Medical treatment for older persons and persons with disabilities: 1990 developments.

Summary

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Article prepared by the staff of the National Legal Center for the Medically Dependent & Disabled Inc.

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Medical treatment for older persons and persons with disabilities: 1990 developments.

Introduction

Courts and legislatures continue to grapple with issues affecting the lives and well-being of persons with disabilities. These decisions have been traditionally made with little input from the very persons they directly affect. In the past year, more effort has been made by persons with disabilities and their advocates to influence the decisions being made about their lives. The National Legal Center for the Medically Dependent & Disabled, Inc., represented individuals with disabilities and disability rights groups as parties and amici in many of the cases summarized in this article. They attempted to caution the courts to be aware of society's misperceptions and irrational fears about persons with disabilities and the way these prejudices, coupled with patronizing attitudes, often result in decisions that devalue the lives of persons with disabilities.

United States Supreme Court

During the 1989-90 term, the United States Supreme Court reviewed two cases of great import to persons with disabilities needing medical treatment and care. A guardian's authority to refuse nutrition and hydration for a permanently unconscious adult was at issue in Cruzan v. Director, Missouri Department of Health, and child eligibility standards for SSI were at issue in Sullivan v. Zebley.

The United States Supreme Court, in its first case dealing with the "right to die" issue, affirmed the decision of the Missouri Supreme Court in Cruzan v. Director, Missouri Department of Health. (1) The Missouri court had denied Nancy Cruzan's guardians (her parents) the authority to withhold from her food and fluids provided through a tube inserted into her stomach. (2) Ms. Cruzan sustained severe injuries in an automobile accident and was in a "persistent vegetative state." (3)

The United States Supreme Court rejected the claim that guardians have an independent constitutional right to exercise the rights of an incompetent person. (4) Next, the Court refused to recognize a "fundamental right" of competent patients to forgo medical treatment and care under the "right to privacy." For purposes of discussion, the Court assumed, without deciding, that competent persons may have a due process "liberty interest" in refusing treatment and care. (5) However, the Court warned that states are not required "to remain neutral in the face of an informed and voluntary decision by a physically able adult to starve to death" because "there can be no gainsaying" the state's "interest in protection and preservation of human life." (6) States may assert a strong interest in life, even an unqualified interest in life as Missouri did, because decisio...

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