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Nancy Cruzan. This decision was appealed to the U.S. Supreme Court.
b) The U.S. Supreme Court’s Ruling
Chief Justice William Rehnquist wrote the majority opinion that establishes the
legal rule of the Cruzan case. Four additional justices joined in this opinion, and
four justices dissented. With the exception of Justice Antonin Scalia, all of the
justices were willing to agree, for the purpose of this case, that a competent person
has a right to refuse life-saving medical treatment. (When judges assume
something for the purpose of a case, it means that what they are assuming is not
critical to their decision and may be reevaluated in other cases.) Justice Scalia
refused to accept this assumption because he believed that this would undermine
the state’s authority to forbid suicide.
Both the majority and dissenting opinions accepted that the patient’s intentions
should be controlling if they are known. The majority found it proper for Missouri
to require these intentions be judged by a standard of clear and convincing
evidence, preferably through a living will or durable power of attorney. The dissent
found the requirement of such formality to be unconstitutionally burdensome,
arguing that the court hearing a termination of life-support case should be bound by
the testimony of the patient’s family and friends. Although accepting such informal
evidence would seem to ease the resolution of these cases, it conflicts with the
general rule disallowing oral testimony:
It is also worth noting that most, if not all, States simply forbid oral
testimony entirely in determining the wishes of parties in transactions that,
although important, simply do not have the consequences that a decision to
terminate a person’s life does. At common law and by statute in most
States, the parole evidence rule prevents the variations of the terms of a
written contract by oral testimony. The statute of frauds makes
unenforceable oral contracts to leave property by will, and statutes
regulating the making of wills universally require that those instruments be
in writing. [Cruzan by Cruzan v. Director, Mo. Dept. of Health, 497 U.S.
261 (1990).]
The states prohibit oral testimony about wills because the person whose intentions
are being sought is dead and thus unavailable to contest the testimony. This rule
evolved as the courts found determining the wishes of dead people to be an
invitation to fraud and family conflict. Given that a patient in a persistent
vegetative state, is, for the purpose of contesting testimony, equivalent to a dead
person, the majority did not find it unconstitutionally burdensome to require these
same protections for termination of life-support decisions.
There is a contentious debate between the majority and dissenting opinions over
the use of the clear-and-convincing standard for proving a patient’s wishes. This
debate is less important for its own merits than as a surrogate for the fundamental
disagreement between the majority and dissenting opinions in Cruzan: Is Nancy
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