CRUZAN v.
DIRECTOR, MISSOURI (Lyka) that Missouri's State Living Will statute embodied a state policy strongly favoring
1991 | Sarmiento, J. | Substantive Due Process
PETITIONERS: Espero Santos Salaw
RESPONDENTS: NATIONAL LABOR RELATIONS COMMISSION,
ASSOCIATED BANK AND/ OR JOSE R. TENGCO, Chairman of the Board,
ROLLIE TUAZON, Manager
SUMMARY:
Salaw executed a Sworn Statement, without aid of counsel, which made it appear
that he, together with a co-employee, sold 20 sewing machines foreclosed by the
bank they were working for and divided the proceeds between them. Salaw was
asked to appear before the bank's Personnel Discipline and Investigation
Committee (PDIC) without counsel. Salaw was dismissed. Labor arbiter found the
dismissal illegal but NLRC reversed the labor arbiter’s decision. SC ruled that
Salaw was illegally dismissed because the investigating committee violated his
constitutional right to due process.
DOCTRINE:
Administrative and quasi-judicial bodies are not bound by the technical rules of
procedure in the adjudication cases. However, the right to counsel, a very basic
requirement of substantive due process, has to be observed
FACTS:
Petitioner Nancy Cruzan is incompetent, having sustained severe injuries in an
automobile accident, and now lies in a Missouri state hospital in what is referred to
as a persistent vegetative state: generally, a condition in which a person exhibits
motor reflexes but evinces no indications of significant cognitive function. The State
is bearing the cost of her care. Hospital employees refused, without court approval,
to honor the request of Cruzan's parents, copetitioners here, to terminate her artificial
nutrition and hydration, since that would result in death.
State trial: authorized the termination, finding that a person in Cruzan's condition has
a fundamental right under the State and Federal Constitutions to direct or refuse the
withdrawal of death-prolonging procedures. Cruzan's expression to a former
housemate that she would not wish to continue her life if sick or injured unless she
could live at least halfway normally suggested that she would not wish to continue
on with her nutrition and hydration.
State Supreme Court: Reversed lower court decision. Questioned the applicability in
this case of the right to refuse treatment embodied in the common-law doctrine of
informed consent. Declined to read into the State Constitution a broad right to
privacy that would support an unrestricted right to refuse treatment and expressed
doubt that the Federal Constitution embodied such a right. The court then decided
the preservation of life, and that Cruzan's statements to her housemate were
unreliable for the purpose of determining her intent. It rejected the argument that her
parents were entitled to order the termination of her medical treatment, concluding
that no person can assume that choice for an incompetent in the absence of the
formalities required by the Living Will statute or clear and convincing evidence of
the patient's wishes.
ISSUES & RATIO:
1.Did the State of Missouri, by requiring 'clear and convincing evidence' for the
Cruzan's to remove their daughter's life support, violate the due process clause of the
Fourteenth Amendment?-- NO
Due process clause: "[N]or shall any State deprive any person of life, liberty, or
property, without due process of law
A competent person has a liberty interest under the Due Process Clause in refusing
unwanted medical treatment. However, the question whether that constitutional right
has been violated must be determined by balancing the liberty interest against
relevant state interests. For purposes of this case, it is assumed that a competent
person would have a constitutionally protected right to refuse lifesaving hydration
and nutrition. This does not mean that an incompetent person should possess the
same right, since such a person is unable to make an informed and voluntary choice
to exercise that hypothetical right or any other right. While Missouri has in effect
recognized that, under certain circumstances, a surrogate may act for the patient in
electing to withdraw hydration and nutrition and thus cause death, it has established
a procedural safeguard to assure that the surrogate's action conforms as best it may to
the wishes expressed by the patient while competent.
Here, Missouri has a general interest in the protection and preservation of human
life, as well as other, more particular interests, at stake. It may legitimately seek to
safeguard the personal element of an individual's choice between life and death. The
State is also entitled to guard against potential abuses by surrogates who may not act
to protect the patient. Similarly, it is entitled to consider that a judicial proceeding
regarding an incompetent's wishes may not be adversarial, with the added guarantee
of accurate factfinding that the adversary process brings with it. The State may also
properly decline to make judgments about the "quality" of a particular individual's
life, and simply assert an unqualified interest in the preservation of human life to be
weighed against the constitutionally protected interests of the individual. It is self-
evident that these interests are more substantial, both on an individual and societal
level, than those involved in a common civil dispute. The clear and convincing
evidence standard also serves as a societal judgment about how the risk of error
should be distributed between the litigants. Missouri may permissibly place the
increased risk of an erroneous decision on those seeking to terminate life-sustaining
treatment. An erroneous decision not to terminate results in a maintenance of the
status quo, with at least the potential that a wrong decision will eventually be
corrected or its impact mitigated by an event such as an advancement in medical
science or the patient's unexpected death. However, an erroneous decision to
withdraw such treatment is not susceptible of correction. Although Missouri's proof
requirement may have frustrated the effectuation of Cruzan's not-fully-expressed
desires, the Constitution does not require general rules to work flawlessly