On June 15, 1990, the U.S. Supreme Court rendered its long-awaited decision in the Cruzan “right-to-die” case. The actual law established by this case is very narrow and is only tangentially related to the termination of life support. This decision has discomfited many physicians because it does not establish an easy- to-administer, national standard for the termination of life support. Cruzan is an important decision because it clarifies several issues surrounding the termination of care for incompetent patients. Although it does not resolve the dilemmas posed by incompetent patients who have not properly formalized their wishes concerning continued care, Cruzan may prove to be a wise compromise for a difficult problem.

The specific facts of the Cruzan case are compelling: a young woman, brain injured in an automobile accident, was trapped in a persistent vegetative state for years. Brain atrophy made recovery or rehabilitation hopeless, and her family requested that her life support be terminated, but the state refused.

Cruzan is a hard case, and hard cases make bad law because they tempt judges and juries to help the injured party rather than follow the law. Cruzan was litigated by a Missouri attorney general seeking to gain support from antiabortion forces by enforcing a statutory provision saying the state favored life in all circumstances. Physicians are not strangers to hard cases. Every birth injury case tempts juries to help the infant by disregarding the legal standard for proof of malpractice. The facts in Cruzan call out to the court to ignore the traditional rule of patient autonomy and allow the family to terminate a patient’s life support. This would be a good result in Cruzan, but would it best serve the needs of future patients and their medical care providers?