Advance Healthcare Directive Real Life: Nancy Cruzan

An Advance Healthcare Directive is a legal document that allows an individual to designate someone else, usually a family member or a trusted friend, to make medical decisions on their behalf if they become unable to do so themselves. The Directive also allows you to confirm your preferences for various potential medical situations, such as the well-known “end-of-life” decision. There are various names for this document such as medical power of attorney and Living Will, but, in California, the Advance Healthcare Directive is most common. 

The Directive is an essential tool for individuals who want to ensure that their healthcare wishes are respected even if they are unable to convey their wishes due to a legal incapacity. By designating a trusted agent to make medical decisions on their behalf, individuals can have peace of mind knowing that their wishes will be followed, even if they are unable to speak for themselves. People began to take more notice of healthcare directives and medical powers of attorney due to several high profile legal cases. One such case is that of Nancy Cruzan.

History of the Case

The Nancy Cruzan case was a landmark legal case that focused on the issue of end-of-life care and the right to die. In 1983, Nancy Cruzan was involved in a car accident that left her in a persistent vegetative state (PVS). She was dependent on a feeding tube to stay alive and had no hope of recovery. Her parents requested that the feeding tube be removed, but the hospital refused without a court order. The case eventually made its way to the Supreme Court, where the issue of the right to die was addressed.

In 1990, the Supreme Court ruled in Cruzan v. Director, Missouri Department of Health that a competent person has the right to refuse medical treatment, including life-sustaining treatment, but that States may require clear and convincing evidence of a person’s wishes before withdrawing such treatment. In Cruzan’s case, there was no evidence of her wishes, so the court ruled that the state of Missouri could require “clear and convincing” evidence of her intent before allowing the removal of the feeding tube. Cruzan’s family gathered additional evidence and presented it to the court, which ultimately granted their request to remove the feeding tube in 1990. 

The Cruzan case had far-reaching implications, including the importance of advance directives, which allow individuals to state their wishes regarding end-of-life care. It also established the legal standard of “clear and convincing evidence” as a requirement for the withdrawal of life-sustaining treatment in cases where the patient’s wishes are not known.

If an individual develops a legal incapacity and, thus, cannot make sound decisions for themselves, an advance directive is critical to ensuring for their immediate care. Otherwise, their loved ones are left with seeking resolution through the Court.

If you want to learn more about getting an advance directive or would like to have yours reviewed, please contact us at 424-242-5021 or at for a complimentary consultation.

Nothing in this article should be construed as legal advice. For specific guidance regarding your situation, please contact an attorney.