Wednesday, June 25th, marks the 35th anniversary of a pivotal moment in the fight for patient-directed care. On this day in 1990, the U.S. Supreme Court issued its decision in Cruzan v. Director, Missouri Department of Health, the first case in which the Court formally recognized a constitutional right to refuse unwanted medical treatment.

For the first time, the Court affirmed that people have the legal right to decline life-sustaining (but potentially painful, harmful or futile) interventions such as artificial nutrition and hydration. The decision also recognized the importance of honoring a person’s previously expressed wishes, whether through an advance directive or conversations with loved ones, when they are no longer able to speak for themselves. It laid the legal foundation for healthcare surrogates to advocate on behalf of patients and helped pave the way for end-of-life options like voluntarily stopping eating and drinking (VSED) for those facing life-limiting illness.

This anniversary comes at a time when these issues are still deeply relevant. Across the country, we continue to see that legal rights are not always enough when institutional policies and state laws stand in the way of honoring a person’s end-of-life decisions. The Adriana Smith case in Georgia has drawn national attention to what can happen when hospital systems override a person’s wishes. In Kansas, Compassion Legal’s recent filing in Vernon v. Kobach challenges a law that fails to recognize valid advance directives for pregnant patients. Our victory in Almerico v. Idaho overturned a harmful pregnancy exclusion policy that denied individuals the right to have their care preferences followed. At the same time, more people are engaging in public conversations about VSED as a compassionate and empowering option.

As we reflect on the legacy of Cruzan, we are reminded why this work matters. Every person deserves the right to make informed decisions about their care, without interference from government or institutional policies. These legal milestones are not just symbolic. They are part of a larger effort to center the individual in healthcare, shifting power toward people and their values, especially at life’s end.

Thank you for being part of this movement. Together, we are building a future where your decisions, your values, and your voice guide the care you receive.

If you or someone you love is facing barriers to getting the end-of-life care you want, or if your advance directive or personal healthcare decisions are not being honored, we are here to help. Call our free and confidential Call Compassion line at 800-247-7421 or use our legal intake form. You do not have to navigate this alone.

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