Nancy Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261 (1990)

CASE: Parents of woman left in vegetative state after automobile accident sue to force her doctors to stop giving her artifial nutrition and hydration.

FACTS: In 1983, at the age of 26, Nancy Cruzan was in an automobile accident that left her in a persistent vegetative state in which she could not even swallow food or water. Her prognosis is negative: her condition is expected to worsen over time so that she will never recover signigicant cognitive function. She is kept alive through the aid of artificial nutrition and hydration, administered through a tube. The state is bearing the costs of her care. After six years, her parents, as her legal guardians, asked the doctors in the state hospital treating their daughter to remove the tube that keeps her alive, to permit her to die. Upon their refusal, the parents obtained an order from a district court ordering the hospital to comply with the wishes of the parents and the patient (about a year earlier, Cruzan had apparently told a housemate that, in the event she were sick or significantly debilitated, she would perfer to die than to face life in a vegetative state). The hospital appealed, and the Missouri Supreme Court overturned the lower court.

HOLDING: State's refusal to terminate artifical nutrition and hydration of a patient in a persistent vegetative state absent clear and convincing evidence of the patient's wishes to withdraw treatment did not violate the patient's right to privacy under the Due Process Clause of the Fourteenth Amendment because the state's interest in safeguarding the personal element in the choice between life or death outweighed the patient's less-than-clear-and-convicing wish to refuse the nutrients and hydration.

RATIONALE:

• The Court assumes, without deciding, that the Constitution would grant a competent person the right to refuse lifesaving hydration and nutrition.
• The state has a legitimate interest in protecting the lives of its citizens and in safeguarding against abuse of the decision whether or not to terminate life on the part of those who act as surrogates for the incompetent.
• The heightend burden is properly placed upon the surrogates because the risk of error is greater in that the decision to terminate a life is final.
• The type of testimony Cruzan's parents seek to introduce in this case would be excluded, by the parol evidence rule, even in matters in which much less is at stake.

DISSENT: (Brennan, Marshall, Blackmun) The dissent emphasizes the hopelessness of Cruzan's condition, that she will never recover and that she will get progressively worse. They argue that no state interests could possibly outweigh the privacy rights of an individual in Nancy's position and that the heightened evidence requirements upheld by the Court do little to enhance the accuracy of the incompetent's decision (pointing out that no proof is required to support a finding that the incompetent person would wish to continue treatment.

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