Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T12:14:52.323Z Has data issue: false hasContentIssue false
  • English
  • Français

A Retrospective on Cruzan

Published online by Cambridge University Press:  29 April 2021

Alan Meisel
Get access Rights & Permissions [Opens in a new window]

Extract

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 widespread 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-Crtrzan legal consensus is stronger than ever.

Type
Article
Information
Law, Medicine and Healthcare , Volume 20 , Issue 4 , Winter 1992 , pp. 340 - 353
Copyright
Copyright © American Society of Law, Medicine and Ethics 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

These states and the leading or seminal case are: Arizona (Rasmussen v. Fleming, 154 Ariz. 107, 741 P.2d 674 (1987)); California (Barber v. Superior Court, 147 Cal. App. 3d 1006, 195 Cal. Rptr. 484 (1983)); Connecticut (McConnell v. Beverly Enterprises-Connecticut, Inc., 109 Conn. 692, 553 A.2d 596 (1989)); Delaware (Severns v. Wilmington Medical Center Inc., 421 A.2d 1334 (Del. 1980)); District of Columbia (in re A. C., 573 A. 2d 1235 (D.C. 1990)); Florida (In re Browning, 568 So. 2d 4 (Fla. 1990)); Georgia (State v. McAfee, 259 Ga. 579, 385 S.E.2d 651 (1989)); Illinois (In re Longeway, 133 Ill. 2d 33, 139 Ill. Dec. 780, 549 N.E.2d 292 (1989)); Indiana (In re Lawrance, 579 N.E.2d 32 (Ind. 1991)); Louisiana (In re P.V.W., 424 So. 2d 1015 (La. 1981)); Maine (In re Gardner, 534 A.2d 947 (Me. 1987)); Maryland (Mack v. Mack, No. 19, September Term, 1992, 1993 WESTLAW 18773, 1993 Md. LEXIS 11 (Feb 2, 1993)); Massachusetts (Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 370 N.E.2d 417 (1977)); Michigan (In re Rosebush, (195 Mich. App. 675, 491 N. W. 2d 633 (1992)); Minnesota (In re Torres, 357 N.W.2d 332 (Minn. 1984)); Missouri (Cruzan v. Harmon, 760 S.W.2d 408 (Mo. 1988)); Nevada (McKay v. Bergstedt, 801 P.2d 617 (Nev. 1990)); New Jersey (In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976)); New York (In re O'Connor, 72 N.Y.2d 517, 531 N.E.2d 607, 534 N.Y.S.2d 886 (1988)); Ohio (Estate of Leach v. Shapiro, 13 Ohio App. 3d 393, 469 N.E.2d 1047 (1984)); Rhode Island (Gray v. Romeo, 697 F. Supp. 580 (D.R.I. 1988)); Washington (In re Grant, 109 Wash. 2d 545, 747 P.2d 445 (1987), modified, 757 P.2d 534 (1988)); West Virginia (Belcher v. Charleston Area Medical Center, 422 S. E. 2d 827 (W. Va. 1992)); Wisconsin (In re L. W., 481 N.W.2d 60 (Wis. 1992)).Google Scholar
Although “it is…difficult to estimate the total number of [life-sustaining medical treatment) cases heard by the judiciary,” the only known, published estimate is that there have been between 1900 and 7000 or more trial court cases during the 15-year period between 1975 and 1989. Hafemeister, Thomas L. et al., “The Judicial Role in Life-Sustaining Medical Treatment Decisions,” 7 Issues in L. & Med. 53, 65 (1991). This means that only a very small proportion (between about 0.7 and 2.6 percent of all right-to-die cases commenced in trial courts is appealed. The number of cases in trial courts is still proportionately small. There are approximately 2.2 million deaths per year in the United States (Brief Amicus Curiae for the American Hospital Association at 3, Cruzan v. Director, 110 S. Ct. 2841 (1990), citing United States National Center for Health Statistics, 37 Monthly Vital Statistics 6 (1989)), approximately 1.3 million of which occur in hospitals. Brief Amicus Curiae for the American Hospital Association at 3, Cruzan v. Director, 110 S.Ct. 2841 (1990), citing United States National Center for Health Statistics, Vital Statistics of the United States (1986). According to the American Hospital Association, “[s]eventy percent die after a decision to forego life-sustaining treatment has been made.” Brief Amicus Curiae for the American Hospital Association at 3, Cruzan v. Director, 110 S. Ct. 1841 (1990), citing Helene Lipton, L. et al., “Do-Not-Resuscitate Decisions in a Community Hospital: Incidence, Implications and Outcomes,” 256 JAMA 1164 (1986). It is not clear whether this means that 70 percent of all deaths occur from forgoing life-sustaining treatment or whether 70 percent of all in-hospital deaths occur from forgoing life-sustaining treatment. It is more likely that it is the latter. Using this latter, more conservative estimate of 70 percent of 1.3 million in-hospital deaths per year, this means that over the 15-year post-Quinlan period, in round numbers there have been about 13.6 million deaths from the forgoing of life-sustaining treatment. Of these cases of death, perhaps somewhere between 2 and 5 per 100,000 (n = between 2900 and 7000) have been litigated at all, and between 37 and 55 in to million (n = between 50 and 75) have been litigated to the point of yielding an appellate decision. Thus, although the proportion of deaths from forgoing life-sustaining treatment that influence the formal law-making process is exceedingly small, the fact that death from forgoing life-sustaining treatment frequently occurs without benefit of judicial blessing has probably had a substantial impact on the acceptance, the development, and the further evolution of the consensus.Google Scholar
110 S. Ct. 2841 (1990).Google Scholar
See, e.g., Harris, Curtis E. & Bostrom, Barry A., “Is the Continued Provision of Food and Fluids in Nancy Cruzan's Best Interests,” 5 Issues in L. & Med. 415, 435 (1990) (“If the United States Supreme Court authorizes the withholding of nutrition from Nancy Cruzan, it will create a constitutional right in guardians to choose death for their dependent wards. The creation of such a right will constitute a dangerous precedent in the law that will not only result in the death of Nancy Cruzan, but will place at risk thousands of persons who are incompetent and reliant on feeding by tube. Most importantly, it will provide, for the first time, constitutional protection for nonvoluntary euthanasia in the United States.”); Tuerk, William F., “Cruzan v. Harmon: The Projected Impact of Pending Supreme Court Litigation on Withdrawal of Life-Sustaining Treatment,” 3(1) Quarterly Newsletter of Veterans Administration Northeast Regional Center for Clinical Ethics 1, 3 (March 1990) (“[I]t is conceivable—though it is not likely—that the Court could rule that the withdrawal of nutrition and hydration is suicide (when ordered by the patient), and homicide (when it is ordered by a surrogate)).Google Scholar
See, e.g., Bopp, James Jr. & Marzen, Thomas J., “Cruzan: Facing the Inevitable,” 19 Law, Med. & Health Care 37, 42 (1991) (“On the whole… Cruzan's caution will almost certainly generate a greater degree of caution in state courts as well.”); Colburn, Don, “Another Chapter in the Case of Nancy Cruzan,” Washington Post, Oct. 16, 1990, at 7 (“Physicians who are already nervous about the risk of malpractice lawsuits…are even more likely to refuse to withhold extraordinary life-continuing care from irreversibly comatose patients unless they have a living will or signed power of attorney form. It's becoming very hard to terminate treatment on anyone in this country…. The Cruzan decision is having that horrible effect—of physicians starting to practice law, basically.”) (quoting George Annas).Google Scholar
The Supreme Court issued its opinion in Cruzan on June 25, 1990. Between that date and September 30, 1992, the following cases, in which it was highly likely or certain that the patient would die if the treatment in question were withheld or withdrawn, were decided by state appellate courts: Newmark v. Williams, 588 A.2d 1108 (Del. 1992); In re Browning, 568 So. 2d 4 (Fla. 1990); In re Dubrcuil, 603 So. 2d 538 (Fla. Dist. Ct. App. 1992); In re Doe, 262 Ga. 389, 418 S.E.2d 3 (1992); In re Estate of Greenspan, 137 Ill. 2d 1, 146 Ill. Dec. 860, 558 N.E.2d 1194 (1990); In re Beth, 412 Mass. 188, 587 N.E.2d 1377 (1992); In re Doc, 411 Mass. 512, 583 N.E.2d 1263 (1991); In re McCauley, 409 Mass. 134, 565 N.E.2d 411 (1991); Norwood Hosp. v. Munoz, 409 Mass. 116, 564 N.E.2d 1017 (1991); In re Rosebush, (195 Mich. App. 675, 491 N. W. 2d 633 (1992)); In re Busalacchi, No. 59582, 1991 WL 26851, 1991 Mo. App. LEXIS 315 (Mar. 5, 1991); McKay v. Bergstedt, 801 P.2d 617 (Nev. 1990); In re Hughes, 259 N.J. Super. 193, 611 A.2d 1149 (App. Div. 1992); In re Moorhouse, 250 N.J. Super. 307, 593 A.2d 1256 (App. Div. 1991); Grace Plaza of Great Neck, Inc., v. Elbaum, 183 App. Div. 2d 10, 588 N. Y. S. 2d 853 (1992); Belcher v. Charleston Area Medical Center, 422 S. E. 2d 827 (W. Va. 1992); In re L.W., 167 Wis. 2d 53, 482 N.W.2d 60 (1992).Google ScholarGoogle Scholar
The facts of the case can be found in more detail in the opinions of the Missouri Supreme Court, Cruzan v. Harmon, 760 S.W.2d 408 (Mo. 1988), and the United States Supreme Court, Cruzan v. Director, 110 S. Ct. 2841 (1990).Google Scholar
Meisel, Alan, The Right to Die §§ 5.15, 5.20 (1989 & Supp. 1993).Google Scholar
Id. §§ 1.1 (Table 1–1), 5.10 (Table 5–1), 5.20.Google Scholar
Cruzan v. Harmon, 760 S.W.2d 408 (Mo. 1988).Google Scholar
See In re Drabick, 200 Cal. App. 3d 185, 245 Cal. Rptr. 840, cert. denied, 488 U.S. 958, reh. denied, 488 U.S. 1024 (1989); In re Estate of Prange, 166 Ill. App. 3d 1091, 520 N.E.2d 946 (Ct. App.), vacated, 527 N.E.2d 303, cert. denied sub nom. Murphy v. Benson, 488 U.S. 892 (1988); In re Storar, 52 N.Y.2d 363, 420 N.E.2d 64, 438 N.Y.S.2d 266, cert. denied, 454 U.S. 858 (1981); In re Jobes, 108 N.J. 394, 529 A.2d 434, reconsideration and stay denied, 108 N.J. 589, 531 A.2d 1360, cert. denied sub nom. Lincoln Park Nursing & Convalescent Home v. Kahn, 483 U.S. 1036 (1987); In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976), cert. denied sub nom. Garger v. New Jersey, 429 U.S. 922 (1976). The court has also denied review in a large number of cases raising related issues. See, e.g., In re Milton, 19 Ohio St. 3d 20, 505 N.E.2d 255 (1987), cert. denied, 484 U.S. 810 (1987); Weber v. Stony Brook Hosp., 95 A.D.2d 587, 467 N.Y.S.2d 685 (per curiam), aff'd, 60 N.Y.2d 208, 456 N.E.2d 1186, 469 N.Y.S.2d 63, cert. denied, 464 U.S. 1026 (1983); In re Infant Doe, No. GU8204–00 (Cir. Ct., Monroe Cty., Ind. Apr. 12, 1981), writ of mandamus dismissed sub nom. State ex rel. Infant Doe v. Baker, No. 482 S 140 (Ind. Sup. Ct. May 27, 1982), cert. denied, 464 U.S. 961 (1983); In re Phillip B., 91 Cal. App. 3d 796, 156 Cal. Rptr. 48, cert. denied sub nom. Bothman v. Warren B., 445 U.S. 949 (1979).Google Scholar
Cruzan v. Director, 110 S. Ct. at 2852.Google Scholar
Rasmussen v. Fleming, 154 Ariz. 107, 741 P.2d 674 (1987); Bouvia v. Superior Court (Glenchur), 179 Cal. App. 3d 1127, 225 Cal. Rptr. 197 (1986); In re Gardner, 534 A.2d 947 (Me. 1987); Brophy v. New England Sinai Hosp., Inc., 398 Mass. 417, 497 N.E.2d 616 (1986); In re Torres, 357 N.W.2d 332 (Minn. 1984); In re Jobes, 108 N.J. 394, 529 A.2d 434 (1987); In re Farrell, 108 N.J. 335, 529 A.2d 404 (1987); In re Conroy, 98 N.J. 321,486 A.2d 1209 (1985); In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976); Delio v. Westchester County Medical Center, 129 A.D.2d 1, 516 N.Y.S.2d 677 (1987); Eichner v. Dillon, 73 A.D.2d 431, 426 N.Y.S.2d 517 (1980); In re Grant, 109 Wash. 2d 545, 747 P.2d 445 (1987), modified, 757 P.2d 534 (1988); In re Ingram, 101 Wash.2d 827, 689 P.2d 1363 (1984); In re Colyer, 99 Wash. 2d 114, 660 P.2d 738 (1983).Google Scholar
In re Deel, 729 F. Supp. 231 (N.D.N.Y. 1990); Gray v. Romeo, 697 F. Supp. 580 (D.R.I. 1988); Rasmussen v. Fleming, 154 Ariz. 207, 741 P.2d 674 (1987); Bouvia v. Superior Court (Glenchur), 179 Cal. App. 3d 1127, 225 Cal. Rptr. 297 (1986); Bartling v. Superior Court, 163 Cal. App. 3d 186, 209 Cal. Rptr. 220 (1984); McConnell v. Beverly Enterprises-Connecticut, Inc., 209 Conn. 692, 553 A.2d 596, 601–02 (1989) (dictum); Foody v. Manchester Memorial Hosp., 40 Conn. Sup. 127, 481 A.2d 713 (1984); Severns v. Wilmington Medical Center Inc., 421 A.2d 1334 (Del. 1980); John F. Kennedy Memorial Hosp. v. Bludworth, 452 So. 2d 921 (Fla. 1984); Corbett v. D'Alessandro, 487 So. 2d 368 (Fla. Dist. Ct. App. 1986); Satz v. Perlmutter, 379 So. 2d 359 (Fla. 1980); In re L.H.R., 253 Ga. 439, 321 S.E.2d 716 (1984); Norwood Hosp. v. Munoz, 409 Mass. 116, 564 N.E.2d 1017 (1991); Brophy v. New England Sinai Hosp., Inc., 398 Mass. 417, 497 N.E.2d 626 (1986); In re Spring, 380 Mass. 629, 405 N.E.2d 115 (1980); Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 370 N.E.2d 417 (1977); In re Torres, 357 N.W.2d 332 (Minn. 1984); In re Farrell, 108 N.J. 335, 529 A.2d 404 (1987); In re Conroy, 98 N.J. 321, 486 A.2d 1209 (1985); In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976); Eichner v. Dillon, 73 A.D.2d 431, 426 N.Y.S.2d 517 (1980); Leach v. Akron Gen. Medical Center, 68 Ohio Misc. 1, 416 N.E.2d 809 (1980); In re Grant, 109 Wash. 2d 545, 747 P.2d 445 (1987), modified, 757 P.2d 534 (1988); In re Ingram, 101 Wash. 2d 827, 689 P.2d 1363 (1984); In re Colyer, 99 Wash. 2d 114, 660 P.2d 738 (1983).Google Scholar
See, e.g., Newmark v. Williams, 588 A.2d 1108 (Del. 1991); In re Fosmire, 75 N.Y.2d 218, 551 N.E.2d 77, 551 N.Y.S.2d 876 (1990); Norwood Hosp. v. Munoz, 409 Mass. 116, 564 N.E.2d 1017 (1991); In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976).Google Scholar
See, e.g., Rasmussen v. Fleming, 154 Ariz. 207, 741 P.2d 674 (1987); Bouvia v. Superior Court, 179 Cal. App. 3d 1127, 225 Cal. Rptr. 297 (1986); Bartling v. Superior Court, 163 Cal. App. 3d 186, 209 Cal. Rptr. 220 (1984); In re Browning, 568 So. 2d 4 (Fla. 1990); Corbett v. D'Alessandro, 487 So. 2d 368 (Fla. Dist. Ct. App. 1986); In re Barry, 445 So. 2d 365 (Fla. Dist. Ct. App. 1984); John F. Kennedy Memorial Hosp. v. Bludworth, 432 So. 2d 611, 619 (Fla. Dist. Ct. App. 1983); In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976); In re Grant, 109 Wash. 2d 545, 747 P.2d 445 (1987), modified, 757 P.2d 534 (1988); In re Colyer, 99 Wash. 2d 114, 660 P.2d 738 (1983).Google Scholar
See, e.g., In re Conroy, 98 N.J. 321, 486 A.2d 1209, 1223 (1985) (“[I])n Quinlan [citation omitted], we indicated that the right of privacy enunciated by the Supreme Court ‘is broad enough to encompass a patient's decision to decline medical treatment under certain circumstances,’ even if that decision might lead to the patient's death. [Citations omitted.] While this right of privacy might apply in a case such as this, we need not decide that issue since the right to decline medical treatment is, in any event, embraced within the common-law right to self-determination.”Google Scholar
110 S. Ct. at 2851 n.7.Google Scholar
See In re Browning, 568 So. 2d 4 (Fla. 1990).Google Scholar
See Newmark v. Williams, 588 A.2d 1108 (Del. 1991) (religious exemption provision in child neglect statute); In re Lawrance, 579 N.E.2d 32 (Ind. 1991) (surrogate decision-making statute).Google Scholar
See, e.g., In re Beth, 412 Mass. 188, 587 N.E.2d 1377 (1992); In re Doe, 411 Mass. 512, 583 N.E.2d 1163 (1992); In re Rosebush, (195 Mich. App. 675, 491 N. W. 2d 633 (1992)); McKay v. Bergstedt, 801 P.2d 617 (Nev. 1990); In re McInnis, 61 Ohio Misc. 2d 790, 584 N.E.2d 1389 (Probate Ct. Stark County, 1991); In re L. W., 482 N.W.2d 60 (Wis. 1992) (in conjunction with statutory and constitutional bases).Google Scholar
A few courts have relied on a federal constitutional right of privacy, though usually in conjunction with some other basis. See, e.g., Norwood Hosp. v. Munoz, 409 Mass. 116, 564 N.E.2d 1017 (1991) (common-law and constitutional right of privacy); In re Crum, 580 N.E.2d 876 (Probate Ct. Franklin County, Ohio, 1991) (right of privacy and surrogate decisionmaking statute).Google Scholar
See, e.g., In re Deel, 729 F. Supp. 231 (N.D.N.Y. 1990); Tune v. Walter Reed Army Medical Hosp., 602 F. Supp. 1452 (D.D.C. 1985); Bouvia v. Superior Court (Glenchur), 179 Cal. App. 3d 1127, 225 Cal. Rptr. 297 (1986); Bartling v. Superior Court, 163 Cal. App. 3d 186, 209 Cal. Rptr. 220 (1984); Wons v. Public Health Trust, 500 So. 2d 679 (Fla. Dist. Ct. App. 1987), aff’d, 541 So. 2d 96 (Fla. 1989); Satz v. Perlmuttcr, 379 So. 2d 359 (Fla. 1980), affirming 362 So. 2d 160 (Fla. Dist. Ct. App. 1978); St. Mary's Hosp. v. Ramsey, 465 So. 2d 666 (Fla. Dist. Ct. App. 1985); State v. McAfee, 259 Ga. 579, 385 S.E.2d 651 (1989); McKay v. Bergstedt, 801 P.2d 617 (Nev. 1990); In re Farrell, 108 N.J. 335, 529 A.2d 404 (1987); In re. Requena, 213 N.J. Super. 443, 517 A.2d 869 (App. Div. 1986); In re Fosmire, 75 N.Y.2d 218, 551 N.E.2d 77, 551 N.Y.S.2d 876 (1990); Saunders v. State, 129 Misc.2d 45, 492 N.Y.S.2d 510 (Sup. Ct. 1985); In re Doe, 16 Phila. 229, 45 Pa. D. & C. 3d 371 (C. P. 1987).Google Scholar
See, e.g., In re President & Dirs. of Georgetown College, 331 F.2d 1000 (D.C. Cir. 1964); John F. Kennedy Memorial Hosp. v. Heston, 58 N.J. 576, 279 A.2d 670 (1971); cf. State Dept. of Human Services v. Northern, 563 S.W.2d 197 (Tenn. App. 1978) (patient, who was intelligent, lucid, communicative and articulate found incompetent to make decision about amputation of her feet because of inability or unwillingness to recognize the actual condition of her feet; decided after Quinlan).Google Scholar
See, e.g., In re President & Dirs. of Georgetown College, 331 F.2d 1000 (D.C. Cir.), aff'd, 331 F.2d 1010 (D.C. Cir.), cert. denied, 377 U.S. 978 (1964); United States v. George, 239 F.Supp. 752 (D. Conn. 1965); Raleigh Fitkin-Paul Memorial Hospital v. Anderson, 42 N.J. 421, 201 A.2d 537 (N.J.), cert. denied, 377 U.S. 985 (1964); Powell v. Columbian Presbyterian Medical Center, 49 Misc.2d 215, 267 N.Y.S.2d 450 (N.Y. Sup. Ct. 1965).Google Scholar
See, e.g., In re President & Dirs. of Georgetown College, 331 F.2d 1000 (D.C. Cir.), aff'd, 331 F.2d 1010 (D.C. Cir.), cert. denied, 377 U.S. 978 (1964); United States v. George, 239 F.Supp. 752 (D. Conn. 1965); John F. Kennedy Memorial Hosp. v. Heston, 58 N.J. 576, 279 A.2d 670 (1971).Google Scholar
Cruzan v. Director, 1 to S. Ct. at 2851.Google Scholar
See, e.g., Bouvia v. Superior Court (Glenchur), 179 Cal. App. 3d 1127, 225 Cal. Rptr. 297 (1986) (feeding tube; patient with multiple sclerosis); Wons v. Pub. Health Trust, 541 So. 2d 96 (Fla. 1989) (blood transfusion); St. Mary's Hosp. v. Ramsey, 465 So. 2d 666 (Fla. Dist. Ct. App. 1985) (blood transfusion); State v. McAfee, 259 Ga. 579, 385 S.E.2d 651 (1989) (ventilatory; quadriplegic patient); Mercy Hosp. Inc. v. Jackson, 62 Md. App. 409, 489 A.2d 1130 (1985) (blood transfusion; pregnant patient); In re Fosmire, 75 N.Y.2d 218, 551 N.E.2d 77, 551 N.Y.S.2d 876 (1990) (blood transfusion; pregnant patient).Google Scholar
Bouvia v. Superior Court (Glenchur), 179 Cal. App. 3d 1127, 225 Cal. Rptr. 297 (1986).Google Scholar
State v. McAfee, 259 Ga. 579, 385 S.E.2d 651 (1989).Google Scholar
Wons v. Pub. Health Trust, 541 So. 2d 96 (Fla. 1989); Mercy Hosp. Inc. v. Jackson, 62 Md. App. 409, 489 A.2d 1130 (1985) vacated and rewarded as moot, 306 Md. 556, 510 A. 2d 562 (1986); In re Fosmire (Nicoleau), 75 N.Y.2d 218, 551 N.E.2d 77, 551 N.Y.S.2d 876 (1990).Google Scholar
Although an intermediate appellate court in Florida overrode the refusal of a life-saving blood transfusion by a Witness, Jehovah's, see In re Dubreuil, 603 So. 2d 538 (Fla. Dist. Ct. App. 1992), the opinion did not rely on Cruzan, nor did it even cite it, and the holding may be in conflict with Florida Supreme Court precedent. See Wons v. Pub. Health Trust, 541 So. 2d 96 (Fla. 1989).Google Scholar
McKay v. Bergstedt, 801 P.2d 617 (Nev. 1990).Google Scholar
Norwood Hosp. v. Munoz, 409 Mass. 116, 564 N.E.2d 1017 (1991).Google Scholar
In re Grant, 747 P.2d at 449; accord Gray v. Romeo, 697 F. Supp. 580 (D.R.I. 1988); Rasmussen v. Fleming, 741 P.2d at 685–86; Foody v. Manchester Memorial Hosp., 40 Conn. Supp. 127, 482 A.2d 713, 721 (1984); In re A.C., 573 A.2d 1235, 1247 (D.C. 1990); In re Browning, 568 So. 2d 4, 12 (Fla. 1990) (“no basis for drawing a constitutional line between the protections afforded to competent persons and incompetent persons”); John F. Kennedy Memorial Hosp. v. Bludworth, 452 So. 2d 921, 926 (Fla. 1984); Corbett v. D'Alessandro, 487 So. 2d 368, 370 (Fla. Dist. Ct. App.), review denied, 492 So. 2d 1331 (Fla. 1986); Brophy v. New England Sinai Hosp., Inc., 497 N.E.2d at 633; In re Spring, 380 Mass. 629, 405 N.E.2d 115, 119 (1980); In re Jobes, 108 N.J. 394, 529 A.2d 434, 451 (1987); In re Peter, 108 N.J. 365, 529 A.2d 419, 423 (1987); In re Visbeck, 210 N.J. Super. 527, 510 A.2d 125, 129 (Ch. Div. 1986); In re Colyer, 99 Wash. 2d 114, 660 P.2d 738, 744 (1983); cf. Barber v. Superior Court, 147 Cal. App. 3d 1006, 195 Cal. Rptr. 484 (1983); Severns v. Wilmington Medical Center, Inc., 421 A.2d 1334 (Del. 1980); In re Barry, 445 So. 2d 365 (Fla. Dist. Ct. App. 1984); In re L.H.R., 253 Ga. 439, 321 S.E.2d 716 (1984); In re P.V.W., 424 So. 2d 1015 (La. 1982); Custody of a Minor, 385 Mass. 697,434 N.E.2d 601 (1982); In re Hier, 18 Mass. App. 200, 464 N.E.2d 959, review denied, 392 Mass. 1102, 465 N.E.2d 261 (1984); In re Torres, 357 N.W.2d 332; In re Clark, 210 N.J. Super. 548, 510 A.2d 136 (Ch. Div. 1986); Leach v. Akron Gen. Medical Center, 68 Ohio Misc. 1, 426 N.E.2d 809 (1980); In re Ingram, 102 Wash. 2d 827, 689 P.2d 1363 (1984); In re Hamlin, 102 Wash. 2d 810, 689 P.2d 1372 (1984).Google Scholar
See generally Meisel, , supra note 8, ch. 9.Google Scholar
See, e.g., In re Browning, 568 So. 2d 4 (Fla. 1990); John F. Kennedy Memorial Hosp. v. Bludworth, 452 So. 2d 921 (Fla. 1984).Google Scholar
See Gray v. Romeo, 697 F. Supp. 580 (D.R.I. 1988); McConnell v. Beverly Enterprises-Connecticut, Inc., 209 Conn. 692, 553 A.2d 596 (1989); In re Gardner, 534 A.2d 947 (Me. 1987); In re Swan, 569 A.2d 1202 (Me. 1990); In re Storar, 52 N.Y.2d 363, 410 N.E.2d 64, 438 N.Y.S.2d 266 (1981); Delio v. Westchester County Medical Center, 129 A.D.2d 1, 516 N.Y.S.2d 677 (1987); Elbaum v. Grace Plaza of Great Neck, Inc., 148 A.D.2d 244, 544 N.Y.S.2d 840 (1989); Couture v. Couture, 48 Ohio App. 3d 208, 549 N.E.2d 571 (1989); Pocono Medical Center v. Harley, 12 Fiduc. Rep. 2d 128 (C.P. Monroe County, Pa., 1990); but compare In re O'Connor, 72 N.Y.2d 517, 531 N.E.2d 607, 534 N.Y.S.2d 886 (1988).Google Scholar
See Cruzan v. Harmon, 760 S.W.2d 408 (Mo. 1988).Google Scholar
See In re O'Connor, 72 N.Y.2d 517, 531 N.E.2d 607, 534 N.Y.S.2d 886 (1988).Google Scholar
See In re Swan, 569 A.2d 1202 (Me. 1990). The Maine Supreme Court has been especially oblique about the standard it requires for surrogate decision-making. In both Swan and In re Gardner, 534 A.2d 947 (Me. 1987), the court held that there was clear and convincing evidence of the patient's wishes, but did not specifically hold that the subjective standard must be met. In Swan, although it stated that, “[a]s in Gardner, we rest our decision on Chad's own conclusion and not on any theory of substituted judgment,” 569 A.2d at 1206, the kind of evidence on which it relied would not have passed muster under the subjective standard as that standard has been applied, for example, in In re O'Connor, 72 N.Y.2d 517, 531 N.E.2d 607, 534 N.Y.S.2d 886 (1988).Google Scholar
Barber v. Superior Court, 147 Cal. App. 3d 1006, 195 Cal. Rptr. 484 (1983); Foody v. Manchester Memorial Hosp., 40 Conn. Sup. 127, 482 A.2d 713 (1984); In re A.C., 573 A.2d 1235 (D.C. 1990); John, F. Kennedy Memorial Hosp. v. Bludworth, 452 So. 2d 921 (Fla. 1984);Corbett v. D'Alessandro, 487 So. 2d 368 (Fla. Dist. Ct. App. 1986), review denied, 492 So. 2d 1331 (Fla. 1986); In re Browning, 568 So. 2d 4 (Fla. 1990); In re Barry, 445 So. 2d 365 (Fla. Dist. Ct. App. 1984); In re P.V.W., 424 So. 2d 1015 (La. 1982); In re Estate of Greenspan, 137 Ill. 2d 1, 146 Ill. Dec. 860, 558 N.E.2d 1194 (1990); In re Longeway, 133 Ill. 2d 33, 139 Ill. Dec. 780, 549 N.E.2d 292 (1989); In re Doc, 411 Mass. 512, 583 N.E.2d 1263 (1992); In re Beth, 412 Mass. 188, 587 N.E.2d 1377 (1992); In re Peter, 108 N.J. 365, 529 A.2d 419 (1987); In re Quinlan, 70 N.J. to, 355 A.2d 647 (1976); Leach v. Akron Gen. Medical Center, 68 Ohio Misc. 1, 426 N.E.2d 809 (1980); In re Ingram, 102 Wash.2d 827, 689 P.2d 1363 (1984); In re Colyer, 99 Wash. 2d 114, 660 P.2d 738 (1983); In re L.W., 167 Wis. 2d 53, 482 N.W.2d 60 (1992); but see In re Drabick, 200 Cal. App. 3d 185, 245 Cal. Rptr. 840 (1988) (although conservator must consider patient's “expressed preferences,” he is not bound by them but instead “must act in the conservatee's best interests”).Google Scholar
See, e.g., In re Browning, 568 So. 2d 4, 13 (Fla. 1990) (“That choice must be the patient's choice whenever possible.”).Google Scholar
See In re Swan, 569 A.2d 1202, 1206 (Me. 1990) (“[W]e rest our decision…not on any theory of substituted judgment,” and finding that patient's verbal reactions to the treatment of others constituted clear and convincing evidence of what he wanted for himself); compare In re O'Connor, 72 N.Y.2d 517, 531 N.E.2d 607, 534 N.Y.S.2d 886 (1988) (holding that similar evidence does not meet subjective standard).Google Scholar
See, e.g., Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 370 N.E.2d 417 (1977) (permitting consideration under aegis of the substituted judgment standard of such factors as the patient's “age, the probable side effects of treatment, the low chance of producing remission, and the certainty that treatment will cause immediate suffering”); compare Barber v. Superior Court, 147 Cal. App. 3d 1006, 195 Cal. Rptr. 484 (1983) (applying best interests standard and considering similar factors).Google Scholar
See Rasmussen v. Fleming, 154 Ariz. 207, 741 P.2d 674, 688–89 (1987); In re Drabick, 200 Cal. App. 3d 185, 245 Cal. Rptr. 840 (1988); Foody v. Manchester Memorial Hosp., 40 Conn. Sup. 127, 482 A.2d 713, 720–21 (1984); Barber v. Superior Court, 147 Cal. App. 3d 1006, 195 Cal. Rptr. 484 (1983); Newmark v. Williams, 588 A.2d 1108 (Del. 1991); In re Torres, 357 N.W.2d 332, 337 (Minn. 1984); In re Conroy, 98 N.J. 321, 486 A.2d 1209 (1985); In re Grant, 109 Wash. 2d 545, 747 P.2d 445, 457 (1987), modified, 757 P.2d 534 (1988); In re Hamlin, 102 Wash. 2d 810, 689 P.2d 1372, 1375, 1377, 1378 (1984); In re L.W., 167 Wis. 2d 53, 482 N.W.2d 60 (1992); see also Cruzan v. Director, 110 S. Ct. 2841, 2882 (1990) (Stevens, J., dissenting) (majority opinion “fails to respect the best interests of the patient. (Footnote omitted.) It, too, relies on what is tantamount to a waiver rationale: The dying patient's best interests are put to one side and the entire inquiry is focused on her prior expressions of intent.”).Google Scholar
Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 370 N.E.2d 417, 428 (1977); In re Torres, 357 N.W.2d 332, 338 (Minn. 1984); In re Hamlin, 102 Wash. 2d 810, 689 P.2d 1372, 1375 (1984); but see Cruzan v. Harmon, 760 S.W.2d 408 (Mo. 1988), aff'd. Cruzan v. Director, 110 S. Ct. 2841 (1990) (not in best interests of patient in persistent vegetative state to discontinue artificial nutrition and hydration because such procedure imposes no burdens on her).Google Scholar
110 S. Ct. at 2888 (Stevens, J., dissenting).Google Scholar
Id.Google Scholar
Id.Google Scholar
Id. at 2854–55 (“[M]any courts which have adopted some sort of substituted judgment procedure in situations like this, whether they limit consideration of evidence to the prior expressed wishes of the incompetent individual, or whether they allow more general proof of what the individual's decision would have been, require a clear and convincing standard of proof for such evidence.”).Google Scholar
Newmark v. Williams, 588 A.2d 1108 (Del. 1991) (child); In re Lawrance, 579 N.E.2d 32 (Ind. 1991) (mentally retarded adult in persistent vegetative state); In re Beth, 412 Mass. 188, 587 N.E.2d 1377 (1992) (infant); In re Doe, 411 Mass. 512, 583 N.E.2d 1263 (1992) (mentally retarded adult in persistent vegetative state); In re Rosebush, (195 Mich. App. 675, 491 N. W. 2d 633 (1992)) (11-year old); In re Moorhouse, 250 N.J. Super. 307, 593 A.2d 1256 (App. Div. 1991) (mentally retarded adult in persistent vegetative state); see also In re L.W., 167 Wis. 2d 53, 482 N.W.2d 60 (1992) (79-year-old man institutionalized for chronic schizophrenia for 40 years); cf. In re McInnis, 61 Ohio Misc. 2d 790, 584 N.E.2d 1389 (Probate Ct. Stark County, 1991) (“In the absence of advance directives the administration or the withdrawal of life-sustaining treatment should be based upon medical expertise, consistent with the patient's wishes, as they are expressed by the family members” is also an implicit rejection of the “subjective standard.”). However, a Pennsylvania trial court, in a decision that was not appealed, applied the subjective standard possibly in the mistaken belief that Cruzan required that it do so. See Ragona v. Preate, 11 Fiduc. Rep. id 1, 1 (C.P. Lackawanna County, Pa., 1990). It found that the evidence of the patient's wishes met the standard. This evidence consisted of the testimony of patient's husband and son of the patient's conduct and statements over 6-ycar period. Id. at 8. It is not likely that such evidence would have passed muster for the Missouri Supreme Court. See also In re O'Connor, 72 N.Y.2d 517, 531 N.E.2d 607, 534 N.Y.S.2d 886 (1988) (holding that evidence similar to that in Ragona did not meet the subjective standard), but compare Elbaum v. Grace Plaza of Great Neck, Inc., 148 A.D.2d 244, 544 N.Y.S.2d 840 (1989) (holding that evidence similar to that in O'Connor and Ragona did meet the subjective standard).Google Scholar
“Surveys show that the overwhelming majority of Americans have not executed such written instructions.” Cruzan v. Director, 110 S. Ct. at 2875 n.21 (Brennan, J., dissenting), citing Emanuel, Linda L., Emanuel, Ezekiel J., “The Medical Directive: A New Comprehensive Advance Care Document,” 261 JAMA 3288 (1989) (9% of Americans execute advance directives); American Medical Association Surveys of Physician and Public Opinion on Health Care Issues 29–30 (1988) (15% of those surveyed had executed living wills); 2 President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Making Health Care Decisions 241–242 (1982) (23% of those surveyed said that they had put treatment instructions in writing). Id. at 2875.Google Scholar
Ariz. Rev. Stat. Ann. § 36–3231 (Supp. 1992); Ark. Stat. Ann. § 20-17-214 (Supp. 1989); Cal. Civ. Code § 1418.8 (West Supp. 1993); Colo. Rev. Stat. §§ 15–18.5–101 to -103 (1987 & Supp. 1992); Conn. Gen. Stat. § 193–571 (Supp. 1990); D.C. Code Ann. § 21–2210 (1989); Fla. Stat. Ann. §§ 765.401; Ga. Code Ann. §§ 31-9-2(3), -4(c), 31-39-2 (1991); Haw. Rev. Stat. §§ 327D-21 (1991); Idaho Code § 39–4303 (1985); (West Supp. 1993) Ill. Ann. Stat. ch. 110 1/2, paras. 851–1 to -55 (Smith-Hurd Supp. 1992); Ind. Code Ann. §§ 16-8-12-4, 16-8-11-14 (Burns 1990); Iowa Code Ann. § 144A.7 (West 1989 & Supp. 1992); La. Rev. Stat. Ann. §§ 40:1299.58.5, 40:1299.53(c) (West 1992); Me. Rev. Stat. Ann. tit. 18-A, § 5–707(b) (West Supp. 1992); Md. Health-Gen. Code Ann. § 20–107(d) (1990); Miss. Code Ann. § 41-41-3 (Supp. 1989); Mont. Code Ann. §§ 50-9-106 to -206 (1991); Nev. Rev. Stat. Ann. § 449.626-.690 (Michie Supp. 1991); N.M. Stat. Ann. § 24-7-8.1.A (Michie 1991); N.Y. Pub. Health Law § 2965(4) (McKinney Supp. 1992); N.C. Gen Stat. § 90–322 (1990); Ohio Rev. Code Ann. § 2133.08 (Anderson Supp. 1991); Or. Rev. Code Ann. § 127.635(2) (1990); S.C. Code Ann. §§ 44-66-10 to -80 (Law. Co-op. Supp. 1992); S.D. Codified Laws Ann. § 34–12C-3 (Supp. 1992); Tex. Health & Safety Code Ann. § 672.009 (West 1992); Utah Code Ann. § 78-14-5(4)0), (d) (Supp. 1989); Utah Code Ann. § 78-14-5(4) (1992); Utah Code Ann. § 75-2-1107 (Supp. 1992); Va. Code Ann. § 54.1–2986 (Michie Supp. 1992); Wash. Rev. Code Ann. § 7.70.065 (19902); W. Va. Code § 16–5C-5a (1991); W. Va. Code § 16–5B-8a (Supp. 1992); Wyo. Stat. § 35-22-105(b) (1988 & Supp. 1992); Wyo. Stat. § 3-5-209(b) (Supp. 1992). See generally Meisel, , supra note 7, § 8.17.Google Scholar
In re Lawrance, 579 N.E.2d 32 (Ind. 1991).Google Scholar
Id. at 41, citing Ind. Code Ann. §§ 16-8-12-4(d) (Burns 1990).Google Scholar
Cal. Stats. 1976, ch. 1439, p. 6478, codified as Cal. Health & Safety Code §§ 7185–7195 (repealed).Google Scholar
Ala. Code §§ 22–8A-1 to -10 (1990); Alaska Stat. §§ 18.12.010-.100 (Supp. 1990); Ariz. Rev. Stat. Ann. §§ 36–3201 to -3262 (Supp. 1992); Ark. Stat. Ann. §§ 20-17-201 to -218 (Supp. 1989); Cal. Health & Safety Code §§ 7185–7194.5 (West Supp. 1991);Colo. Rev. Stat. §§ 15-18-101 to -113 (1987 & Supp. 1992); Conn. Gen. Stat. Ann. §§ 193–570 to -575 (West Supp. 1991), as amended by 1991 Conn. Legis. Serv. P.A. 91–283 (S.H.B. 7184) (West, June 26, 1991); Del. Code Ann, tit. 16, §§ 2501–2509 (1983); D.C. Code Ann. §§ 6–2421 to 6–2430 (1989); Fla. Stat. Ann. §§ 765.101-.401 (West Supp.); Ga. Code Ann. §§ 31-32-1 to -12 (1991 & Supp. 1992); Haw. Rev. Stat. §§ 327D-1 to -27 (1991); Idaho Code §§ 39–4502 to -4509 (Supp. 1989); Ill. Ann. Stat. ch. 110, paras. 701–710 (Smith-Hurd Supp. 1989); Ind. Code Ann. §§ 16-8-11-1 to -22 (Burns 1990); Iowa Code Ann. §§ 144A.1 to .12 (West 1989 & Supp.); Kan. Stat. Ann. §§ 65–28, 101 to -28, 109 (1985 & Supp. 1988); Ky. Rev. Stat. Ann. §§ 311.622-.642 (Baldwin 1990); La. Rev. Stat. Ann. §§ 40:1299.58.1-.10 (West 1992); Me. Rev. Stat. Ann. tit. 18-A, §§ 5–701 to 1714 (West Supp. 1991); Md. Health-Gen. Code Ann. §§ 5–601 to -614 (Supp. 1988); Minn. Stat. Ann. §§ 145B.01-.17 (West 1989); Miss. Code Ann. §§ 41-41-101 to -121 (Supp. 1988); Mo. Ann. Stat. §§ 459.010-.055 (Vernon Supp. 1990); Mont. Code Ann. §§ 50-9-101 to -206 (1991); 1992 Neb. Laws 671 §§ 1–16; Nev. Rev. Stat. Ann. §§ 449–535 -.690 (Michie Supp. 1991); N.H. Rev. Stat. Ann. §§ 137-H:1 to: 15 (Supp. 1992); N.J. Stat. Ann. §§ 2.6:2H-53 to -78 (West Supp. 1992); N.M. Stat. Ann. §§ 24-7-1 to -11 (Supp. 1988); N.C. Gen. Stat. §§ 90–320 to -323 (1989); N.D. Cent. Code §§ 23–06.4–01 to -14 (1991); Ohio Rev. Code Ann. §§ 2133.01 to 2133.15 (Anderson 1991); Okla. Stat. Ann. tit. 63, §§ 3101.1 to .16 (West Supp.); Or. Rev. Stat. §§ 127.605 -.650 (1990); 20 Pa. Cons. Stat. Ann. §§ 5401–5416 (Supp.); R.I. Gen. Laws §§ 3–4.10–1 to -2 (1989); S.C. Code Ann. §§ 44-77-10 to -160 (Law. Co-op. Supp. 1991); S.D. Codified Laws Ann. §§ 34–12D-1 to -22 (Supp. 1991); Tenn. Code Ann. §§ 32-11-101 to -112 (Supp. 1991); Tex. Health & Safety Code Ann. §§ 672.001-.021 (West 1991); Utah Code Ann. §§ 75-2-1101 to -1118 (Supp. 1990); Vt. Stat. Ann. tit. 18, §§ 5251–5262 (Supp. 1988); Va. Code Ann. §§ 54.1–2981 to -2993 (Michie Supp. 1992); Wash. Rev. Code Ann. §§ 70.122.010 to .905 (West Supp.); W. Va. Code §§ 16-30-1 to -10 (Supp. 1987); Wis. Stat. Ann. §§ 154.01-.15 (West 1989 & Supp. 1992); Wyo. Stat. §§ 35-21-101 to -109 (1988 & Supp. 1992).Google Scholar
Alaska Stat. §§ 13.26.332-.356 (1988); Ariz. Rev. Stat. Ann. §§§ 36–3201 to -3262 (Supp. 1992); Ark. Stat. Ann. § 20-17-202(b) (Supp. 1990) (proxy provision in living will statute); Cal. Civ. Code §§ 2430–2444, 2500–2508 (West Supp. 1992); Colo. Rev. Stat. §§ 15-14-503 to -509 (Supp. 1992); 1991 Conn. Pub. Acts. No. 91–283 § 1(5) (amended 1991), to be codified as Conn. Gen. Stat Ann. §§ 19a-570 to 19a-575 (proxy provision in living will statute); Del. Code Ann. tit. 16, § 2502(b) (1983) (proxy provision in living will statute); D.C. Code Ann. §§ 21–2201 to -2213 (1989); Fla. Stat. Ann. §§ 765.101-.401 (West Supp.); Ga. Code Ann. § 31-36-1 to -13 (Michie 1990); 1992 Haw. Sess. Laws 1930, §§ 1–6, to be codified at Haw. Rev. Stat. Ann. § 551D- (proxy provision in living will statute) (as construed by In re Crabtree, No. 86–0031 (Haw. Fam. Ct. 1st Cir. Apr. 26, 1990)); Idaho Code §§ 39–4505 to -4509 (Supp. 1990); Ill. Ann. Stat. ch. 110 1/2, paras. 804–1 to -12 (Smith-Hurd Supp. 1990); Ind. Code Ann. § 16-8-12-6 (Burns 1990); Iowa Code Ann. §§ 144B.1 to .12 (West Supp. 1992); Iowa Code Ann. § 144A.71 (West 1989) (proxy provision in living will statute); Iowa Code Ann. § 633.705 (West Supp. 1992) (living will statute, Iowa Code Ann. § 144A.71 (West 1989), authorizes agent appointed under this statute, which is a general durable power of attorney statute, to make health care decisions); Kan. Stat. Ann. § 58–625 to -632 (Supp. 1990); Ky. Rev. Star. Ann. §§ 311.970-.986 (Baldwin Supp. 1990); La. Rev. Civ. Code Ann. art. 2997 (West Supp. 1991) (amending general durable power of attorney statute which authorizes an agent to make health care decisions for the principal, not including life-sustaining procedures, if expressly authorized to do so by the principal); La. Rev. Stat. Ann. § 40:1299.58.3(0 (1) (West Supp. 1991) (proxy provision in living will statute); Me. Rev. Stat. Ann. tit. 18-A, §§ 5–701 to 714 (West Supp. 1991) (proxy provision in living will statute); Me. Rev. Stat. Ann. tit. 18-A § 5–501 (West Supp. 1991); Md. Est. & Trusts Code Ann. §§13–601 to -602 (1974) (as interpreted by 73 Op. Md. Atty Gen. 253 (October 17, 1988)); Mass. Gen. Laws Ann. ch. 201D, §§ 1–17 (West Supp. 1991); Mich. Comp. Laws § 700.496 (Supp. 1991); Minn. Stat. Ann. §§ 145B.01 -.17 (West Supp.) (proxy provision in living will statute); Miss. Code Ann. §§ 41-41-151 to -183 (Supp. 1990); Mo. Ann. Stat. §§ 404.800-.870 (Vernon Supp. 1992) (incorporating procedures and requirements of an enumerated list of provisions from durable power of attorney statute, Mo. Ann. Stat. §§ 404.705, .707.1, .707.2, .710, .714, .717, .723.1, .723.2, .727, .731 (Vernon 1990 & Supp. 1991)); Mont. Code Ann. §§ 50-9-101 to 50-9-206 (1991) (proxy provision in living will statute); Mont. Code Ann. § 72-5-501 to -502 (1989) (living will statute, Mont. Code Ann. §§ 50-9-101 to -206 (1991), permits the use of either the living will statute or the general durable power of attorney statute, Mont. Code Ann. § 72-5-501 to -502 (1989), to appoint a health care proxy); 1992 Neb. Laws 696, §§ 1–34 (effective Jan. 1, 1993); Nev. Rev. Stat. Ann. §§ 449.800-.860 (Michie 1991 & Supp. 1991); Nev. Rev. Stat. Ann. §§ 449–535 -.690 (Michie Supp. 1991) (proxy provision in living will statute); N.H. Rev. Stat. Ann. §§ 137-J:1–16 (Supp. 1991); N.J. Stat. Ann. §§ 26:28–53 to 26:2H-78 (West Supp. 1992); N.M. Stat. Ann. §§ 45-5-501 to -502 (1989); N.Y. Pub. Health Law §§ 2980–2994 (McKinney Supp. 1990); N.C. Gen. Stat. §§ 32A-15 to -26 (1991); N.D. Cent. Code §§ 23–06.5–01 to -18 (1991); Ohio Rev. Code Ann. §§ 1337.11 -.17 (Anderson Supp. 1991); Okla. Stat. Ann. tit. 63, §§ 3101,1 -.16 (West Supp.) (proxy provision in living will statute); Or. Rev. Stat. § 127.505-.585 (Supp. 1990); 20 Pa. Cons. Stat. Ann. §§ 5401–5416 (Supp.); R.I. Gen. Laws §§ 23–4.10–1 to -2 (1989); S.C. Code Ann. §§ 62-5-501 to -504 (Law Co-op. Supp. 1992); S.C. Code Ann. §§ 44-77-50 (Law. Co-op. Supp. 1991) (proxy provision in living will statute); S.D. Codified Laws Ann. §§ 59-7-2.1 -.8 (Supp. 1991); Tenn. Code Ann. §§ 34-6-201 to -215 (Supp. 1991); Tex. Civ. Prac. & Rem. Code Ann. §§ 135.001-.018 (West Supp. 1992); Utah Code Ann. § 75-2-1106 (Supp. 1990) (proxy provision in living will statute); Vt. Stat. Ann. tit. 14, §§ 3451–3467 (Supp. 1989); Va. Code Ann. §§ 54.1–2981 to -2993 (Michie Supp. 1992) (proxy provision in living will statute); Va. Code Ann. § 11–9.1 to -9.4 (Michie 1989); Wash. Rev. Code Ann. §§ 11.94.010-.040 (Supp. 1991); W. Va. Code §§ 16–30A-1 to -20(1991); Wis. Stat. Ann §§ 155.01–155.80 (West Supp. 1992);Wyo. Stat. §§ 3-5-201 to -213 (Supp. 1992); Wyo. Stat. Ann. § 35-22-102(d) (1988 & Supp. 1992) (proxy provision in living will statute).Google Scholar
See, e.g., N.J. Stat. Ann. §§ 26:2H-53 to 16:2H-78 (West Supp. 1992); 20 Pa. Cons. Stat. Ann. §§ 5401–5416 (Supp.).Google Scholar
See, e.g., Gray v. Romeo, 697 F. Supp. 580 (D.R.I. 1988); McConnell v. Beverly Enterprises-Connecticut, Inc., 209 Conn. 692, 553 A.2d 596 (1989); John F. Kennedy Memorial Hasp. v. Bludworth, 452 So. 2d 921 (Fla. 1984); In re Gardner, 534 A.2d 947 (Me. 1987); Elbaum v. Grace Plaza of Great Neck, Inc., 148 A.D.2d 244, 544 N.Y.S.2d 840 (1989); Delio v. Westchester County Medical Center, 129 A.D.2d 1, 516 N.Y.S.2d 677 (1987); Eichner v. Dillon, 52 N.Y.2d 363, 410 N.E.2d 64, 438 N.Y.S.2d 266 (1981); Ragona v. Preate, 11 Fiduc. Rep. 2d I (C.P. Lackawanna County, Pa., 1990); Pocono Medical Center v. Harley, 11 Fiduc. Rep. 2d 128 (C.P. Monroe County, Pa. 1990); cf. Couture v. Couture, 48 Ohio App. 3d 208, 549 N.E.2d 571 (1989); In re McInnis, 61 Ohio Misc. 2d 790, 584 N.E.2d 1389, 1390 (Probate Ct. Stark County 1991).Google Scholar
See, e.g., In re Browning, 568 So. 2d 4 (Fla. 1990). Most living will statutes state that they are not intended to supersede common-law decisionmaking rights or to be the sole means by which an advance directive can be executed. See generally Uniform Rights of the Terminally Ill Act § 11(d),(e), 9B U.L.A. 79, 94 (Supp. 1991) (prefatory note).Google Scholar
See, e.g., Eichner v. Dillon, 52 N.Y.2d 363, 420 N.E.2d 64, 438 N.Y.S.2d 166 (1981).Google Scholar
Cruzan v. Director, 110 S. Ct. 2877 (Brennan, J. dissenting).Google Scholar
Id.Google Scholar
Id. at 2857 (O'Connor J., concurring).Google Scholar
See In re Estate of Greenspan, 137 Ill. 2d 1, 558 N.E.2d 1194, 146 Ill. Dec. 860 (1990); see also In re McInnis, 61 Ohio Misc. 2d 790, 584 N.E.2d 1389 (Probate Ct. Stark County, 1991).Google Scholar
See Newmark v. Williams, 588 A.2d 1108 (Del. 1991) (3-year-old); In re Beth, 412 Mass. 188, 587 N.E.2d 1377 (1992) (infant); In re Rosebush, 195 Mich. App. 675,491 N.W. 2d 633 (1992)) (11-year old); see also In re Crum, 580 N.E.2d 876 (Probate Ct. Franklin County, Ohio, 1991) (“a child not quite eighteen years of age”).Google Scholar
In re Lawrance, 579 N.E.2d 32 (Ind. 1991); In re Doe, 411 Mass. 512, 583 N.E.2d 1263 (1992); In re Moorhouse, 250 N.J. Super. 307, 593 A.2d 1256 (App. Div. 1991); see also In re L.W., 167 Wis. 2d 53, 482 N.W.2d 60 (1992) (79-year-old man institutionalized for chronic schizophrenia for 40 years).Google Scholar
Toward the end of 1989 at about the time of the oral argument in Cruzan, 41 states had living will statutes and 20 had health care power of attorney statutes. In early 1991, about 8 months after the Supreme Court's decision, 44 had living will statutes and 44 (though not the same 44) had health care power of attorney statutes. Virtually every living will statute was amended in some way during this period.Google Scholar
See Meisel, , supra note 8, § 11.15.Google Scholar
Id. § 11.12.Google Scholar
Pub. L. 101–508, §§ 4206, 4751 (OBRA), 42 U.S.C. § 1395cc(f)(1) & 42 U.S.C. § 1396a(a) (Supp. 1991).Google Scholar
See Joint Comm'n on Accreditation of Healthcare Organizations, Accreditation Manual for Hospitals (1992) (standard R1.1.1.3.2): Organizational policies and procedures [must] describe the mechanisms by which the following rights are protected and exercised:Google ScholarGoogle Scholar
In re Conroy, 98 N.J. 321, 486 A.2d 1209, 1236 (1985).Google Scholar
In re Longeway, 133 Ill. 2d 33, 139 Ill. Dec. 780, 549 N.E.2d 292, 292–03 (1989) (Ward, J., dissenting) (“A recent Federal survey reports that 19.4% of all patients in Illinois' 237 intermediate care facilities and 33.8% of all residents in this State's skilled nursing homes receive tube-feeding or need assistance to obtain sustenance. (Health Standards & Quality Bureau, United States Health Care Financing Administration, Medicare/Medicaid Nursing Home Information 87/88, 1 Report on Illinois, 1, 4 (Dec. 1, 1988)”).Google Scholar
See, e.g., Gray v. Romeo, 697 F. Supp. 580 (D.R.I. 1988); Rasmussen v. Fleming, 154 Ariz. 207, 741 P.2d 674 (1987); In re Drabick, 200 Cal. App. 3d 185, 245 Cal. Rptr. 840 (1988); McMahon v. Lopez, 199 Cal. App. 3d 829, 245 Cal. Rptr. 172 (1988); In re Morrison, 206 Cal. App. 3d 304, 253 Cal. Rptr. 530 (1988); Bouvia v. Superior Court (Glenchur), 179 Cal. App, 3d 1127, 225 Cal. Rptr. 297 (1986); Barber v. Superior Court, 147 Cal. App. 3d 1006, 195 Cal. Rptr. 484 (1983); McConnell v. Beverly Enterprises-Connecticut, Inc., 209 Conn. 692, 553 A.2d 596 (1989); In re Browning, 568 So. 2d 4 (Fla. 1990); Corbett v. D'Alessandro, 487 So.2d 368 (Fla. Dist. Ct. App.), review denied, 492 So. 2d 1331 (Fla. 1986); In re Estate of Greenspan, 137 Ill. 2d 1, 146 Ill, Dec. 860, 558 N.E.2d 1194 (1990); In re Longeway, 133 Ill. 2d 33, 139 Ill. Dec. 780, 549 N.E.2d 292 (1989); In re Lawrance, 579 N.E.2d 32 (Ind. 1991); In re Swan, 569 A.2d 1202 (Me. 1990); In re Gardner, 534 A.2d 947 (Me. 1987); In re Doe, 411 Mass. 512, 583 N.E.2d 1263 (1992); Brophy v. New England Sinai Hosp., Inc., 398 Mass. 417, 497 N.E.2d 626 (1986); In re Hier, 18 Mass. App. 200, 464 N.E.2d 959, review denied, 392 Mass. 1102, 465 N.E.2d 261 (1984); In re Jobes, 108 N.J. 394, 529 A.2d 434 (1987); In re Peter, 108 N.J. 365, 529 A.2d 419 (1987); In re Conroy, 98 N.J. 321, 486 A.2d 1209 (1985); In re Requena, 213 N.J. Super. 443, 517 A.2d 869 (App. Div. 1986); Elbaum v. Grace Plaza of Great Neck, Inc., 148 A.D.2d 244, 544 N.Y.S.2d 840 (1989); Delio v. Westchester County Medical Center, 129 A.D.2d 1, 516 N.Y.S.2d 677 (1987); In re L. W., 167 Wis. 2d 53, 482 N.W.2d 60 (1992); but cf. In re Grant, 109 Wash. 2d 545. 747 P.2d 445 (1987), modified, 757 P.2d 534 (1988) (a justice who had voted in the original decision with the majority to authorize the parents of a terminally-ill child to forgo artificial nutrition and hydration switched her vote, thus changing a 5–4 decision into a 4–5 decision, though presumably after treatment had been terminated).Google Scholar
See American Medical Association, Current Opinions of the Council on Ethical and Judicial Affairs § 2.18, at 12–13 (1986).Google Scholar
See “Position of the American Academy of Neurology on Certain Aspects of the Care and Management of the Persistent Vegetative State Patient,” 39 Neurology 125 (1989).CrossRefGoogle Scholar
See American Thoracic Society, “Withholding and Withdrawing Life-Sustaining Therapy,” 144 Am. Rev. Respir. Dis. 720 (1991), reprinted in 115 Annals of Internal Med. 478 (1991).Google Scholar
See “Guidelines on Withdrawing or Withholding Food and Fluid,” in 2 Biolaw U.1123 (Oct. 1988), excerpted in 88 Am. J. Nursing 797 (1988).Google Scholar
110 S. Ct. at 2852.Google Scholar
Id.Google Scholar
Id.Google Scholar
See Fla. Stat. Ann. § 765.03(3) (West 1986). The statute has since been amended to permit the forgoing of artificial nutrition and hydration. See Fla. Stat. Ann. §§ 765.101 et seq.Google Scholar
In re Browning, 568 So. 2d 4 (Fla. 1990).Google Scholar
See In re Estate of Greenspan, 137 Ill. 2d 1, 558 N.E.2d 1194, 146 Ill. Dec. 860 (1990).Google Scholar
See In re Lawrance, 579 N.E.2d 32 (Ind. 1991) (never-competent patient).Google Scholar
See In re Doe, 411 Mass. 512, 583 N.E.2d 1263 (1992) (never-competent patient).Google Scholar
See In re L.W., 167 Wis. 2d 53, 482 N.W.2d 60 (1992) (patient institutionalized for chronic schizophrenia for 40 years).Google Scholar
See Ragona v. Preate, 11 Fiduc. Rep. 2d 1 (C.P. Lackawanna County, Pa., 1990).Google Scholar
See In re Crum, 580 N.E.2d 876 (Probate Ct. Franklin County, Ohio, 1991) (never-competent patient).Google Scholar
See Cruzan v. Mouton, Estate No. CV384–9P (Cir. Ct., Jasper County., Mo. Dec. 14, 1990), reported in 6 issues in Law & Med. 433 (1991).Google Scholar
Malcolm, Andrew H., “Missouri Family Renews Battle Over Right to Die,” N.Y. Times, Nov. 2, 1990, at A12 col. 1 (nat'l ed.); Gianelli, Diane, “The Last Battle?” Am. Med. News, at 1, col. 3, Nov. 16, 1990.Google Scholar
N.Y. Times, Dec. 19, 1990, at 14, col. 5 (nat'l ed.).Google Scholar
Colby, William H., “The Lessons of the Cruzan Case,” 39 U. Kan. L. Rev. 519, 520 (1991); see also N.Y. Times, Dec. 21, 1990, at A30, col. 1 (nat'l ed.).Google Scholar
N.Y. Times, Dec. 27, 1990, at A19, col. 1 (nat'l ed.).Google Scholar
See, e.g., In re Lawrance, 579 N.E.2d 32 (Ind. 1991); In re Beth, 412 Mass. 188, 587 N.E.2d 1377 (1992); In re Moorhouse, 250 N.J. Super. 307, 593 A.2d 1256 (App. Div. 1991); In re McInnis, 61 Ohio Misc. 2d 790, 584 N.E.2d 1389 (Probate Ct. Stark County, 1991).Google Scholar
See, e.g., In re Browning, 568 So. 2d 4 (Fla. 1990); In re Estate of Greenspan, 137 Ill. 2d 1, 146 Ill. Dec. 860, 558 N.E.2d 1194 (1990); In re Doe, 411 Mass. 512, 583 N.E.2d 1263 (1992); In re Crum, 580 N.E.2d 876 (Probate Ct. Franklin County, Ohio, 1991).Google Scholar
See Cruzan v. Harmon, 760 S.W.2d 408 (Mo. 1988).Google Scholar
The state withdrew because, according to Missouri Attorney General William Webster, the state's “aim in the original case was merely to clarify Missouri's law when parties other than the patients ask for the removal of life support …” Belkin, Lisa, “State Asks to Quit Right-to-Die Case,” N.Y. Times, Oct. 12, 1990, at A-9, cols. 1–2 (nat'l ed.). Further, Nancy Cruzan's guardians ad litem who were bound to maintain an adversary position could adequately protect her interests. Id., col. 3.Google Scholar
See Mo. Ann. Stat. §§ 404.800-.865 (Vernon Supp. 1992).Google Scholar
Id. § 404.820.Google Scholar
In re Busalacchi, No. 59582, 1991 WL 26851, 1991 Mo. App. LEXIS 315 (Mar. 5, 1991), appealed & remanded, No. 73677 (Mo. Oct. 16, 1991).Google Scholar
Id., slip. op. at 10.Google Scholar
Id. at 12–13.Google Scholar
In re Busalacchi, No. 73677, 1993 WESTLAW 32356 (Mo. Jan. 26, 1993). Three days later, on application of a self-described “right-to-life advocate,” a St. Louis trial court issued a restraining order barring any transfer. See “A Right-to-Die Battle Is Still On in Missouri,” N. Y. Times, Jan. 31, 1993, at 29, col. 5 (late ed.).Google Scholar
2 BNA Health Law Reporter 200 (Feb. 18, 1993).Google Scholar
See generally Meisel, , supra note 8, §§ 8.31 & 8.32.Google Scholar
See, e.g., Barber v. Superior Court, 147 Cal. App. 3d 1006, 195 Cal. Rptr. 484, 493 (1983); In re Browning, 568 So. 2d 4, 16 (Fla. 1990); In re Conroy, 98 N.J. 321, 486 A.2d 1209, 1242 (1985); In re Storar, 52 N.Y.2d 363, 420 N.E.2d 64, 74, 438 N.Y.S.2d 266 (1981).Google Scholar