The Case of Nancy Cruzan
The case of Nancy Cruzan has become one of the landmark cases for withdrawal of artificial nutrition and hydration because of important ethical issues the case brings to light. At the time of the case, the United States Supreme Court had already established the right of an individual to refuse medical treatment. This issue therefore is not novel to the Cruzan case. Furthermore, there was not any controversy over who was the appropriate decision maker for Nancy Cruzan. The significant issue that the Cruzan case did bring to the table of medical ethics regarded whether or not a substituted decision make could choose to withdraw artificial hydration and nutrition on behalf of another individual.
Because the Missouri Supreme Court ruled against the removal of Nancy Cruzan’s artificial hydration and nutrition on the grounds that “clear and convincing” evidence of Nancy’s wishes was not provided, the Cruzan family appealed the decision to the United States Supreme Court arguing that Nancy was being deprived of her right to refuse medical treatment. The Supreme Court ruling affirmed that competent patients have the right to refuse unwanted medical treatment, but also noted that incompetent patients are not capable of exercising this right. Consequently, states may establish their own safe-guards to govern cases in which a substituted decision maker wishes to refuse treatment for an incompetent patient. This ruling therefore upheld the decision of Missouri’s Supreme Court.
The major implication of this decision is that each state decides the type of evidence required to withhold or withdraw medical treatment from an incompetent patient. The state laws reflect the morality of the state, common law, and other factors unique to the state. This establishes a system with wide variety across the country regarding what a surrogate decision maker is allowed to do. At the time of the Court’s ruling, eighteen states and Washington, D.C. had laws that allowed family members to withhold treatment from patients lacking the capacity to make medical decisions. The majority of these statutes required that the patient be terminally ill. As of June 1998, thirteen states require that the proxy have specific authorization and/or specific conditions be met in order to withhold artificial nutrition and hydration.
The practically speaking, the case of Nancy Cruzan highlights the fact that an individual cannot rely only on telling his would be decision maker what type of care is desired should that individual become incompetent. Such evidence may not be viewed as sufficient to refuse medical treatment as happened with Nancy Cruzan. It thereby becomes important to record exactly what type of treatment should be accepted or refused if one’s decision making capacity is lost. The most common way to do this is in the form of an advance directive. Such a document would...