Cruzan v. Director, Missouri Department of Health (end-of-life 2025)
The Facts
Nancy Cruzan suffered severe brain damage in a 1983 automobile accident and was left in a persistent vegetative state with no chance of recovery. She was sustained by artificial hydration and nutrition. Her parents sought court authorization to remove the feeding tube, presenting statements Nancy had made before her accident indicating she would not want to live in such a condition. Missouri courts refused, applying the state's clear-and-convincing evidence standard for establishing an incompetent person's prior wishes.
The Application
The Court recognized that Nancy Cruzan, though competent when she expressed her wishes, was now incompetent and unable to exercise her liberty interest directly, requiring the state to address how surrogates could act on her behalf. While acknowledging Cruzan's constitutional right to refuse treatment, the Court upheld Missouri's requirement for clear and convincing evidence that her prior statements reflected a genuine desire to refuse life-sustaining care in her current condition, rather than permitting surrogates to decide based on lower evidentiary standards. Missouri's procedural safeguard was constitutionally permissible because it served the state's legitimate interests in protecting incompetent patients from potentially erroneous or premature decisions to terminate treatment. The Court thus balanced Cruzan's protected liberty interest against the state's interest in ensuring accuracy and preventing abuse, holding that procedural constraints on surrogate decisions do not violate the Due Process Clause.
The Conclusion
Cruzan established that the constitutional right to refuse treatment extends to life-sustaining care, grounding the right in substantive due process rather than a freestanding right to die. The decision left states broad latitude to set procedural requirements for surrogate decisions. In practical effect, it accelerated the adoption of advance directive statutes and living will legislation across the country.
Flag an issue
This tracker is maintained by BrynoDC and is free because readers fund it. Support