Imagine lying in a hospital bed, kept alive by a machine, for seven years. You aren't "there" in any sense that most of us would define as living. This was the reality for Nancy Cruzan. In 1983, a horrific car accident left the 25-year-old in a "persistent vegetative state." She could breathe on her own, but she required a feeding tube to stay alive. Her parents knew she wouldn't want to live like that. They fought for years to take her off life support. But the state of Missouri said no. This sparked Cruzan v Missouri Department of Health, the first "right to die" case to ever reach the U.S. Supreme Court. It changed everything about how we handle medical end-of-life decisions today.
The Legal Battle Over a Feeding Tube
Nancy’s parents, Lester and Joyce Cruzan, weren't trying to be radicals. They were grieving parents who wanted peace for their daughter. They requested that hospital employees remove her artificial nutrition and hydration. The hospital refused without a court order. When the case first hit a probate court, the judge actually agreed with the parents. He found that Nancy had a fundamental right under the state and federal constitutions to refuse "death-prolonging procedures."
Missouri didn't see it that way. The state appealed, and the Missouri Supreme Court reversed the decision. They argued that because Nancy hadn't left a "living will" or any clear, written instructions, the state had an interest in preserving life. They demanded "clear and convincing evidence" of Nancy's wishes. Basically, the state wanted proof that was almost impossible to provide without a notarized document.
What the Supreme Court Actually Decided
In 1990, the U.S. Supreme Court took the case. It was a 5-4 split. Honestly, the ruling was a bit of a mixed bag for privacy advocates. On one hand, the Court recognized that competent individuals have a constitutionally protected "liberty interest" in refusing unwanted medical treatment. This was huge. It solidified the idea that you own your body.
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But—and this is a big "but"—the Court also ruled that Missouri was allowed to require "clear and convincing evidence." Chief Justice William Rehnquist wrote the majority opinion. He argued that because the stakes are so high (death is pretty permanent, after all), a state has the right to be extra cautious. If a patient is incompetent, the state can insist on high evidentiary standards to make sure nobody is making a mistake or acting with bad intentions.
Justice William Brennan wrote a stinging dissent. He argued that Nancy's right to avoid unwanted medical intervention was being swallowed up by bureaucratic requirements. He felt the state's "interest in life" shouldn't override an individual's right to be free from bodily intrusion. It was a clash of philosophies: the sanctity of life versus the autonomy of the person.
The Practical Fallout for Families
The ruling meant the Cruzans lost their Supreme Court battle. But the story didn't end there. Because the Court said states could require clear and convincing evidence, it didn't mean they had to. Eventually, more friends of Nancy came forward to testify about conversations they'd had with her. They recalled her saying she would never want to live as a "vegetable."
The state of Missouri eventually dropped its opposition. In December 1990, Nancy's feeding tube was removed. she passed away twelve days later. It was a somber, quiet end to a decade-long legal storm.
You’ve probably heard of the Terry Schiavo case that happened years later. That media circus happened because the legal precedent set by Cruzan v Missouri Department of Health left so much up to the states. It created a patchwork of laws. Some states are very liberal about letting families decide; others are incredibly restrictive.
Why You Need an Advance Directive Right Now
If you take one thing away from the Cruzan tragedy, let it be this: oral statements are rarely enough. The Supreme Court basically told the American public that if you don't put it in writing, the state can step in and take over your medical care.
- The Living Will: This is where you specify which treatments you want or don't want. Do you want a ventilator? A feeding tube? CPR? You need to be specific.
- Durable Power of Attorney for Healthcare: This is arguably more important than a living will. You designate a person (a proxy) to make decisions for you if you can't. This avoids the "clear and convincing" trap because the court generally trusts your hand-picked representative.
Without these documents, your family might end up in a courtroom instead of by your bedside. Legal fees can destroy an estate. The emotional toll of a public legal battle is even worse.
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Misconceptions About the Right to Die
People often confuse this case with physician-assisted suicide. They aren't the same thing. Cruzan v Missouri Department of Health was about the right to refuse treatment, not the right to request a lethal dose of medication. Refusing treatment is considered a "negative right"—the right to be left alone.
Another misconception is that this only applies to the elderly. Nancy Cruzan was 25. Accidents happen to young people every single day. If you are over 18, you are legally an adult, and your parents no longer have an automatic, absolute right to make medical decisions for you if the state disagrees.
Actionable Steps for Your Future
Don't leave your fate to a Supreme Court justice who doesn't know your name. Take control of your medical narrative while you're healthy and thinking clearly.
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- Download your state-specific forms. Every state has different requirements for witnesses and notarization. Websites like the National Hospice and Palliative Care Organization (NHPCO) provide these for free.
- Have the "uncomfortable conversation." Talk to your parents, spouse, or kids. Tell them exactly what "quality of life" means to you. Is it being able to recognize their faces? Is it being able to breathe without a machine?
- Distribute the copies. A living will in a safe deposit box is useless. Your doctor needs a copy. Your healthcare proxy needs a copy. Keep one on your fridge or in your glove box.
- Review every five years. Your views on life and death might change as you age or if you receive a specific diagnosis. These aren't "set it and forget it" documents.
The legacy of Nancy Cruzan isn't just a footnote in a law textbook. It's a reminder that liberty includes the right to a natural death. By documenting your wishes today, you ensure that your family never has to go through the public heartache that the Cruzans endured.