Justices Give State Priority Over Parent in Life Support Case

The Supreme Court, in its first ruling in a “right-to-die” case, said today states may bar the removal of life-sustaining treatment from comatose patients who have not made or cannot make their desires known.

By a 5-4 vote, the justices blocked the parents of a permanently unconscious Missouri woman, Nancy Cruzan, from ordering the removal of tubes that provide her with food and water.

The court said Cruzan’s rights were not violated by allowing the state’s interest in preserving life to outweigh her parents’ wishes.

But the court, indirectly supporting so-called “living will” laws, said the Constitution guarantees a competent person a right to refuse medical treatment. That issue was not presented squarely in the Cruzan case since she is incompetent to decide her future, the court said.

Dick Kurtenbach, who has worked with the Cruzans as head of the Kansas City, Mo., office of the American Civil Liberties Union, commented:

“When we looked at it realistically, and with the recent history of the court, this is not that surprising.

“I’m sure the family is going to be extremely disappointed.”

Chief Justice William H. Rehnquist, writing for the court, said Missouri may require “clear and convincing” proof that Cruzan wants to die before allowing the withdrawal of life-sustaining treatment. Such evidence is lacking in Cruzan’s case, he said.

The chief justice also said that “not all incompetent patients will have loved ones available to serve as surrogate decision makers. A state is entitled to guard against potential abuses in such situations.”

“In sum, we conclude that a state may apply a clear and convincing evidence standard in proceedings where a guardian seeks to discontinue nutrition and hydration of a person diagnosed to be in a persistent vegetative state,” Rehnquist said.

He was joined by Justices Byron R. White, Sandra Day O’Connor, Antonin J. Scalia and Anthony M. Kennedy.

Dissenting were Justices William J. Brennan, Thurgood Marshall, Harry A. Blackmun and John Paul Stevens.

Brennan, in an opinion joined by Marshall and Blackmun, said, “Nancy Cruzan is entitled to choose to die with dignity.”

Missouri and the Supreme Court “have displaced Nancy’s own assessment of the processes associated with dying,” Brennan said.

“They have discarded evidence of her will, ignored her values, and deprived her of the right to a decision as closely approximating her own choice as humanly possible.”

But Brennan said he is heartened that the court tentatively concluded that in some cases a competent person must be allowed to choose death.

State courts generally have permitted removal of life-sustaining treatment for patients like Cruzan.