The case of Ms. Nancy Cruzan and the care of the elderly

The case of Ms. Nancy Cruzan is the first so-called "right to die" case to be heard by the US Supreme Court. The Missouri Supreme Court had ruled that Ms. Cruzan's parents, who are also her court-appointed guardians, cannot authorize the withdrawal of artificial hydration and nutrition from their daughter. Ms. Cruzan has been in a persistent vegetative state since an auto accident more than six years ago. Even though Ms. Cruzan is only 32 years old, the decision in her case will have serious implications for care of the elderly. Key features of the Missouri Supreme Court decision include their claims that (1) the authority for surrogate decision-making flows from the parens patriae power of the State rather than from the authority of the incompetent person, (2) the State has an unqualified interest in the preservation of life, and (3) the medical provision of nutrition and hydration ought to be considered differently than other forms of medical treatment. Such claims are at considerable variance from accepted standards of ethically defensible decision-making that focus on the well-being of the patient understood according to the patient's own values and life goals. If the US Supreme Court restricts decisions to forgo life-sustaining treatment according to patient prognosis, capacity for decision-making, type of treatment, or state of residence, then a patient-centered standard of medical decision-making will be impossible to sustain and the maximization of life extension will be required without regard to the suffering thereby imposed.