Choices about death touch the core of liberty. 1872); J. Hawley & M. McGregor, Criminal Law 152 (3d ed. Ms. Comer testified that: "Nancy said she would never want to live [as a vegetative state] because if she couldn't be normal or even, you know, like half way, and do things for yourself, because Nancy always did, that she didn't want to live . The more precise constitutional significance of death is difficult to describe; not much may be said with confidence about death unless it is said from faith, and that alone is reason enough to protect the freedom to conform choices about death to individual conscience. But until Nancy's wishes have been determine… Accord, Gray v. Romeo, 697 F. Supp. Not all incompetent patients will have loved ones available to serve as surrogate decisionmakers. at 542. See ante at 497 U. S. 278-279. The longest any person has ever been in a persistent vegetative state and recovered was 22 months. Washington v. Harper, 494 U. S. 210, 494 U. S. 221-222 (1990). A State's procedures must guard against the risk that the survivors' interests are not mistaken for the patient's. . " They dwell in ivory towers.". She openly affirms that "the Court has often deemed state incursions into the body repugnant to the interests protected by the Due Process Clause," that there is a liberty interest in avoiding unwanted medical treatment, and that it encompasses the right to be free of "artificially delivered food and water." See also Brief for American Academy of Neurology as Amicus Curiae 9 (expressing same concern). They rely primarily upon our decisions in Michael H. v. Gerald D., 491 U. S. 110 (1989), and Parham v. J.R., 442 U. S. 584 (1979). Although many state courts have held that a right to refuse treatment is encompassed by a generalized constitutional right of privacy, we have never so held. See ante at 497 U. S. 283. Declining to adopt a best interests standard for deciding when it would be appropriate to exercise a ward's right because it "lets another make a determination of a patient's quality of life," the court opted instead for a substituted judgment standard. [Footnote 9] See Ohio v. Akron Center for Reproductive. ", "Second, in all persistent vegetative state patients studied to date, post-mortem examination reveals overwhelming bilateral damage to the cerebral hemispheres to a degree incompatible with consciousness. We have interpreted the Constitution to interpose barriers to a State's efforts to sterilize some criminals not only because the proposed punishment would do "irreparable injury" to bodily integrity, but because "[m]arriage and procreation" concern "the basic civil rights of man." . at 42, 139 Ill.Dec. Her family wanted to stop life support treatments so she could die. exercise of a fundamental right, as the majority admits, ante at 497 U. S. 282-283, n. 10. 393, 60 U. S. 450 (1857); compare Tyson & Bro. Perhaps the State could lawfully remove more vital organs for transplanting into others who would then be cured of their ailments, provided the State placed Nancy on some other life-support equipment to replace the lost function. There is, however, nothing "hypothetical" about Nancy Cruzan's constitutionally protected interest in freedom from unwanted treatment, and the difficulties involved in ascertaining what her interests are do not in any way justify the State's decision to oppose her interests with its own. See President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life Sustaining Treatment 15, n. 1, and 17-18 (1983) (hereafter President's Commission). where irrationality and oppression may theoretically occur, and if it tries to do so, it will destroy itself. Missouri's heightened evidentiary standard attempts to achieve balance by discounting evidence; the guardian ad litem technique achieves balance by probing for additional evidence. Id. In a later trilogy of cases, the New Jersey Supreme Court stressed that the analytic framework adopted in Conroy was limited to elderly, incompetent patients with shortened life expectancies, and established alternative approaches to deal with a different set of situations. These have vast fact and opinion gathering and synthesizing powers unavailable to courts; the exercise of these powers is particularly appropriate where issues invoke the concerns of medicine, ethics, morality, philosophy, theology and law. at 745, 752-753, 757-758, 370 N.E.2d at 427, 431, 434.