The Bill of Rights provides an outline for many of the individual rights guaranteed by the Constitution. Police power is granted to the states by the Tenth Amendment of the Constitution so to preserve and protect the safety, health, and welfare of its residents. The Fourteenth Amendment, designed as a safeguard, is intended to deter states from denying an individual’s right to due process or equal protection as well as restricting a state’s ability to “enforce any law which shall abridge [their] privileges and immunities.” U.S. Const. Amendment XIV. The right to refuse life-sustaining medical treatment is not supported by the text of the Constitution. As a result, the issue falls under the police power of each state.
In Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261 614 (1990), the Supreme Court rejected a request to remove a feeding tube from a patient in a persistent vegetative state. The events leading up to this decision began on January 11, 1983, when the petitioner, Nancy Cruzan, survived an automobile accident that left her unconscious at the scene. From the accident, she was transported to a state hospital to obtain immediate medical attention. At the request of her husband, the facility inserted a feeding tube to facilitate her recovery. After all medical treatment was exhausted, the doctor determined Mrs. Cruzan’s condition would not improve and that she would remain in a persistent vegetative state. However, her parents requested the removal of the feeding tube. The doctor refused, which resulted in legal action. The claim brought forth to the trial court was whether the petitioner has a right to remove her feeding tube, which would eventually become the cause of her death, implying a broader constitutional right to die. The trial court concluded an incapacitated person “had a fundamental right under the State and Federal Constitutions to refuse or direct the withdrawal of ‘life-prolonging procedures.’” Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261 614 (1990).
On appeal, the Missouri Supreme Court denied the court order for the parents of Mrs. Cruzan, rejecting a “broad right of privacy” with the removal of life-saving procedures in any circumstance. The emerging principle being:
“no person can assume that choice for an incompetent in the absence of the formalities required under [state law] or the clear and convincing, inherently reliable evidence. . . .” Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261 614 (1990).
The Supreme Court granted certiorari and expanded the legal standard established by the Missouri Supreme Court. Thus the liberty interest of an incapacitated person to refuse medical treatment is qualified. The Court supported the implication of a liberty interest but only under limited restrictions. For one, the liberty interest would be protected from state action if there is a living will or an advance medical directive in the absence of a living will. An advance medical directive or a living will is a legal document that gives specific instructions about the health care treatment administered in the event of one’s illness or incapacitation. In the absence of such a document, the Court applies the clear and convincing evidence standard. The Supreme Court interpreted the clear and convincing standard to encompass an “objective ‘best interest’ standard.” So,
“if the burden of a prolonged life from the experience of pain and suffering markedly outweighed its satisfactions, treatment could be terminated. . . .” Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261 (1990).
Therefore, the Court in Cruzan concluded the state law requiring a living will or an advance medical directive was not unconstitutional, thus not a violation of the Due Process Clause of the Fourteenth Amendment. However, in the absence of a living will or an advance directive, the state’s interest in preserving life may outweigh an individual’s liberty interest in refusing medical treatment. Soon after, the Federal government enacted the Patient Self-Determination Act. The Act requires health care facilities to inform patients of their decision-making rights, such as the right to make their own health care decision or their right to refuse or accept treatment. The Act also requires health care facilities to inquire if a patient has an advance medical directive or a living will and to note this in their medical records. A related topic to refusing medical treatment is whether one has the right to physician-assisted suicide.
In a more recent case, Washington v. Glucksberg, U.S. 521 (1997), the Supreme Court ruled that physician-assisted suicide is not a fundamental liberty interest protected by the Due Process Clause of the Fourteenth Amendment. The Court reasoned that a state statute that made it a felony for a person to assist in death was rationally related to the legitimate state interest of preserving life. However, the Supreme Court deferred to the States to determine whether physician-assisted suicides would be allowed, and several states have implemented “Death with Dignity” statutes to allow such practice.
