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Cruzan v. Director, Missouri Department of Health

Supreme Court of the United States · 1990 · Constitutional Law

Constitutional LawDue ProcessRefusal of Medical TreatmentRight to DieDue Process Clauseliberty interestrefuse medical treatmentincompetent patient

Facts

Nancy Cruzan suffered severe brain damage after an automobile accident and entered a persistent vegetative state with virtually no chance of regaining cognitive function. She received nutrition and hydration through a surgically implanted gastrostomy tube, and all agreed that removing it would cause her death. Her parents asked hospital employees to terminate the artificial feeding and hydration, and after the hospital refused without court approval, they obtained authorization from a Missouri trial court. The Missouri Supreme Court reversed because Nancy's prior statements were not clear and convincing evidence of her desire to have life-sustaining treatment withdrawn under these circumstances.

Issue

Does the United States Constitution require Missouri to withdraw life-sustaining artificial nutrition and hydration from an incompetent person when her family requests it, despite the State's requirement of clear and convincing evidence of the patient's own wishes? More specifically, does the Due Process Clause forbid Missouri from imposing that evidentiary requirement before a surrogate may elect withdrawal of treatment?

Rule

Assuming a competent person has a constitutionally protected liberty interest in refusing lifesaving hydration and nutrition, a State does not violate the Due Process Clause by requiring clear and convincing evidence of an incompetent patient's wishes before a guardian may discontinue such treatment. The Constitution does not require a State to accept substituted judgment by family members absent that evidentiary showing.

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One of 10 multiple-choice questions for this case. Pick an answer to see why.

Elena Ortiz, a 34-year-old woman in a persistent vegetative state at a long-term care facility in Columbus, Ohio, receives nutrition and hydration through a surgically implanted tube. Ohio requires a guardian seeking withdrawal of artificial nutrition and hydration to prove the incompetent patient's wishes by clear and convincing evidence. Elena's brother argues that the Due Process Clause requires only a preponderance standard because continuation of treatment invades bodily integrity.

Is Elena's brother's constitutional challenge likely to succeed?

Explanation. The majority assumed that a competent person has a constitutionally protected liberty interest in refusing lifesaving hydration and nutrition, but held that this does not end the inquiry. A State may balance that interest against its interests in preserving life, guarding against abuse, and protecting the personal and final nature of the choice. Because withdrawal is irreversible, the State may place the risk of error on those seeking termination by requiring clear and convincing evidence.