Cruzan: the Right to Die-part I
| Publication year | 1990 |
| Pages | 2055 |
1990, October, Pg. 2055. Cruzan: The Right to Die-Part I
In January 1983, Nancy Cruzan was driving late at night on a dark road when she lost control of her car. Paramedics found Nancy lying in a ditch and resuscitated her. By then, she had not been breathing for about fourteen minutes. During those crucial minutes, she suffered a severe loss of oxygen to the brain. Today, Nancy Cruzan continues to "live" in a persistent vegetative state ("PVS").(fn1)
Fourteen years ago, the plight of Karen Ann Quinlan gave birth to the first appellate court case ever permitting the withdrawal of artificial life-support from an incompetent person.(fn2) Since then, the courts of many states have wrestled with the question of when life-support may be withdrawn.(fn3) The answers given by the state appellate courts have been as varied as the states themselves.
Part I of this two-part article discusses the Quinlan and Cruzan cases and the appellate cases that lie between. The U.S. Supreme Court's seminal decision in Cruzan v. Director, Missouri Department of Health,(fn4) is the focus of this first part.
Colorado has never issued an appellate court opinion on withdrawing artificial life-support;(fn5) neither had the U.S. Supreme Court until the Cruzan case was decided in June 1990. The Cruzan directive is that the states are free to establish their own safeguards for withdrawing life-support. Given this, rulings from other states form a useful framework for Colorado. Therefore, another focus of Part I is a brief examination of the law in other states.
Part II of this article, to be published in the November issue, will focus on Colorado's two trial court opinions on the right to die and will highlight the issues and the relevant state statutes on the right to die. Part II will also suggest some statutory solutions to Colorado's unresolved questions concerning the right to die.(fn6)
In the case of Karen Quinlan, Karen's father, as guardian, petitioned for the removal of his 22-year-old daughter's respirator, but not her feeding tube.(fn7) The Quinlan court found that Karen Quinlan would not want to continue living in a PVS and that, since she was not competent to exercise her rights, her father could.
The Quinlan case was the forerunner in establishing both a constitutional right of privacy to refuse unwanted medical treatment and in affirming the family's and guardian's role in surrogate decisionmaking.(fn8) The Quinlan court decried the role of the courts in making medical decisions that more appropriately belong in the physician-patient-family relationship. Most important, the Quinlan court held that the state's interest in preserving life weakens, and the individual's privacy right grows, as the degree of bodily invasion increases and prospects for recovery diminish.(fn9)
None of the original holdings in Quinlan can be found in the majority's opinion in Cruzan, despite the similarities between the two cases. Nancy Cruzan's parents waited several years before asking the Missouri Probate Court to remove Nancy's feeding tube.(fn10) The state-operated hospital in which Nancy was maintained objected to the request. The Attorney General's Office intervened and, in March 1988, the Probate Court heard the parents' request to withdraw Nancy's feeding tube.
Acting as her court-appointed guardians, Nancy's parents presented evidence through family and friends that, were Nancy able to speak for herself, she would ask that the feeding tube be withdrawn. The trial court, ruling in favor of the family, found that there was clear and convincing evidence that Nancy was permanently brain damaged and that there was suggestive evidence that Nancy would not want to live in a PVS.(fn11)
The Attorney General and the guardian ad litem(fn12) appealed the trial court's decision to the Missouri Supreme Court. That court's decision is widely considered to be one of the most conservative opinions ever written on the issue of the right to die.(fn13)
The testimony in the trial court showed that, although Nancy Cruzan had suffered severe and permanent brain damage, she was not terminally ill and could be maintained for many more years.(fn14) Recognizing that Nancy was not terminally ill, the state supreme court held that Missouri has an absolute interest in preserving life, regardless of the quality of that life. The court describes the state's paramount interest in preserving life as being "immense."(fn15) Nancy's conversations with friends about refusing medical treatment were found to be unreliable, and Missouri's strong public policy of preserving life was found to prevail over Nancy's "weak" assertion of her right to refuse treatment.(fn16)
On appeal by Nancy's parents, the U.S. Supreme Court narrowly construed the issue before it. The Court asked whether Missouri's standard of clear and convincing evidence impermissibly restrained any constitutional right Nancy may have had to refuse treatment. A narrow majority found it did not.(fn17) Writing for the majority, Justice Rehnquist found in the due process clause a protected liberty interest in refusing unwanted medical treatment.(fn18) However, Rehnquist cautioned that finding a "liberty interest" is not the end of the inquiry. The liberty interest must be balanced against competing, relevant state interests.(fn19) In Missouri's case, the state interests prevailed.
The majority found that various state opinions had distilled four separate, but relevant...
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