Cruzan by Cruzan v. Director, Missouri Department of Health

PETITIONER: Cruzan by Cruzan
RESPONDENT: Director, Missouri Department of Health
LOCATION: Residence of Cruzan

DOCKET NO.: 88-1503
DECIDED BY: Rehnquist Court (1988-1990)
LOWER COURT: Supreme Court of Missouri

CITATION: 497 US 261 (1990)
ARGUED: Dec 06, 1989
DECIDED: Jun 25, 1990

ADVOCATES:
Kenneth W. Starr - Department of Justice, argued the cause for the United States as amicus curiae urging affirmance
Robert L. Presson - Argued the cause for the respondent
William H. Colby - Argued the cause for the petitioners

Facts of the case

In 1983, Nancy Beth Cruzan was involved in an automobile accident which left her in a "persistent vegetative state." She was sustained for several weeks by artificial feedings through an implanted gastronomy tube. When Cruzan's parents attempted to terminate the life-support system, state hospital officials refused to do so without court approval. The Missouri Supreme Court ruled in favor of the state's policy over Cruzan's right to refuse treatment.

Question

Did the Due Process Clause of the Fourteenth Amendment permit Cruzan's parents to refuse life-sustaining treatment on their daughter's behalf?

Media for Cruzan by Cruzan v. Director, Missouri Department of Health

Audio Transcription for Oral Argument - December 06, 1989 in Cruzan by Cruzan v. Director, Missouri Department of Health

William H. Rehnquist:

We'll hear argument first this today in No. 88-1503, Nancy Beth Cruzan v. the Director of the Missouri Department of Health.

Mr. Colby.

William H. Colby:

Thank you, Mr. Chief Justice, and may it please the Court:

Nancy Cruzan is a 32-year-old Missouri woman who is in a persistent vegetative state.

Persistent vegetative state is a specific clinical diagnosis for a patient who is permanently unconscious.

All thought, all memory, all ability to interact with the world around her in any way is gone.

It is undisputed in the record below that Nancy will never recover from this condition and will never interact with the world around her.

She's been in this condition for over six years, the result of a car accident.

Approximately three weeks after the accident, when hope for her recovery remained strong, her parents and her husband at the time consented to the surgical insertion of a gastrostomy tube necessary to feed Nancy.

No one told the Cruzans at that time that their consent was irrevocable; no one suggested to them that the purpose of this surgical insertion of the tube was to perpetuate Nancy in an unconscious state indefinitely.

Antonin Scalia:

Mr. Colby, is it clear... I'm... I'm not sure it... it seems to me that there may be some dispute on the point as to whether she could have been fed manually if that had not been done.

Apparently your opponents say that it is... it would have been more difficult, but that she could have been fed manually by... by massaging the food down her throat or something of that sort.

Is that correct or not?

William H. Colby:

I think that is... is not correct.

At the time the tube was inserted, Nancy had just come out of intensive care.

She was being fed through... it's not completely clear in the record, but it appears both a nasogastric tube and through an I.V. tube.

It was clear that her long-term care was going to require more nutrition, and the operational report for the surgery stated that the reason for the surgery was malnutrition.

After the tube was inserted, when she transferred out of the hospital and into the rehabilitation center, they attempted to feed her through mouth while she still had the tube in place, but they were not able to feed her sufficiently to provide for her needs.

Sandra Day O'Connor:

Mr. Colby, at the time the family said, yes, go ahead and insert the feeding tube, if they had refused that permission, would the state law have required that refusal to be honored?

Was the family's consent required at the time for the insertion of the tube?

William H. Colby:

The family's consent was required for the surgery to insert the tube.

Sandra Day O'Connor:

By state law?

William H. Colby:

By state law.

It would have been--

Sandra Day O'Connor:

Is that by statute or by some state common law?

William H. Colby:

--By common law.

It would have been a battery for the doctor to perform a surgery without consent.

And the only statutory exception to that in Missouri is in the event there is an emergency.

And that's defined in the Missouri statute as a person is in imminent danger of dying and there was no one around to provide the necessary consent.

Sandra Day O'Connor:

Well, what if they refused?