How did the Nancy Cruzan case affect the legal right to refuse tube feeding?

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A pediatrician in a white coat listens to a young boy's chest with a stethoscope during a health exam; the boy is smiling and pulling aside his shirt. — health law Physicians must provide proper and skillful care to their patients.

In the landmark 1990 case Cruzan v. Director, Missouri Department of Health, the U.S. Supreme Court addressed the legal right to refuse life-sustaining treatment, including tube feeding.12

The Court affirmed that competent individuals possess a constitutionally protected right to refuse any medical treatment. However, for patients who lack the capacity to make their own decisions, the Court ruled that states may constitutionally require "clear and convincing evidence" of the patient's prior wishes before allowing the withdrawal of life support.123

Because Nancy Cruzan was in a persistent vegetative state and could not express her own desires, the Court upheld Missouri’s refusal to terminate her artificial feeding in the absence of such evidence. Following the ruling, the Cruzan family presented additional evidence of Nancy’s prior wishes to a lower court, which authorized the removal of the feeding tube.32

Ultimately, the case highlighted the critical importance of advance directives, such as a living will or a health care proxy, which allow individuals to clearly document their treatment preferences should they become incompetent to act on their own behalf.1