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Massachusetts Medical Society




[...]the majority improperly implied that continued existence and treatment in a persistent vegetative state is either beneficial or neutral, whereas in fact "an erroneous decision not to terminate life-support robs a patient of the very qualities protected by the right to avoid unwanted medical treatment... [a] degraded existence is perpetuated; his family's suffering is protracted; the memory he leaves behind becomes more and more distorted.5 " Finally, Justice Brennan argued that the Missouri rules are simply out of touch with reality; people do not write elaborate documents about all the possible ways they might die and the various interventions doctors might have available to prolong their lives. [...]Justice O'Connor gave special emphasis to an issue the Court specifically declined to address --naming a surrogate decision maker. Since she agreed that few people will provide explicit instructions, she suggested that everyone appoint a proxy decision maker, and she noted that the Cruzan decision "does not preclude a future determination that the Constitution requires the States to implement the decisions of a duly appointed surrogate." The Cruzan decision virtually casts in stone the post-Reagan Court's general view that although citizens have personal constitutional rights, the states can restrict them as long as the restriction furthers a legitimate state interest and is not "irrational." [...]Nancy Cruzan can be subjected to treatment she never consented to, and according to all who knew her would never consent to, in order to further the state's interest in protecting the lives of incompetent patients who do not have loving families, even though Cruzan admittedly has a loving family. [...]if state legislatures or courts want to adopt new evidentiary procedures and standards, they would do well to recognize that most families can and do speak for their loved ones, and put the burden on the state to prove by clear and convincing evidence that the family's wishes are inconsistent with the wishes of the patient before removing decision-making authority from the family.


From The New England Journal of Medicine, George J. Annas, Nancy Cruzan and the Right to Die, Volume 323, Page 670 Copyright ©(1990) Massachusetts Medical Society. Reprinted with permission.

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