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Health Prog. 1990 Oct;71(8):38-41, 57.

After Cruzan. The U. S. Supreme Court's decision settles the case but raises new questions.

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Center for Health Law Studies, St. Louis University.


In its Cruzan v. Director, Missouri Department of Health, decision the U.S. Supreme Court addressed only states' authority in the refusal of medical treatment. But the case itself drew national attention to the issue, and physicians and healthcare facilities should expect to see living wills and durable powers of attorney increase as a result. Legal concerns will also arise as a result of misconceptions regarding the law. The Court was careful to qualify and limit its support of the Missouri Supreme Court's decision. As opposed to the latter's nearly outright denial of an individual's right to refuse medical treatment, the U.S. Supreme Court's majority opinion asserted that a competent person has a "constitutionally protected liberty interest in refusing unwanted medical treatment." And although the Court upheld Missouri's requirement that there be "clear and convincing evidence" of an incompetent patient's previously expressed wishes before treatment can be discontinued, it did not make such evidence mandatory for states with different law. Finally, in a separate concurring opinion Justice Sandra Day O'Connor asserted that a patient-designated proxy could be an acceptable "source of evidence" of a patient's intent. If the proxy does in fact have some constitutional status, this status should motivate state courts and legislatures to recognize the practice.

[Indexed for MEDLINE]

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