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Abstract

As medical expertise and technologies improve, many patients who would otherwise die of their illnesses or injuries survive. For many of these patients and their families, the knowledge and therapies that save their lives are a blessing. Unfortunately for some, survival means not recovery, but rather a severely limited existence dependent on some form of life-sustaining treatment, such as a ventilator or feeding tube. For some of these patients, such an existence is not a blessing, but a curse, not a triumph over death, but rather a cruel prolonging of their dying. These patients, or their families, seek to have their life-supporting therapies withdrawn, allowing them to complete the process of dying which their bodies have already begun. Many patients are successful in having such treatments withdrawn. Success comes to others, though, only as the result of lengthy legal battles, which add to the grief of the patients and families involved. Most state courts confronted with withdrawal-of-support problems have found that patients do indeed have the right to demand the termination of life-supporting therapies, and most state courts have found that right to be derived from the federal constitutional right of privacy. The Supreme Court of Missouri, however, in its 1988 decision Cruzan v. Harmon, came to the opposite conclusion.Nancy Cruzan is a young woman in a persistent vegetative state as the result of an automobile accident. Her parents and co-guardians sought an order allowing them to authorize the removal of the feeding tube through which Ms. Cruzan receives the necessary nutrition and hydration to remain alive. The Missouri court noted over four dozen withdrawal-of-support cases from other states that had "nearly unanimously" respected the patients' requests to have treatment halted. Despite that, the court found that Ms. Cruzan has no right of privacy or self-determination that can outweigh the "immense, clear fact of life in which the state maintains a vital interest." The most troublesome aspect of the Cruzan decision was the court's assertion that because Ms. Cruzan feels no pain, the treatments she receives are "not burdensome" to her. The court reached this conclusion despite evidence that Ms. Cruzan had said she would not want to be maintained in such a condition and that she would not want her family to suffer the pain of seeing her in such straits. The court's statement shows a stunning lack of sensitivity to Ms. Cruzan's human dignity, a dignity that is given meaning by, among other things, individual rights of self-determination, the "right to be let alone." Ms. Cruzan's parents and co-guardians appealed the Missouri decision to the United States Supreme Court. The Court heard arguments in Cruzan, its first withdrawal-of-support case, in December, 1989. This case gives the Court a chance to conclusively resolve the issue of how and by whom withdrawal-of-support decisions are made. A patient's decision to order the cessation of treatment is a personal medical decision and should be made, like any other personal medical decision, in the privacy of the doctor-patient relationship, not in a courtroom. A clear and definitive ruling by the Court that every patient has a right, guaranteed by the federal Constitution, to order treatment discontinued will return these treatment decisions to their proper place, the patient's bedside. This Comment will discuss the problems created by the current state of affairs, which all too frequently forces patients and their families into the courts to have fundamental questions of medical treatment decided. It will then discuss the foundation of a patient's federal constitutional right to order the withdrawal of life-sustaining therapies. It is imperative that the Court clearly enunciate this right for many reasons; these will be discussed in the final section of this Comment.

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