouri Supreme Court reversed and refused to read the State Constitution so broadly to support a person’s right to terminate medical treatment in every circumstances. Rather, the Missouri Supreme Court found the roommate’s story unreliable and held that there was not ‘‘clear and convincing’’ evidence to support the termination.

In a close call, the Court affirmed the State Supreme Court’s decision. First, reviewing relevant state cases, the Court found that the common-law doctrine of informed consent is always viewed as encompassing a competent individual’s right to refuse medical treatment. However, reluctant to establish such a doctrine under the Constitution, the Court simply ‘‘assumed’’ that the U.S. Constitution would grant a similar right to a competent person. Second, the Court refused to extend such a right to incompetent persons and held that states may adopt certain procedural requirements to safeguard relevant state interests. In the present case, after a balance, the Court validated Missouri’s claimed interest in ‘‘the protection and preservation of human life’’ and approved Missouri’s imposition of heightened evidentiary requirements (that is, the incompetent’s wish to withdraw treatment must be proved by ‘‘clear and convincing’’ evidence) against potential abuses that might result harsh erroneous decisions. Justice O’Connor filed a separate concurring opinion and clarified her belief that a right to refuse unwanted medical treatment might be inferred from the Constitution. In another concurring opinion, Justice Scalia traced the traditional opposition of suicide by states and struggled with the distinction between action (for example, suicide) and inaction (right to refuse treatment). Rather, Justice Scalia believed that this is not a proper issue for the Constitution. Justices Brennan, Marshall, and Blackmun dissented. They argued that Nancy Cruzan ‘‘has a fundamental right to be free of unwanted artificial nutrition and hydration,’’ and her incompetent condition does not deprive her of such a right. The state’s general interest in the preservation of life cannot subdue Nancy Cruzan’s particularized interest, and the procedural obstacles placed by the Missouri Supreme Court imposed an impermissible burden on Nancy Cruzan’s right. Compared with the majority, the dissenters would clearly assign more weight to evidence provided by family members and friends in determining Cruzan’s personal wishes. Justice Stevens filed a separate dissenting opinion and argued that the State Supreme Court’s decision totally ignored Nancy Cruzan’s best interests. Rather, the state should have given appropriate respect to her best interests when it evaluated evidence based on the ‘‘clear and convincing’’ standard.

Six months after the Court’s ruling, Nancy Cruzan died after her family and friends presented new evidence and the judge ruled that there was clear evidence to show her wishes. The significance of Nancy Cruzan lies in the fact that the Court recognized a competent patient’s right to terminate medical treatment, although states may impose necessary protection procedures to incompetent patients. However, the Court refused to go one-step further to honor active euthanasia or physician-Assisted Suicide (see Washington v. Glucksberg, 521 U.S. 702 (1997); Vacco v. Quill, 521 U.S. 793 (1997)), leaving the line between active and inactive euthanasia arguable. Nancy Cruzan and later relevant cases showed a continuous weighing by the courts the value of life against the value of death and what is the meaning of diminished human lives to the incompetent patients.

BIN LIANG

References and Further Reading

• Angell, Marcia. ‘‘The Supreme Court and Physician- Assisted Suicide—The Ultimate Right.’’ The New England Journal of Medicine 336 (1997): 50–53.
• Annas, George J., The ‘‘Right to Die’’ in America: Sloganeering from Quinlan and Cruzan to Quill and Kevorkian, Duquesne University Law Review 34 (1996): 875–897.
• Baggett, Sandy D., In Search of a Right to Die: Preventing Government Infliction of Pain, University of Tennessee Law Review 65 (1997): 245–292.
• Bopp, James Jr., and Daniel Avila, The Due Process ‘‘Right to Life’’ in Cruzan and its Impact on ‘‘Right-to-Die’’ Law, University of Pittsburgh Law Review 53 (1991): 193–233.
• ———, Perspectives on Cruzan: The Siren’s Lure of Invented Consent: A Critique of Autonomy-Based Surrogate Decisionmaking for Legally-Incapacitated Older Persons, Hastings Law Journal 42 (1991): 779–815.
• Martyn, Susan R., and Henry J. Bourguignon, Perspective on Cruzan: Coming to Terms with Death: The Cruzan Case, Hastings Law Journal 42 (1991): 817–858.
• Robertson, John A., Cruzan and The Constitutional Status of Nontreatment Decisions for Incompetent Patients, University of Georgia Law Review 25 (1991): 1139–1203.
• Ronzetti, T. A. Tucker, Constituting Family and Death Through the Struggle with State Power: Cruzan v. Director, Missouri Department of Health, University of Miami Law Review 46 (1991): 149–204.

Cases and Statutes Cited

• Vacco v. Quill, 521 U.S. 793 (1997)
• Washington v. Glucksberg, 521 U.S. 702 (1997)