Cruzan V. Director, Missouri Department Of Health, 497 U.S. 261 (1990).

Cruzan V. Director, Missouri Department Of Health, 497 U.S. 261 (1990).


Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990

When we were younger our parents would usually make our decisions for us, then as we began to grow up and we were taught how to make decisions for ourselves based on experiences. Decision making is primarily based on our interests and what we want to do when. Not all decisions we make are necessarily in our favor some decisions we make as individuals hurt us, but at the end of the day the consequences of these decisions fall on ourselves. Think of this: When is it okay, if it is ever okay for someone to make a fatal decision regarding someone else’s life?

This issue is thought about a lot during a case regarding Nancy Cruzan. In 1983 the twenty-five-year-old Nancy got in a car accident on her way home from her job, leaving her in a what is known as a vegetative state, “(‘A condition in which a person exhibits motor reflexes but evinces no indications of significant cognitive function).” As per the doctors and Cruzan’s physical state it was obvious that she was not getting any better nor was she going to get any better as she was only hanging on due to life support. After a while of seeing no improvement in Cruzan’s condition both her parents requested the doctors to terminate the life support. Due to the fact that the hospital had no solid proof or evidence that terminating life support is what Cruzan would have wanted they had to take this matter to the State court who refused to take action based on the request of her parents. This matter can be looked at form multiple perspectives and each perspective comes with its own solutions, which one is the most reasonable is the real question.

Any reasonable person would say it is unbearable for both a mother and father to see their child suffer fighting a battle that they will not win because of the brutality of the situation. Many parents if put in the same circumstances would not be able to handle the idea of having to make such a decision to take their child’s life away. This tells a lot about the state Cruzan was in. Nancy was at a very low point where she was unable to do anything for herself as she was artificially fed in order to keep gaining nutrients and stay hydrated. For Nancy’s parents to consider this even being a decision tells any reasonable person that her condition was very harsh on her and on her parents to witness.

When Nancy’s parents suggested this idea to the hospital in Missouri it was rejected in the sense that the decision was not up to Nancy’s parents regardless of how difficult the situation was on them, it was not their decision to take her life away. As Nancy is a twenty-five-year-old woman she was no longer considered a minor and all decisions regarding her and her life were up to her and no longer her parents. This situation was very difficult on the hospital and the court because there were so many variables that played in to taking action on the decision but they all came down to the same thing, that as an individual who is no longer dependent on her parents the decision had to come from Nancy herself. Because there was no clear resolution because there wasn’t enough evidence from both sides weather that be her parents or the hospital this case was taken to trial on behalf of Nancy.

The question that was brought up in trial was “Did the Due Process Clause of the Fourteenth Amendment permit Cruzan’s parents to refuse life-sustaining treatment on their daughter’s behalf?” The votes came down to a simple majority of 5-4 arguing the fact again that there was no clear evidence to prove that Nancy wanted termination of life support. In the Due Clause process, it does give individuals the right to decline medical treatment under all circumstances but that of incompetence, which Nancy applied to. The reason behind the court acting in this way and taking this decision is that there was no guarantee that family members no matter how close would always make decisions in favor of the incompetent patient. Once removing a patient from medical treatment there is no way back which is why the court stuck to its decision of preserving human life, that being preserving Nancy’s life.

As the courts final decision is what hold the highest power, Nancy stayed on life support for almost eight years after this trial. She was near to paralyzed. She had seizures from time to time and vomited. She was able to open her eyes occasionally but still failed to recognize her family members. After one month of being on life support the hospital inserted a feeding tube in Nancy stomach to allow her to continue receiving nourishment. By this time Nancy was thirty-two years old and was able to breathe without assistance from a ventilator and in 1990 the case was reopened as new evidence came from Nancy’s Co-workers at a cheese factory. With this evidence they were able to bring back the case and gain majority vote suspending the artificial hydration and nutrition that was keeping Nancy alive. Considering the circumstance Nancy died not long after being taken off life-support.

This case definitely opens people’s eyes to what’s called a living will. A living will is a written statement regarding an individual’s desire towards their medical treatment in circumstances where god forbid they are no longer able to express and advocate for themselves. As individuals we sometimes refuse to think that we would ever be put in such a positon, but after a case like Nancy’s one should consider taking the precautions to save them and their family a lot of frustration and aggravation. Consider how different Nancy’s case would have been if she had indeed written a living will. The living will in itself stands as proof and speaks for Nancy as it would be signed by her and would be signed legally by her.

There is a lot to consider when taking away someone’s life especially at such a young age like Nancy who has no will conflicts will always come up. Psychologically on her family think of how hard it must be on them when it comes to distributing her property, things will not be distributed the way Nancy would have wanted as she is not the on distributing it. This causes a lot of conflict between family members as the being to feud within each other cause a lot of mental stress which may later on lead to depression considering everything they have been through. There is a lot of financial problems that can come up in the fact that the money of the deceased may not be passed away in a way that will benefit family members. Financially a lot of problems come to the table in the fact that family members are usually the ones who would have to pay for such heavy treatment that is given during this period of time. If a family decides to keep an individual on life support so much comes into play that being that medical bills are very heavy, which adds a lot of pressure on other family members in order to try and pay them. Which is another reason why the court believes that they can’t guarantee that family members will take the decision based on what is best for the patient. They may just in fact be looking out for themselves and only want to take the patient of life-support to save money for themselves rather than relieve the patient of their struggle. Also think of it in a business where if someone was to co-sing a loan and one person passes away, it is the living persons responsibility to pay all of what’s left by themselves. Relating this back to Nancy’s case it is psychologically hard on her parents if they then had all of her possessions and no will to look back to stating what is to be done with her stuff. A decision like taking someone’s life away especially when that person be your daughter or son, that pain will never go away and will always be a constant feeling that stays with you till the end of time. If a living will is written prior to situations like this it causes the individual to save a lot of damage to be done to them and their family members as they would have had something to guide them and their family through it.

There are a lot of different medical-care types of treatments in order to try and help the patients and their family. One of those being palliative care. Palliative care is a process in which doctors, nurses, psychologists, etc.. all come together and try to improve the quality of life for both the patients and their families when it comes to life-threating illnesses. They do so by early identification which causes them to relief the pain of suffering on the patient early. They guide families through a time like this as they stand as a support system to help the family with whatever it is they may need offering counseling and therapy for them to try and cope with the situation. The goal of palliative care is both doctors and other staff members try to come together and find a way to get the patient and family through a situation like this as best as possible with the lest possible damage done. We also see another type of medical care that being recuperative care. Recuperative care is a nonprofit program that offers the homeless a safe place to go when they are no longer in need to be hospitalized but are still at a point in which they need to heal from the illness or injury. Recuperative care is mainly for the less fortunate and is usually for a short period of time. Through Recuperative care clients are able to save taxpayer dollars as it costs a lot less to go through recuperative care than it does to stay in the hospital for a long period of time. Also, many clients who go through recuperative care are more likely to find permanent housing for themselves.

If a patient is incompetent, over the age of eighteen, and does not have a living will like Nancy Cruzan in this case things become a little more complicated. Nancy is first and foremost no longer a minor which is why no one but her can have a say in terminating life-support, which brings us to death by refusal. Death by refusal is the patients right to refuse any and all lifesaving treatment. Death by refusal can only be an option if the patient is competent at the time in which they are declaring to go through it. When put in this situations doctors are very hesitant on whether or not they should continue to force life through treatment to keep the patient alive when he or she does is no longer willing to go through the process. The reason being is if physicians keep a patient alive through treatment that they refuse to keep taking brings a lot of ethical and legal issues to light. Death by refusal is in fact different than assisted suicide and overpowers the states appeal to preserving life. Death by refusal in fact is not the same as assisted suicide. In assisted suicide the doctor is agreeing with the patient to take their life away. In death by refusal the doctor is not giving or supplying the patient with anything to take their life away they are instead removing the factors that are keeping the patient alive. These factors being the treatments such as oxygen, nutrition, hydration, and any other means of treatment keeping the patient alive. Assisted suicide is on the other hand a very controversial topic that is still very debatable until this day because it brings ethical and moral issues to the table. This is a very sensitive medical-care-treatment as it is very hard to deal with within the family the decision is that of the patient. Even with all of these medical-care treatments at the end of the day if the patient is no longer a minor the decision falls completely in their hands or in the words of their living will.

Another option that is sometimes overlooked is the option of health care directive. Health care directive is a living will but comes with an agent. A health care directive is a legal document that states what one wishes to be done when they are in a state in which they will not be able to communicate and have a chosen agent. The health care directive document must be signed by the agent for it to be of any worth legally. A health care directive once signed by the agent eliminates all previous documents that may have been written up for the same regard. The agent act as a mediator in a way as they are in charge of fulfilling the patient’s wishes but is limited as to what they can and cannot do on the behalf of the patient. Agents are usually family members or close friends of the patient who are over the age of eighteen. The benefit of having an agent is like having an advocate, someone you trust to speak on your behalf and make sure your wish is granted. A living will and health care directive make this situation a little easier on families as they do not have to make difficult decisions as the patient has already made the decisions prior and all they can do it live with the fact that this is what their loved one wanted to do. Like a living will a health care directive is singed by an agent and by the patient holding all of the decisions in writing binding it as a legal document.

When it comes to a situation where a loved one is suffering and being put in positons where you either have to see your loved one suffer or see your loved one’s life taken away in front of your eyes it is never easy. During times like these is when it is curtail for families to come together rather than pick apart as they all need each other the most at this very moment. Things are already complicated, emotions are on a roller coaster, and it is hard to stay sane during times like these. During cases like these there is not much a doctor can do but doctors should definitely be honest and straight forward with the family. As the family deals with so much and is going through a lot the last thing they would need is a doctor who won’t tell them how the situation really is. During this time believe it or not doctors can stand as councilors and support to the family as they have been through this experience different times with different families from different backgrounds. A lot of people don’t think of the importance of writing up wills or writing up living wills as we fail to see the future and fail to put ourselves in positions where we are at harm. Through Nancy Cruzan we are able to see that certain situations we are put in are inevitable. Nancy Cruzan a twenty-five-year-old female could never have guessed that her life would be taken away from her so soon and when it was her and her family were put through a tremendous amount of suffering. Accepting the fact that one may be put in a situation like Nancy’s is hard and having to accept the fact that one is to consider writing up a living will or health care directive is also very difficult. What is even more difficult on the other hand is having to go through the exact same thing as Nancy Cruzan. She was put in a situation where she was in a vegetative state and could not advocate for herself and due to the fact that there was not enough proof that she did in fact want to terminate her life her and her family went through eight years of waiting till she was able to rest in peace. When it comes to terminating one’s life it is never easy as so much is at stake not only the patient’s life. This case being brought up to court does not only effect Nancy but it effects the country as a whole. This case can be looked at from many different perspectives and many people based on the experiences they have been through will have a lot of different opinions but at the end of the day it all comes down to the patient and what they have chosen for themselves. After analyzing many different variables that come up during the process of this case I have come to conclusion that it is never okay for someone to make a decision regarding someone else’s life for more reasons than one. I do not believe that any reasonable person would ever want to take responsibility of terminating someone’s life weather that be family, friends, or doctors. It causes so much hardships and adversity on that person until the end of their lives. Not only would they have to deal with the hardships but they would also have to deal with the fact that now there is so many other matters at hand like the absence of a will for example and all the issues and feuds that will come up because of that. This case may be seen as if it was an injustice to Nancy Cruzan as she spent 8 years of her life suffering for them to later find out that if it was up to her she would have indeed wanted to be taken off of life-support but the state acted based upon reason. No solid evidence was shown that Nancy would have wanted to terminate her life so as a person who is no longer a minor no one could make this decision but Nancy. Writing up a living will and health care directive will not make the pain go away, will not make the grief less, and will definitely not guarantee an easy trial, but it will indeed take away a lot of stress factors that this family had to deal with. As individuals who are no longer minors we are the ones who are in charge of our own decisions and regardless of the brutality of the situation the country, state, and law all protect our right to making our own decisions.


Bear, Joe Joe. “Pallative Care.” Pallative Care :: Joe Joe Bear,

“Cruzan v. Director, Missouri Department of Health.” Casebriefs Cruzan v Director Missouri Department of Health Comments,

Glover, J J. “The Case of Ms. Nancy Cruzan and the Care of the Elderly.” Journal of the American Geriatrics Society, U.S. National Library of Medicine, May 1990,

Glover, J J. “The Case of Ms. Nancy Cruzan and the Care of the Elderly.” Journal of the American Geriatrics Society, U.S. National Library of Medicine, May 1990,

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