Cruzan v. Harmon.

• Author: Barkow, Joel Mark
• Position: Powers of guardians of the incompetent, Missouri

Cruzan v. Harmon

HELD: A guardian may not order that food and water be

withheld from an incompetent ward in a persistent vegetative state

who is neither dead nor terminally ill as defined under Missouri

state statute. Informed refusal by the patient was necessary

prior to termination of food and water to that patient.

In 1983, an auto accident left Nancy Cruzan in a coma for three weeks. Cruzan v. Harmon, 760 S.W.2d 408, 410, 411 (Mo.banc 1988). Ms. Cruzan improved to the point that she could take nutrition orally, but to make feeding easier and to assist in her recovery, a gastronomy feeding tube was surgically implanted. Id. at 411. Subsequently, Ms. Cruzan's parents (coguardians) requested that the hospital terminate the provision of food and fluids to Ms. Cruzan. Id. at 410. The hospital refused the request. Id. Ms. Cruzan's parents (coguardians) then filed a declaratory judgment action seeking judicial sanction and enforcement of their request. Id.

The trial court found Ms. Cruzan to be a "spastic quadriplegic" with normal respiration and circulation, unaware of her environment except for "reflexive responses" to sound and painful stimuli, and having irreversible cerebral cortical atrophy. Id. at 411. The court further concluded that Ms. Cruzan has no cognitive or reflexive ability to swallow food or water and that such ability will never be recovered sufficiently to satisfy her needs. Id.

Basing its decision on Ms. Cruzan's constitutional right to liberty and equal protection of the law, the trial court approved Petitioners' request to terminate Ms. Cruzan's food and fluids. Id. at 41. Both the state and guardian ad litem appealed the decision to the Missouri Supreme Court. Id. at 410.

The Missouri Supreme Court framed the issue presented as follows: "May a guardian order that food and water be withheld from an incompetent ward who is in a persistent vegetative state but who is otherwise alive within the meaning of section 194.005, RSMo 1986, and not terminally ill?"

After examining other court decisions on the issue, id. 412-16, the court determined, inter alia, that "informed refusal" by the patient was necessary prior to terminating the provision of food and water to a patient. Id. at 417. "A decision to refuse treatment, when that decision will bring about death, should be as informed as a decision to accept treatment." Id. at 424. "Informed refusal" is the "necessary corollary" to the common law principle of "informed consent."...