Cruzan v. Missouri Department of Health

Newer Laws and Protests

At the time that this case took place, there were about 10,000 people in this country who were also in a persistent vegetative state. Their families didn't know if they or anyone, could decide to end their lives. This landmark case has recognized that right, but has left it up to the states to create their own standards.

On the night that doctors removed Nancy Cruzan's feeding tube, there were various groups of people who went to the hospital and protested. "Right-to-life advocates" argued that removing the feeding tube and starving Cruzan to death, devalued life. Although there were a lot of people who diagreed with the final verdict, there were many who agreed.

More recently, there have been laws made in some states that legalize assisted suicide (CA, OR, CO, WA, VT, MT, and DC.) In most states, the right to refuse medical treatment with enough "clear and convincing" evidence, and the right to passive euthanasia has been secured. Other countries, such as Belgium, Canada, Finland, Germany, Luxembourg, the Netherlands, and Switzerland, have also legalized assisted suicide.

People Involved

The fight to secure the "right-to-die" is an ongoing one. The Cruzan v. Missouri case was only a first step in this fight, and we will definitely see more on this in the future.

Arguments and Opinions

Nancy Beth Cruzan, and her parents Lester and Joyce Cruzan, versus the Director of the Missouri Department of Health, et al.

Missouri argued that it is strongly concerned with preserving life, so requiring "clear and convincing" evidence of the person's wishes is necessary. Also, that no matter the person, removing the feeding tube would be considered murder under Missouri Law.

The Cruzan family argued that they should be able to consult with the doctors and make the decision about ending medical treatment. They said that the Missouri Supreme Court didn't consider the suffering that Nancy Cruzan and her family had gone through, and only looked at the general situation.

Nancy Cruzan was left mentally incompetent after a car crash in 1983. Her parents were her petitioners in court, who fought to get an order for the doctors to remove her feeding tube.

The doctors at the Missouri hospital that Cruzan was at, refused to remove her feeding tube because it would kill her. They said that people would see it as immoral, and would not do it unless the court approved.

Overview

Supreme Court

Missouri State Courts

The Cruzans first went to the trial court to get an order, granting permission for the removal of Nancy Cruzan's feeding tube. The trial court authorized this, saying that she had a fundamental right to refuse the treatment. And, that it was enough "clear and convincing" evidence, that she had expressed to her friend that she would not like to continue living is she could not live at least halfway normally.

In a 5-4 decision, the Supreme Court affirmed what the Missouri Supreme Court had ruled.

Majority Opinion: They decided that a competent person has a right to refuse medical treatment, but in this case, Nancy Cruzan was mentally incompetent so she could not have the same right, because she could not make an informed choice. They found that Missouri requiring "clear and convincing" evidence of what the person would want if they could make their own decisions is constitutional because families wouldn't always make the right decision for the person, and this decision is an irreversible one.

Dissenting Opinions: Four justices dissented, saying that Nancy Cruzan was being denied of her freedom to choose to refuse medical treatment, and that that choice should be made by the people who knew what she would want, not by the state, who was only concerned with the preservation of life.

The Missouri Supreme Court then reversed this decision. The court recognized the right to refuse treatment in the common law, but they didn't believe that it was totally applicable in this case. They also decided that Missouri's Living Will statue expressed a strong policy towards preserving life and that Cruzan's statement to her friend wasn't enough to determine what she wanted. And, they decided that her parents could not make that choice for her.

Two months after the Supreme Court's decision was made, the Cruzan family asked for another trial to be held. Three of Nancy Cruzan's coworkers presented new evidence, saying that she had previously stated she wouldn't want to "live like a vegetable", and her doctor recommended the feeding tube to be removed. The trial court approved their request to remove the feeding tube, saying that there was enough "clear and convincing" evidence. The removal was done soon after, and Nancy Cruzan died twelve days later.

Cruzan v. Missouri Department of Health

Cruzan v. Missouri Department of Health, took place in 1990, and it was the first "right to die" case ever heard by the Supreme Court. Nancy Cruzan was in a major car accident (1983) when she was just 25 years old. She suffered crippling injuries and was without oxygen for 15 minutes, which resulted in severe brain damage. She was given CPR and was put on life support. After a month, the doctors declared that she was in a "persistent vegetative state", which means that she had no brain function and couldn't respond to her environment, and it would be virtually impossible for her to recover. Four years later, her parents requested to take her off life support. The doctors refused saying that it would be illegal and immoral. Her parents then went to the Missouri trial court to get an order to allow the doctors to take her off life support...

Previous Laws

“A State may condition the exercise of a patient’s right to terminate life-sustaining treatment on a showing of clear and convincing evidence of the desire of the patient to exercise such a right.”

Missouri Common Law

Research Questions

(by precedent)

If this was the first "right to die" case ever heard by the Supreme Court, what Missouri laws already existed about euthanasia and the right to refuse lifesaving medical treatment?

William H. Colby (the Cruzan's advocate in court) stated that the "Due Process Clause" of the 14th Amendment "protects a individual, conscious or unconscious, from such invasion by the state," refering to the state forcing her to her to have medical treatment.

Does the Constitution protect the right for someone to end their own life? And, can a state order someone to receive certain medical treatment when it is against the person's or the family's wishes?

The Constitution protects the right to be free from state intrusion (the doctors could not force her to take food and water.)

Sources

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• “Cruzan by Cruzan v. Director, Missouri Department of Health.” Legal Information Institute, Cornell Law School, www.law.cornell.edu/supremecourt/text/497/261
• Lewin, Tamar. “Nancy Cruzan Dies, Outlived by a Debate Over the Right to Die.” The New York Times, The New York Times, 27 Dec. 1990, www.nytimes.com/1990/12/27/us/nancy-cruzan-dies-outlived-by-a-debate-over-the-right-to-die.html.
• 'Missouri Department of Health and Senior Services.” Dept. of Health Logo, health.mo.gov/.
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• Gladwell, Malcolm. “Court Rules Woman Has Right to Die; Cruzan Case Leaves Unresolved Issues, Legal Experts Say.” HighBeam Research - Newspaper Archives and Journal Articles, The Washington Post, 15 Dec. 1990, www.highbeam.com/doc/1P2-1163974.html.
• Lumas, Edward. “With 'Right to Die' Laws, Guard against Abuse: #Tellusatoday.” USA Today, Gannett Satellite Information Network, 23 Oct. 2015, www.usatoday.com/story/opinion/2015/10/22/right-die-laws-assisted-suicide-tellusatoday-your-say/74429342/.
• “Cruzan v. Director, Missouri Dept. of Health, 1990.” Prentice Hall Bridge , www.phschool.com/curriculum_support/interactive_constitution/scc/scc08.htm.
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• Wester, Madeleine. “Opinion: Death with Dignity.” The Charger Account, 16 Nov. 2015, thechargeraccount.org/29358/features/opinion-death-with-dignity/.
• “Euthanasia & Physician-Assisted Suicide (PAS) around the World .” ProCon, 20 July 2016, euthanasia.procon.org/view.resource.php?resourceID=000136.
• “Legality of Euthanasia.” Wikipedia, Wikimedia Foundation, en.wikipedia.org/wiki/Legality_of_euthanasia#United_States.
• “Cruzan v. Director, Missouri Department of Health.” Wikipedia, Wikimedia Foundation, en.wikipedia.org/wiki/Cruzan_v._Director,_Missouri_Department_of_Health.
• Gisleson, John Kenneth. “Right to Die, Forced to Live: Cruzan v. Director, Missouri Department of Health.” Journal of Contemporary Health Law & Policy, vol. 7, no. 1, pp. 401–411., scholarship.law.edu/cgi/viewcontent.cgi?article=1567&context=jchlp.