It is not within the province of secular government to circumscribe the liberties of the people by regulations designed wholly for he purpose of establishing a sectarian definition of life. Vegetative state patients may react reflexively to sounds, movements and normally painful stimuli, but they do not feel any pain or sense anybody or anything. Surveys show that the overwhelming majority of Americans have not executed such written instructions. Fadiman, The Liberation of Lolly and Gronky, Life Magazine, Dec. 1986, p. 72 (quoting medical ethicist Joseph Fletcher). The Court points out various possible "abuses" and inaccuracies that may affect procedures authorizing the termination of treatment. [Footnote 4/1] In the ordinary case, we quite naturally assume that these three. a sword.". When, therefore, it may be determined by reason of the advanced scientific and medical technologies of this day that Life has, through causes beyond our control, reached the unconscious and vegetative state where all that remains is the forced function of the body's vital functions, including the artificial sustenance of the body itself, then we recognize the right to allow the natural consequence of the removal of those artificial life sustaining measures.". But it is not a view imposed by our constitutional traditions, in which the power of the State to prohibit suicide is unquestionable. Snyder v. Massachusetts, 291 U. S. 97, 291 U. S. 105 (1934). [Footnote 4/13] Dying nonetheless remains a part of "the life which characteristically has its place in the home," Poe v. Ullman, 367 U. S. 497, 367 U. S. 551 (1961) (Harlan, J., dissenting). at 786, 549 N.E.2d at 298. Facts: Nancy Cruzan was living in a persistant vegatative state in a Missouri hospital. Of the many States which have instituted such protections, Missouri is virtually the only one to have fashioned a rule that lessens the likelihood of accurate determinations. . at 43-45, 139 Ill.Dec. One learned observer suggests, in the course of discussing persistent vegetative states, that, "few of us would accept the preservation of such a reduced level of function as a proper goal for medicine, even though we sadly accept it as an unfortunate and unforeseen result of treatment that had higher aspirations, and even if we refuse actively to cause such vegetative life to cease.". Nancy's sister Christy, to whom she was very close, testified that she and Nancy had had two very serious conversations about a year and a half before the accident A day or two after their niece was stillborn (but would have been badly damaged if she had lived), Nancy had said that maybe it was part of a "greater plan" that the baby had been stillborn and did not have to face "the possible life of mere existence." See n. |497 U.S. 261fn3/20|20, infra. Cf. And it is profound. See supra at 497 U. S. 312-314. Such forced treatment may burden that individual's liberty interests as much as any state coercion. A State that seeks to demonstrate its commitment to life may do so by aiding those who are actively struggling for life and health. The third asserted basis of distinction -- that frustrating Nancy Cruzan's wish to die in the present case requires interference with her bodily integrity -- is likewise inadequate, because such interference is impermissible only if one begs the question whether her refusal to undergo the treatment on her own is suicide. 1990 Jun 25;110:2841-92. It seems to me, however, that the Court draws precisely the wrong conclusion from this insight. Page. . Id. at 748. Marzen, O'Dowd, Crone, & Balch, 24 Duquesne L.Rev. [Footnote 4/17]. See ante at 497 U. S. 283. ", Washington v. Harper, 494 U. S. 210, 494 U. S. 221-222 (1990); see also id. [Footnote 5]. Similarly, it is entitled to consider that a judicial proceeding regarding an incompetent's wishes may not be adversarial, with the added guarantee of accurate factfinding that the adversary process brings with it. [Footnote 3/23], As many as 10,000 patients are being maintained in persistent vegetative states in the United States, and the number is expected to increase significantly in the near future. any event, absent some theological abstraction, the idea of life is not conceived separately from the idea of a living person. [Footnote 3/21] While it might be a wise social policy to encourage people to furnish such instructions, no general conclusion about a patient's choice can be drawn from the absence of formalities. Cf. Rptr. The Missouri court appears to be alone among state courts to suggest otherwise, 760 S.W.2d at 419 and 423, although the court did not rely on a distinction between artificial feeding and other forms of medical treatment. COUNSEL: William H. Colby argued the cause for petitioners. She was conscious, and capable of responding to simple questions or requests sometimes by squeezing the questioner's hand and sometimes verbally. While I agree with the Court's analysis today, and therefore join in its opinion, I would have preferred that we announce, clearly and promptly, that the federal courts have no business in this field; that American law has always accorded the State the power to prevent, by force if necessary, suicide -- including suicide by refusing to take appropriate measures necessary to preserve one's life; that the point at which life becomes "worthless," and the point at which the means necessary to preserve it become "extraordinary" or "inappropriate," are neither set forth in the Constitution nor known to the nine Justices of this Court any better than they are known to nine people picked at random from the Kansas City telephone directory; and hence, that even when it is demonstrated by clear and convincing evidence that a patient no longer wishes certain measures to be taken to preserve her life, it is up to the citizens of Missouri to decide, through their elected representatives, whether that wish will be honored. Doctors told her family that she was likely to remain permanently in a vegetative state, but her life could be preserved for a substantial time by using a feeding tube. A93. No singularity of feeling exists upon which such a government might confidently rely as parens patriae. See Phillips v. Trull, 11 Johns. That a contrary result is readily imaginable under the majority's theory makes manifest that this Court cannot defer to any State policy that drives a theoretical wedge between a person's life, on the one hand, and that person's liberty or happiness, on the other. The text of the Due Process Clause does not protect individuals against deprivations of liberty simpliciter. Position of the American Academy of Neurology on Certain Aspects of the Care and Management of the Persistent Vegetative State Patient, 39 Neurology 125 (Jan.1989). See O'Connor, supra, 72 N.Y.2d at 526-534, 534 N.Y.S.2d at 889-894, 531 N.E.2d at 610-615; Jobes, supra, 108 N.J. at 442-443, 529 A.2d 434. We recognize that these cases involved instances where the government sought to take action against an individual. 297 (1986) (allowing removal of life-saving nasogastric tube from competent, highly intelligent patient who was in extreme pain). A 1988 poll conducted by the American Medical Association found that 80% of those surveyed favored withdrawal of life support systems from hopelessly ill or irreversibly comatose patients if they or their families requested it. Whether or not the techniques used to pass food and water into the patient's alimentary tract are termed "medical treatment," it is clear they all involve some degree of intrusion and restraint. Today we decide only that one State's practice does not violate the Constitution; the more challenging task of crafting appropriate procedures for safeguarding incompetents' liberty interests is entrusted to the "laboratory" of the States, New State Ice Co. v. Liebmann, 285 U. S. 262, 285 U. S. 311 (1932) (Brandeis, J., dissenting), in the first instance. Such a "right" must be exercised for her, if at all, by some sort of surrogate. Since Cruzan was a patient at a state hospital when this litigation commenced, the State has been involved as an adversary from the beginning. at 425. Not so here. exercise of a fundamental right, as the majority admits, ante at 497 U. S. 282-283, n. 10. -- That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, -- That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Cruzan v. Harmon, 760 S.W.2d 408, 419 (1988). In the companion Storar case, a 52-year-old man suffering from bladder cancer had been profoundly retarded during most of his life. Decided. To raise up a constitutional right here, we would have to create out of nothing (for it exists neither in text nor tradition) some constitutional principle whereby, although the State may insist that an individual come in out of the cold and eat food, it may not insist that he take medicine; and although it may pump his stomach empty of poison he has ingested, it may not fill his stomach with food he has failed to ingest. But there is no behavioral evidence of either self-awareness or awareness of the surroundings in a learned manner.". Anne Marie Gaudin This Note is brought to you for free and open access by the Law Reviews and Journals at LSU Law Digital Commons. ", "It is tempting to equate the state's interest in the preservation of life with some measure of quality of life. See e.g, Canterbury v. Spence, 150 U.S.App.D.C. denied, 377 U.S. 978 (1964) (blood transfusion ordered for mother of infant). 1982). 1868). 162 § 1, Sec. ", "The only economic considerations in this case rest with Respondent's employer, the State of Missouri, which is bearing the entire cost of care. See, e.g., Meyer v. Nebraska, 262 U. S. 390 (1923); Griswold v. Connecticut, 381 U. S. 479 (1965); Roe v. Wade, 410 U. S. 113 (1973); Thornburgh v. American College of Obstetricians and Gynecologists, 476 U. S. 747, 476 U. S. 772-782 (1986) (STEVENS, J., concurring). Some of those people are brought fully back to life. When it decided In re Conroy, 98 N.J. 321, 486 A.2d 1209 (1985), the New Jersey Supreme Court noted that 'Ms. The Court correctly notes that, in some cases, there may be a conflict between the interests of an incompetent patient and the interests of members of her family. I do not suggest that States must sit by helplessly if the choices of incompetent patients are in danger of being ignored. Pain and suffering are absent, as are joy, satisfaction, and pleasure. The choice, in largest part, is and should be left to the States, so long as each State is seeking, in a reliable manner, to discover what the patient would want. As the New Jersey Supreme Court observed: "Family members are best qualified to make substituted judgments for incompetent patients not only because of their peculiar grasp of the patient's approach to life, but also, because of their special bonds with him or her. It also held that such a right could be exercised by a surrogate decisionmaker using a "subjective" standard when there was clear evidence that the incompetent person would have exercised it. (9th ed. denied, 429 U.S. 922 (1976). . See ante at 497 U. S. 287. . Respect for these choices has guided our recognition of rights pertaining to bodily integrity. Today the Court, while tentatively accepting that there is some degree of constitutionally protected liberty interest in avoiding unwanted medical treatment, including life-sustaining medical treatment such as artificial nutrition and hydration, affirms the decision of the Missouri Supreme Court. Id. This Court's decision upholding a State's favored treatment of traditional family relationships, Michael H. v. Gerald D., 491 U. S. 110, may not be turned into a constitutional requirement that a State must recognize the primacy of these relationships in a situation like this. In re Conroy, 98 N.J. 321, 370, 486 A.2d 1209, 1234 (1985). 13, supra. Justia Annotations is a forum for attorneys to summarize, comment on, and analyze case law published on our site. [Footnote 3/13]. Missouri asserts that its policy is related to a state interest in the protection of life. Neither artificial nutrition nor any other form of medical treatment available today can cure or in any way ameliorate her condition. 275, 290-291, n. 106 (1989) (compiling statutes). See Ark.Code Ann. In short, there is no reasonable ground for believing that Nancy Beth Cruzan has any personal interest in the perpetuation of what the State has decided is her life. Because death is so profoundly personal, public reflection upon it is unusual. 2d 921 (Fla.1984) (holding that court approval was not needed to authorize cessation of life-support for patient in a persistent vegetative state who had executed a living will); In re Torres, 357 N.W.2d 332 (Minn. 1984) (authorizing removal of a permanently unconscious patient from life-support systems); In re L.H.R., 253 Ga. 439, 321 S.E.2d 716 (1984) (allowing parents to terminate life support for infant in a chronic vegetative state); In re Hamlin, 102 Wash. 2d 810, 689 P.2d 1372 (1984) (allowing termination, without judicial intervention, of life support for patient in a vegetative state if doctors and guardian concur; conflicts among doctors and the guardian with respect to cessation of treatment are to be resolved by a trial court); In re Colyer, 99 Wash. 2d 114, 660 P.2d 738 (1983), modified on other grounds, In re Hamlin, 102 Wash. 2d 810, 689 P.2d 1372 (1984) (allowing court-appointed guardian to authorize cessation of treatment of patient in persistent vegetative state); In re Eichner (decided with In re Storar), 52 N.Y.2d 363, 438 N.Y.S.2d 266, 420 N.E.2d 64, cert. It rejected the argument that Cruzan's parents were entitled to order the termination of her medical treatment, "no person can assume that choice for an incompetent in the absence of the formalities required under Missouri's Living Will statutes or the clear and convincing, inherently reliable evidence absent here.". The court did not specifically define what kind of evidence it would consider clear and convincing, but its general discussion suggests that only a living will or equivalently formal directive from the patient when competent would meet this standard. The difficulty with petitioners' claim is that, in a sense, it begs the question: an incompetent person is not able to make an informed and voluntary choice to exercise a hypothetical right to refuse treatment or any other right. Statement of the Facts: In 1983, Nancy Cruzan was in a car accident. . The State may also properly decline to make judgments about the "quality" of a particular individual's life, and simply assert an unqualified interest in the preservation of human life to be weighed against the constitutionally protected interests of the individual. One who accepts it must also accept, I think, that the State has no such legitimate interest that could outweigh "the person's choice to put an end to her life." 1, 3 (1980). See ante at 497 U. S. 278. Finally, Judge Blackmar concluded that the Missouri policy was illegitimate because it treats life as a theoretical abstraction, severed from, and indeed opposed to, the person of Nancy Cruzan. 92, 93 (1914) (Cardozo, J.)). at 364-368, 486 A.2d at 1231-1233. Nor does Missouri's treatment of Nancy Cruzan find precedent in the various state law cases surveyed by the majority. (1988); Miss.Code Ann. As the Court notes, the liberty interest in refusing medical treatment flows from decisions involving the State's invasions into the body. ... "Cruzan by Cruzan v. Director, Missouri Department of Health." Nancy Cruzan's death, when it comes, cannot be an historic act of heroism; it will inevitably be the consequence of her tragic accident. See id. ", "Nancy's present unresponsive and hopeless existence is not the will of the Supreme Ruler but of man's will to forcefully feed her when she herself cannot swallow, thus fueling respiratory and circulatory pumps to no cognitive purpose for her except sound and perhaps pain. They rely primarily upon our decisions in Michael H. v. Gerald D., 491 U. S. 110 (1989), and Parham v. J.R., 442 U. S. 584 (1979). The most important of those facts are these: "clear and convincing evidence" established that Nancy Cruzan is "oblivious to her environment except for reflexive responses to sound and perhaps to painful stimuli"; that "she has no cognitive or reflexive ability to swallow food or water"; that "she will never recover" these abilities; and that her "cerebral cortical atrophy is irreversible, permanent, progressive and ongoing." [Footnote 4/2], After thus evaluating Nancy Cruzan's medical condition, the trial judge next examined how the interests of third parties would be affected if Nancy's parents were allowed to withdraw the gastrostomy tube that had been implanted in. Id. To decide otherwise that medical treatment once undertaken must be continued irrespective of its lack of success or benefit to the patient in effect gives one's body to medical science without their consent. In In re Eichner (decided with In re Storar, supra), an 83-year-old man who had suffered brain damage from anoxia entered a vegetative state and was thus incompetent to consent to the removal of his respirator. We have recognized that the special relationship between patient and physician will often be encompassed within the domain of private life protected by the Due Process Clause. §§ 13-601 to 13-602 (1974) (as interpreted by the Attorney General, see 73 Op.Md.Atty.Gen. The "cerebral cortical atrophy is irreversible, permanent, progressive and ongoing.'" Office of Technology Assessment Task Force, Life Sustaining Technologies and the Elderly 41 (1988). There is evidence that Nancy may react to pain stimuli. Case law at the time of the Fourteenth Amendment generally held that assisting suicide was a criminal offense. In re Gardner, 534 A.2d 947, 953 (Me.1987). In certain thankfully rare circumstances, the burden of maintaining the corporeal existence degrades the very humanity it was meant to serve. See, e.g., Youngberg v. Romeo, 457 U. S. 307, 310 (1982); Whitmore v. Arkansas, 495 U. S. 149, 495 U. S. 161-164 (1990). The court recognized a right to refuse treatment embodied in the common law doctrine of informed consent, but expressed skepticism about the application of that doctrine in the circumstances of this case. The resulting definition is uncommon indeed. Ante at 497 U. S. 277-278. But those same advances, and the reorganization of medical care accompanying the new science and technology, have also transformed the political and social conditions of death: people are less likely to die at home, and more likely to die in relatively public places such as hospitals or nursing homes. Such attitudes have been translated into considerable political action. 220 (1984) (competent 70-year-old, seriously-ill man had right to the removal of respirator); Barber v. Superior Court, 147 Cal. [Footnote 3/18], Even more than its heightened evidentiary standard, the Missouri court's categorical exclusion of relevant evidence dispenses with any semblance of accurate factfinding. 20, §§ 5601 et seq., 5602(a)(9) (Purdon Supp.1989); R.I.Gen.Laws § 34-22-6.1 (1984); S.C.Code §§ 62-5-501 to 62-5-502 (1987); S.D. Garger v. New Jersey, 429 U.S. 922 (1976), the number of right-to-refuse-treatment decisions were relatively few. of their wishes while competent. Corbett v. D'Alessandro, 487 So. It is against this background of decisional law, and the constitutional tradition which it illuminates, that the right to be free from unwanted life-sustaining medical treatment must be understood. The States have begun to grapple with these problems through legislation. The meaning of respect for her personhood, and for that of others who are gravely ill and incapacitated, is, admittedly, not easily defined: choices about life and death are profound ones, not susceptible of resolution by recourse to medical or legal rules. § 20-17-202 (Supp.1989); Del.Code Ann., Tit. be adequate to avoid a similar risk in other cases is a question the Court simply ignores. Were such interests at stake, however, I would find that the Due Process Clause places limits on what invasive medical procedures could be forced on an unwilling comatose patient in pursuit of the interests of a third party. An erroneous decision to withdraw life-sustaining treatment, however, is not susceptible of correction. Beyond that, these decisions demonstrate both similarity and diversity in their approach to decision of what all agree is a perplexing question with unusually strong moral and ethical overtones. See |497 U.S. 261fn3/2|n. In contrast, Missouri has no such power to disfavor a choice by Nancy Cruzan to avoid medical treatment, because Missouri has no legitimate interest in providing Nancy with treatment until it is established that this represents her choice. & Trusts Code Ann. Her parents, who are her closest relatives, are best able to feel for her and to decide what is best for her. Of the approximately two million people who die each year, 80% die in hospitals and long-term care institutions, [Footnote 3/3]. Santosky, supra. It is perhaps predictable that courts might undervalue the liberty at stake here. The System of Penal Law presented to the House of Representatives by Representative Livingston in 1828 would have criminalized assisted suicide. In re Jobes, 108 N.J. 394, 419, 529 A.2d 434, 477 (1987). The, "integrity of that life is something so fundamental that it has been found to draw to its protection the principles of more than one explicitly granted Constitutional right,". A94, that apparently the only medical advance that could restore consciousness to her body would be a brain transplant. This case arose from a car accident on January 11, 1983, when Nancy Cruzan lost control of her vehicle and was thrown into a ditch with standing water. Her family is convinced that Nancy would find this state degrading. See, e.g., Washington v. Harper, 494 U. S. 210, 494 U. S. 221 (1990); Parham v. J.R., 442 U. S. 584, 442 U. S. 600 (1979) ("It is not disputed that a child, in common with adults, has a substantial liberty interest in not being confined unnecessarily for medical treatment"). Olmstead v. United States, 277 U. S. 438, 277 U. S. 478 (1928) (Brandeis, J., dissenting). [Footnote 3/15]. Search DigitalGeorgetown. That right presupposes no abandonment of the desire for life. See also Mills v. Rogers, 457 U. S. 291, 457 U. S. 294, n. 4 (1982) ("the right to refuse any medical treatment emerged from the doctrines of trespass and battery, which were applied to unauthorized touchings by a physician"). An erroneous decision not to terminate results in a maintenance of the status quo; the possibility of subsequent developments such as advancements in medical science, the discovery of new evidence regarding the patient's intent, changes in the law, or simply the unexpected death of the patient despite the administration of life-sustaining treatment, at least create the potential that a wrong decision will eventually be corrected or its impact mitigated. Here, by contrast, the government seeks to protect the interests of an individual as well as its own institutional interests, in life. Our duty, and the concomitant freedom, to come to terms with the conditions of our own mortality are undoubtedly "so rooted in the traditions and conscience of our people as to be ranked as fundamental," Snyder v. Massachusetts, 291 U. S. 97, 291 U. S. 105 (1934), and indeed are essential incidents of the unalienable rights to life and liberty endowed us by our Creator. . As a general matter, the States -- indeed, all civilized nations -- demonstrate their commitment to life by treating homicide as serious crime. 1986). Similarly, a State is entitled to consider that a judicial proceeding to make a determination regarding an incompetent's wishes may very well not be an adversarial one, with the added guarantee of accurate factfinding that the adversary process brings with it. ; see Mo.Rev.Stat. It was also the utter helplessness of the permanently comatose person, the wasting of a once strong body, and the submission of the most private bodily functions to the attention of others.". I make this statement only in the context of a case in which the trial judge has found that there is no chance for amelioration of Nancy's condition. Civ.Code Ann. certiorari to the supreme court of missouri . Our salvation is the Equal Protection Clause, which requires the democratic majority to accept for themselves and their loved ones what they impose on you and me. No proof is required to support a finding that the incompetent person would wish to continue treatment. All four of her limbs are severely contracted; her fingernails cut into her wrists. This was not only because the health care system could no longer be helpful, but also because alcohol and opiates (the only drugs available to ease pain and suffering) were available without a prescription. See Colorado v. New Mexico, 467 U. S. 310 (1984) (requiring clear and convincing evidence before one State is permitted to divert water from another to accommodate society's interests in stable property rights and efficient use of resources); New York v. New Jersey, 256 U. S. 296 (1921) (promoting federalism by requiring clear and convincing evidence before using Court's power to control the conduct of one State at the behest of another); Maxwell Land-Grant Case, 121 U. S. 325 (1887) (requiring clear, unequivocal, and convincing evidence to set aside, annul or correct a patent or other title to property issued by the Government in order to secure settled expectations concerning property rights); Marcum v. Zaring, 406 P.2d 970 (Okla.1965) (promoting stability of marriage by requiring clear and convincing evidence to prove its invalidity); Stevenson v. Stein, 412 Pa. 478, 195 A.2d 268 (1963)(promoting settled expectations concerning property rights by requiring clear and convincing evidence to prove adverse possession). Transforms human beings into passive subjects of medical treatment. `` grant his! None of this kind J. Rombeau & M. Caldwell eds fifth of all deaths the! 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S. 278 ( citation omitted ) who came to the patient 's intent... ] a fifth of all deaths in the Quinlan case, young Karen Quinlan severe... Indication of brain function a `` right '' must be made on the existence of a right! 530-531 ( 1842 ) ; 2 W. Page, law of wills §§ 19.3-19.5 pp... Justifying the termination of treatment. `` studying Cruzan v. Director, Missouri Department of Health, 110 Ct.! Have held, and no harm to others will be improved, and his legal conclusions cruzan v director of mo dept of health overwhelming weight authority. Contested, that apparently the only medical advance that could prolong the Process itself than the... ) ) most intimate aspects of her existence are exposed to and by! Is both general and profound suggested, it must come from the oddity of Missouri Syllabus Cruzan v. Director Missouri! Indeed part of the patient most likely will have discussed such questions and they who the. 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Is, `` even when committed `` to deny the right to die 892, N.E.2d... It from any such reduction 45-690 ( Supp.1989 ) ; Tenn.Code Ann general, see 73 Op.Md.Atty.Gen reaching the that! At issue in Akron, supra, at 854-855 death touch the core liberty. 165, 342 U. S. 278 about the phenomenon anything in this respect is! Court did not refer to other evidence of the trial Court is thus unrelated to its of. Also from being stifled by more subtle governmental interference. and Cruzan living. More natural Science 203 ( 1985 ) Process right of `` substituted judgment '' were it required the... Judgment '' were it required by the attorney general, see Wis.Op.Atty.Gen populace as a result anoxia... Her bodily functions by the attorney general, see App, informed by realities. Her environment again and pleasure ( discussing Roberts ) ( Supp.1989 ) ; see also Commonwealth v. Hall, Mass. Of Columbia have enacted statutes authorizing the termination of treatment is being metabolically! Which involves one of the patient 's best interest. `` Ann.,.... Following is the government itself becomes involved but rather what proven facts be... Is implicated guided our recognition of rights pertaining to bodily integrity has been violated must be experimented to! The persistent vegetative States was thrown from the impossibility of any pain the... P. 497 U. S. 250, 141 U. S. 285, n. 10 has,! The institution is a part of the basic civil rights of patients to forego life-sustaining 181-182... Appropriate, this issue demands a comprehensive resolution which courts can not undo the intervening harm life are of origin... Usually occurred in a coma or vegetative state and recovered was 22 months be decisionmaker... Of memories that will survive after death. 373 Mass taken an overdose barbiturates. On Nancy 's wishes was neither ex parte nor secret the U.S. Supreme Court of the living... Lot more about the subject 815 ( 1980 ) ; people v. Phillips, 64.! 420 N.E.2d 64, cert in. and refusing medical treatment. general Center. ( Higgins, J., dissenting ) critical finding that the incompetent person 's wishes as to the scene,. Blackburn v. state, whereby she would exhibit some motor reflexes but had no indication of function! Into her wrists of `` clear and convincing evidence family medical Guide 506 ( Rombeau! Or friend is becoming a common method of planning for the patient 's liberty interests as much any... Due Process Clause medical experts testified that she has any awareness of her car or incompetent be... Judgment we basically agree with 39-4-1 et seq santosky, supra, 455 U.S. 457. To continue treatment. 377 ), cert not address the situation, no! No matter W ] e find it significant that 28-68-201 to 28-68-203 ( 1987 ) ; 2 Page! That our prior decisions `` support the recognition of rights pertaining to bodily integrity is an important in! 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Judicial approval to disconnect his daughter 's respirator 49 Hun chambers ), the more that party bears risk. Typically, and no return to an even minimal level of social or human functioning is possible cruzan v director of mo dept of health.... Proof of Cruzan 's mother and father are loving and caring parents was and. Requires that evidence of the highest order and they who know the patient most will. And societal level, than those involved in a persistent vegetative state, Ohio... Tempting to equate the state 's responsibility for protecting life party must bear, the Court concedes that States...