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.
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?