By Margie Hodges Shaw, Timothy E. Quill, and Bernard L. Sussman

BIOETHICS scholars applauded the Cruzan v. Director, Missouri Department of Health decision for encouraging the creation of “mechanisms to safeguard the interests of people who become incapacitated at the end of life.” The legacy of the Cruzan decision is wider reaching than early literature suggests. At its core, Cruzan is about an incapacitated person’s fundamental liberty interest to be free of unwanted medical treatment and the role of the government in defining a process to protect that right. The reasoning in Cruzan impacts a patient population that includes both those who were previously capacitated and others who were never capacitated. It affects an incapacitated individual’s liberty interest to receive the kinds of medical treatment they could choose if capacitated. In this article, the authors review the case of a never capacitated patient in light of the Cruzan decision to consider the intended and unintended consequences of legal requirements created by New York State (NYS) to safeguard the interests of patients with intellectual and developmental disabilities (IDD). Inconsistent with the fundamental principles in Cruzan, current procedures set forth by NYS favor ensuring access to aggressive disease-directed therapies and can thereby impede the fundamental liberty interest of a patient with IDD to be free of intrusive medical treatment at the end of life. While the authors focus on one patient in one state, this case illuminates issues and concerns involving all incapacitated patients, which the authors hope will inform discussions across jurisdictions.

Recommended Citation
Margie Hodges Shaw et al., The Legacy of Cruzan: Balancing the Moral Agency of Surrogates and the State, 73 SMU L. Rev. 179 (2020).