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Cruzan V. Director, of Missouri Department of Public Health

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CRUZAN, BY HER PARENTS AND CO-GUARDIANS v. DIRECTOR, MISSOURI DEPARTMENT OF HEALTH

SUPREME COURT OF THE UNITED STATES
497 U.S. 261
June 25, 1990, Decided

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Petitioner Nancy Beth Cruzan was rendered incompetent as a result of severe injuries sustained during an automobile accident. Co-petitioners Lester and Joyce Cruzan, Nancy's parents and co-guardians, 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.

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Cruzan was appealed to the U.S. Supreme Court, which affirmed (5-4) the Missouri decision, on the grounds that an incompetent person does not have the same constitutionally protected right as a competent person to refuse life sustaining treatment. In such cases a state may, but is not required to, recognize a family's decision making role, and may require clear and convincing proof of a patient's determination to forgo hydration and nutrition.

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The Cruzan decision disappointed those who had hoped that the Supreme Court would find that families have a constitutional right to terminate a patient's life support. The American Medical Association has supported substituted decision making for termination of life support, both because of concern with family suffering and because it is convenient for the physicians. The dissent in Cruzan implied that without substituted decision making, physicians would be forced to keep most patients in critical care alive forever.