1. Cruzan v. Director, MO. Dept. of Health, (1990)
2. Facts: Cruzan was rendered a vegetable by a car accident in 1983. She was kept alive by life support equipment that gave her nourishment through a tube. Her parents sought to have her removed from the life support equipment. A Missouri statute allowed a responsible party to pull the plug only if there was “clear and convincing evidence” of the patient’s intent. The only evidence of Cruzan’s intent was statements to former roomates that she would not want to live if she were a “vegetable.”
3. Procedural Posture: The trial court found that Cruzan’s intent was “clear and convincing” and ordered the hospital to remove the life support equipment. The state supreme court reversed.
4. Issue: Whether the state statute requiring the high evidentiary standard of “clear and convincing evidence” in a right to die case is constitutional under the 14th amendment substantive due process “liberty” interest.
5. Holding: Yes.
6. Majority Resaoning: There exists a right to refuse medical treatment under the liberty interest. This right does extend to an incompetent person who is in a vegetative state. However, the person’s constitutional rights must be determined by balancing his liberty interest against the relevant state interests. The state has a strong and unqualified interest in the preservation of human life. The evidentiary standard of “clear and convincing evidence” is not unconstitutional because it puts the burden of error on those who seek termination of life. If the state is wrong, then the person continues to live, awaiting changes in the law or in medical science which may change the error. If the party is wrong, the error can not be corrected. This statute is similar to the standard required for regular wills.
7. Concurrence Reasoning: [O’Connor] reasoned that the court only decided whether the standard of “clear and convincing” evidence was constitutional under these facts. The court has not yet made the more challenging decision of crafting appropriate procedures for determining when the surrogate should be allowed to make decisions for the incompetent. That question will be left for now to the “laboratory” of the states. [Scalia] felt that the court had no business in this field at all. There was no constitutional basis for the right to die, and the court was no better able to determine the correct balance of state and individual interests than was the state citizenry. The safeguard against violation of individual constitutional rights is the Equal Protection Clause which requires that the same laws apply to the democratic majority as are applied to any individual.
8. Dissent Reasoning: [Brennan] felt that the evidentiary burden of “clear and convincing” evidence was an impermissible burden on the individual’s right to refuse medical treatment. Since a fundamental right was at issue, the proper standard should have been a form of strict scrutiny. The state statute could only be upheld if it is closely tailored to effectuate only those interests which are legitimate. Here, the state interest could not outweigh that of the individual. [Stevens} felt likewise that the state interest could never outweigh that of the individual.
