Missouri Department of Health Cruzan v. Director

Nancy Beth Cruzan was 25 years old when her car slid out of control on an icy Missouri road and rolled over one January night in 1983. Ejected from the car, she landed in a ditch, and by the time an ambulance arrived and restored vital signs, her brain had been without necessary oxygen for an estimated 12 to 14 minutes; brain damage occurs after six minutes without oxygen. This left her in what doctors defined as a "permanent vegetative state"--she was awake, but unaware; she had some motor reflexes but showed no evidence of cognitive abilities. She could not move, speak, or communicate in any way, though nurses at the Missouri Rehabilitation Center did report that Cruzan was able to turn her body toward someone who spoke to her, and cried on one occasion when a valentine card was read aloud to her. The rest of her body survived the accident relatively intact and, to ease care, doctors surgically implanted a tube in her stomach that provided food and water. Cruzan's life expectancy in this condition was estimated at another 30 years.

By 1988, Cruzan's family had lost hope that their daughter might emerge from her vegetative state. Her parents, Lester and Joyce Cruzan, asked doctors at the center to disconnect the feeding tube, on the grounds that their daughter had, as an adult, made definite statements that if she were to become chronically ill or seriously injured she would not want to live, unless she could get by at least somewhat normally. A local probate court granted authorization to remove the tube, but the state's attorney general, William L. Webster, filed an appeal on the grounds that the parents and a court-appointed legal guardian had not sufficiently proved that Cruzan had once made such statements about refusing medical treatment. The Missouri State Supreme Court reversed the lower court's decision, and the Cruzans appealed to the U.S. Supreme Court.