A Retrospective onCruzan

Abstract

In 1990, the United States Supreme Court issued a decision in the Cruzan case, the first "right-to-die case" to reach that Court. Prior to the Court's decision, there was wide-spread speculation as to what it would decide and what the impact of the decision would be. Speculation about the impact of the decision intensified after it was announced, with many suggesting that it would prove to be a serious setback to the consensus about the legality of terminating life-sustaining medical treatment that had evolved in the state courts since the Karen Quinlan case ushered in the era of right-to-die litigation in 1976. This article examines a number of aspects of the legal consensus about forgoing life-sustaining treatment that emerged prior to Cruzan and discusses their viability in light both of what Cruzan did and did not decide and in light of subsequent judicial decisions in right-to-die cases. Two years after the Supreme Court's decision, it is apparent that the pre-Cruzan legal consensus is stronger than ever.

Comfort Feeding Only: A Proposal to Bring Clarity to Decision‐Making Regarding Difficulty with Eating for Persons with Advanced Dementia

“…The Supreme Court's decision in Cruzan v. Director, Missouri Department of Health supports a patient's right to forgo PEG feeding tube insertion, through a proxy decision‐maker or advance directive, 13 but despite the consensus of the literature regarding the marginal benefits of feeding tubes in patients with advanced dementia 6,7,14 and a clear legal right to forgo a feeding tube, feeding tubes are common in patients with advanced dementia in nursing homes, whereas orders to forgo artificial hydration and nutrition are not prevalent in this population 5,15 . Furthermore, national studies have shown up to a 10‐fold difference in states in the prevalence of feeding tubes in patients with advanced dementia, suggesting that factors external to the patient's disease affect feeding tube decisions 16,17 .…”