Cruzan v. Missouri

Who makes the decision, the family or the State?

The Facts

-Twenty-five-year old Nancy Cruzan was in a nearly fatal car accident and was left in an unconscious state after being resuscitated by paramedics at the scene of the accident

-After it became clear that Ms. Cruzan was not going to improve, her parents, the petitioners, asked the hospital to terminate life support without court approval.

-The family took the case to court and the state refused to withdraw life support without "clear and certain" evidence that Ms. Cruzan would have wanted life support to be terminated.

- Ms. Cruzan had told her room mate and close friend that if she were left in a vegetative state, she would not want to prolong her life unless their was a chance she could live a normal life.

-Ms. Cruzan's parents felt that this is what their daughter would have chosen and wanted to end her suffering, especially after Ms. Cruzan's doctor told them there was no hope.

-Ms. Cruzan was on life support for five years.

-In the state of Missouri, it is considered a criminal offense to make any life-threatening decisions without the consent of the patient.

-Nancy Cruzan did not have her wishes to end her life if she were ever to be on life support in a written will, therefore, the state had the right to make the decisions.

-Because of the Due Process Clause in the 14th Amendment, which ensures that all people have equal protection from the states, Ms. Cruzan's parents request to take Nancy off of life support was denied.

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The Issue

The state of Missouri refused to withdraw care from Nancy Cruzan without a written will.


Legal: Does the state of Missouri have the right to decide when to discontinue life support if the patient is incompetent?


Conflict in Values: Is it more important for a state to preserve a human life or to allow for their family to make the decision the patient would have wanted? Is sustaining life more important than the wishes of the patient?


Public Policy: Should states have the right to make medical decisions for those who are unable to make them for themselves?

The Arguments

Respondent (The State of Missouri):

  • It is the state's right to decide how they give rights to patients who are on life support
  • It is considered a criminal act to withdraw support from a patient without clear evidence
  • Humans are entitled to life; the state has the right preserve human life

Petitioner (Ms. Cruzan and Family):

  • The state does not have the right to decide what is best for the patient
  • Family and friends know what is right for their loved one and should be able to make the decision to terminate support if the patient is unable to do so
  • Federal courts have no right to interfere in such personal matters.


The respondent, the state of Missouri, had a stronger argument, because they have more facts. They had more solid evidence instead of what Ms. Cruzan had told her family and friends.


I think this argument is a two sided argument. I do not think there is any alternative to this argument.The right either goes to the family or lies with the state if the victim does not have their choice in their written will. There is no third party to decide and no in between, it either goes to the state or to the family.

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The Decision

5-4 Split Decision

5 of the justices voted for the Missouri Department of Health and 4 voted against

While people have the right to refuse treatment under the Due Process claus, there was not "clear and convincing" evidence that Nancy Cruzan would have wanted life support terminated. The court ruled that the state's actions to continue to keep her alive were in fact constitutional. The majority opinion was that the State of Missouri's actions were constitutional. Nancy Cruzan did not have her wishes to terminate life support if she were ever in an incompetent state in her living will, and the state can not always depend on the decision of the family being the wishes of the patient. Those who disagreed argued that Ms. Cruzan was not in a responsive state and has remained that way for five years, therefore her chance of waking up is not great.


Nancy Cruzan's life was prolonged because of this decision. The state has the right to choose what is best for any patient if they do not have a written will under the Due Process Clause.


This case was taken back to the state of Missouri where a judge ruled in favor of Ms. Cruzan's wishes. She died 11 days later.


Nancy Cruzan had voiced that she would not want to prolong her life if she would not be able to live her life normally. I do not think the court has the right to say that they will prolong her suffering as well as her families suffering just because she did record her wishes in her living will. Ms. Cruzan had voiced her decision to her room mate, but that was not enough evidence for the court. Ms. Cruzan, according to friends and family, did not want to live off of a machine for a prolonged period of time and I do believe it is not the state's decision to prolong life.

Works Cited

"Cruzan v. Director, Missouri Dept. of Health | Casebriefs." Casebriefs. N.p., n.d. Web. 08 Dec. 2014.


"14th Amendment." LII / Legal Information Institute. N.p., n.d. Web. 05 Dec. 2014.


Gaudin, Anne Marie. "Cruzan v. Director, Missouri Department of Health: To Die or Not to Die: That Is the Question - But Who Decides?" N.p., n.d. Web.


"CRUZAN v. DIRECTOR, MISSOURI DEPT. OF HEALTH." Cruzan v. Director, Missouri Dept. of Health. N.p., n.d. Web. 07 Dec. 2014.


"Cruzan v. DIRECTOR, MISSOURI DEPT. OF HEALTH." Phschool.com. N.p., n.d. Web. 08 Dec. 2014.