CRUZAN v. DIRECTOR, MISSOURI DEPT. OF HEALTH

CRUZAN v. DIRECTOR, MISSOURI DEPT. OF HEALTH

Background

On January 11, 1983, Nancy Cruzan lost control of her car. She was thrown from the vehicle and landed face-down in a water-filled ditch. Paramedics found her with no vital signs, but they resuscitated her. After three weeks in a coma, she was diagnosed as being in a persistent vegetative state (PVS). Surgeons inserted a feeding tube for her long-term care.

By Marizza Gallegos

The Decision

Term: 1980-1989

Legal provision: Due Process

In a 5-to-4 decision, the Court held that while individuals enjoyed the right to refuse medical treatment under the Due Process Clause, incompetent persons were not able to exercise such rights. Absent "clear and convincing" evidence that Cruzan desired treatment to be withdrawn, the Court found the State of Missouri's actions designed to preserve human life to be constitutional. Because there was no guarantee family members would always act in the best interests of incompetent patients, and because erroneous decisions to withdraw treatment were irreversible, the Court upheld the state's heightened evidentiary requirements.

Decision: 5 votes for Director, Missouri Dept. of Health, 4 vote(s) against

Some Extra knowledge for you

The Issue

She was sustained for several weeks by artificial feedings through an implanted gastronomy tube. When Cruzan's parents attempted to terminate the life-support system, state hospital officials refused to do so without court approval. The Missouri Supreme Court ruled in favor of the state's policy over Cruzan's right to refuse treatment.

When someone is bedridden

When a person is confined to bed, there is a gradual shift of fluids away from the legs towards the abdomen, thorax and head. Research has shown that bedrest of longer than 24 hours results in a shift of around 1L of fluid from the legs to the chest. This temporarily increases venous return to the heart and elevates intracardial pressure.

The result is an increase in urine output and a progressive reduction in blood volume that can often lead to dehydration. Healthcare professionals can avoid severe dehydration in bedridden patients by carefully monitoring fluid intake and urine output, and ensuring they have access to fresh water. Unconscious patients usually need isotonic saline drips to maintain hydration.

After four weeks of bedrest, the resting heart rate typically increases by around 10 beats per minute. Also, the heart rate after exercise is up to 40 beats per minute faster in patients who have just had four weeks of bedrest. Exercise tolerance in these patients does not fully return to normal for 5-10 weeks after they become mobile again.

Thank You!

After the Decision

After the case was decided the family went back and found more proof that Nancy Cruzan would have wanted her life support terminated and eventually won a court order to have her removed from life support. Cruzan died 11 days later on December 26, 1990. This decision has influenced many other cases.

Prolonged bedrest rapidly leads to skeletal muscle atrophy throughout the body. Loss of muscle mass from the legs impairs the skeletal muscle pump, significantly reducing venous return.