Cruzan v. Director, Missouri Dep’t of Health 
Author: Lindsey

Facts

P was in a persistent vegetative state.  When it was clear P had no chance of recovering, P’s parents wanted to remove the feeding tube.  P had remarked before that she didn’t want to live as a vegetable.   

Procedural History

Court concluded that there was enough evidence that P wouldn’t want to live in a vegetative state.  Missouri Supreme Court reversed saying that either P had to have a living will or there had to be “clear and convincing” evidence of her wishes.  They found none.   

Issue

• 1. Does an incompetent person have a constitutional right to refuse treatment? 
  2. Is the state’s requirement of clear and convincing evidence of the incompetent’s wishes constitutional (can the state put a procedural requirement on the exercise of a liberty?)

Holding

• 1. The court has found previously that a competent person has a liberty interest in refusing unwanted medical treatment.  This right can be extended to an incompetent person. 
  2. Yes, the state can put procedural requirements on the exercise of this liberty. 

1. 1. The clear and convincing evidence requirement is on par with the level of interest the state has in preserving life. 

1. 2. Further, the state is allowed to refuse to use the family’s judgment in place of the clear and convincing evidence requirement.

Judgment

Affirm Missouri Supreme Court ruling.   

Comments

O’Connor concur:  The state’s imposition of medical treatment on the incompetent involves intrusion.  Requiring an incompetent person to undergo feeding against her wishes violates the patient’s liberty. 

Scalia concur:  Agrees, but would like to announce that the court is in no better position to decide this issue than the state.  The federal courts should stay out of this field.  There’s a right to refuse medical treatment, but there’s not a right to refuse a life-saving medical treatment. 

Brennan dissent:  P has a fundamental right to be free of artificial feeding, and because it is fundamental it cannot be outweighed by the interests of the state in preserving life.  The procedural requirements burden this fundamental right.   

Stevens dissent:  A person belongs to themselves and not to others.  The best interests of the individual must always prevail over any general state policy that simply ignores those interests.