Missouri appears in the book as the state where the Nancy Cruzan Case moved from a national debate over the right to refuse life-sustaining care to a decision about how a patient’s wishes could be established. Its role is legal rather than descriptive: the state is presented through the court ruling that allowed Cruzan’s nutrition to be discontinued after evidence of her wishes was heard.

The Case in Missouri

Nancy Cruzan was thirty-three and severely brain-damaged after a car accident in Missouri. Years later, her parents sought to have the feeding tube that nourished her removed. The dispute brought questions of patient liberty and proof of preference before the U.S. Supreme Court.

State Authority and Proof of Wishes

The Court recognized that the right to liberty included the right to refuse life-sustaining medical care and die. At the same time, it allowed states to require clear and convincing evidence of a patient’s wishes to discontinue care, rather than relying only on what others believed would be in the patient’s best interest. The ruling therefore left Missouri, like other states, room to set a demanding standard for deciding whether treatment could be withdrawn.

The Missouri Decision

A Missouri judge later allowed Cruzan’s nutrition to be discontinued after acquaintances testified that this was what she would have wanted. The book connects the case to the wider adoption of living wills and advance directives: documenting treatment preferences before a catastrophe could help make a patient’s wishes legible when the patient could no longer express them.