Informed Consent

This chapter presents a clinical vignette and discusses the US Supreme Court case of Cruzan v. Director, Missouri Department of Health, 110 SCt 2841 (1990). This case involved Nancy Cruzan, a young woman who had a profound brain injury after a motor vehicle accident that made her decisionally incompetent. While the family’s initial petition focused on end-of-life decision-making, the Cruzan decision has had broader implications for medical practice. This decision affirmed the right of competent persons to make decisions about life-sustaining treatments, including the decision to refuse treatment. This chapter addresses ethical and practical considerations regarding end-of-life decision-making and the Cruzan decision. For healthcare professionals, a practical implication of this decision is the importance of proactively discussing patients’ wishes about treatment preferences should they lose the capacity to make medical decisions. In light of Cruzan, treatment preferences expressed by an individual when competent are valued over family or caretaker preferences and quality-of-life concerns.