The Right to Death

The tragedy of Nancy Cruzan’s life is now part of American constitutional law. Before her automobile accident in 1983, she was an energetic twenty-four-year-old recently married woman. Her injuries deprived her brain of oxygen for fourteen minutes, and left her in what doctors describe as a permanent vegetative state. Only the lower part of her brain stem continued to function. She was unconscious and oblivious to the environment, though she had reflexive responses to sound and perhaps to painful stimuli. She was fed and hydrated through tubes implanted in her stomach, and other machines performed her other bodily functions. She was washed and turned regularly, but all of her limbs were contracted and her fingernails cut into her wrists.

For months after the accident her parents and her then husband pressed doctors to do everything possible to restore her to some kind of life. But when it became plain that she would remain in a vegetative state until she died, which might mean for thirty more years, her parents, who had become her legal guardians, asked the state hospital to remove the tubes and allow her to die at once. Since the hospital refused to do so without a court order, the parents petitioned a Missouri court, which appointed a guardian ad litem (a special guardian appointed to represent her in these proceedings) to offer arguments why it should not grant that order. After a hearing the court granted the order on the ground that it was in Cruzan’s best interests to be permitted to die with some dignity now rather than to live on in an unconscious state.

The guardian ad litem felt it his duty to appeal the order to the Missouri supreme court, though he told that court that he did not disagree with the decision. But the supreme court reversed the lower court’s decision: it held that Cruzan’s legal guardians had no power to order feeding stopped without “clear and convincing” evidence that she herself had decided, when competent, not to be fed in her present circumstances. Though a friend had testified that Cruzan had said, in a conversation soon after the death of her grandmother, that she would not want to be kept alive if she could not really live, the supreme court held that this testimony was not adequate evidence of the necessary decision.

Cruzan’s parents appealed to the United States Supreme Court: their lawyers argued that the Missouri decision violated her right not to be subjected to unwanted medical treatment. The Court had not previously ruled on the question how far states must respect that right. Last June 25, by a five-to-four vote, the Court refused to reverse the Missouri decision: it denied that Cruzan had a constitutional right that could be exercised by her parents in these circumstances.

The main opinion was written by Chief Justice Rehnquist, and was joined by Justices Kennedy and White. Many newspaper reports and comments on the case declared that, although the …

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Letters

The Right to Death’ March 28, 1991