*265Chief Justice Rehnquist

delivered the opinion of the Court.

Petitioner Nancy Beth Cruzan was rendered incompetent as a result of severe injuries sustained during an automobile accident. Copetitioners Lester and Joyce Cruzan, Nancy’s parents and coguardians, sought a court order directing the withdrawal of their daughter’s artificial feeding and hydration equipment after it became apparent that she had virtually no chance of recovering her cognitive faculties. The Supreme Court of Missouri held that because there was no clear and convincing evidence of Nancy’s desire to have life-sustaining treatment withdrawn under such circumstances, her parents lacked authority to effectuate such a request. We granted certiorari, 492 U. S. 917 (1989), and now affirm.

*266On the night of January 11, 1983, Nancy Cruzan lost control of her car as she traveled down Elm Road in Jasper County, Missouri. The vehicle overturned, and Cruzan was discovered lying face down in a ditch without detectable respiratory or cardiac function. Paramedics were able to restore her breathing and heartbeat at the accident site, and she was transported to a hospital in an unconscious state. An attending neurosurgeon diagnosed her as having sustained probable cerebral contusions compounded by significant anoxia (lack of oxygen). The Missouri trial court in this case found that permanent brain damage generally results after 6 minutes in an anoxic state; it was estimated that Cru-zan was deprived of oxygen from 12 to 14 minutes. She remained in a coma for approximately three weeks and then progressed to an unconscious state in which she was able to orally ingest some nutrition. In order to ease feeding and' further the recovery, surgeons implanted a gastrostomy feeding and hydration tube in Cruzan with the consent of her then husband. Subsequent rehabilitative efforts proved unavailing. She now lies in a Missouri state hospital in what is commonly referred to as a persistent vegetative state: generally, a condition in which a person exhibits motor reflexes but evinces no indications of significant cognitive function.1 The State of Missouri is bearing the cost of her care.

*267After it had become apparent that Nancy Cruzan had virtually no chance of regaining her mental faculties, her parents asked hospital employees to terminate the artificial nutrition and hydration procedures. All agree that such a *268removal would cause her death. The employees refused to honor the request without court approval. The parents then sought and received authorization from the state trial court for termination. The court found that a person in Nancy’s condition had a fundamental right under the State and Federal Constitutions to refuse or direct the withdrawal of “death prolonging procedures.” App. to Pet. for Cert. A99. The court also found that Nancy’s “expressed thoughts at age twenty-five in somewhat serious conversation with a housemate friend that if sick or injured she would not wish to continue her life unless she could live at least halfway normally suggests that given her present condition she would not wish to continue on with her nutrition and hydration.” Id., at A97-A98.

The Supreme Court of Missouri reversed by a divided vote. The court recognized a right to refuse treatment embodied in the common-law doctrine of informed consent, but expressed skepticism about the application of that doctrine in the circumstances of this case. Cruzan v. Harmon, 760 S. W. 2d 408, 416-417 (1988) (en banc). The court also declined to read a broad right of privacy into the State Constitution which would “support the right of a person to refuse medical treatment in every circumstance,” and expressed doubt as to whether such a right existed under the United States Constitution. Id., at 417-418. It then decided that the Missouri Living Will statute, Mo. Rev. Stat. §459.010 et seq. (1986), embodied a state policy strongly favoring the preservation of life. 760 S. W. 2d, at 419-420. The court found that Cruzan’s statements to her roommate regarding her desire to live or die under certain conditions were “unreliable for the purpose of determining her intent,” id., at 424, “and thus insufficient to support the co-guardians[’] claim to exercise substituted judgment on Nancy’s behalf.” Id., at 426. It rejected the argument that Cruzan’s parents were entitled to order the termination of her medical treatment, *269concluding that “no person can assume that choice for an incompetent in the absence of the formalities required under Missouri’s Living Will statutes or the clear and convincing, inherently reliable evidence absent here.” Id., at 425. The court also expressed its view that “[b]road policy questions bearing on life and death are more properly addressed by representative assemblies” than judicial bodies. Id., at 426.

We granted certiorari to consider the question whether Cruzan has a right under the United States Constitution which would require the hospital to withdraw life-sustaining treatment from her under these circumstances.

At common law, even the touching of one person by another without consent and without legal justification was a battery. See W. Keeton, D. Dobbs, R. Keeton, & D. Owen, Prosser and Keeton on Law of Torts § 9, pp. 39-42 (5th ed. 1984). Before the turn of the century, this Court observed that “[n]o right is held more sacred, or is more carefully guarded, by the common law, than the right of every individual to the possession and control of his own person, free from all restraint or interference of others, unless by clear and unquestionable authority of law.” Union Pacific R. Co. v. Botsford, 141 U. S. 250, 251 (1891). This notion of bodily integrity has been embodied in the requirement that informed consent is generally required for medical treatment. Justice Cardozo, while on the Court of Appeals of New York, aptly described this doctrine: “Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable in damages.” Schloendorff v. Society of New York Hospital, 211 N. Y. 125, 129-130, 105 N. E. 92, 93 (1914). The informed consent doctrine has become firmly entrenched in American tort law. See Keeton, Dobbs, Keeton, & Owen, supra, §32, pp. 189-192; F. Rozovsky, Consent to Treatment, A Practical Guide 1-98 (2d ed. 1990).

*270The logical corollary of the doctrine of informed consent is that the patient generally possesses the right not to consent, that is, to refuse treatment. Until about 15 years ago and the seminal decision in In re Quinlan, 70 N. J. 10, 355 A. 2d 647, cert. denied sub nom. Garget v. New Jersey, 429 U. S. 922 (1976), the number of right-to-refuse-treatment decisions was relatively few.2 Most of the earlier cases involved patients who refused medical treatment forbidden by their religious beliefs, thus implicating First Amendment rights as well as common-law rights of self-determination.3 More recently, however, with the advance of medical technology capable of sustaining life well past the point where natural forces would have brought certain death in earlier times, cases involving the right to refuse life-sustaining treatment have burgeoned. See 760 S. W. 2d, at 412, n. 4 (collecting 54 reported decisions from 1976 through 1988).

In the Quinlan case, young Karen Quinlan suffered severe brain damage as the result of anoxia and entered a persistent vegetative state. Karen’s father sought judicial approval to disconnect his daughter’s respirator. The New Jersey Supreme Court granted the relief, holding that Karen had a right of privacy grounded in the Federal Constitution to terminate treatment. In re Quinlan, 70 N. J., at 38-42, 355 A. 2d, at 662-664. Recognizing that this right was not absolute, however, the court balanced it against asserted state interests. Noting that the State’s interest “weakens and the individual’s right to privacy grows as the degree of bodily invasion increases and the prognosis dims,” the court concluded that the state interests had to give way in that case. Id., at *27141, 355 A. 2d, at 664. The court also concluded that the “only practical way” to prevent the loss of Karen’s privacy right due to her incompetence was to allow her guardian and family to decide “whether she would exercise it in these circumstances.” Ibid.

After Quinlan, however, most courts have based a right to refuse treatment either solely on the common-law right to informed consent or on both the common-law right and a constitutional privacy right. See L. Tribe, American Constitutional Law § 15-11, p. 1365 (2d ed. 1988). In Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 370 N. E. 2d 417 (1977), the Supreme Judicial Court of Massachusetts relied on both the right of privacy and the right of informed consent to permit the withholding of chemotherapy from a profoundly retarded 67-year-old man suffering from leukemia. Id., at 737-738, 370 N. E. 2d, at 424. Reasoning that an incompetent person retains the same rights as a competent individual “because the value of human dignity extends to both,” the court adopted a “substituted judgment” standard whereby courts were to determine what an incompetent individual’s decision would have been under the circumstances. Id., at 745, 752-753, 757-758, 370 N. E. 2d, at 427, 431, 434. Distilling certain state interests from prior case law — the preservation of life, the protection of the interests of innocent third parties, the prevention of suicide, and the maintenance of the ethical integrity of the medical profession — the court recognized the first interest as paramount and noted it was greatest when an affliction was curable, “as opposed to the State interest where, as here, the issue is not whether, but when, for how long, and at what cost to the individual [a] life may be briefly extended.” Id., at 742, 370 N. E. 2d, at 426.

In In re Storar, 52 N. Y. 2d 363, 420 N. E. 2d 64, cert. denied, 454 U. S. 858 (1981), the New York Court of Appeals declined to base a right to refuse treatment on a constitutional privacy right. Instead, it found such a right “ade*272quately supported” by the informed consent doctrine. Id., at 376-377, 420 N. E. 2d, at 70. In In re Eichner (decided with In re Storar, supra), an 83-year-old man who had suffered brain damage from anoxia entered a vegetative state and was thus incompetent to consent to the removal of his respirator. The court, however, found it unnecessary to reach the question whether his rights could be exercised by others since it found the evidence clear and convincing from statements made by the patient when competent that he “did not want to be maintained in a vegetative coma by use of a respirator.” Id., at 380, 420 N. E. 2d, at 72. In the companion Storar case, a 52-year-old man suffering from bladder cancer had been profoundly retarded during most of his life. Implicitly rejecting the approach taken in Saikewicz, supra, the court reasoned that due to such life-long incompetency, “it is unrealistic to attempt to determine whether he would want to continue potentially life prolonging treatment if he were competent.” 52 N. Y. 2d, at 380, 420 N. E. 2d, at 72. As the evidence showed that the patient’s required blood transfusions did not involve excessive pain and without them his mental and physical abilities would deteriorate, the court concluded that it should not “allow an incompetent patient to bleed to death because someone, even someone as close as a parent or sibling, feels that this is best for one with an incurable disease.” Id., at 382, 420 N. E. 2d, at 73.

Many of the later cases build on the principles established in Quinlan, Saikewicz, and Storar/Eichner. For instance, in In re Conroy, 98 N. J. 321, 486 A. 2d 1209 (1985), the same court that decided Quinlan considered whether a nasogastric feeding tube could be removed from an 84-year-old incompetent nursing-home resident suffering irreversible mental and physical ailments. While recognizing that a federal right of privacy might apply in the case, the court, contrary to its approach in Quinlan, decided to base its decision on the common-law right to self-determination and informed con*273sent. 98 N. J., at 348, 486 A. 2d, at 1223. “On balance, the right to self-determination ordinarily outweighs any countervailing state interests, and competent persons generally are permitted to refuse medical treatment, even at the risk of death. Most of the cases that have held otherwise, unless they involved the interest in protecting innocent third parties, have concerned the patient’s competency to make a rational and considered choice.” Id., at 353-354, 486 A. 2d, at 1225.

Reasoning that the right of self-determination should not be lost merely because an individual is unable to sense a violation of it, the court held that incompetent individuals retain a right to refuse treatment. It also held that such a right could be exercised by a surrogate decisionmaker using a “subjective” standard when there was clear evidence that the incompetent person would have exercised it. Where such evidence was lacking, the court held that an individual’s right could still be invoked in certain circumstances under objective “best interest” standards. Id., at 361-368, 486 A. 2d, at 1229-1233. Thus, if some trustworthy evidence existed that the individual would have wanted to terminate treatment, but not enough to clearly establish a person’s wishes for purposes of the subjective standard, and the burden of a prolonged life from the experience of pain and suffering markedly outweighed its satisfactions, treatment could be terminated under a “limited-objective” standard. Where no trustworthy evidence existed, and a person’s suffering would make the administration of life-sustaining treatment inhumane, a “pure-objective” standard could be used to terminate treatment. If none of these conditions obtained, the court held it was best to err in favor of preserving life. Id., at 364-368, 486 A. 2d, at 1231-1233.

The court also rejected certain categorical distinctions that had been drawn in prior refusal-of-treatment cases as lacking substance for decision purposes: the distinction between actively hastening death by terminating treatment and pas*274sively allowing a person to die of a disease; between treating individuals as an initial matter versus withdrawing treatment afterwards; between ordinary versus extraordinary treatment; and between treatment by artificial feeding versus other forms of life-sustaining medical procedures. Id., at 369-374, 486 A. 2d, at 1233-1237. As to the last item, the court acknowledged the “emotional significance” of food, but noted that feeding by implanted tubes is a “medical procedure] with inherent risks and possible side effects, instituted by skilled health-care providers to compensate for impaired physical functioning” which analytically was equivalent to artificial breathing using a respirator. Id., at 373, 486 A. 2d, at 1236.4

In contrast to Conroy, the Court of Appeals of New York recently refused to accept less than the clearly expressed wishes of a patient before permitting the exercise of her right to refuse treatment by a surrogate decisionmaker. In re Westchester County Medical Center on behalf of O’Connor, 72 N. Y. 2d 517, 531 N. E. 2d 607 (1988) (O’Connor). There, the court, over the objection of the patient’s family members, granted an order to insert a feeding tube into a 77-year-old *275woman rendered incompetent as a result of several strokes. While continuing to recognize a common-law right to refuse treatment, the court rejected the substituted judgment approach for asserting it “because it is inconsistent with our fundamental commitment to the notion that no person or court should substitute its judgment as to what would be an acceptable quality of life for another. Consequently, we adhere to the view that, despite its pitfalls and inevitable uncertainties, the inquiry must always be narrowed to the patient’s expressed intent, with every effort made to minimize the opportunity for error.” Id., at 530, 531 N. E. 2d, at 613 (citation omitted). The court held that the record lacked the requisite clear and convincing evidence of the patient’s expressed intent to withhold life-sustaining treatment. Id., at 531-534, 531 N. E. 2d, at 613-615.

Other courts have found state statutory law relevant to the resolution of these issues. In Conservatorship of Drabick, 200 Cal. App. 3d 185, 245 Cal. Rptr. 840, cert. denied, 488 U. S. 958 (1988), the California Court of Appeal authorized the removal of a nasogastric feeding tube from a 44-year-old man who was in a persistent vegetative state as a result of an auto accident. Noting that the right to refuse treatment was grounded in both the common law and a constitutional right of privacy, the court held that a state probate statute authorized the patient’s conservator to order the withdrawal of life-sustaining treatment when such a decision was made in good faith based on medical advice and the conservatee’s best interests. While acknowledging that “to claim that [a patient’s] ‘right to choose’ survives incompetence is a legal fiction at best,” the court reasoned that the respect society accords to persons as individuals is not lost upon incompetence and is best preserved by allowing others “to make a decision that reflects [a patient’s] interests more closely than would a purely technological decision to do whatever is possible.”5 *276Id., at 208, 245 Cal. Rptr., at 854-855. See also In re Conservatorship of Torres, 357 N. W. 2d 332 (Minn. 1984) (Minnesota court had constitutional and statutory authority to authorize a conservator to order the removal of an incompetent individual’s respirator since in patient’s best interests).

In In re Estate of Longeway, 133 Ill. 2d 33, 549 N. E. 2d 292 (1989), the Supreme Court of Illinois considered whether a 76-year-old woman rendered incompetent from a series of strokes had a right to the discontinuance of artificial nutrition and hydration. Noting that the boundaries of a federal right of privacy were uncertain, the court found a right to refuse treatment in the doctrine of informed consent. Id., at 43-45, 549 N. E. 2d, at 296-297. The court further held that the State Probate Act impliedly authorized a guardian to exercise a ward’s right to refuse artificial sustenance in the event that the ward was terminally ill and irreversibly comatose. Id., at 45-47, 549 N. E. 2d, at 298. 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. Id., at 49, 549 N. E. 2d, at 299. Finding the “expressed intent” standard utilized in O’Connor, supra, too rigid, the court noted that other clear and convincing evidence of the patient’s intent could be considered. 133 Ill. 2d, at 50-51, 549 N. E. 2d, at 300. The court also adopted the “consensus opinion [that] treats artificial nutrition and hydration as medical treatment.” Id., at 42, 549 N. E. 2d, at 296. Cf. McConnell v. Beverly Enterprises-Connecticut, Inc., 209 Conn. 692, 705, *277553 A. 2d 596, 603 (1989) (right to withdraw artificial nutrition and hydration found in the Connecticut Removal of Life Support Systems Act, which “provides] functional guidelines for the exercise of the common law and constitutional rights of self-determination”; attending physician authorized to remove treatment after finding that patient is in a terminal condition, obtaining consent of family, and considering expressed wishes of patient).6

As these cases demonstrate, the common-law doctrine of informed consent is viewed as generally encompassing the right of a competent individual to refuse medical treatment. Beyond that, these cases demonstrate both similarity and diversity in their approaches to decision of what all agree is a perplexing question with unusually strong moral and ethical overtones. State courts have available to them for decision a number of sources — state constitutions, statutes, and common law — which are not available to us. In this Court, the question is simply and starkly whether the United States Constitution prohibits Missouri from choosing the rule of decision which it did. This is the first case in which we have been squarely presented with the issue whether the United States Constitution grants what is in common parlance referred to as a “right to die.” We follow the judicious counsel of our decision in Twin City Bank v. Nebeker, 167 U. S. 196, 202 (1897), where we said that in deciding “a ques*278tion of such magnitude and importance ... it is the [better] part of wisdom not to attempt, by any general statement, to cover every possible phase of the subject.”

The Fourteenth Amendment provides that no State shall “deprive any person of life, liberty, or property, without due process of law. ” The principle that a competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment may be inferred from our prior decisions. In Jacobson v. Massachusetts, 197 U. S. 11, 24-30 (1905), for instance, the Court balanced an individual’s liberty interest in declining an unwanted smallpox vaccine against the State’s interest in preventing disease. Decisions prior to the incorporation of the Fourth Amendment into the Fourteenth Amendment analyzed searches and seizures involving the body under the Due Process Clause and were thought to implicate substantial liberty interests. See, e. g., Breithaupt v. Abram, 352 U. S. 432, 439 (1957) (“As against the right of an individual that his person be held inviolable . . . must be set the interests of society . . .”).

Just this Term, in the course of holding that a State’s procedures for administering antipsychotic medication to prisoners were sufficient to satisfy due process concerns, we recognized that prisoners possess “a significant liberty interest in avoiding the unwanted administration of antipsychotic drugs under the Due Process Clause of the Fourteenth Amendment.” Washington v. Harper, 494 U. S. 210, 221-222 (1990); see also id,., at 229 (“The forcible injection of medication into a nonconsenting person’s body represents a substantial interference with that person’s liberty”). Still other cases support the recognition of a general liberty interest in refusing medical treatment. Vitek v. Jones, 445 U. S. 480, 494 (1980) (transfer to mental hospital coupled with mandatory behavior modification treatment implicated liberty interests); Parham v. J. R., 442 U. S. 584, 600 (1979) (“[A] child, in common with adults, has a substantial liberty *279interest in not being confined unnecessarily for medical treatment”).

But determining that a person has a “liberty interest” under the Due Process Clause does not end the inquiry;7 “whether respondent’s constitutional rights have been violated must be determined by balancing his liberty interests against the relevant state interests.” Youngberg v. Romeo, 457 U. S. 307, 321 (1982). See also Mills v. Rogers, 457 U. S. 291, 299 (1982).

Petitioners insist that under the general holdings of our cases, the forced administration of life-sustaining medical treatment, and even of artificially delivered food and water essential to life, would implicate a competent person’s liberty interest. Although we think the logic of the cases discussed above would embrace such a liberty interest, the dramatic consequences involved in refusal of such treatment would inform the inquiry as. to whether the deprivation of that interest is constitutionally permissible. But for purposes of this case, we assume that the United States Constitution would grant a competent person a constitutionally protected right to refuse lifesaving hydration and nutrition.

Petitioners go on to assert that an incompetent person should possess the same right in this respect as is possessed by a competent person. They rely primarily on our decisions in Parham v. J. R., supra, and Youngberg v. Romeo, supra. In Parham, we held that a mentally disturbed minor child had a liberty interest in “not being confined unnecessarily for medical treatment,” 442 U. S., at 600, but we certainly did not intimate that such a minor child, after commitment, would have a liberty interest in refusing treatment. In Youngberg, we held that a seriously retarded adult had a lib*280erty interest in safety and freedom from bodily restraint, 457 U. S., at 320. Youngberg, however, did not deal with decisions to administer or withhold medical treatment.

The difficulty with petitioners’ claim is that in a sense it begs the question: An incompetent person is not able to make an informed and voluntary choice to exercise a hypothetical right to refuse treatment or any other right. Such a “right” must be exercised for her, if at all, by some sort of surrogate. Here, Missouri has in effect recognized that under certain circumstances a surrogate may act for the patient in electing to have hydration and nutrition withdrawn in such a way as to cause death, but it has established a procedural safeguard to assure that the action of the surrogate conforms as best it may to the wishes expressed by the patient while competent. Missouri requires that evidence of the incompetent’s wishes as to the withdrawal of treatment be proved by clear and convincing evidence. The question, then, is whether the United States Constitution forbids the establishment of this procedural requirement by the State. We hold that it does not.

Whether or not Missouri’s clear and convincing evidence requirement comports with the United States Constitution depends in part on what interests the State may properly seek to protect in this situation. Missouri relies on its interest in the protection and preservation of human life, and there can be no gainsaying this interest. As a general matter, the States — indeed, all civilized nations — demonstrate their commitment to life by treating homicide as a serious crime. Moreover, the majority of States in this country have laws imposing criminal penalties on one who assists another to commit suicide.8 We do not think a State is required to remain neutral in the face of an informed and voluntary decision by a physically able adult to starve to death.

*281But in the context presented here, a State has more particular interests at stake. The choice between life and death is a deeply personal decision of obvious and overwhelming finality. We believe Missouri may legitimately seek to safeguard the personal element of this choice through the imposition of heightened evidentiary requirements. It cannot be disputed that the Due Process Clause protects an interest in life as well as an interest in refusing life-sustaining medical treatment. Not all incompetent patients will have loved ones available to serve as surrogate decisionmakers. And even where family members are present, “[t]here will, of course, be some unfortunate situations in which family members will not act to protect a patient.” In re Jobes, 108 N. J. 394, 419, 529 A. 2d 434, 447 (1987). A State is entitled to guard against potential abuses in such situations. Similarly, a State is entitled to consider that a judicial proceeding to make a determination regarding an incompetent’s wishes may very well not be an adversarial one, with the added guarantee of accurate factfinding that the adversary process brings with it.9 See Ohio v. Akron Center for Reproductive *282Health, post, at 515-516. Finally, we think a State may properly decline to make judgments about the “quality” of life that a particular individual may enjoy, and simply assert an unqualified interest in the preservation of human life to be weighed against the constitutionally protected interests of the individual.

In our view, Missouri has permissibly sought to advance these interests through the adoption of a “clear and convincing” standard of proof to govern such proceedings. “The function of a standard of proof, as that concept is embodied in the Due Process Clause and in the realm of factfinding, is to ‘instruct the factfinder concerning the degree of confidence our society thinks he should have in the correctness of factual conclusions for a particular type of adjudication.’” Addington v. Texas, 441 U. S. 418, 423 (1979) (quoting In re Winship, 397 U. S. 358, 370 (1970) (Harlan, J., concurring)). “This Court has mandated an intermediate standard of proof — ‘clear and convincing evidence’ — when the individual interests at stake in a state proceeding are both ‘particularly important’ and ‘more substantial than mere loss of money.’” Santosky v. Kramer, 455 U. S. 745, 756 (1982) (quoting Addington, supra, at 424). Thus, such a standard has been required in deportation proceedings, Woodby v. INS, 385 U. S. 276 (1966), in denaturalization proceedings, Schneiderman v. United States, 320 U. S. 118 (1943), in civil commitment proceedings, Addington, supra, and in proceedings for the termination of parental rights, Santosky, supra.10" Fur*283ther, this level of proof, “or an even higher one, has traditionally been imposed in cases involving allegations of civil fraud, and in a variety of other kinds of civil cases involving such issues as . . . lost wills, oral contracts to make bequests, and the like.” Woodby, supra, at 285, n. 18.

We think it self-evident that the interests at stake in the instant proceedings are more substantial, both on an individual and societal level, than those involved in a run-of-the-mine civil dispute. But not only does the standard of proof reflect the importance of a particular adjudication, it also serves as “a societal judgment about how the risk of error should be distributed between the litigants.” Santosky, supra, at 755; Addington, supra, at 423. The more stringent the burden of proof a party must bear, the more that party bears the risk of an erroneous decision. We believe that Missouri may permissibly place an increased risk of an erroneous decision on those seeking to terminate an incompetent individual’s life-sustaining treatment. An erroneous decision not to terminate results in a maintenance of the status quo; the possibility of subsequent developments such as advancements in medical science, the discovery of new evidence regarding the patient’s intent, changes in the law, or simply the unexpected death of the patient despite the administration of life-sustaining treatment at least create the potential that a wrong decision will eventually be corrected or its impact mitigated. An erroneous decision to withdraw life-sustaining treatment, however, is not susceptible of correction. In Santosky, one of the factors which led the Court to require proof by clear and convincing evidence in a proceeding to terminate parental rights was that a decision in such a case was final and irrevocable. Santosky, supra, at 759. The same must surely be said of the decision to discontinue hydration and nutrition of a patient such as Nancy Cru-zan, which all agree will result in her death.

*284It is also worth noting that most, if not all, States simply forbid oral testimony entirely in determining the wishes of parties in transactions which, while important, simply do not have the consequences that a decision to terminate a person’s life does. At common law and by statute in most States, the parol evidence rule prevents the variations of the terms of a written contract by oral testimony. The statute of frauds makes unenforceable oral contracts to leave property by will, and statutes regulating the making of wills universally require that those instruments be in writing. See 2 A. Corbin, Contracts §398, pp. 360-361 (1950); 2 W. Page, Law of Wills §§ 19.3-19.5, pp. 61-71 (1960). There is no doubt that statutes requiring wills to be in writing, and statutes of frauds which require that a contract to make a will be in writing, on occasion frustrate the effectuation of the intent of a particular decedent, just as Missouri’s requirement of proof in this case may have frustrated the effectuation of the not-fully-expressed desires of Nancy Cruzan. But the Constitution does not require general rules to work faultlessly; no general rule can.

In sum, we conclude that a State may apply a clear and convincing evidence standard in proceedings where a guardian seeks to discontinue nutrition and hydration of a person diagnosed to be in a persistent vegetative state. We note that many courts which have adopted some sort of substituted judgment procedure in situations like this, whether they limit consideration of evidence to the prior expressed wishes of the incompetent individual, or whether they allow more general proof of what the individual’s decision would have been, require a clear and convincing standard of proof for such evidence. See, e. g., Longeway, 133 Ill. 2d, at 50-51, 549 N. E. 2d, at 300; McConnell, 209 Conn., at 707-710, 553 A. 2d, at 604-605; O’Connor, 72 N. Y. 2d, at 529-530, 531 N. E. 2d, at 613; In re Gardner, 534 A. 2d 947, 952-953 (Me. 1987); In re Jobes, 108 N. J., at 412-413, 529 A. 2d, *285at 443; Leach v. Akron General Medical Center, 68 Ohio Misc. 1, 11, 426 N. E. 2d 809, 815 (1980).

The Supreme Court of Missouri held that in this case the testimony adduced at trial did not amount to clear and convincing proof of the patient’s desire to have hydration and nutrition withdrawn. In so doing, it reversed a decision of the Missouri trial court which had found that the evidence “suggested]” Nancy Cruzan would not have desired to continue such measures, App. to Pet. for Cert. A98, but which had not adopted the standard of “clear and convincing evidence” enunciated by the Supreme Court. The testimony adduced at trial consisted primarily of Nancy Cruzan’s statements made to a housemate about a year before her accident that she would not want to live should she face life as a “vegetable,” and other observations to the same effect. The observations did not deal in terms with withdrawal of medical treatment or of hydration and nutrition. We cannot say that the Supreme Court of Missouri committed constitutional error in reaching the conclusion that it did.11

Petitioners alternatively contend that Missouri must accept the “substituted judgment” of close family members even in the absence of substantial proof that their views re-*286fleet the views of the patient. 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). But we do not think these cases support their claim. In Michael H., we upheld the constitutionality of California’s favored treatment of traditional family relationships; such a holding may not be turned around into a constitutional requirement that a State must recognize the primacy of those relationships in a situation like this. And in Parham, where the patient was a minor, we also upheld the constitutionality of a state scheme in which parents made certain decisions for mentally ill minors. Here again petitioners would seek to turn a decision which allowed a State to rely on family decisionmaking into a constitutional requirement that the State recognize such de-cisionmaking. But constitutional law does not work that way.

No doubt is engendered by anything in this record but that Nancy Cruzan’s mother and father are loving and caring parents. If the State were required by the United States Com stitution to repose a right of “substituted judgment” with anyone, the Cruzans would surely qualify. But we do not think the Due Process Clause requires the State to repose judgment on these matters with anyone but the patient herself. Close family members may have a strong feeling — a feeling not at all ignoble or unworthy, but not entirely disinterested, either — that they do not wish to witness the continuation of the life of a loved one which they regard as hopeless, meaningless, and even degrading. But there is no automatic assurance that the view of close family members will necessarily be the same as the patient’s would have been had she been confronted with the prospect of her situation while competent. All of the reasons previously discussed for allowing Missouri to require clear and convincing evidence of the patient’s wishes lead us to conclude that the State may *287choose to defer only to those wishes, rather than confide the decision to close family members.12

The judgment of the Supreme Court of Missouri is

Affirmed.

Justice O’Connor,

concurring.

I agree that a protected liberty interest in refusing unwanted medical treatment may be inferred from our prior decisions, see ante, at 278-279, and that the refusal of artificially delivered food and water is encompassed within that liberty interest. See ante, at 279. I write separately to clarify why I believe this to be so.

As the Court notes, the liberty interest in refusing medical treatment flows from decisions involving the State’s invasions into the body. See ante, at 278-279. Because our notions of liberty are inextricably entwined with our idea of physical freedom and self-determination, the Court has often deemed state incursions into the body repugnant to the interests protected by the Due Process Clause. See, e. g., Rochin v. California, 342 U. S. 165, 172 (1952) (“Illegally breaking into the privacy of the petitioner, the struggle to open his mouth and remove what was there, the forcible extraction of his *288stomach’s contents ... is bound to offend even hardened sensibilities”); Union Pacific R. Co. v. Botsford, 141 U. S. 250, 251 (1891). Our Fourth Amendment jurisprudence has echoed this same concern. See Schmerber v. California, 384 U. S. 757, 772 (1966) (“The integrity of an individual’s person is a cherished value of our society”); Winston v. Lee, 470 U. S. 753, 759 (1985) (“A compelled surgical intrusion into an individual’s body for evidence . . . implicates expectations of privacy and security of such magnitude that the intrusion may be ‘unreasonable’ even if likely to produce evidence of a crime”). The State’s imposition of medical treatment on an unwilling competent adult necessarily involves some form of restraint and intrusion. A seriously ill or dying patient whose wishes are not honored may feel a captive of the machinery required for life-sustaining measures or other medical interventions. Such forced treatment may burden that individual’s liberty interests as much as any state coercion. See, e. g., Washington v. Harper, 494 U. S. 210, 221 (1990); Parham v. J. R., 442 U. S. 584, 600 (1979) (“It is not disputed that a child, in common with adults, has a substantial liberty interest in not being confined unnecessarily for medical treatment”).

The State’s artificial provision of nutrition and hydration implicates identical concerns. Artificial feeding cannot readily be distinguished from other forms of medical treatment. See, e. g., Council on Ethical and Judicial Affairs, American Medical Association, AMA Ethical Opinion 2.20, Withholding or Withdrawing Life-Prolonging Medical Treatment, Current Opinions 13 (1989); The Hastings Center, Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying 59 (1987). Whether or not the techniques used to pass food and water into the patient’s alimentary tract are termed “medical treatment,” it is clear they all involve some degree of intrusion and restraint. Feeding a patient by means of a nasogastric tube requires a physician to pass a long flexible tube through the patient’s *289nose, throat, and esophagus and into the stomach. Because of the discomfort such a tube causes, “[m]any patients need to be restrained forcibly and their hands put into large mittens to prevent them from removing the tube.” Major, The Medical Procedures for Providing Food and Water: Indications and Effects, in By No Extraordinary Means: The Choice to Forgo Life-Sustaining Food and Water 25 (J. Lynn ed. 1986). A gastrostomy tube (as was used to provide food and water to Nancy Cruzan, see ante, at 266) or jejunostomy tube must be surgically implanted into the stomach or small intestine. Office of Technology Assessment Task Force, Life-Sustaining Technologies and the Elderly 282 (1988). Requiring a competent adult to endure such procedures against her will burdens the patient’s liberty, dignity, and freedom to determine the course of her own treatment. Accordingly, the liberty guaranteed by the Due Process Clause must protect, if it protects anything, an individual’s deeply personal decision to reject medical treatment, including the artificial delivery of food and water.

I also write separately to emphasize that the Court does not today decide the issue whether a State must also give effect to the decisions of a surrogate decisionmaker. See ante, at 287, n. 12. In my view, such a duty may well be constitutionally required to protect the patient’s liberty interest in refusing medical treatment. Few individuals provide explicit oral or written instructions regarding their intent to refuse medical treatment should they become incompetent.1 *290States which decline to consider any evidence other than such instructions may frequently fail to honor a patient’s intent. Such failures might be avoided if the State considered an equally probative source of evidence: the patient’s appointment of a proxy to make health care decisions on her behalf. Delegating the authority to make medical decisions to a family member or friend is becoming a common method of planning for the future. See, e. g., Areen, The Legal Status of Consent Obtained from Families of Adult Patients to Withhold or Withdraw Treatment, 258 JAMA 229, 230 (1987). Several States have recognized the practical wisdom of such a procedure by enacting durable power of attorney statutes that specifically authorize an individual to appoint a surrogate to make medical treatment decisions.2 Some state courts have suggested that an agent appointed pursuant to a general durable power of attorney statute would also be empowered to make health care decisions on behalf of the patient.3 See, e. g., In re Peter, 108 N. J. 365, 378-379, 529 *291A. 2d 419, 426 (1987); see also 73 Op. Md. Atty. Gen. No. 88-046 (1988) (interpreting Md. Est. & Trusts Code Ann. §§ 13-601 to 13-602 (1974), as authorizing a delegatee to make health care decisions). Other States allow an individual to designate a proxy to carry out the intent of a living will.4 These procedures for surrogate decisionmaking, which appear to be rapidly gaining in acceptance, may be a *292valuable additional safeguard of the patient’s interest in directing his medical care. Moreover, as patients are likely to select a family member as a surrogate, see 2 President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Making Health Care Decisions 240 (1982), giving effect to a proxy’s decisions may also protect the “freedom of personal choice in matters of . . . family life.” Cleveland Board of Education v. LaFleur, 414 U. S. 632, 639 (1974).

Today’s decision, holding only that the Constitution permits a State to require clear and convincing evidence of Nancy Cruzan’s desire to have artificial hydration and nutrition withdrawn, does not preclude a future determination that the Constitution requires the States to implement the decisions of a patient’s duly appointed surrogate. Nor does it prevent States from developing other approaches for protecting an incompetent individual’s liberty interest in refusing medical treatment. As is evident from the Court’s survey of state court decisions, see ante, at 271-277, no national consensus has yet emerged on the best solution for this difficult and sensitive problem. Today we decide only that one State’s practice does not violate the Constitution; the more challenging task of crafting appropriate procedures for safeguarding incompetents’ liberty interests is entrusted to the “laboratory” of the States, New State Ice Co. v. Liebmann, 285 U. S. 262, 311 (1932) (Brandeis, J., dissenting), in the first instance.

Justice Scalia,

concurring.

The various opinions in this case portray quite clearly the difficult, indeed agonizing, questions that are presented by the constantly increasing power of science to keep the human body alive for longer than any reasonable person would want to inhabit it. The States have begun to grapple with these problems through legislation. I am concerned, from the tenor of today’s opinions, that we are poised to confuse that *293enterprise as successfully as we have confused the enterprise of legislating concerning abortion — requiring it to be conducted against a background of federal constitutional imperatives that are unknown because they are being newly crafted from Term to Term. That would be a great misfortune.

While I agree with the Court’s analysis today, and therefore join in its opinion, I would have preferred that we announce, clearly and promptly, that the federal courts have no business in this field; that American law has always accorded the State the power to prevent, by force if necessary, suicide-including suicide by refusing to take appropriate measures necessary to preserve one’s life; that the point at which life becomes “worthless,” and the point at which the means necessary to preserve it become “extraordinary” or “inappropriate,” are neither set forth in the Constitution nor known to the nine Justices of this Court any better than they are known to nine people picked at random from the Kansas City telephone directory; and hence, that even when it is demon-,. strated by clear and convincing evidence that a patient no longer wishes certain measures to be taken to preserve his or her life, it is up to the citizens of Missouri to decide, through their elected representatives, whether that wish will be honored. It is quite impossible (because the Constitution says nothing about the matter) that those citizens will decide upon a line less lawful than the one we would choose; and it is unlikely (because we know no more about “life and death” than they do) that they will decide upon a line less reasonable.

The text of the Due Process Clause does not protect individuals against deprivations of liberty simpliciter. It protects them against deprivations of liberty “without due process of law.” To determine that such a deprivation would not occur if Nancy Cruzan were forced to take nourishment against her will, it is unnecessary to •:eopen the historically recurrent debate over whether “due process” includes substantive restrictions. Compare Murray's Lessee v. Hoboken Land and Improvement Co., 18 How. 272 (1856), with Scott *294v. Sandford, 19 How. 393, 450 (1857); compare Tyson & Brother v. Banton, 273 U. S. 418 (1927), with Olsen v. Nebraska ex rel. Western Reference & Bond Assn., Inc., 313 U. S. 236, 246-247 (1941); compare Ferguson v. Skrupa, 372 U. S. 726, 730 (1963), with Moore v. East Cleveland, 431 U. S. 494 (1977) (plurality opinion); see Easterbrook, Substance and Due Process, 1982 S. Ct. Rev. 85; Monaghan, Our Perfect Constitution, 56 N. Y. U. L. Rev. 353 (1981). It is at least true that no “substantive due process” claim can be maintained unless the claimant demonstrates that the State has deprived him of a right historically and traditionally protected against state interference. Michael H. v. Gerald D., 491 U. S. 110, 122 (1989) (plurality opinion); Bowers v. Hardwick, 478 U. S. 186, 192 (1986); Moore, supra, at 502-503 (plurality opinion). That cannot possibly be established here.

At common law in England, a suicide — defined as one who “deliberately puts an end to his own existence, or commits any unlawful malicious act, the consequence of which is his own death,” 4 W. Blackstone, Commentaries *189 — was criminally liable. Ibid. Although the States abolished the penalties imposed by the common law (i. e., forfeiture and ignominious burial), they did so to spare the innocent family and not to legitimize the act. Case law at the time of the adoption of the Fourteenth Amendment generally held that assisting suicide was a criminal offense. See Marzen, O’Dowd, Crone, & Balch, Suicide: A Constitutional Right?, 24 Duquesne L. Rev. 1, 76 (1985) (“In short, twenty-one of the thirty-seven states, and eighteen of the thirty ratifying states prohibited assisting suicide. Only eight of the states, and seven of the ratifying states, definitely did not”); see also 1 F. Wharton, Criminal Law § 122 (6th rev. ed. 1868). The System of Penal Law presented to the House of Representatives by Representative Livingston in 1828 would have criminalized assisted suicide. E. Livingston, A System of Penal Law, Penal Code 122 (1828). The Field Penal Code, *295adopted by the Dakota Territory in 1877, proscribed attempted suicide and assisted suicide. Marzen, O’Dowd, Crone, & Balch, supra, at 76-77. And most States that did not explicitly prohibit assisted suicide in 1868 recognized, when the issue arose in the 50 years following the Fourteenth Amendment’s ratification, that assisted and (in some cases) attempted suicide were unlawful. Id., at 77-100; id., at 148-242 (surveying development of States’ laws). Thus, “there is no significant support for the claim that a right to suicide is so rooted in our tradition that it may be deemed ‘fundamental’ or ‘implicit in the concept of ordered liberty.’” Id., at 100 (quoting Palko v. Connecticut, 302 U. S. 319, 325 (1937)).

Petitioners rely on three distinctions to separate Nancy Cruzan’s case from ordinary suicide: (1) that she is permanently incapacitated and in pain; (2) that she would bring on her death not by any affirmative act but by merely declining treatment that provides nourishment; and (3) that preventing her from effectuating her presumed wish to die requires violation of her bodily integrity. None of these suffices. Suicide was not excused even when committed “to avoid those ills which [persons] had not the fortitude to endure.” 4 Blackstone, supra, at *189. “The life of those to whom life has become a burden — of those who are hopelessly diseased or fatally wounded — nay, even the lives of criminals condemned to death, are under the protection of the law, equally as the lives of those who are in the full tide of life’s enjoyment, and anxious to continue to live.” Blackburn v. State, 23 Ohio St. 146, 163 (1873). Thus, a man who prepared a poison, and placed it within reach of his wife, “to put an end to her suffering” from a terminal illness was convicted of murder, People v. Roberts, 211 Mich. 187, 198, 178 N. W. 690, 693 (1920); the “incurable suffering of the suicide, as a legal question, could hardly affect the degree of criminality . . . .” Note, 30 Yale L. J. 408, 412 (1921) (discussing Roberts). Nor would the imminence of the patient’s death have *296affected liability. “The lives of all are equally under the protection of the law, and under that protection to their last moment. . . . [Assisted suicide] is declared by the law to be murder, irrespective of the wishes or the condition of the party to whom the poison is administered . . . .” Blackburn, supra, at 163; see also Commonwealth v. Bowen, 13 Mass. 356, 360 (1816).

The second asserted distinction — suggested by the recent cases canvassed by the Court concerning the right to refuse treatment, ante, at 270-277 — relies on the dichotomy between action and inaction. Suicide, it is said, consists of an affirmative act to end one’s life; refusing treatment is not an affirmative act “causing” death, but merely a passive acceptance of the natural process of dying. I readily acknowledge that the distinction between action and inaction has some bearing upon the legislative judgment of what ought to be prevented as suicide — though even there it would seem to me unreasonable to draw the line precisely between action and inaction, rather than between various forms of inaction. It would not make much sense to say that one may not kill oneself by walking into the sea, but may sit on the beach until submerged by the incoming tide; or that one may not intentionally lock oneself into a cold storage locker, but may refrain from coming indoors when the temperature drops below freezing. Even as a legislative matter, in other words, the intelligent line does not fall between action and inaction but between those forms of inaction that consist of abstaining from “ordinary” care and those that consist of abstaining from “excessive” or “heroic” measures. Unlike action versus inaction, that is not a line to be discerned by logic or legal analysis, and we should not pretend that it is.

But to return to the principal point for present purposes: the irrelevance of the action-inaction distinction. Starving oneself to death is no different from putting a gun to one’s temple as far as the common-law definition of suicide is concerned; the cause of death in both cases is the suicide’s con*297scious decision to “pu[t] an end to his own existence.” 4 Blackstone, supra, at *189. See In re Caulk, 125 N. H. 226, 232, 480 A. 2d 93, 97 (1984); State ex rel. White v. Narick, 170 W. Va. 195, 292 S. E. 2d 54 (1982); Von Holden v. Chapman, 87 App. Div. 2d 66, 450 N. Y. S. 2d 623 (1982). Of course the common law rejected the action-inaction distinction in other contexts involving the taking of human life as well. In the prosecution of a parent for the starvation death of her infant, it was no defense that the infant’s death was “caused” by no action of the parent but by the natural process of starvation, or by the infant’s natural inability to provide for itself. See Lewis v. State, 72 Ga. 164 (1883); People v. McDonald, 49 Hun 67, 1 N. Y. S. 703 (5th Dept., App. Div. 1888); Commonwealth v. Hall, 322 Mass. 523, 528, 78 N. E. 2d 644, 647 (1948) (collecting cases); F. Wharton, Law of Homicide §§ 134-135, 304 (2d ed. 1875); 2 J. Bishop, Commentaries on Criminal Law §686 (5th ed. 1872); J. Hawley & M. McGregor, Criminal Law 152 (3d ed. 1899). A physician, moreover, could be criminally liable for failure to provide care that could have extended the patient’s life, even if death was immediately caused by the underlying disease that the physician failed to treat. Barrow v. State, 17 Okla. Cr. 340, 188 P. 351 (1920); People v. Phillips, 64 Cal. 2d 574, 414 P. 2d 353 (1966).

It is not surprising, therefore, that the early cases considering the claimed right to refuse medical treatment dismissed as specious the nice distinction between “passively submitting to death and actively seeking it. The distinction may be merely verbal, as it would be if an adult sought death by starvation instead of a drug. If the State may interrupt one mode of self-destruction, it may with equal authority interfere with the other.” John F. Kennedy Memorial Hosp. v. Heston, 58 N. J. 576, 581-582, 279 A. 2d 670. 672-673 (1971); see also Application of President & Directors of Georgetown College, Inc., 118 U. S. App. D. C, 80, 88-89. 331 F. 2d 1000, *2981008-1009 (Wright, J., in chambers), cert. denied, 377 U. S. 978 (1964).

The third asserted basis of distinction — that frustrating Nancy Cruzan’s wish to die in the present case requires interference with her bodily integrity — is likewise inadequate, because such interference is impermissible only if one begs the question whether her refusal to undergo the treatment on her own is suicide. It has always been lawful not only for the State, but even for private citizens, to interfere with bodily integrity to prevent a felony. See Phillips v. Trull, 11 Johns. 486 (N. Y. 1814); City Council v. Payne, 2 Nott & McCord 475 (S. C. 1821); Vandeveer v. Mattocks, 3 Ind. 479 (1852); T. Cooley, Law of Torts 174-175 (1879); Wilgus, Arrest Without a Warrant, 22 Mich. L. Rev. 673 (1924); Restatement of Torts §119 (1934). That general rule has of course been applied to suicide. At common law, even a private person’s use of force to prevent suicide was privileged. Colby v. Jackson, 12 N. H. 526, 530-531 (1842); Look v. Choate, 108 Mass. 116, 120 (1871); Commonwealth v. Mink, 123 Mass. 422, 429 (1877); In re Doyle, 16 R. I. 537, 539, 18 A. 159, 159-160 (1889); Porter v. Ritch, 70 Conn. 235, 255, 39 A. 169, 175 (1898); Emmerich v. Thorley, 35 App. Div. 452, 456, 54 N. Y. S. 791, 793-794 (1898); State v. Hembd, 305 Minn. 120, 130, 232 N. W. 2d 872, 878 (1975); 2 C. Addison, Law of Torts §819 (1876); Cooley, supra, at 179-180. It is not even reasonable, much less required by the Constitution, to maintain that although the State has the right to prevent a person from slashing his wrists, it does not have the power to apply physical force to prevent him from doing so, nor the power, should he succeed, to apply, coercively if necessary, medical measures to stop the flow of blood. The state-run hospital, I am certain, is not liable under 42 U. S. C. § 1983 for violation of constitutional rights, nor the private hospital liable under general tort law, if, in a State where suicide is unlawful, it pumps out the stomach of a person who has inten*299tionally taken an overdose of barbiturates, despite that person’s wishes to the contrary.

The dissents of Justices Brennan and Stevens make a plausible case for our intervention here only by embracing— the latter explicitly and the former by implication — a political principle that the States are free to adopt, but that is demonstrably not imposed by the Constitution. “[T]he State,” says Justice Brennan, “has no legitimate general interest in someone’s life, completely abstracted from the interest of the person living that life, that could outweigh the person’s choice to avoid medical treatment.” Post, at 313 (emphasis added). The italicized phrase sounds moderate enough and is all that is needed to cover the present case — but the proposition cannot logically be so limited. One who accepts it must also accept, I think, that the State has no such legitimate interest that could outweigh “the person’s choice to put an end to her life.” Similarly, if one agrees with Justice Brennan that “the State’s general interest in life must accede to Nancy Cruzan’s particularized and intense interest in self-determination in her choice of medical treatment,” post, at 314 (emphasis added), he must also believe that the State must accede to her “particularized and intense interest in self-determination in her choice whether to continue living or to die.” For insofar as balancing the relative interests of the State and the individual is concerned, there is nothing distinctive about accepting death through the refusal of “medical treatment,” as opposed to accepting it through the refusal of food, or through the failure to shut off the engine and get out of the car after parking in one’s garage after work. Suppose that Nancy Cruzan were in precisely the condition she is in today, except that she could be fed and digest food and water without artificial assistance. How is the State’s “interest” in keeping her alive thereby increased, or her interest in deciding whether she wants to continue living reduced? It seems to me, in other words, that Justice Brennan’s position ultimately rests upon the proposition that it is none of the State’s *300business if a person wants to commit suicide. Justice Stevens is explicit on the point: “Choices about death touch the core of liberty. . . . [N]ot 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.” Post, at 343. This is a view that some societies have held, and that our States are free to adopt if they wish. But it is not a view imposed by our constitutional traditions, in which the power of the State to prohibit suicide is unquestionable.

What I have said above is not meant to suggest that I would think it desirable, if we were sure that Nancy Cruzan wanted to die, to keep her alive by the means at issue here. I assert only that the Constitution has nothing to say about the subject. To raise up a constitutional right here we would have to create out of nothing (for it exists neither in text nor tradition) some constitutional principle whereby, although the State may insist that an individual come in out of the cold and eat food, it may not insist that he take medicine; and although it may pump his stomach empty of poison he has ingested, it may not fill his stomach with food he has failed to ingest. Are there, then, no reasonable and humane limits that ought not to be exceeded in requiring an individual to preserve his own life? There obviously are, but they are not set forth in the Due Process Clause. What assures us that those limits will not be exceeded is the same constitutional guarantee that is the source of most of our protection — what protects us, for example, from being assessed a tax of 100% of our income above the subsistence level, from being forbidden to drive cars, or from being required to send our children to school for 10 hours a day, none of which horribles are categorically prohibited by the Constitution. Our salvation is the Equal Protection Clause, which requires the democratic majority to accept for themselves and their loved ones what they impose on you and me. This Court need not, and has no authority to, inject itself into every field of human activity *301where irrationality and oppression may theoretically occur, and if it tries to do so it will destroy itself.

Justice Brennan,

with whom Justice Marshall and Justice Blackmun join, dissenting.

“Medical technology has effectively created a twilight zone of suspended animation where death commences while life, in some form, continues. Some patients, however, want no part of a life sustained only by medical technology. Instead, they prefer a plan of medical treatment that allows nature to take its course and permits them to die with dignity.”1

Nancy Cruzan has dwelt in that twilight zone for six years. She is oblivious to her surroundings and will remain so. Cruzan v. Harmon, 760 S. W. 2d 408, 411 (Mo. 1988). Her body twitches only reflexively, without consciousness. Ibid. The areas of her brain that once thought, felt, and experienced sensations have degenerated badly and are continuing to do so. The cavities remaining are filling with cerebro-spinal fluid. The ‘“cerebral cortical atrophy is irreversible, permanent, progressive and ongoing.’” Ibid. “Nancy will never interact meaningfully with her environment again. She will remain in a persistent vegetative state until her death.” Id., at 422.2 Because she cannot swallow, her nutrition and hydration are delivered through a tube surgically implanted in her stomach.

A grown woman at the time of the accident, Nancy had previously expressed her wish to forgo continuing medical care under circumstances such as these. Her family and her *302friends are convinced that this is what she would want. See n. 20, infra. A guardian ad litem appointed by the trial court is also convinced that this is what Nancy would want. See 760 S. W. 2d, at 444 (Higgins, J., dissenting from denial of rehearing). Yet the Missouri Supreme Court, alone among state courts deciding such a question, has determined that an irreversibly vegetative patient will remain a passive prisoner of medical technology — for Nancy, perhaps for the next 30 years. See id., at 424, 427.

Today the Court, while tentatively accepting that there is some degree of constitutionally protected liberty interest in avoiding unwanted medical treatment, including life-sustaining medical treatment such as artificial nutrition and hydration, affirms the decision of the Missouri Supreme Court. The majority opinion, as I read it, would affirm that decision on the ground that a State may require “clear and convincing” evidence of Nancy Cruzan’s prior decision to forgo life-sustaining treatment under circumstances such as hers in order to ensure that her actual wishes are honored. See ante, at 282-283, 286-287. Because I believe that Nancy Cruzan has a fundamental right to be free of unwanted artificial nutrition and hydration, which right is not outweighed by any interests of the State, and because I find that the improperly biased procedural obstacles imposed by the Missouri Supreme Court impermissibly burden that right, I respectfully dissent. ■ Nancy Cruzan is entitled to choose to die with dignity.

I

A

“[T]he timing of death — once a matter of fate — is now a matter of human choice.” Office of Technology Assessment Task Force, Life Sustaining Technologies and the Elderly 41 (1988). Of the approximately 2 million people who die each year, 80% die in hospitals and long-term care institutions,3 *303and perhaps 70% of those after a decision to forgo life-sustaining treatment has been made.4 Nearly every death involves a decision whether to undertake some medical procedure that could prolong the process of dying. Such decisions are difficult and personal. They must be made on the basis of individual values, informed by medical realities, yet within a framework governed by law. The role of the courts is confined to defining that framework, delineating the ways in which government may and may not participate in such decisions.

The question before this Court is a relatively narrow one: whether the Due Process Clause allows Missouri to require a now-incompetent patient in an irreversible persistent vegetative state to remain on life support absent rigorously clear and convincing evidence that avoiding the treatment represents the patient’s prior, express choice. See ante, at 277-278. If a fundamental right is at issue, Missouri’s rule of decision must be scrutinized under the standards this Court has always applied in such circumstances. As we said in Zablocki v. Redhail, 434 U. S. 374, 388 (1978), if a requirement imposed by a State “significantly interferes with the exercise of a fundamental right, it cannot be upheld unless it is supported by sufficiently important state interests and is closely tailored to effectuate only those interests.” The Constitution imposes on this Court the obligation to “examine carefully . . . the extent to which [the legitimate government interests advanced] are served by the challenged regulation.” Moore v. East Cleveland, 431 U. S. 494, 499 (1977). See also Carey v. Population Services International, 431 U. S. 678, 690 (1977) (invalidating a requirement that bore “no relation to the State’s interest”). An evidentiary rule, just as a substantive prohibition, must meet these standards if it significantly burdens a fundamental liberty interest. Funda*304mental rights “are protected not only against heavy-handed frontal attack, but also from being stifled by more subtle governmental interference.” Bates v. Little Rock, 361 U. S. 516, 523 (1960).

B

The starting point for our legal analysis must be whether a competent person has a constitutional right to avoid unwanted medical care. Earlier this Term, this Court held that the Due Process Clause of the Fourteenth Amendment confers a significant liberty interest in avoiding unwanted medical treatment. Washington v. Harper, 494 U. S. 210, 221-222 (1990). Today, the Court concedes that our prior decisions “support the recognition of a general liberty interest in refusing medical treatment.” See ante, at 278. The Court, however, avoids discussing either the measure of that liberty interest or its application by assuming, for purposes of this case only, that a competent person has a constitutionally protected liberty interest in being free of unwanted artificial nutrition and hydration. See ante, at 279. Justice O’Connor’s opinion is less parsimonious. 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 ante, at 287.

But if a competent person has a liberty interest to be free of unwanted medical treatment, as both the majority and Justice O’Connor concede, it must be fundamental. “We are dealing here with [a decision] which involves one of the basic civil rights of man.” Skinner v. Oklahoma ex rel. Williamson, 316 U. S. 535, 541 (1942) (invalidating a statute authorizing sterilization of certain felons). Whatever other liberties protected by the Due Process Clause are fundamental, “those liberties that are ‘deeply rooted in this Nation’s history and tradition’” are among them. Bowers v. Hardwick, *305478 U. S. 186, 192 (1986) (quoting Moore v. East Cleveland, supra, at 503 (plurality opinion). “Such a tradition commands respect in part because the Constitution carries the gloss of history.” Richmond Newspapers, Inc. v. Virginia, 448 U. S. 555, 589 (1980) (Brennan, J., concurring in judgment).

The right to be free from medical attention without consent, to determine what shall be done with one’s own body, is deeply rooted in this Nation’s traditions, as the majority acknowledges. See ante, at 270. This right has long been “firmly entrenched in American tort law” and is securely grounded in the earliest common law. Ante, at 269. See also Mills v. Rogers, 457 U. S. 291, 294, n. 4 (1982) (“[T]he right to refuse any medical treatment emerged from the doctrines of trespass and battery, which were applied to unauthorized touchings by a physician”). “Anglo-American law starts with the premise of thorough-going self determination. It follows that each man is considered to be master of his own body, and he may, if he be of sound mind, expressly prohibit the performance of lifesaving surgery, or other medical treatment.” Natanson v. Kline, 186 Kan. 393, 406-407, 350 P. 2d 1093, 1104 (1960). “The inviolability of the person” has been held as “sacred” and “carefully guarded” as any common-law right. Union Pacific R. Co. v. Botsford, 141 U. S. 250, 251-252 (1891). Thus, freedom from unwanted medical attention is unquestionably among those principles “so rooted in the traditions and conscience of our people as to be ranked as fundamental.” Snyder v. Massachusetts, 291 U. S. 97, 105 (1934).5

*306That there may be serious consequences involved in refusal of the medical treatment at issue here does not vitiate the right under our common-law tradition of medical • self-determination. It is “a well-established rule of general law . . . that it is the patient, not the physician, who ultimately decides if treatment — any treatment — is to be given at all. . . . The rule has never been qualified in its application by either the nature or purpose of the treatment, or the gravity of the consequences of acceding to or foregoing it.” Tune v. Walter Reed Army Medical Hospital, 602 F. Supp. 1452, 1455 (DC 1985). See also Downer v. Veilleux, 322 A. 2d 82, 91 (Me. 1974) (“The rationale of this rule lies in the fact that every competent adult has the right to forego treatment, or even cure, if it entails what for him are intolerable consequences or risks, however unwise his sense of values may be to others”).6

*307No material distinction can be drawn between the treatment to which Nancy Cruzan continues to be subject — artificial nutrition and hydration — and any other medical treatment. See ante, at 288-289 (O’Connor, J., concurring). The artificial delivery of nutrition and hydration is undoubtedly medical treatment. The technique to which Nancy Cru-zan is subject — artificial feeding through a gastrostomy tube — involves a tube implanted surgically into her stomach through incisions in her abdominal wall. It may obstruct the intestinal tract, erode and pierce the stomach wall, or cause leakage of the stomach’s contents into the abdominal cavity. See Page, Andrassy, & Sandler, Techniques in Delivery of Liquid Diets, in Nutrition in Clinical Surgery 66-67 (M. Deitel 2d ed. 1985). The tube can cause pneumonia from reflux of the stomach’s contents into the lung. See Bernard & Forlaw, Complications and Their Prevention, in Enteral and Tube Feeding 553 (J. Rombeau & M. Caldwell eds. 1984). Typically, and in this case (see Tr. 377), commercially prepared formulas are used, rather than fresh food. See Matarese, Enteral Alimentation, in Surgical Nutrition 726 (J. Fischer ed. 1983). The type of formula and method of administration must be experimented with to avoid gastrointestinal problems. Id,., at 748. The patient must be monitored daily by medical personnel as to weight, fluid intake, and fluid output; blood tests must be done weekly. Id., at 749, 751.

Artificial delivery of food and water is regarded as medical treatment by the medical profession and the Federal Government.7 According to the American Academy of Neurology: *308“The artificial provision of nutrition and hydration is a form of medical treatment . . . analogous to other forms of life-sustaining treatment, such as the use of the respirator. When a patient is unconscious, both a respirator and an artificial feeding device serve to support or replace normal bodily functions that are compromised as a result of the patient’s illness.” Position of the American Academy of Neurology on Certain Aspects of the Care and Management of the Persistent Vegetative State Patient, 39 Neurology 125 (Jan. 1989). See also Council on Ethical and Judicial Affairs of the American Medical Association, Current Opinions, Opinion 2.20 (1989) (“Life-prolonging medical treatment includes medication and artifically or technologically supplied respiration, nutrition or hydration”); President’s Commission 88 (life-sustaining treatment includes respirators, kidney dialysis machines, and special feeding procedures). The Federal Government permits the cost of the medical devices and formulas used in enteral feeding to be reimbursed under Medicare. See Pub. L. 99-509, § 9340, note following 42 U. S. C. §1395u, p. 592 (1982 ed., Supp. V). The formulas are regulated by the federal Food and Drug Administration as “medical foods,” see 21 U. S. C. §360ee, and the feeding tubes are regulated as medical devices, 21 CFR §876.5980 (1989).

Nor does the fact that Nancy Cruzan is now incompetent deprive her of her fundamental rights. See Yonngberg v. Romeo, 457 U. S. 307, 315-316, 319 (1982) (holding that severely retarded man's liberty interests in safety, freedom from bodily restraint, and reasonable training survive involuntary commitment); Parham v. J. R., 442 U. S. 584, 600 (1979) (recognizing a child’s substantial liberty interest in not being confined unnecessarily for medical treatment); Jackson v. Indiana, 406 U. S. 715, 730, 738 (1972) (holding that Indiana could not violate the due process and equal protection rights of a mentally retarded deaf mute by committing him for an indefinite amount of time simply because he was incompetent to stand trial on the criminal charges filed against *309him). As the majority recognizes, ante, at 280, the question is not whether an incompetent has constitutional rights, but how such rights may be exercised. As we explained in Thompson v. Oklahoma, 487 U. S. 815 (1988): “The law must often adjust the manner in which it affords rights to those whose status renders them unable to exercise choice freely and rationally. Children, the insane, and those %vho are irreversibly ill with loss of brain function, for instance, all retain ‘rights,’’ to be sure, but often such rights are only meaningful as they are exercised by agents acting with the best interests of their principals in mind.” Id., at 825, n. 23 (emphasis added). “To deny [its] exercise because the patient is unconscious or incompetent would be to deny the right.” Foody v. Manchester Memorial Hospital, 40 Conn. Super. 127, 133, 482 A. 2d 713, 718 (1984).

II

A

The right to be free from unwanted medical attention is a right to evaluate the potential benefit of treatment and its possible consequences according to one’s own values and to make a personal decision whether to subject oneself to the intrusion. For a patient like Nancy Cruzan, the sole benefit of medical treatment is being kept metabolically alive. Neither artificial nutrition nor any other form of medical treatment available today can cure or in any way ameliorate her condition.8 Irreversibly vegetative patients are devoid of thought, *310emotion, and sensation; they are permanently and completely unconscious. See n. 2, supra.9 As the President’s Commission concluded in approving the withdrawal of life support equipment from irreversibly vegetative patients:

“[Treatment ordinarily aims to benefit a patient through preserving life, relieving pain and suffering, protecting against disability, and returning maximally effective functioning. If a prognosis of permanent unconsciousness is correct, however, continued treatment cannot confer such benefits. Pain and suffering are absent, as are joy, satisfaction, and pleasure. Disability is total and no return to an even minimal level of social or human functioning is possible.” President’s Commission 181— 182.

There are also affirmative reasons why someone like Nancy might choose to forgo artificial nutrition and hydration under these circumstances. Dying is personal. And it is profound. For many, the thought of an ignoble end, steeped in decay, is abhorrent. A quiet, proud death, bodily integ*311rity intact, is a matter of extreme consequence. “In certain, thankfully rare, circumstances the burden of maintaining the corporeal existence degrades the very humanity it was meant to serve.” Brophy v. New England Sinai Hospital, Inc., 398 Mass. 417, 434, 497 N. E. 2d 626, 635-636 (1986) (finding the subject of the proceeding “in a condition which [he] has indicated he would consider to be degrading and without human dignity” and holding that “[t]he duty of the State to preserve life must encompass a recognition of an individual’s right to avoid circumstances in which the individual himself would feel that efforts to sustain life demean or degrade his humanity”). Another court, hearing a similar case, noted:

“It is apparent from the testimony that what was on [the patient’s] mind was not only the invasiveness of life-sustaining systems, such as the [nasogastric] tube, upon the integrity of his body. It was also the utter helplessness of the permanently comatose person, the wasting of a once strong body, and the submission of the most private bodily functions to the attention of others.” In re Gardner, 534 A. 2d 947, 953 (Me. 1987).

Such conditions are, for many, humiliating to contemplate,10 as is visiting a prolonged and anguished vigil on one’s parents, spouse, and children. A long, drawn-out death can have a debilitating effect on family members. See Carnwath & Johnson, Psychiatric Morbidity Among Spouses of Patients With Stroke, 294 Brit. Med. J. 409 (1987); Livingston, Families Who Care, 291 Brit. Med. J. 919 (1985). For some, the idea of being remembered in their persistent vegetative *312states rather than as they were before their illness or accident may be very disturbing.11

B

Although the right to be free of unwanted medical intervention, like other constitutionally protected interests, may not be absolute,12 no state interest could outweigh the rights of an individual in Nancy Cruzan’s position. Whatever a State’s possible interests in mandating life-support treatment under other circumstances, there is no good to be obtained here by Missouri’s insistence that Nancy Cruzan remain on life-support systems if it is indeed her wish not to do so. Missouri does not claim, nor could it, that society as a whole will be benefited by Nancy’s receiving medical treatment. *313No third party’s situation will be improved and no harm to others will be averted. Cf. nn. 6 and 8, supra.13

The only state interest asserted here is a general interest in the preservation of life.14 But the State has no legitimate general interest in someone’s life, completely abstracted from the interest of the person living that life, that could outweigh the person’s choice to avoid medical treatment. “[T]he regulation of constitutionally protected decisions . . . must be predicated on legitimate state concerns other than disagreement with the choice the individual has made. . . . Otherwise, the interest in liberty protected by the Due Process Clause would be a nullity.” Hodgson v. Minnesota, post, at *314435 (opinion of Stevens, J.) (emphasis added). Thus, the State’s general interest in life must accede to Nancy Cruzan’s particularized and intense interest in self-determination in her choice of medical treatment. There is simply nothing legitimately within the State’s purview to be gained by superseding her decision.

Moreover, there may be considerable danger that Missouri’s rule of decision would impair rather than serve any interest the State does have in sustaining life. Current medical practice recommends use of heroic measures if there is a scintilla of a chance that the patient will recover, on the assumption that the measures will be discontinued should the patient improve. When the President’s Commission in 1982 approved the withdrawal of life-support equipment from irreversibly vegetative patients, it explained that “[a]n even more troubling wrong occurs when a treatment that might save life or improve health is not started because the health care personnel are afraid that they will find it very difficult to stop the treatment if, as is fairly likely, it proves to be of little benefit and greatly burdens the patient.” President’s Commission 75. A New Jersey court recognized that families as well as doctors might be discouraged by an inability to stop life-support measures from “even attempting certain types of care [which] could thereby force them into hasty and premature decisions to allow a patient to die.” In re Conroy, 98 N. J. 321, 370, 486 A. 2d 1209, 1234 (1985). See also Brief for American Academy of Neurology as Amicus Curiae 9 (expressing same concern).13

*315rH HH 1 — 4

This is not to say that the State has no legitimate interests to assert here. As the majority recognizes, ante, at 281-282, Missouri has a parens patriae interest in providing Nancy Cruzan, now incompetent, with as accurate as possible a determination of how she would exercise her rights under these circumstances. Second, if and when it is determined that Nancy Cruzan would want to continue treatment, the State may legitimately assert an interest in providing that treatment. But until Nancy’s wishes have been deter*316mined, the only state interest that may be asserted is an interest in safeguarding the accuracy of that determination.

Accuracy, therefore, must be our touchstone. Missouri may constitutionally impose only those procedural requirements that serve to enhance the accuracy of a determination of Nancy Cruzan’s wishes or are at least consistent with an accurate determination. The Missouri “safeguard” that the Court upholds today does not meet that standard. The determination needed in this context is whether the incompetent person would choose to live in a persistent vegetative state on life support or to avoid this medical treatment. Missouri’s rule of decision imposes a markedly asymmetrical evi-dentiary burden. Only evidence of specific statements of treatment choice made by the patient when competent is admissible to support a finding that the patient, now in a persistent vegetative state, would wish to avoid further medical treatment. Moreover, this evidence must be clear and convincing. No proof is required to support a finding that the incompetent person would wish to continue treatment.

A

The majority offers several justifications for Missouri’s heightened evidentiary standard. First, the majority explains that the State may constitutionally adopt this rule to govern determinations of an incompetent’s wishes in order to advance the State’s substantive interests, including its unqualified interest in the preservation of human life. See ante, at 282-283, and n. 10. Missouri’s evidentiary standard, however, cannot rest on the State’s own interest in a particular substantive result. To be sure, courts have long erected clear and convincing evidence standards to place the greater risk of erroneous decisions on those bringing disfavored claims.16 In such cases, however, the choice to discourage *317certain claims was a legitimate, constitutional policy choice. In contrast, Missouri has no such power to disfavor a choice by Nancy Cruzan to avoid medical treatment, because Missouri has no legitimate interest in providing Nancy with treatment until it is established that this represents her choice. See supra, at 312-314. Just as a State may not override Nancy’s choice directly, it may not do so indirectly through the imposition of a procedural rule.

Second, the majority offers two explanations for why Missouri’s clear and convincing evidence standard is a means of enhancing accuracy, but neither is persuasive. The majority initially argues that a clear and convincing evidence standard is necessary to compensate for the possibility that such proceedings will lack the “guarantee of accurate factfinding that the adversary process brings with it,” citing Ohio v. Akron Center for Reproductive Health, post, at 515-516 (upholding a clear and convincing evidence standard for an ex parte proceeding). Ante, at 281-282. Without supporting the Court’s decision in that case, I note that the proceeding to determine an incompetent’s wishes is quite different from a proceeding to determine whether a minor may bypass notifying her parents before undergoing an abortion on the ground that she is mature enough to make the decision or that the abortion is in her best interests.

*318An adversarial proceeding is of particular importance when one side has a strong personal interest which needs to be counterbalanced to assure the court that the questions will be fully explored. A minor who has a strong interest in obtaining permission for an abortion without notifying her parents may come forward whether or not society would be satisfied that she has made the decision with the seasoned judgment of an adult. The proceeding here is of a different nature. Barring venal motives, which a trial court has the means of ferreting out, the decision to come forward to request a judicial order to stop treatment represents a slowly and carefully considered resolution by at least one adult and more frequently several adults that discontinuation of treatment is the patient’s wish.

In addition, the bypass procedure at issue in Akron, supra, is ex parte and secret. The court may not notify the minor’s parents, siblings, or friends. No one may be present to submit evidence unless brought forward by the minor herself. In contrast, the proceeding to determine Nancy Cruzan’s wishes was neither ex parte nor secret. In a hearing to determine the treatment preferences of an incompetent person, a court is not limited to adjusting burdens of proof as its only means of protecting against a possible imbalance. Indeed, any concern that those who come forward will present a one-sided view would be better addressed by appointing a guardian ad litem, who could use the State’s powers of discovery to gather and present evidence regarding the patient’s wishes. A guardian ad litem’s task is to uncover any conflicts of interest and ensure that each party likely to have relevant evidence is consulted and brought forward — for example, other members of the family, friends, clergy, and doctors. See, e. g., In re Colyer, 99 Wash. 2d 114, 133, 660 P. 2d 738, 748-749 (1983). Missouri’s heightened evidentiary standard attempts to achieve balance by discounting evidence; the guardian ad litem technique achieves balance by probing for additional evidence. Where, as here, the family members, *319friends, doctors, and guardian ad litem agree, it is not because the process has failed, as the majority suggests. See ante, at 281, n. 9. It is because there is no genuine dispute as to Nancy’s preference.

The majority next argues that where, as here, important individual rights are at stake, a clear and convincing evidence standard has long been held to be an appropriate means of enhancing accuracy, citing decisions concerning what process an individual is due before he can be deprived of a liberty interest. See ante, at 283. In those cases, however, this Court imposed a clear and convincing standard as a constitutional minimum on the basis of its evaluation that one side’s interests clearly outweighed the second side’s interests and therefore the second side should bear the risk of error. See Santosky v. Kramer, 455 U. S. 745, 753, 766-767 (1982) (requiring a clear and convincing evidence standard for termination of parental rights because the parent’s interest is fundamental but the State has no legitimate interest in termination unless the parent is unfit, and finding that the State’s interest in finding the best home for the child does not arise until the parent has been found unfit); Addington v. Texas, 441 U. S. 418, 426-427 (1979) (requiring clear and convincing evidence in an involuntary commitment hearing because the interest of the individual far outweighs that of a State, which has no legitimate interest in confining individuals who are not mentally ill and do not pose a danger to themselves or others). Moreover, we have always recognized that shifting the risk of error reduces the likelihood of errors in one direction at the cost of increasing the likelihood of errors in the other. See Addington, supra, at 423 (contrasting heightened standards of proof to a preponderance standard in which the two sides “share the risk of error in roughly equal fashion” because society does not favor one outcome over the other). In the cases cited by the majority, the imbalance imposed by a heightened evidentiary standard was not only acceptable but required because the standard was deployed to protect an in*320dividual’s exercise of a fundamental right, as the majority admits, ante, at 282-283, n. 10. In contrast, the Missouri court imposed a clear and convincing evidence standard as an obstacle to the exercise of a fundamental right.

The majority claims that the allocation of the risk of error is justified because it is more important not to terminate life support for someone who would wish it continued than to honor the wishes of someone who would not. An erroneous decision to terminate life support is irrevocable, says the majority, while an erroneous decision not to terminate “results in a maintenance of the status quo.” See ante, at 283.17 But, from the point of view of the patient, an erroneous decision in either direction is irrevocable. An erroneous decision to terminate artificial nutrition and hydration, to be sure, will lead to failure of that last remnant of physiological life, the brain stem, and result in complete brain death. An erroneous decision not to terminate life support, however, robs a patient of the very qualities protected by the right to avoid unwanted medical treatment. His own degraded existence is perpetuated; his family’s suffering is protracted; the memory he leaves behind becomes more and more distorted.

Even a later decision to grant him his wish cannot undo the intervening harm. But a later decision is unlikely in any event. “[T]he discovery of new evidence,” to which the ma*321jority refers, ibid., is more hypothetical than plausible. The majority also misconceives the relevance of the possibility of “advancements in medical science,” ibid., by treating it as a reason to force someone to continue medical treatment against his will. The possibility of a medical miracle is indeed part of the calculus, but it is a part of the patient’s calculus. If current research suggests that some hope for cure or even moderate improvement is possible within the lifespan projected, this is a factor that should be and would be accorded significant weight in assessing what the patient himself would choose.18

B

Even more than its heightened evidentiary standard, the Missouri court’s categorical exclusion of relevant evidence dispenses with any semblance of accurate factfinding. The court adverted to no evidence supporting its decision, but held that no clear and convincing, inherently reliable evidence had been presented to show that Nancy would want to avoid further treatment. In doing so, the court failed to consider statements Nancy had made to family members and a close friend.19" The court also failed to consider testimony *?from Nancy’s mother and sister that they were certain that Nancy would want to discontinue artificial nutrition and hydration,20 even after the court found that Nancy’s family was loving and without malignant motive. See 760 S. W. 2d, at 412. The court also failed to consider the conclusions of the guardian ad litem, appointed by the trial court, that there was clear and convincing evidence that Nancy would want to *323discontinue medical treatment and that this was in her best interests. Id., at 444 (Higgins, J., dissenting from denial of rehearing); Brief for Respondent Guardian Ad Litem 2-3. The court did not specifically define what kind of evidence it would consider clear and convincing, but its general discussion suggests that only a living will or equivalently formal directive from the patient when competent would meet this standard. See 760 S. W. 2d, at 424-425.

Too few people execute living wills or equivalently formal directives for such an evidentiary rule to ensure adequately that the wishes of incompetent persons will be honored.21 While it might be a wise social policy to encourage people to furnish such instructions, no general conclusion about a patient’s choice can be drawn from the absence of formalities. The probability of becoming irreversibly vegetative is so low that many people may not feel an urgency to marshal formal evidence of their preferences. Some may not wish to dwell on their own physical deterioration and mortality. Even someone with a resolute determination to avoid life support under circumstances such as Nancy’s would still need to know that such things as living wills exist and how to execute one. Often legal help would be necessary, especially given the majority’s apparent willingness to permit States to insist that a person’s wishes are not truly known unless the particular medical treatment is specified. See ante, at 285.

*324As a California appellate court observed: “The lack of generalized public awareness of the statutory scheme and the typically human characteristics of procrastination and reluctance to contemplate the need for such arrangements however makes this a tool which will all too often go unused by those who might desire it.” Barber v. Superior Court, 147 Cal. App. 3d 1006, 1015, 195 Cal. Rptr. 484, 489 (1983). When a person tells family or close friends that she does not want her life sustained artificially, she is “express[ing] her wishes in the only terms familiar to her, and ... as clearly as a lay person should be asked to express them. To require more is unrealistic, and for all practical purposes, it precludes the right of patients to forego life-sustaining treatment.” In re O'Connor, 72 N. Y. 2d 517, 551, 531 N. E. 2d 607, 626 (1988) (Simons, J., dissenting).22 When Missouri enacted a living will statute, it specifically provided that the absence of a living will does not warrant a presumption that a patient wishes continued medical treatment. See n. 15, supra. *325Thus, apparently not even Missouri’s own legislature believes that a person who does not execute a living will fails to do so because he wishes continuous medical treatment under all circumstances.

The testimony of close friends and family members, on the other hand, may often be the best evidence available of what the patient’s choice would be. It is they with whom the patient most likely will have discussed such questions and they who know the patient best. “Family members have a unique knowledge of the patient which is vital to any decision on his or her behalf.” Newman, Treatment Refusals for the Critically and Terminally Ill: Proposed Rules for the Family, the Physician, and the State, 3 N. Y. L. S. Human Rights Annual 35, 46 (1985). The Missouri court’s decision to ignore this whole category of testimony is also at odds with the practices of other States. See, e. g., In re Peter, 108 N. J. 365, 529 A. 2d 419 (1987); Brophy v. New England Sinai Hospital, Inc., 398 Mass. 417, 497 N. E. 2d 626 (1986); In re Severns, 425 A. 2d 156 (Del. Ch. 1980).

The Missouri court’s disdain for Nancy’s statements in serious conversations not long before her accident, for the opinions of Nancy’s family and friends as to her values, beliefs and certain choice, and even for the opinion of an outside objective factfinder appointed by the State evinces a disdain for Nancy Cruzan’s own right to choose. The rules by which an incompetent person’s wishes are determined must represent every effort to determine those wishes. The rule that the Missouri court adopted and that this Court upholds, however, skews the result away from a determination that as accurately as possible reflects the individual’s own preferences and beliefs. It is a rule that transforms human beings into passive subjects of medical technology.

“[Mjedical care decisions must be guided by the individual patient’s interests and values. Allowing persons to determine their own medical treatment is an important way in which society respects persons as individuals. *326Moreover, the respect due to persons as individuals does not diminish simply because they have become incapable of participating in treatment decisions. . . . [I]t is still possible for others to make a decision that reflects [the patient’s] interests more closely than would a purely technological decision to do whatever is possible. Lacking the ability to decide, [a patient] has a right to a decision that takes his interests into account.” Conservatorship of Drabick, 200 Cal. App. 3d 185, 208, 245 Cal. Rptr. 840, 854-855, cert. denied, 488 U. S. 958 (1988).

C

I do not suggest that States must sit by helplessly if the choices of incompetent patients are in danger of being ignored. See ante, at 281. Even if the Court had ruled that Missouri’s rule of decision is unconstitutional, as I believe it should have, States would nevertheless remain free to fashion procedural protections to safeguard the interests of incompetents under these circumstances. The Constitution provides merely a framework here: Protections must be genuinely aimed at ensuring decisions commensurate with the will of the patient, and must be reliable as instruments to that end. Of the many States which have instituted such protections, Missouri is virtually the only one to have fashioned a rule that lessens the likelihood of accurate determinations. In contrast* nothing in the Constitution prevents States from reviewing the advisability of a family decision, by requiring a court proceeding or by appointing an impartial guardian ad litem.

There are various approaches to determining an incompetent patient’s treatment choice in use by the several States today, and there may be advantages and disadvantages to each and other approaches not yet envisioned. The choice, in largest part, is and should be left to the States, so long as each State is seeking, in a reliable manner, to discover what the patient would want. But with such momentous interests in the balance, States must avoid procedures that will preju*327dice the decision. “To err either way — to keep a person alive under circumstances under which he would rather have been allowed to die, or to allow that person to die when he would have chosen to cling to life — would be deeply unfortunate.” In re Conroy, 98 N. J., at 343, 486 A. 2d, at 1220.

D

Finally, I cannot agree with the majority that where it is not possible to determine what choice an incompetent patient would make, a State’s role as parens patriae permits the State automatically to make that choice itself. See ante, at 286 (explaining that the Due Process Clause does not require a State to confide the decision to “anyone but the patient herself”). Under fair rules of evidence, it is improbable that a court could not determine what the patient’s choice would be. Under the rule of decision adopted by Missouri and upheld today by this Court, such occasions might be numerous. But in neither case does it follow that it is constitutionally acceptable for the State invariably to assume the role of deciding for the patient. A State’s legitimate interest in safeguarding a patient’s choice cannot be furthered by simply appropriating it.

The majority justifies its position by arguing that, while close family members may have a strong feeling about the question, “there is no automatic assurance that the view of close family members will necessarily be the same as the patient’s would have been had she been confronted with the prospect of her situation while competent.” Ibid. I cannot quarrel with this observation. But it leads only to another question: Is there any reason to suppose that a State is more likely to make the choice that the patient would have made than someone who knew the patient intimately? To ask this is to answer it. As the New Jersey Supreme Court observed: “Family members are best qualified to make substituted judgments for incompetent patients not only because of their peculiar grasp of the patient’s approach to life, but also *328because of their special bonds with him or her. . . . It is . . . they who treat the patient as a person, rather than a symbol of a cause.” In re Jobes, 108 N. J. 394, 416, 529 A. 2d 434, 445 (1987). The State, in contrast, is a stranger to the patient.

A State’s inability to discern an incompetent patient’s choice still need not mean that a State is rendered powerless to protect that choice. But I would find that the Due Process Clause prohibits a State from doing more than that. A State may ensure that the person who makes the decision on the patient’s behalf is the one whom the patient himself would have selected to make that choice for him. And a State may exclude from consideration anyone having improper motives. But a State generally must either repose the choice with the person whom the patient himself would most likely have chosen as proxy or leave the decision to the patient’s family.23

IV

As many as 10,000 patients are being maintained in persistent vegetative states in the United States, and the number is expected to increase significantly in the near future. See Cranford, supra n. 2, at 27, 31. Medical technology, developed over the past 20 or so years, is often capable of resuscitating people after they have stopped breathing or their hearts have stopped beating. Some of those people are brought fully back to life.' Two decades ago, those who were not and could not swallow and digest food, died. Intravenous solutions could not provide sufficient calories to maintain people for more than a short time. Today, various forms of artificial feeding have been developed that are able to keep people metabolically alive for years, even decades. See Spencer & Palmisano, Specialized Nutritional Support of *329Patients — A Hospital’s Legal Duty?, 11 Quality Rev. Bull. 160, 160-161 (1986). In addition, in this century, chronic or degenerative ailments have replaced communicable diseases as the primary causes of death. See R. Weir, Abating Treatment with Critically Ill Patients 12-13 (1989); President’s Commission 15-16. The 80% of Americans who die in hospitals are “likely to meet their end ... ‘in a sedated or comatose state; betubed nasally, abdominally and intravenously; and far more like manipulated objects than like moral subjects. ’ ”24 A fif th of all adults surviving to age 80 will suffer a progressive dementing disorder prior to death. See Cohen & Eisdorfer, Dementing Disorders, in The Practice of Geriatrics 194 (E. Calkins, P. Davis, & A. Ford eds. 1986).

“[L]aw, equity and justice must not themselves quail and be helpless in the face of modern technological marvels presenting questions hitherto unthought of.” In re Quinlan, 70 N. J. 10, 44, 355 A. 2d 647, 665, cert. denied, 429 U. S. 922 (1976). The new medical technology can reclaim those who would have been irretrievably lost a few decades ago and restore them to active lives. For Nancy Cruzan, it failed, and for others with wasting incurable disease, it may be doomed to failure. In these unfortunate situations, the bodies and preferences and memories of the victims do not escheat to the State; nor does our Constitution permit the State or any other government to commandeer them. No singularity of feeling exists upon which such a government might confidently rely as parens patriae. The President’s Commission, after years of research, concluded:

“In few areas of health care are people’s evaluations of their experiences so varied and uniquely personal as in their assessments of the nature and value of the processes associated with dying. For some, every moment of life is of inestimable value; for others, life without *330some desired level of mental or physical ability is worthless or burdensome. A moderate degree of suffering may be an important means of personal growth and religious experience to one person, but only frightening or despicable to another.” President’s Commission 276.

Yet Missouri and this Court have displaced Nancy’s own assessment of the processes associated with dying. They have discarded evidence of her will, ignored her values, and deprived her of the right to a decision as closely approximating her own choice as humanly possible. They have done so disingenuously in her name and openly in Missouri’s own. That Missouri and this Court may truly be motivated only by concern for incompetent patients makes no matter. As one of our most prominent jurists warned us decades ago: “Experience should teach us to be most on our guard to protect liberty when the government’s purposes are beneficent. . . . The greatest dangers to liberty lurk in insidious encroachment by men of zeal, well meaning but without understanding.” Olmstead v. United States, 277 U. S. 438, 479 (1928) (Brandeis, J., dissenting).

I respectfully dissent.

Justice Stevens,

dissenting.

Our Constitution is born of the proposition that all legitimate governments must secure the equal right of every person to “Life, Liberty, and the pursuit of Happiness.”1 In the ordinary case we quite naturally assume that these three *331ends are compatible, mutually enhancing, and perhaps even coincident.

The Court would make an exception here. It permits the State’s abstract, undifferentiated interest in the preservation of life to overwhelm the best interests of Nancy Beth Cruzan, interests which would, according to an undisputed finding, be served by allowing her guardians to exercise her constitutional right to discontinue medical treatment. Ironically, the Court reaches this conclusion despite endorsing three significant propositions which should save it from any such dilemma. First, a competent individual’s decision to refuse life-sustaining medical procedures is an aspect of liberty protected by the Due Process Clause of the Fourteenth Amendment. See ante, at 278-279. Second, upon a proper eviden-tiary showing, a qualified guardian may make that decision on behalf of an incompetent ward. See, e. g., ante, at 284-285. Third, in answering the important question presented by this tragic case, it is wise “ ‘not to attempt, by any general statement, to cover every possible phase of the subject.’” See ante, at 278 (citation omitted). Together, these considerations suggest that Nancy Cruzan’s liberty to be free from medical treatment must be understood in light of the facts and circumstances particular to her.

I would so hold: In my view, the Constitution requires the State to care for Nancy Cruzan’s life in a way that gives appropriate respect to her own best interests.

HH

This case is the first in which we consider whether, and how, the Constitution protects the liberty of seriously ill patients to be free from life-sustaining medical treatment. So put, the question is both general and profound. We need not, however, resolve the question in the abstract. Our responsibility as judges both enables and compels us to treat the problem as it is illuminated by the facts of the controversy before us.

*332The most important of those facts are these: “Clear and convincing evidence” established that Nancy Cruzan is “oblivious to her environment except for reflexive responses to sound and perhaps to painful stimuli”; that “she has no cognitive or reflexive ability to swallow food or water”; that “she will never recover” these abilities; and that her “cerebral cortical atrophy is irreversible, permanent, progressive and ongoing.” App. to Pet. for Cert. A94-A95. Recovery and consciousness are impossible; the highest cognitive brain function that can be hoped for is a grimace in “recognition of ordinarily painful stimuli” or an “apparent response to sound.” Id.,at A95.2

After thus evaluating Nancy Cruzan’s medical condition, the trial judge next examined how the interests of third parties would be affected if Nancy’s parents were allowed to withdraw the gastrostomy tube that had been implanted in *333their daughter. His findings make it clear that the parents’ request had no economic motivation,3 and that granting their request would neither adversely affect any innocent third parties nor breach the ethical standards of the medical profession.4 He then considered, and rejected, a religious objection to his decision,5 and explained why he concluded that the ward’s constitutional “right to liberty” outweighed the general public policy on which the State relied:

“There is a fundamental natural right expressed in our Constitution as the ‘right to liberty,’ which permits an individual to refuse or direct the withholding or withdrawal of artificial death prolonging procedures when the person has no more cognitive brain function than our Ward and all the physicians agree there is no hope of further recovery while the deterioration of the brain continues with further overall worsening physical contrac-tures. To the extent that the statute or public policy prohibits withholding or withdrawal of nutrition and hydration or euthanasia or mercy killing, if such be the definition, under all circumstances, arbitrarily and with no exceptions, it is in violation of our ward’s constitutional rights by depriving her of liberty without due process of *334law. To decide otherwise that medical treatment once undertaken must be continued irrespective of its lack of success or benefit to the patient in effect gives one’s body to medical science without their [sic] consent.

“The Co-guardians are required only to exercise their legal authority to act in the best interests of their Ward as they discharge their duty and are free to act or not with this authority as they may determine.” Id., at A98-A99 (footnotes omitted).

I — I

Because he believed he had a duty to do so, the independent guardian ad litem appealed the trial court’s order to the Missouri Supreme Court. In that appeal, however, the guardian advised the court that he did not disagree with the trial court’s decision. Specifically, he endorsed the critical finding that “it was in Nancy Cruzan’s best interests to have the tube feeding discontinued.”6

That important conclusion thus was not disputed by the litigants. One might reasonably suppose that it would be dis-positive: If Nancy Cruzan has no interest in continued treatment, and if she has a liberty interest in being free from unwanted treatment, and if the cessation of treatment would have no adverse impact on third parties, and if no reason exists to doubt the good faith of Nancy’s parents, then what possible basis could the State have for insisting upon continued medical treatment? Yet, instead of questioning or endorsing the trial court’s conclusions about Nancy Cruzan’s interests, the State Supreme Court largely ignored them.

*335The opinion of that court referred to four different state interests that have been identified in other somewhat similar cases, but acknowledged that only the State’s general interest in “the preservation of life” was implicated by this case.7 It defined that interest as follows:

“The state’s interest in life embraces two separate concerns: an interest in the prolongation of the life of the individual patient and an interest in the sanctity of life itself.” Cruzan v. Harmon, 760 S. W. 2d 408, 419 (1988).

Although the court did not characterize this interest as absolute, it repeatedly indicated that it outweighs any countervailing interest that is based on the “quality of life” of any individual patient/ In the view of the state-court majority, *336that general interest is strong enough to foreclose any decision to refuse treatment for an incompetent person unless that person had previously evidenced, in a clear and convincing terms, such a decision for herself. The best interests of the incompetent individual who had never confronted the issue — or perhaps had been incompetent since birth — are entirely irrelevant and unprotected under the reasoning of the State Supreme Court’s four-judge majority.

The three dissenting judges found Nancy Cruzan’s interests compelling. They agreed with the trial court’s evaluation of state policy. In his persuasive dissent, Judge Blackmar explained that decisions about the care of chronically ill patients were traditionally private:

“My disagreement with the principal opinion lies fundamentally in its emphasis on the interest of and the role of the state, represented by the Attorney General. Decisions about prolongation of life are of recent origin. For most of the world’s history, and presently in most parts of the world, such decisions would never arise because the technology would not be available. Decisions about medical treatment have customarily been made by the patient, or by those closest to the patient if the patient, because of youth or infirmity, is unable to make the decisions. This is nothing new in substituted deci-sionmaking. The state is seldom called upon to be the decisionmaker.

“I would not accept the assumption, inherent in the principal opinion, that, with our advanced technology, the state must necessarily become involved in a decision about using extraordinary measures to prolong life. Decisions of this kind are made daily by the patient or relatives, on the basis of medical advice and their conclusion as to what is best. Very few cases reach court, and

*337I doubt whether this case would be before us but for the fact that Nancy lies in a state hospital. I do not place primary emphasis on the patient’s expressions, except possibly in the very unusual case, of which I find no example in the books, in which the patient expresses a view that all available life supports should be made use of. Those closest to the patient are best positioned to make judgments about the patient’s best interest. ” Id., at 428.

Judge Blackmar then argued that Missouri’s policy imposed upon dying individuals and their families a controversial and objectionable view of life’s meaning:

“It is unrealistic to say that the preservation of life is an absolute, without regard to the quality of life. I make this statement only in the context of a case in which the trial judge has found that there is no chance for amelioration of Nancy’s condition. The principal opinion accepts this conclusion. It is appropriate to consider the quality of life in making decisions about the extraordinary medical treatment. Those who have made decisions about such matters without resort to the courts certainly consider the quality of life, and balance this against the unpleasant consequences to the patient. There is evidence that Nancy may react to pain stimuli. If she has any awareness of her surroundings, her life must be a living hell. She is unable to express herself or to do anything at all to alter her situation. Her parents, who are her closest relatives, are best able to feel for her and to decide what is best for her. The state should not substitute its decisions for theirs. Nor am I impressed with the crypto-philosophers cited in the principal opinion, who declaim about the sanctity of any life without regard to its quality. They dwell in ivory towers.” Id., at 429.

*338Finally, Judge Blackmar concluded that the Missouri policy was illegitimate because it treats life as a theoretical abstraction, severed from, and indeed opposed to, the person of Nancy Cruzan.

“The Cruzan family appropriately came before the court seeking relief. The circuit judge properly found the facts and applied the law. His factual findings are supported by the record and his legal conclusions by overwhelming weight of authority. The principal opinion attempts to establish absolutes, but does so at the expense of human factors. In so doing it unnecessarily subjects Nancy and those close to her to continuous torture which no family should be forced to endure.” Id., at 429-430.

Although Judge Blackmar did not frame his argument as such, it propounds a sound constitutional objection to the Missouri majority’s reasoning: Missouri’s regulation is an unreasonable intrusion upon traditionally private matters encompassed within the liberty protected by the Due Process Clause.

The portion of this Court’s opinion that considers the merits of this case is similarly unsatisfactory. It, too, fails to respect the best interests of the patient.9 It, too, relies on what is tantamount to a waiver rationale: The dying patient’s best interests are put to one side, and the entire inquiry is focused on her prior expressions of intent.10 An innocent person’s constitutional right to be free from unwanted medical treatment is thereby categorically limited to those patients who had the foresight to make an unambiguous state*339ment of their wishes while competent. The Court’s decision affords no protection to children, to young people who are victims of unexpected accidents or illnesses, or to the countless thousands of elderly persons who either fail to decide, or fail to explain, how they want to be treated if they should experience a similar fate. Because Nancy Beth Cruzan did not have the foresight to preserve her constitutional right in a living will, or some comparable “clear and convincing” alternative, her right is gone forever and her fate is in the hands of the state legislature instead of in those of her family, her independent neutral guardian ad litem, and an impartial judge — all of whom agree on the course of action that is in her best interests. The Court’s willingness to find a waiver of this constitutional right reveals a distressing misunderstanding of the importance of individual liberty.

HH h-H

It is perhaps predictable that courts might undervalue the liberty at stake here. Because death is so profoundly personal, public reflection upon it is unusual. As this sad case shows, however, such reflection must become more common if we are to deal responsibly with the modern circumstances of death. Medical advances have altered the physiological conditions of death in ways that may be alarming: Highly invasive treatment may perpetuate human existence through a merger of body and machine that some might reasonably regard as an insult to life rather than as its continuation. But those same advances, and the reorganization of medical care accompanying the new science and technology, have also transformed the political and social conditions of death: People are less likely to die at home, and more likely to die in relatively public places, such as hospitals or nursing homes.11

*340Ultimate questions that might once have been dealt with in intimacy by a family and its physician12 have now become the concern of institutions. When the institution is a state hos*341pital, as it is in this case, the government itself becomes involved. 13 Dying nonetheless remains a part of “the life which characteristically has its place in the home,” Poe v. Ullman, 367 U. S. 497, 551 (1961) (Harlan, J., dissenting). The “integrity of that life is something so fundamental that it has been found to draw to its protection the principles of more than one explicitly granted Constitutional right,” id., at 551-552, and our decisions have demarcated a “private realm of family life which the state cannot enter.” Prince v. Massachusetts, 321 U. S. 158, 166-167 (1944). The physical boundaries of the home, of course, remain crucial guarantors of the life within it. See, e. g., Payton v. New York, 445 U. S. 573, 589 (1980); Stanley v. Georgia, 394 U. S. 557, 565 (1969). Nevertheless, this Court has long recognized that the liberty to make the decisions and choices constitutive of private life is so fundamental to our “concept of ordered liberty,” Palko v. Connecticut, 302 U. S. 319, 325 (1937), that those choices must occasionally be afforded more direct pro*342tection. See, e. g., Meyer v. Nebraska, 262 U. S. 390 (1923); Griswold v. Connecticut, 381 U. S. 479 (1966); Roe v. Wade, 410 U. S. 113 (1973); Thornburgh v. American College of Obstetricians and Gynecologists, 476 U. S. 747, 772-782 (1986) (Stevens, J., concurring).

Respect for these choices has guided our recognition of rights pertaining to bodily integrity. The constitutional decisions identifying those rights, like the common-law tradition upon which they built,14 are mindful that the “makers of our Constitution . . . recognized the significance of man’s spiritual nature.” Olmstead v. United States, 277 U. S. 438, 478 (1928) (Brandeis, J., dissenting). It may truly be said that “our notions of liberty are inextricably entwined with our idea of physical freedom and self-determination.” Ante, at 287 (O’Connor, J., concurring). Thus we have construed the Due Process Clause to preclude physically invasive recoveries of evidence not only because such procedures are “brutal” but also because they are “offensive to human dignity.” Rochin v. California, 342 U. S. 165, 174 (1952). 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.” Skinner v. Oklahoma ex rel. Williamson, 316 U. S. 535, 541 (1942). The sanctity, and individual privacy, of the human body is obviously fundamental to liberty. “Every violation of a person’s bodily integrity is an invasion of his or her liberty.” Washington v. Harper, 494 U. S. 210, 237 (1990) (Stevens, J., concurring in part and dissenting in part). Yet, just as the constitutional protection for the “physical curtilage of the home ... is surely *343... a result of solicitude to protect the privacies of the life within,” Poe v. Ullman, 367 U. S., at 551 (Harlan, J., dissenting), so too the constitutional protection for the human body is surely inseparable from concern for the mind and spirit that dwell therein.

It is against this background of decisional law, and the constitutional tradition which it illuminates, that the right to be free from unwanted life-sustaining medical treatment must be understood. That right presupposes no abandonment of the desire for life. Nor is it reducible to a protection against batteries undertaken in the name of treatment, or to a guarantee against the infliction of bodily discomfort. Choices about death touch the core of liberty. Our duty, and the concomitant freedom, to come to terms with the conditions of our own mortality are undoubtedly “so rooted in the traditions and conscience of our people as to be ranked as fundamental,” Snyder v. Massachusetts, 291 U. S. 97, 105 (1934), and indeed are essential incidents of the unalienable rights to life and liberty endowed us by our Creator. See Meachum v. Fano, 427 U. S. 215, 230 (1976) (Stevens, J., dissenting).

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. We may also, however, justly assume that death is not life’s simple opposite, or its necessary terminus,13 but rather its completion. Our ethical tradition has long regarded an appreciation of mortality as essential to understanding life’s significance. It may, in fact, be impossible to live for anything without being prepared to die for something. Certainly there was no disdain for life in Nathan Hale’s most famous declaration or in Patrick Henry’s; *344their words instead bespeak a passion for life that forever preserves their own lives in the memories of their countrymen.16 From such “honored dead we take increased devotion to that cause for which they gave the last full measure of devotion.”17

These considerations cast into stark relief the injustice, and unconstitutionality, of Missouri’s treatment of Nancy Beth Cruzan. Nancy Cruzan’s death, when it comes, cannot be an historic act of heroism; it will inevitably be the consequence of her tragic accident. But Nancy Cruzan’s interest in life, no less than that of any other person, includes an interest in how she will be thought of after her death by those whose opinions mattered to her. There can be no doubt that her life made her dear to her family and to others. How she dies will affect how that life is remembered. The trial court’s order authorizing Nancy’s parents to cease their daughter’s treatment would have permitted the family that cares for Nancy to bring to a close her tragedy and her death. Missouri’s objection to that order subordinates Nancy’s body, her family, and the lasting significance of her life to the State’s own interests. The decision we review thereby interferes with constitutional interests of the highest order.

To be constitutionally permissible, Missouri’s intrusion upon these fundamental liberties must, at a minimum, bear a reasonable relationship to a legitimate state end. See, e. g., Meyer v. Nebraska, 262 U. S., at 400; Doe v. Bolton, 410 U. S. 179, 194-195, 199 (1973). Missouri asserts that its policy is related to a state interest in the protection of life. In my view, however, it is an effort to define life, rather than to protect it, that is the heart of Missouri’s policy. Missouri insists, without regard to Nancy Cruzan’s own interests, upon *345equating her life with the biological persistence of her bodily functions. Nancy Cruzan, it must be remembered, is not now simply incompetent. She is in a persistent vegetative state and has been so for seven years. The trial court found, and no party contested, that Nancy has no possibility of recovery and no consciousness.

It seems to me that the Court errs insofar as it characterizes this case as involving “judgments about the ‘quality’ of life that a particular individual may enjoy,” ante, at 282. Nancy Cruzan is obviously “alive” in a physiological sense. But for patients like Nancy Cruzan, who have no consciousness and no chance of recovery, there is a serious question as to whether the mere persistence of their bodies is “life” as that word is commonly understood, or as it is used in both the Constitution and the Declaration of Independence.18 The State’s unflagging determination to perpetuate Nancy Cru-zan’s physical existence is comprehensible only as an effort to define life’s meaning, not as an attempt to preserve its sanctity.

This much should be clear from the oddity of Missouri’s definition alone. Life, particularly human life, is not commonly thought of as a merely physiological condition or func*346tion.19 Its sanctity is of ten thought to derive from the impossibility of any such reduction. When people speak of life, they often mean to describe the experiences that comprise a person’s history, as when it is said that somebody “led a good life. ”20 They may also mean to refer to the practical manifestation of the human spirit, a meaning captured by the familiar observation that somebody “added life” to an assembly. If there is a shared thread among the various opinions on this subject, it may be that life is an activity which is at once the matrix for, and an integration of, a person’s interests. In *347any event, absent some theological abstraction, the idea of life is not conceived separately from the idea of a living person. Yet, it is by precisely such a separation that Missouri asserts an interest in Nancy Cruzan’s life in opposition to Nancy Cruzan’s own interests. The resulting definition is uncommon indeed.

The laws punishing homicide, upon which the Court relies, ante, at 280, do not support a contrary inference. Obviously, such laws protect both the life and interests of those who would otherwise be victims. Even laws against suicide presuppose that those inclined to take their own lives have some interest in living, and, indeed, that the depressed people whose lives are preserved may later be thankful for the State’s intervention. Likewise, decisions that address the “quality of life” of incompetent, but conscious, patients rest upon the recognition that these patients have some interest in continuing their lives, even if that interest pales in some eyes when measured against interests in dignity or comfort. Not so here. Contrary to the Court’s suggestion, Missouri’s protection of life in a form abstracted from the living is not commonplace; it is aberrant.

Nor does Missouri’s treatment of Nancy Cruzan find precedent in the various state-law cases surveyed by the majority. Despite the Court’s assertion that state courts have demonstrated “both similarity and diversity in their approaches” to the issue before us, none of the decisions surveyed by the Court interposed an absolute bar to the termination of treatment for a patient in a persistent vegetative state. For example, In re Westchester County Medical Center on behalf of O’Connor, 72 N. Y. 2d 517, 531 N. E. 2d 607 (1988), pertained to an incompetent patient who “was not in a coma or vegetative state. She was conscious, and capable of responding to simple questions or requests sometimes by squeezing the questioner’s hand and sometimes verbally.” *348Id,., at 524-525, 531 N. E. 2d, at 609-610. Likewise, In re Storar, 52 N. Y. 2d 363, 420 N. E. 2d 64 (1981), involved a conscious patient who was incompetent because “profoundly retarded with a mental age of about 18 months.” Id., at 373, 420 N. E. 2d, at 68. When it decided In re Conroy, 98 N. J. 321, 486 A. 2d 1209 (1985), the New Jersey Supreme Court noted that “Ms. Conroy was not brain dead, comatose, or in a chronic vegetative state,” 98 N. J., at 337, 486 A. 2d, at 1217, and then distinguished In re Quinlan, 70 N. J. 10, 355 A. 2d 647 (1976), on the ground that Karen Quinlan had been in a “persistent vegetative or comatose state.” 98 N. J., at 358-359, 486 A. 2d, at 1228. By contrast, an unbroken stream of cases has authorized procedures for the cessation of treatment of patients in persistent vegetative states.21 Con*349sidered against the background of other cases involving patients in persistent vegetative states, instead of against the broader — and inapt — category of cases involving chronically ill incompetent patients, Missouri’s decision is anomolous.

*350In short, there is no reasonable ground for believing that Nancy Beth Cruzan has any personal interest in the perpetuation of what the State has decided is her life. As I have already suggested, it would be possible to hypothesize such an interest on the basis of theological or philosophical conjecture. But even to posit such a basis for the State’s action is to condemn it. It is not within the province of secular government to circumscribe the liberties of the people by regulations designed wholly for the purpose of establishing a sectarian definition of life. See Webster v. Reproductive Health Services, 492 U. S. 490, 566-572 (1989) (Stevens, J., dissenting).

My disagreement with the Court is thus unrelated to its endorsement of the clear and convincing standard of proof for cases of this kind. Indeed, I agree that the controlling facts must be established with unmistakable clarity. The critical question, however, is not how to prove the controlling facts but rather what proven facts should be controlling. In my view, the constitutional answer is clear: The best interests of the individual, especially when buttressed by the interests of all related third parties, must prevail over any general state policy that simply ignores those interests.22 Indeed, the only apparent secular basis for the State’s interest in life is the policy’s persuasive impact upon people other than Nancy and her family. Yet, “[although the State may properly perform a teaching function,” and although that teaching may foster respect for the sanctity of life, the State may not pursue its project by infringing constitutionally protected inter*351ests for “symbolic effect.” Carey v. Population Services International, 431 U. S. 678, 715 (1977) (Stevens, J., concurring in part and concurring in judgment). The failure of Missouri’s policy to heed the interests of a dying individual with respect to matters so private is ample evidence of the policy’s illegitimacy.

Only because Missouri has arrogated to itself the power to define life, and only because the Court permits this usurpation, are Nancy Cruzan’s life and liberty put into disquieting conflict. If Nancy Cruzan’s life were defined by reference to her own interests, so that her life expired when her biological existence ceased serving any of her own interests, then her constitutionally protected interest in freedom from unwanted treatment would not come into conflict with her constitutionally protected interest in life. Conversely, if there were any evidence that Nancy Cruzan herself defined life to encompass every form of biological persistence by a human being, so that the continuation of treatment would serve Nancy’s own liberty, then once again there would be no conflict between life and liberty. The opposition of life and liberty in this case are thus not the result of Nancy Cruzan’s tragic accident, but are instead the artificial consequence of Missouri’s effort, and this Court’s willingness, to abstract Nancy Cruzan’s life from Nancy Cruzan’s person.

IV

Both this Court’s majority and the state court’s majority express great deference to the policy choice made by the state legislature.23 That deference is, in my view, based *352upon a severe error in the Court’s constitutional logic. The Court believes that the liberty interest claimed here on behalf of Nancy Cruzan is peculiarly problematic because “[a]n incompetent person is not able to make an informed and voluntary choice to exercise a hypothetical right to refuse treatment or any other right.” Ante, at 280. The impossibility of such an exercise affords the State, according to the Court, some discretion to interpose “a procedural requirement” that effectively compels the continuation of Nancy Cruzan’s treatment.

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. As this case comes to us, the crucial question — and the question addressed by the Court — is not what Nancy Cruzan’s interests are, but whether the State must give effect to them. There is certainly nothing novel about the practice of permitting a next friend to assert constitutional rights on behalf of an incompetent patient who is unable to do so. See, e. g., Youngberg v. Romeo, 457 U. S. 307, 310 (1982); Whitmore v. Arkansas, 495 U. S. 149, 161-164 (1990). Thus, if Nancy Cruzan’s incapacity to “exercise” her rights is to alter the balance between her interests and the State’s, there must be some further explanation of how it does so. The Court offers two possibilities, neither of them satisfactory.

The first possibility is that the State’s policy favoring life is by its nature less intrusive upon the patient’s interest than any alternative. The Court suggests that Missouri’s policy “results in a maintenance of the status quo,” and is subject to reversal, while a decision to terminate treatment “is not sus*353ceptible of correction” because death is irreversible. Ante, at 283. Yet, this explanation begs the question, for it assumes either that the State’s policy is consistent with Nancy Cruzan’s own interests, or that no damage is done by ignoring her interests. The first assumption is without basis in the record of this case, and would obviate any need for the State to rely, as it does, upon its own interests rather than upon the patient’s. The second assumption is unconscionable. Insofar as Nancy Cruzan has an interest in being remembered for how she lived rather than how she died, the damage done to those memories by the prolongation of her death is irreversible. Insofar as Nancy Cruzan has an interest in the cessation of any pain, the continuation of her pain is irreversible. Insofar as Nancy Cruzan has an interest in a closure to her life consistent with her own beliefs rather than those of the Missouri Legislature, the State’s imposition of its contrary view is irreversible. To deny the importance of these consequences is in effect to deny that Nancy Cruzan has interests at all, and thereby to deny her personhood in the name of preserving the sanctity of her life.

The second possibility is that the State must be allowed to define the interests of incompetent patients with respect to life-sustaining treatment because there is no procedure capable of determining what those interests are in any particular case. The Court points out various possible “abuses” and inaccuracies that may affect procedures authorizing the termination of treatment. See ante, at 281-282. The Court correctly notes that in some cases there may be a conflict between the interests of an incompetent patient and the interests of members of his or her family. A State’s procedures must guard against the risk that the survivors’ interests are not mistaken for the patient’s. Yet, the appointment of the neutral guardian ad litem, coupled with the searching inquiry conducted by the trial judge and the imposition of the clear and convincing standard of proof, all effectively avoided that risk in this case. Why such procedural safeguards should not *354be adequate to avoid a similar risk in other cases is a question the Court simply ignores.

Indeed, to argue that the mere possibility of error in any case suffices to allow the State’s interests to override the particular interests of incompetent individuals in every case, or to argue that the interests of such individuals are unknowable and therefore may be subordinated to the State’s concerns, is once again to deny Nancy Cruzan’s personhood. The meaning of respect for her personhood, and for that of others who are gravely ill and incapacitated, is, admittedly, not easily defined: Choices about life and death are profound ones, not susceptible of resolution by recourse to medical or legal rules. It may be that the best we can do is to ensure that these choices are made by those who will care enough about the patient to investigate his or her interests with particularity and caution. The Court seems to recognize as much when it cautions against formulating any general or inflexible rule to govern all the cases that might arise in this area of the law. Ante, at 277-278. The Court’s deference to the legislature is, however, itself an inflexible rule, one that the Court is willing to apply in this case even though the Court’s principal grounds for deferring to Missouri’s Legislature are hypothetical circumstances not relevant to Nancy Cruzan’s interests.

On either explanation, then, the Court’s deference seems ultimately to derive from the premise that chronically incompetent persons have no constitutionally cognizable interests at all, and so are not persons within the meaning of the Constitution. Deference of this sort is patently unconstitutional. It is also dangerous in ways that may not be immediately apparent. Today the State of Missouri has announced its intent to spend several hundred thousand dollars in preserving the life of Nancy Beth Cruzan in order to vindicate its general policy favoring the preservation of human life. Tomorrow, another State equally eager to champion an interest in the “quality of life” might favor a policy designed to ensure quick *355and comfortable deaths by denying treatment to categories of marginally hopeless cases. If the State in fact has an interest in defining life, and if the State’s policy with respect to the termination of life-sustaining treatment commands deference from the judiciary, it is unclear how any resulting conflict between the best interests of the individual and the general policy of the State would be resolved.24 I believe the Constitution requires that the individual’s vital interest in liberty should prevail over the general policy in that case, just as in this.

That a contrary result is readily imaginable under the majority’s theory makes manifest that this Court cannot defer to any state policy that drives a theoretical wedge between a person’s life, on the one hand, and that person’s liberty or happiness, on the other.25 The consequence of such a theory *356is to deny the personhood of those whose lives are defined by the State’s interests rather than their own. This consequence may be acceptable in theology or in speculative philosophy, see Meyer, 262 U. S., at 401-402, but it is radically inconsistent with the foundation of all legitimate government. Our Constitution presupposes a respect for the per-sonhood of every individual, and nowhere is strict adherence to that principle more essential than in the judicial branch. See, e. g., Thornburgh v. American College of Obstetricians and Gynecologists, 476 U. S., at 781-782 (Stevens, J., concurring).

V

In this case, as is no doubt true in many others, the predicament confronted by the healthy members of the Cruzan family merely adds emphasis to the best interests finding made by the trial judge. Each of us has an interest in the kind of memories that will survive after death. To that end, individual decisions are often motivated by their impact on others. A member of the kind of family identified in the trial court’s findings in this case would likely have not only a normal interest in minimizing the burden that her own illness imposes on others, but also an interest in having their memories of her filled predominantly with thoughts about her past vitality rather than her current condition. The meaning and completion of her life should be controlled by persons who have her best interests at heart — not by a state legislature concerned only with the “preservation of human life.”

The Cruzan family’s continuing concern provides a concrete reminder that Nancy Cruzan’s interests did not disappear with her vitality or her consciousness. However commendable may be the State’s interest in human life, it cannot pursue that interest by appropriating Nancy Cruzan’s life as a symbol for its own purposes. Lives do not exist in abstrac*357tion from persons, and to pretend otherwise is not to honor but to desecrate the State’s responsiblity for protecting life. A State that seeks to demonstrate its commitment to life may-do so by aiding those who are actively struggling for life and health. In this endeavor, unfortunately, no State can lack for opportunities: There can be no need to make an example of tragic cases like that of Nancy Cruzan.

I respectfully dissent.

ALTENBERND, Judge.

In these three related cases involving the pending guardianship proceeding of Theresa Marie Schiavo, we conclude that a final order entered in a guardianship adversary proceeding, requiring the guardian to discontinue life-prolonging procedures, is the type of order that may be challenged by an interested party at any time prior to the death of the ward on the ground that it is no longer equitable to give prospective application to the order. See Fla. R. Civ. P. 1.540(b)(5). In most, if not all circumstances, the interested party should challenge the final order by a motion for relief from judgment filed in the adversary proceeding in the guardianship. In the rare event that an independent action might be required to challenge such an order under Florida Rule of Civil Procedure 1.540, that independent action must be filed as an adversary proceeding within the guardianship.

*554At this time, Robert and Mary Schindler, Mrs. Schiavo’s parents, have not filed a facially sufficient motion for relief from the order discontinuing life-prolonging procedures. Thus, in appellate case number 2D01-1836, we affirm the guardianship court’s denial of the Schindlers’ motion for relief from judgment because the motion filed was facially insufficient. On remand, however, we provide the Schindlers with an opportunity to file, if appropriate, a revised motion for relief from judgment pursuant to rule 1.540(b)(5) on the basis that it is no longer equitable that the order should have prospective application. We caution, however, that any proceeding to challenge a final order on this basis is extraordinary and should not be filed merely to delay an order with which an interested party disagrees or to retry an adversary proceeding. The interested party must establish that new circumstances make it no longer equitable to enforce the earlier order. In this case, if the Schindlers believe a valid basis for relief from the order exists, they must plead and prove newly discovered evidence of such a substantial nature that it proves either (1) that Mrs. Schiavo would not have made the decision to withdraw life-prolonging procedures fourteen months earlier when the final order was entered, or (2) that Mrs. Schiavo would make a different decision at this time based on developments subsequent to the earlier court order.

In appellate case number 2D01-1891, we reverse a temporary injunction entered by a judge of the general civil division. That injunction was entered in a separate action filed by the Schindlers against Mr. Schia-vo, the ward’s husband. The order granting the injunction lacked the necessary findings. Moreover, the pleadings and the evidence supporting the injunction were insufficient. To the extent that this separate action was intended as an independent action seeking relief from the guardianship order pursuant to rule 1.540, that action, and any motion seeking a temporary injunction related to it, must be filed as an adversary proceeding within the guardianship.

Finally, in appellate case number 2D00-1269, the case number for the original appeal of the guardianship court’s order authorizing the discontinuation of life-prolonging procedures, we deny the motion to enforce mandate filed by Mr. Schiavo.

As discussed at the end of this opinion, on remand, the guardianship court should make all efforts to expedite these post-judgment challenges.

I. THE FACTS

On February 11, 2000, after Theresa Marie Schiavo had been in a persistent vegetative state for nearly a decade, the guardianship court entered an order pursuant to chapter 765, Florida Statutes (2000), and In re Guardianship of Browning, 568 So.2d 4 (Fla.1990), determining by clear and convincing evidence that Mrs. Schiavo would then elect to cease life-prolonging procedures if she were competent to make her own decision.1 The guardianship court authorized her husband and legal guardian, Michael Schiavo, to discontinue the life-prolonging procedures. Mrs. Schiavo’s parents, Robert and Mary Schindler, were interested parties in the guardianship proceeding and they appealed the order. This court affirmed that decision in January 2001, and denied rehearing on February 22, 2001. In re *555Guardianship of Schiavo (Schindler v. Schiavo), 780 So.2d 176 (Fla. 2d DCA 2001). The Florida Supreme Court denied review of the case on April 23, 2001. The guardianship court then authorized Michael Schiavo, as guardian, to discontinue the life-prolonging procedures. Those procedures were discontinued on April 24.

Almost as soon as the procedures were discontinued, the Schindlers were informed of new evidence that they believe establishes that their daughter would either not have made that decision fourteen months earlier at the time the original order was entered, or that she would make a different decision at this time. On April 26, 2001, the Schindlers filed a motion for relief from judgment in the guardianship proceeding. That motion alleged that the Schindlers had discovered new evidence in the form of testimony from a new witness. According to the motion, this witness was a former girlfriend of Mr. Schiavo. She allegedly would testify that Mr. Schiavo told her that Mrs. Schiavo and Mr. Schiavo never discussed what Mrs. Schiavo’s wishes would be in her present condition. The motion alleged that this testimony was contrary to Mr. Schiavo’s testimony at trial, and that it might prove Mr. Schiavo committed perjury in the proceedings. The Schindlers attached two affidavits to the motion. Neither of these affidavits was executed by the witness. Instead, the affidavits were given by Mr. Schindler and by a private investigator hired by Mr. Schindler, and contained hearsay allegations regarding what this potential witness told them.2

The guardianship proceeding had been assigned to Judge Greer for several years. He is the judge who heard and evaluated the evidence in the proceeding to discontinue life-prolonging procedures in February 2000. He reviewed the motion for relief from judgment and entered an order denying it. The order denying the motion found that the only two grounds for the motion were intrinsic fraud and newly discovered evidence. The trial court did not reach the merits of this motion, but denied it as untimely, because a motion made upon either of these two grounds must be filed within a year of the entry of the final order or judgment from which relief is sought. See Fla. R. Civ. P. 1.540(b)(2), (3).

After the guardianship court denied this motion, the Schindlers immediately filed a separate action in the general civil division of the circuit court. The “verified complaint” filed in this separate action appears to have been prepared by a lawyer, but it was signed only by Mr. and Mrs. Schindler. Oddly, in the acknowledgment, the notary affirmatively states that the Schin-dlers did not swear to the facts of the complaint under oath.

In this complaint, the Schindlers attempted to bring suit as the “natural guardians” of Theresa Marie Schiavo, even though they know she is an adult, married daughter with an appointed legal guardian and a pending guardianship proceeding. The complaint initially sued Mr. Schiavo, individually, and did not sue him in his • capacity as legal guardian. The complaint alleged that certain actions had been taken by Mr. Schiavo in his care of Mrs. Schiavo. These actions appear to be matters that had been presented at earlier times before Judge Greer. The complaint then alleged that after the entry of Judge Greer’s final order in February 2000, the Schindlers had discovered a new witness, Mr. Schiavo’s former girlfriend, who would *556testily that Mr. Schiavo perjured himself during the initial trial when he testified that he and Mrs. Schiavo had discussed her desires regarding extraordinary life-prolonging procedures. According to the complaint, Judge Greer had found Mr. Schiavo’s perjured testimony credible and had relied upon it in making a decision within the guardianship proceeding. After briefly setting forth the factual allegations, the last two paragraphs of the complaint alleged, in pertinent part: “Defendant has engaged in an intentional, outrageous, deceptive, and intolerable course of conduct that amounts to perjury and fraud on the court.... This course of conduct has caused the Plaintiffs a decade-long ordeal ... and has caused Plaintiffs extraordinary mental anguish, suffering and virtually total disruption of their lives.” In the ad damnum clause, the Schindlers demanded “judgment for damages” and requested a jury trial.

Along with the complaint, the Schindlers filed a motion for emergency temporary injunction. This very terse motion, which was signed by an attorney, alleged that Mrs. Schiavo was in imminent danger of death, which death would cause irreparable injury to the Schindlers, and that Mrs. Schiavo should be kept alive until the court could resolve the issues presented in the complaint. The motion sought an order requiring Mr. Schiavo to resume the life-prolonging medical treatments.

Under the standard procedures for assignment of civil cases, this lawsuit was assigned to Judge Quesada. He received the pleading during the afternoon of April 26, 2001. Judge Quesada provided immediate notice to Mr. Schiavo’s attorney and convened an emergency hearing at 7:15 p.m. that evening. During that hearing, the trial court permitted the Schindlers to amend their complaint to sue Mr. Schiavo, individually, and as guardian of Theresa Marie Schiavo. Mr. Schiavo moved to transfer these proceedings, particularly as they related to the medical treatment of Mrs. Schiavo, to the guardianship division of the court. The trial court denied this request. The Schindlers presented the two affidavits that had been previously filed in the guardianship court with the motion for relief from judgment. The Schindlers also presented other court documents from the guardianship proceeding and documents from a resolved medical malpractice case brought by Mr. Schiavo on behalf of Mrs. Schiavo several years earlier. No other evidence was presented. At the conclusion of the hearing, the trial court granted the request for an injunction. The order entered by Judge Quesa-da contains no specific findings, but it required Mr. Schiavo to take the necessary steps to restore life-prolonging procedures to Mrs. Schiavo until further order of the court. Judge Quesada recognized that the facts in the case were still developing, so he stressed that once further discovery had been obtained, Mr. Schiavo could seek dissolution of the injunction.

In response to this injunction, Mr. Schiavo filed an emergency motion with this court to enforce the mandate from our prior opinion affirming the guardianship court’s order. This motion sought an order from this court vacating the injunction in the separate civil action filed by the Schindlers, and ruling that no circuit or county judge would have any authority to enter any order under any claim or theory pertaining to the life-prolonging procedures without first obtaining the permission of this court.

This court questioned whether an order enforcing mandate could affect the judge and parties in an action other than the case that had been appealed. Therefore, we issued an order requiring further argument on the motion to enforce mandate. *557Meanwhile, Mr. Schiavo filed a nonfinal appeal of the temporary injunction in the separate civil action, and the Schindlers filed an appeal of the denial of their rule 1.540motion in the guardianship proceeding.

This court expedited briefing in all of these matters. In light of the procedural complexities of the matter and the serious due process issues affecting life, we also permitted oral argument on all three cases. We now consolidate these three appellate proceedings solely for the purpose of this opinion.

II. APPEAL NUMBER 2D01-1836

DENIAL OF THE RULE 1.540MOTION

The Schindlers sought relief from the order of the guardianship court pursuant to rule 1.540 with allegations that suggest that they viewed the legal proceeding as a typical lawsuit in which Mr. Schiavo was the plaintiff and they were the defendants. In this emotionally charged proceeding, they apparently view themselves as the defendants against whom some final judgment has been entered in law. Before this court can determine the application of rule 1.540to the guardianship order of February 2000, it is necessary to take a more dispassionate view of the proceedings.

After the supreme court’s decision in In re Guardianship of Browning, 568 So.2d 4, the legislature wisely revised chapter 765 to better address the issues of life-prolonging treatment. Ch. 92-199, Laws of Fla. The Florida Probate Rules Committee created a new rule to allow rapid resolution of these issues when necessary. See Fla. Prob. R. 5.900. This rule contemplates a quick proceeding in which the trial court approves the decision already reached by the guardian.

In this case, as explained in our earlier opinion, Mr. Schiavo, as guardian, did not file a petition under rule 5.900. Given years of bitter disagreement between the Schindlers and Mr. Schiavo, he filed a petition requesting the trial court to make an independent determination of Mrs. Schiavo’s terminal condition and to make the decision to continue or discontinue life-prolonging procedures. See In re Guardianship of Browning, 568 So.2d at 16. Mr. Schiavo, as guardian, requested the court to function as the proxy in light of the dissension within the family.3 Mr. Schiavo immediately and appropriately asked the trial court to treat the petition as an adversary proceeding pursuant to Florida Probate Rule 5.025.

The Schindlers are not defendants from whom anything was requested in this adversary proceeding. Although it would not appear that they qualified as “next of kin,” see § 744.102(12), Fla. Stat. (1997), they were “interested persons” who were entitled to appear in the adversary proceeding and present their viewpoint. See Fla. Prob. R. 5.025(b); § 731.201(21), Fla. Stat. (1997).

When the adversary proceeding concluded, the trial court entered an order authorizing the guardian to discontinue life-prolonging procedures. Although the Schindlers were undoubtedly disappointed by this order, no judgment was entered against them like a judgment is entered against a defendant in a typical civil lawsuit. Because the Schindlers are only “interested parties,” it is not clear that they have standing after the appeal to file a motion pursuant to rule 1.540. Because the judgment directly affects the wurd *558only, it is possible that the right to seek postjudgment relief should be limited to the ward’s legal guardian. We have found no case addressing this issue, but in this unusual context affecting the ward’s due process interest in life, we conclude that interested parties should have standing— not directly for themselves but in the interest of the ward — to request relief from a judgment of a guardianship court when the final order requires termination of life-prolonging procedures.

The Schindlers’ motion for relief from judgment alleged only two grounds, newly discovered evidence and intrinsic fraud. Although not specified in their motion, these grounds request relief under Florida Rule of Civil Procedure 1.540(b)(2) and (b)(3). It has long been well-established that such grounds must be filed within one year of a final order. See Fla. R. Civ. P. 1.540(b) (stating that “[t]he motion shall be made within a reasonable time, and for reasons (1), (2), and (3) not more than 1 year after the judgment, decree, order, or proceeding was entered or taken”); Hartley v. Andriuli, 595 So.2d 311 (Fla. 2d DCA 1992); Wescott v. Wescott, 444 So.2d 495 (Fla. 2d DCA 1984); Seven-Up Bottling Co. v. George Constr. Corp. 153 So.2d 11 (Fla. 3d DCA 1963). The Schindlers’ motion was filed more than one year after the entry of the final order in the adversary proceeding.

The Schindlers ask this court to hold, for the purposes of rule 1.540, that the one-year period commences upon resolution of any appeal of a final order and not upon entry of the appealed order. This suggested rule is expressly contrary to case law. Seven-Up Bottling Co., 153 So.2d 11; Flemenbaum v. Flemenbaum, 636 So.2d 579 (Fla. 4th DCA 1994). See also Fla. R. Civ. P. 1.540 (author’s cmt, 1967) (stating that “ffliling of an appeal, however, does not toll the one year limitation in which a motion to vacate a judgment must be filed”). The Schindlers rely primarily upon Native Hammock Nursery, Inc. v. E.I. DuPont, 774 So.2d 727 (Fla. 3d DCA 2000). Native Hammock Nursery, however, is distinguishable. It addresses the separate question of when the one-year period commences if a trial court vacates a final judgment and an appellate court thereafter reinstates the judgment. It is doubtful that this court even has the power to rewrite the content of rule 1.540(b) to extend the one-year period in which to challenge a final order based on grounds 1 through 3. We decline to make this change.4 As a result, the one-year limitation in rule 1.540(b) applies. The guardianship court properly denied the motion because it was untimely on its face.

The discussion at oral argument in this case was fruitful. It caused the court to realize that the parties in this emotional case have overlooked the nature of the order entered on February 11, 2000. Although guardianship law is now predominately statutory, the statutes evolved from the equitable powers of chancery. See 39 Am.Jur.2d Guardian and Ward, § 34, at 37 (1999); SunTrust Bank v. Nichols, 701 So.2d 107 (Fla. 5th DCA 1997). The order *559requiring the termination of life-prolonging procedures is not a standard legal judgment, but an order in the nature of a mandatory injunction compelling certain actions by the guardian and, indirectly, by the health care providers.5 Until the life-prolonging procedures are discontinued, such an order is entirely executory, and the ward and guardian continue to be under the jurisdiction and supervision of the guardianship court. As long as the ward is alive, the order is subject to recall and is executory in nature.

Rule 1.540(b)(5) has long permitted a party to challenge a judgment without time limitation if “it is no longer equitable that the judgment or decree should have prospective application.” In order to preserve the finality of judgments, this ground has been rather narrowly construed. See Hensel v. Hensel, 276 So.2d 227 (Fla. 2d DCA 1973).6 This ground was modeled after Federal Rule of Civil Procedure 60(b)(5). In federal cases, it has been applied specifically to mandatory injunctions, consent decrees, and other ongoing or executory judgments. DeWeerth v. Baldinger, 38 F.3d 1266 (2d Cir.1994). See also Rufo v. Inmates of Suffolk County Jail, 502 U.S. 367, 112 S.Ct. 748, 116 L.Ed.2d 867 (1992); Paul Revere Variable Annuity Ins. Co. v. Zang, 248 F.3d 1 (1st Cir.2001); Evans v. Williams, 206 F.3d 1292 (D.C.Cir.2000). We conclude that this ground should apply to an order of a guardianship court that requires the termination of life-prolonging procedures.

Like federal rule 60(b)(5), this rule provides “extraordinary relief’ reserved for “exceptional circumstances”; it requires the trial judge to strike the “delicate balance” between the sanctity of final judgments and the need for ongoing or executory equitable remedies to remain equitable. See Zang, 248 F.3d at 5; Twelve John Does v. District of Columbia, 841 F.2d 1133, 1138 (D.C.Cir.1988). This ground does not allow a party to retry a case merely because the judgment provides equitable relief and the party has found additional evidence. Instead, the *560rule requires the movant to establish that significant new evidence or substantial changes in circumstances arising after the entry of the judgment make it “no longer equitable” for the trial court to enforce its earlier order.

Hypothetically, in a case involving life-prolonging procedures, if the ward’s condition dramatically and unexpectedly improved after trial, it might no longer be equitable to conclude that the ward was in a terminal condition, see § 765.101(17), Fla. Stat. (2000), or that the ward would have exercised her informed consent to withdraw the life-prolonging procedures. Likewise, if an interested party discovered the ward’s advance directive7 or her written designation of a health care surrogate8 hidden in a desk after the trial, and it conflicted with the court’s judgment, that might be grounds for relief from the prospective nature of the judgment. Certainly, if medical research suddenly discovered a complete cure for what had previously been thought to be a terminal condition as defined in section 765.101(17), Florida Statutes (2000), we would treat that new circumstance as a matter warranting relief from such a judgment.

However, at this time, the Schin-dlers have not seriously contested the fact that Mrs. Schiavo’s brain has suffered major, permanent damage. In the initial adversary proceeding, a board-certified neurologist who had reviewed a CAT scan of Mrs. Schiavo’s brain and an EEG testified that most, if not all, of Mrs. Schiavo’s cerebral cortex — the portion of her brain that allows for human cognition and memory — is either totally destroyed or damaged beyond repair. Her condition is legally a “terminal condition.” § 765.101(17), Fla. Stat. (2000). Although it is conceivable that extraordinary treatment might improve some of the motor functions of her brain stem or cerebellum, the Schindlers have presented no medical evidence suggesting that any new treatment could restore to Mrs. Schiavo a level of function within the cerebral cortex that would allow her to understand her perceptions of sight and sound or to communicate or respond cognitively to those perceptions.

The new information the Schindlers provided to the guardianship court in the hearsay affidavits supporting their motion for relief from judgment is not as forceful as the evidence described in our hypothetical scenarios.9 The affidavits concern alleged statements by Mr. Schiavo several years ago. We note that the guardianship court’s original order expressly relied upon and found credible the testimony of witnesses other than Mr. Schiavo or the Schindlers. We recognize that Mrs. Schia-vo’s earlier oral statements were important evidence when deciding whether she would choose in February 2000 to withdraw life-prolonging procedures. See § 765.401(3), Fla. Stat. (2000); In re Guardianship of Browning, 568 So.2d 4, 16. Nevertheless, the trial judge, acting as her proxy, also properly considered evidence of Mrs. Schiavo’s values, personality, and her own decision-making process.

This case is not the usual case in which a proxy makes a decision about life-prolonging procedures. Often, the decision to dis*561continue such procedures is made within weeks or months from the time the ward is competent to make such a decision. Often the ward has lived to such an age that he or she has had ample opportunity to reflect upon and discuss these issues of mortality. In this case, the proxy had to make a decision for a woman in her mid-thirties when she had not been competent since her mid-twenties. It would be unrealistic to expect the proxy to pretend that the ward was not aging and remained twenty-five. The proxy had to use the best available evidence to ascertain the decision that Theresa Marie Schiavo would have made in February 2000 if she had remained competent to assess her own terminal condition and make her own informed decision. We are confident that the guardianship court understood this difficult task when it made its decision in February 2000.

Thus, although we conclude that the Schindlers have the right to seek relief from judgment under rule 1.540(b)(5) for the benefit of the ward, we caution that any such motion must allege new circumstances affecting the decision made by the trial judge as the ward’s proxy in February 2000, and those circumstances must make it no longer equitable for the trial court to enforce its earlier decision.

A motion for relief from judgment does not operate to stay a judgment. Fla. R. Civ. P. 1.540(b) (stating that “[a] motion under this subdivision does not affect the finality of a judgment or decree or suspend its operation”). Under the unique circumstances of this case, however, we direct the guardianship court to refrain from any attempt to enforce its original order until Monday, July 23, 2001, to give the Schin-dlers an opportunity to file a facially suffi-dent motion pursuant to Florida Rule of Civil Procedure 1.540(b)(5).10 The Schin-dlers are authorized to file such a motion in the guardianship proceedings on or before the regular close of court on Friday, July 20, 2001. The trial court shall exercise its own judgment and discretion concerning the resolution of any such motion. See Cutler Ridge Corp. v. Green Springs, Inc., 249 So.2d 91 (Fla. 3d DCA 1971).

To avoid any confusion arising from the various proceedings since April of this year, the trial court shall issue an order that either expressly enforces its earlier order or vacates it. If the trial court elects to enforce its earlier order, it should enter an order informing all interested parties of the day and time that the guardian must instruct the health care providers to discontinue life-prolonging procedures.

III. APPEAL NUMBER 2D01-1891

THE TEMPORARY INJUNCTION

Judge Quesada was given an unenviable task in this case. Late in the day he received an emergency motion involving the life of a young woman. The pleadings were poorly drafted and the affidavits were little better. He did not have the benefit of any case law squarely addressing the issues presented to him. None of the lawyers involved in the hearing had had adequate time to prepare and reflect upon these difficult issues. We cannot fault him for wanting to enter some type of stay order to give himself and the parties the opportunity to review this matter in a more deliberate fashion. However, the record presented on that day was insufficient to support the entry of a temporary injunction, and the temporary injunction *562order entered is deficient in its content. Moreover, we conclude that any action challenging the final order of the guardianship court must be filed as an adversary proceeding within the guardianship. In light of our ruling permitting an interested party to file a motion under rule 1.540(b)(5), we doubt that an independent action is necessary in this matter.

The action filed by the Schin-dlers in the general civil division did not actually state a cause of action for an “independent action” as that term is used in rule 1.540. An independent action is filed to “relieve a party from a judgment.” See Fla. R. Civ. P. 1.540(b). At least under the circumstances in this case, such an independent action must allege an extrinsic fraud upon the court. See DeClaire v. Yohanan, 453 So.2d 375 (Fla.1984); Winston v. Winston, 684 So.2d 315 (Fla. 4th DCA 1996). The fraud must be alleged with specificity. See Fla. R. Civ. P. I.120(b); Daugharty v. Daugharty, 456 So.2d 1271, 1274 (Fla. 1st DCA 1984) (noting rule of specificity is even more important in independent action). The action filed by the Schindlers sought monetary damages from Mr. Schiavo in his individual capacity. It failed to state a cause of action that would allow anyone — particularly on behalf of the ward — to obtain relief from the judgment of the guardianship court.11

The Schindlers’ motion for a temporary injunction and the evidence they presented to support it was also deficient. In order to be entitled to a temporary injunction, a movant must establish four elements, including a substantial likelihood of success on the merits of the case. Duryea v. Slater, 677 So.2d 79 (Fla. 2d DCA 1996). The trial court abused its discretion in determining that the content of this record established this element, particularly when the complaint itself did not appear to state a valid cause of action. Moreover, an order granting a temporary injunction must contain clear, definite, and unequivocal findings to support the four elements required for entry of an injunction. Snibbe v. Napoleonic Soc’y of Am., 682 So.2d 568 (Fla. 2d DCA 1996). This order contains no such findings. Accordingly, we reverse the temporary injunction.

We conclude that any independent action seeking relief from the order entered in the guardianship proceeding, or any effort to obtain an injunction contrary to the guardianship court’s order, must be filed as an adversary proceeding within that guardianship. As we explained earlier in this opinion, the Schindlers take this action as interested parties for the benefit of the ward. Given that the guardianship is still pending and that the guardianship court has continuing jurisdiction over the ward, it is simply inconceivable that another circuit judge can or should be given the power to override an order entered in the pending guardianship. As a general rule, one trial court judge does not have the *563power to review the final order of another trial judge. See Groover v. Walker, 88 So.2d 312 (Fla.1956); Davis v. Fisher, 391 So .2d 810 (Fla. 5th DCA 1980). Although the independent action allowed by DeClaire, 453 So.2d 375, may occasionally be an exception to this general rule, when the initial action involves a guardianship that is still pending and that court has not lost jurisdiction over the ward, we see no basis to allow a deviation from the general rule. Thus, although Judge Quesada had jurisdiction to initially consider the merits of the pleadings placed before him, upon learning of the pending guardianship proceedings, he was compelled to transfer any independent action for relief from the guardianship order and any request for temporary injunction related to the guardianship order to the guardianship court for resolution.

It is unclear to this court whether the Schindlers maintain that they can now allege in good faith a fraud upon the court as required for an independent action by De-Claire. If they wish to plead such a fraud with the necessary specificity, that action should be filed in the guardianship court within the same period that this court has provided for the filing of a motion pursuant to rule 1.540(b)(5). The filing of such an action will not stay the February 11, 2000, order. To stay the earlier final order, the Schindlers would need to apply for, and prove entitlement to, a temporary injunction in the guardianship court.

Because we have permitted the Schin-dlers time to file a new independent action in the guardianship proceedings, to the extent that the complaint filed before Judge Quesada seeks this relief, that portion of the complaint should be dismissed. Our scope of review in this case does not include the question of whether the complaint filed before Judge Quesada states a cause of action for money damages against Mr. Schiavo personally. Thus, that portion of the complaint is not affected by this appeal and remains pending in the general civil division.

IY. CASE NUMBER 2D00-1269

MOTION TO ENFORCE MANDATE

It is extremely rare for a trial court or a trial lawyer to disobey the order of an appellate court when the matter returns to the trial court after the appellate court issues its mandate. In those rare cases where compliance is an issue, a motion to enforce mandate can be filed in the appellate court. See Blackhawk Heating & Plumbing Co. v. Data Lease Fin. Corp., 328 So.2d 825 (Fla.1975). We can at least envision the possibility of a situation in which an appellate court might issue an order on a motion to enforce mandate that was directed to someone other than a party to the appeal or a judge or court clerk involved in that proceeding on remand in the trial court. Such an order, which would be similar to a contempt order, should be rarely, if ever, issued.

In this case, Judge Greer has not disobeyed this court’s mandate. Because we conclude that the Schindlers have standing to file motions or proceedings pursuant to rule 1.540(b) to challenge the February 2000 order, that action does not violate our mandate. At this point, we are unwilling to conclude that the filing of any such motion would be so baseless or frivolous as to constitute a violation of our mandate. The merits of the motion or action are better left to the trial court that actually made the factual determinations supporting the February 11, 2000, order. Accordingly, the motion to enforce mandate and any pending amendment to that motion is denied.

*564V. FUTURE APPELLATE REVIEW

This court recognizes that if the Schindlers file a renewed motion or independent action seeking relief from the guardianship order, an order resolving that motion or action is appealable. An order by the guardianship court granting or denying a temporary injunction would also be subject to appeal. This court is very aware that the postjudgment proceedings and the appellate process could delay implementation of an order for many months. Accordingly, we encourage the guardianship court to resolve this matter with all deliberate speed. We will expedite any appeal of a future order in this case. Moreover, if the guardianship court enters an order that is appealed, and the guardianship court is confident in its own decision and is convinced that an appeal is sought merely to delay its order, the guardianship court can use its discretion in determining whether to grant or deny a stay pending the appeal. This court would review the grant or denial of a stay on an expedited basis. See Fla. R.App. P. 9.310(f).

Because we have not consolidated these appeals, any motion for rehearing concerning this opinion should be filed in the specific appellate case. We elect to expedite the rehearing process. Thus, any motion for rehearing must be filed and delivered to opposing counsel before the regular close of court on July 16, 2001. Any response to such a motion for rehearing must be filed before the regular close of court on July 18, 2001. The filing of such a motion will not stay or automatically extend the period set forth in this opinion within which a motion or independent action must be filed to seek relief from the guardianship order.

Despite all of the published opinions and public interest in this case, it should not be overlooked that the courts in this case are attempting to honor Theresa Marie Schia-vo’s constitutional right of privacy as it affects her medical decisions. See In re Guardianship of Browning, 568 So.2d 4. The judicial process must be sufficient to assure the accuracy of the proxy’s decision, but not so slow as to deprive the ward of a final decision — one way or the other.

Affirmed in part, reversed in part, and remanded for further proceedings consistent with this opinion.

BLUE, C.J., and PARKER, J., Concur.

Whitbeck, J.

A jury convicted defendant of second-degree murder1 and delivering a controlled substance.2 The trial court sentenced him to concurrent prison terms of ten to twenty-five years for the murder conviction and seven years for the controlled substance conviction. Defendant appeals as of right and we affirm.

1. OVERVIEW

This case is about death; in particular, the death of former racecar driver Thomas Youk in September 1998. Youk was fifty-two years old and had amyotrophic lateral sclerosis (als), also known as Lou Gehrig’s disease. Defendant twice videotaped himself interacting with Youk. In the first videotape, defendant went to Youk’s home to discuss his condition. In *375the second videotape, defendant administered a lethal drug to Youk. Defendant later was a guest on the television news show 60 Minutes, during which segments from both videotapes were shown. The jury saw the videotapes and the 60 Minutes interview at defendant’s trial. Nevertheless, defendant attempted to persuade the jury not to convict him because the murder he was charged with committing was, in his view, a “mercy killing.”

Given this factual setting, this appeal presents a fascinating paradox. Though he made an impassioned plea to the jury to adopt his views on euthanasia, in this appeal defendant has given almost no attention to his claim that this homicide had a legal justification or excuse. Indeed, exactly seven of the fifty pages in his brief to this Court address euthanasia. Even during oral arguments, defendant’s appellate counsel made not a single reference to this issue.

Nevertheless, euthanasia is at the core of this case. But for defendant’s self-described zealotry, Thomas Youk’s death would, in all probability, not have been the subject of national attention, much less a murder trial. Defendant, in what is now apparently something of an afterthought, asks us to conclude that euthanasia is legal and, therefore, to reverse his conviction on constitutional grounds. We refuse. Such a holding would be the first step down a very steep and very slippery slope. To paraphrase the United States Supreme Court in Washington v Glucksberg,3 it would expand the right to privacy to include a right to commit euthanasia and thus place the issue outside the arenas of public debate and legislative action. Such a *376holding would also involve the judiciary in deciding questions that are simply beyond our capacity. Succinctly put, there is no principled basis for us to legalize euthanasia.

Defendant’s other issues are more mundane and we describe the relevant facts in more detail in the appropriate discussion sections. First, defendant asserts that his trial attorney, David Gorosh, did not provide him with his constitutional right to effective representation. However, defendant has failed to demonstrate that Gorosh performed deficiently at any time he actually acted as counsel. Defendant also failed to prove that Gorosh, while acting as standby counsel, took control of the case or did anything to destroy the jury’s perception that defendant was representing himself. Even assuming for the sake of argument that a claim alleging ineffective assistance of standby counsel is legally cognizable, defendant still has not proved that Gorosh acted deficiently and prejudicially. Defendant chose — almost certainly unwisely but nevertheless knowingly, intelligently, voluntarily, and unequivocally — to represent himself. He cannot now assign the blame for his conviction to someone who did not act as his trial counsel.

Second, defendant claims that the prosecutor improperly referred to defendant’s decision to exercise his right to remain silent, thereby denying him his rights under the Fifth Amendment. The remarks at issue were the prosecutor’s proper objections to defendant’s repeated and improper attempts to inject into his closing argument facts that were not in evidence. As such, the prosecutor’s remarks were not direct and unequivocal references to defendant’s failure to testify, and therefore, the making of those remarks did not constitute misconduct.

*377Third, defendant claims that the trial court erred in excluding the testimony of Terrence and Melody Youk, Thomas’ brother and sister-in-law. However, defendant misreads the applicable standards with respect to res gestae witnesses and then fails entirely to demonstrate how the proposed testimony would have been relevant. Thus, even on this narrow evidentiary issue, defendant’s arguments have no merit.

n. THE DEATH OF THOMAS YOUK

A. THE SEPTEMBER 15, 1998, VIDEOTAPE

On September 15, 1998, at 9:55 P.M., defendant went to Youk’s home to discuss Youk’s condition. As the videotape of this discussion revealed, defendant stated that he was recording their interaction in “connection with a request from Thomas [Youk] for help in . . . ending his suffering.” Youk then described his condition. He recalled that his symptoms of als first became obvious to him in 1994 and that he had been confined to a wheelchair since 1997. By September 1998, Youk said, he could not move his left arm or his legs, he had minimal use of his right arm, he had difficulty swallowing and breathing, he was fed through a tube, and he was forced to use a machine to help him breathe. Youk stated that, at the time, he could not do anything for himself, that he had discussed “his wishes” with his mother, brothers, and wife, and that they “understand why. It’s my decision.”

Defendant then told Youk that he needed to sign a form indicating that he was consenting to a “direct injection instead of using the device, the machine.” Defendant asked Youk if he wished to donate his *378organs, and Youk declined. Defendant then read the consent form, which stated in part:

I, Thomas Youk, the undersigned, entirely voluntarily, without any reservation, external persuasion, pressure, or duress, and after prolonged and thorough deliberation, hereby consent to the following medical procedure of my own choosing, and that you have chosen direct injection, or what they call active euthanasia, to be administered by a competent medical professional, in order to end with certainty my intolerable and hopelessly incurable suffering.

The meeting ended at 10:15 P.M.

B. THE SEPTEMBER 16, 1998, VIDEOTAPE

On September 16, 1998, at 9:49 P.M., defendant again videotaped himself and Youk at Youk’s home. Youk stated that he “wanted to go through with this” and signed the consent form. Defendant remarked that he would inject Youk in the vein because “it’s quicker,” and stated, “now I’m going to put on a cardiogram so we know when your heart is stopped, okay.” Defendant established a connection between Youk and the electrocardiogram. Defendant injected Youk with Anectine and Seconal before injecting Youk with potassium chloride. During this time, defendant provided a commentary on what was occurring:

Sleepy Tom? Tom are you asleep? And now we’ll inject the Anectine. You asleep Tom? Tom? You asleep? He’s asleep. Now the Potassium Chloride. This machine is recording for some reason so I’m pulling it by hand until the heart stops. It’s been, it’s been about two minutes since I injected the, ah, seconal, and one minute since I injected the — . Now we’re getting agonal complexes and that’s about the, the Potassium Chloride will stop the heart, so. Now there’s a straight line. A straight line and the cardiogram will be turned off. His heart is stopped.

*379C. CAUSE OF DEATH

The police were dispatched to Youk’s house on September 17, 1998, at 1:30 A.M. They found Youk lying on his bed, dead. The police also found a Federal Express receipt with defendant’s name at the scene. Officials conducted Youk’s autopsy at 10:00 A.M. the same day. The medical examiner listed the manner of death as homicide and the cause of death as intravenous injection of substances. Dining the autopsy, the medical examiner found two “fresh” needle marks on Youk’s left and right wrists that had been covered with makeup. The autopsy protocol stated that the cause of death was “poisoning by intravenous injection of substances.”

Oakland County Medical Examiner Ljubisa J. Dragovic, ah expert in neuropathology and pathology who later testified for the prosecution at defendant’s trial, witnessed the autopsy. Dr. Dragovic found three significant drugs in Youk’s bodily fluids. First, Youk had a high level of the barbiturate Seconal, also known as Secobarbital, in his blood. Seconal is a Schedule 2 controlled substance4 typically used to induce sleep. Dr. Dragovic believed that the amount of Seconal in Youk’s blood would have killed him in a few hours. Second, Dr. Dragovic found Anectine, a paralyzing muscle relaxant, present in Youk’s body in an amount that could have killed Youk within five to eight minutes by causing brain death. However, Dr. Dragovic determined that it was the third drug, potassium chloride, that defendant injected into Youk that caused his death. As Dr. Dragovic explained, when *380potassium chloride is injected into the body in a concentrated form at once, rather than in small amounts over time, it stops the heart from beating within a matter of seconds. According to Dr. Dragovic, the toxicology reports did not reveal the presence of potassium chloride in Youk’s body because that substance is naturally present in the body after red blood cells die.

Dr. Dragovic also confirmed that Youk had als. However, in Dr. Dragovic’s opinion, Youk did not die from als, als was not an underlying cause of Youk’s death, and als did not contribute to Youk’s death in any way. Rather, Dr. Dragovic firmly reiterated that the poisons injected into Youk killed him, constituting a homicide.

D. THE 60 MINUTES INTERVIEW

News correspondent Mike Wallace interviewed defendant for 60 Minutes. In the first clip from the interview shown to the jury, Wallace stated at the outset, “You killed him.” Defendant responded: “I did, but it could be Manslaughter not Murder. It’s not necessarily Murder. But it doesn’t bother me what you call it. I know what it is. This could never be a crime in any society which deems itself enlightened.” Defendant indicated that he was making an example of Youk. Wallace then suggested that Youk was initially a little reluctant because Youk “thought he was getting assisted suicide.” Defendant replied that “this is better than assisted suicide, I explained that to him. It’s better control.”

Defendant also explained to Wallace the process leading to Youk’s death. According to defendant, the first injection paralyzed Youk’s muscles and slowed *381his ability to take in oxygen. When the oxygen was “cut off” and Youk could not breathe, defendant injected the “potassium chloride to stop the heart.” Defendant then told Wallace that “[e]ither they go or I go,” apparently meaning that he would be acquitted for killing Youk or, if convicted, he would starve to death in prison. As defendant put it: “I’ve got to force them to act. They must charge me. Because if they do not, that means they don’t think it’s a crime. Because they don’t need any more evidence do they? Do you have to dust for fingerprints on this[?]”

Wallace suggested that defendant was “engaged in a political, medical, macabre . . . publicity venture,” and had a “ghoulish . . . desire to see the deed done.” Defendant did not disagree with those assertions, stating: “Well, it could be, I, I can’t argue with that. Maybe it is ghoulish. I don’t know. It appears that way to you. I can’t criticize you for that.” In fact, defendant agreed with Wallace, emphasizing that “the main point is . . . that the deed be done.” Evidently in response to the argument that legalizing euthanasia could be problematic in practice, defendant commented that “[e]verything can be abused. You learn from abuse, you punish the abuser, and then ... if you want to control, you say that only certain doctors can do this in certain areas, nobody else. . . . That’s the way to control it.”

Defendant then returned to one of his main themes, saying:

If you don’t have liberty and self-determination, you got nothing. That’s what this country’s built on and this is the ultimate self-determination to determine when and how you’re gonna die when you’re suffering.

[Wallace]: And those who say that [defendant], Dr. Death, is a fanatic?

*382[Defendant]: Zealot. No, not if, sure, you try to take a liberty away and I turn fanatic. . . . I’m fighting for me, Mike, me. This is a right I want when I, I’m 71, I’ll be 71. You don’t know what’ll happen when you get older. I may end up terribly suffering. I want some colleague to be free to come and help me when I say the time has come. That’s why I’m fighting for, me. Now that sounds selfish. And if it helps everybody else, so be it.

m. EUTHANASIA AND THE CONSTITUTION

A. FACTS AND ARGUMENT

Before trial, defendant, relying on the Ninth Amendment,5 filed a motion asking the trial court to dismiss the charges against him. Evidently, defendant intended to argue that the people had retained the right to active euthanasia. The trial court denied the motion on the grounds that it was untimely and that defendant had failed to cite any support for his argument. Defendant then filed an emergency application for leave to appeal the trial court’s order with this Court. In addition to challenging the trial court’s ruling, he also claimed that the prosecution violated the Michigan constitutional counterpart to the Ninth Amendment.6 This Court ultimately determined that defendant failed to articulate the need for immediate appellate review.7

On appeal, defendant makes two related, but separate, constitutional arguments. First, he argues that the unenumerated rights protected by the Ninth Amendment and its Michigan constitutional counter*383part8 include a patient’s right to be free from unbearable pain and suffering. Second, he maintains that the Fourteenth Amendment9 and its Michigan constitutional counterpart10 also include this right by proscribing state deprivation of liberty without due process of law either under constitutional privacy concepts or as a “necessary and direct corollary of this position . . . that a person should not be forced to suffer unbearably.” Defendant claims that he has standing to raise these due process arguments. Defendant thus contends that he is entitled to have his murder conviction reversed and no further criminal proceedings instituted against him for “aiding in Thomas Youk’s assertion of his constitutional right to be free from intolerable pain and suffering.”

B. STANDARD OF REVIEW

We review a trial court’s decision to grant or deny a motion to dismiss charges for an abuse of discretion.11 However, review de novo is appropriate for the core constitutional questions that underlie the trial court’s ruling on the motion to dismiss the charges.12

C. CONSTITUTIONAL PROVISIONS

The Ninth Amendment of the United States Constitution states that “[t]he enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.”13 The *384counterpart provision in the Michigan Constitution states that “[t]he enumeration in this constitution of certain rights shall not be construed to deny or disparage others retained by the people.”14

The Fourteenth Amendment of the United States Constitution states, in relevant part, that no state shall “deprive any person of life, liberty, or property, without due process of law.”15 The counterpart provision in the Michigan Constitution states, in relevant part, that “[n]o person shall be . . . deprived of life, liberty or property, without due process of law.”16

D. THE NATURE OF DEFENDANT’S ARGUMENTS

At the outset it is important to understand the nature of defendant’s constitutional claims. The best way to do this is to state clearly the constitutional arguments that defendant does not raise.

First, defendant does not ask us to hold that he acted properly in furtherance of the right to refuse life-sustaining medical treatment. In Cruzan v Director, Missouri Dep’t of Health,17 the United States Supreme Court “assume[d] that the United States Constitution would grant a competent person a constitutionally protected right to refuse lifesaving hydration and nutrition,” likely under a Fourteenth Amendment due process liberty interest analysis.18 More recently, in Glucksberg,19 the Court strengthened the *385constitutional basis for the Cruzan decision, interpreting Cruzan as holding that “the right to refuse unwanted medical treatment was so rooted in our history, tradition, and practice as to require special protection under the Fourteenth Amendment.” Here, defendant does not, and could not, rely on Cruzan-, factually, this case does not involve removing life support. Further, though not resting their decisions precisely on the Fourteenth Amendment, Michigan courts have arrived at the same conclusion regarding a patient’s right to refuse life-sustaining medical care.20 The limited scope of these cases does not establish a right to be free from unbearable pain and suffering that would make euthanasia legal. There is, of course, a substantial factual distinction between refusing care, even if doing so hastens death, and purposefully ending a life.

Second, defendant does not make any claim that this case concerns medical efforts to relieve pain or discomfort, though these medical efforts may hasten death. Michigan exempts such medical efforts from criminal penalties.21 Importantly, however, the exemption does not apply to medical efforts designed to cause death.22 Factually, there is not a scintilla of evidence that defendant administered potassium chloride to Youk to relieve Youk’s pain or discomfort. Defendant admits as much in his brief on appeal:

*386The only medical relief for Thomas Youk’s conditions was the relief that he sought from [defendant]. The injection [defendant] gave to Thomas Youk was the only effective medical way to alleviate Thomas Youk’s unbearable suffering. No pain medication would suffice, and there was no other beneficial medical alternative that would have aided Thomas Youk.[23]

Third, defendant does not ask us to find that his actions in this matter constituted some form of permissible assisted suicide. In Michigan, assisting in a suicide — that is, providing the physical means by which another person attempts or commits suicide or participating in a physical act by which another person attempts or commits suicide — is illegal.24 The Michigan Supreme Court has upheld the statute in question against both a Title-Object Clause challenge under the Michigan Constitution and a Due Process Clause challenge under the United States Constitution.25 In reaching its decision on the due process challenge, a majority of the Court observed:

' Presently, a substantial number of jurisdictions have specific statutes that criminalize assisted suicide and the Model Penal Code also provides for criminal penalties. Further, nearly all states expressly disapprove of suicide and assisted suicide either in statutes dealing with durable powers of attorney in health-care situations, or in “living will” statutes. In addition, all states provide for the involuntary commitment of persons who may harm themselves as the result of mental illness, and a number of states allow the use of nondeadly force to thwart suicide attempts. [26]

*387Referring to Cruzan, the majority observed:

Indeed, the United States Supreme Court repeatedly and unequivocally has affirmed the sanctity of human life and rejected the notion that there is a right of self-destruction inherent in any common-law doctrine or constitutional phrase.[27]

Several years after the Michigan Supreme Court decision in Kevorkian I, the United States Supreme Court in Glucksberg upheld a similar Washington statute against a similar Due Process Clause challenge under the United States Constitution.28 The Glucksberg majority held that the prohibition in the Washington statute against “ ‘caus[ing]’ ” or “ ‘aid[ing]’ ” a suicide did not offend the Fourteenth Amendment of the United States Constitution.29

Here, defendant makes no attempt to assert that he was engaged in assisted suicide when he injected Youk with potassium chloride, causing his death. Rather, he asserts that if the Ninth Amendment “is to have any substantive meaning,” the right to be free from inexorable pain and suffering must be among the unenumerated rights protected by that amendment and its Michigan counterpart. Further, defendant asserts that the right to be free from unbearable pain and suffering caused by a medical condition is inherently part of the liberty interests secured by the Fourteenth Amendment and its Michigan counterpart. Defendant then contends that he cannot be prosecuted for “aiding in Thomas Youk’s assertion of his *388constitutional right to be free from intolerable pain and suffering.” Although defendant’s appellate counsel has carefully avoided using the words, as we have already noted, the record indicates that defendant was quite specific when describing his actions; he said he was engaged in “active euthanasia” and the consent form that Youk signed directly refers to such active euthanasia.

In summary, defendant does not, nor could he, ask us to hold that his actions were legally justifiable because he simply helped Youk exercise his right to refuse medical care. Defendant does not, nor could he, ask us to hold that he was lawfully attempting to alleviate Youk’s pain and suffering by any means other than causing his death. Defendant does not, nor could he, ask us to hold that his actions constituted a legal form of assisted suicide. In a nutshell, and using his own terminology, defendant asks us to legalize euthanasia.

E. RESERVED RIGHTS

Defendant’s argument that the people have reserved the right to euthanasia under the Ninth Amendment and its Michigan counterpart is basically formless. He states that a right to be free from inexorable pain and suffering “must be among” the rights protected by these two constitutional provisions. Further, he argues that states “should recognize such a right and give it force.” Defendant does not cite a single case for this extraordinary request. As the Supreme Court said in Mitcham v Detroit,30

*389It is not enough for an appellant in his brief simply to announce a position or assert an error and then leave it up to this Court to discover and rationalize the basis for his claims, or unravel and elaborate for him his arguments, and then search for authority either to sustain or reject his position. The appellant himself must first adequately prime the pump; only then does the appellate well begin to flow. Failure to brief a question on appeal is tantamount to abandoning it.[31]

We conclude, therefore, that defendant has abandoned this argument on appeal.

F. EUTHANASIA AS A DUE PROCESS RIGHT TO PRIVACY

(1) DEFENDANTS ARGUMENT

Defendant starts with the proposition that there is a right to privacy that is part of the liberty interest protected by the Fourteenth Amendment and its Michigan counterpart. He then asserts that the “intensely personal and private right of a patient to be free from intolerable and irremediable suffering” is either part of or similar to this privacy right. Citing Vacco, he argues that if the administration of aggressive painkilling drugs is acceptable even if this may hasten death, then the “necessary and direct corollary of this position is that a person should not be forced to suffer unbearably.”

Defendant then reviews the positions of Justices O’Connor, Breyer, Souter, and Stevens in Glucksberg to reach the conclusion that “Justices on the Supreme Court have suggested allowing for interpretation of the Fourteenth Amendment’s guarantee of liberty to apply to various privacy rights, including those *390related to personal and private medical procedures.”32 Finally, defendant argues that he has standing to assert Youk’s constitutional right to be free from intolerable pain, claiming that Justice Stevens in Glucksberg,33 “recognized the possibility that an individual who provides assistance to a patient who was suffering interminably could prevail on a Constitutional challenge” and that, if we agree that there is a constitutionally protected right to be free from unbearable suffering, then the charges against him must be dismissed. We do not agree.

(2) ENCOMPASSING EUTHANASIA WITHIN THE RIGHT TO PRIVACY

It is one thing to assert, as defendant does, that there is a large body of case law suggesting that due process sometimes relies on the right to privacy to protect fundamental liberty interests.34 It is quite another thing, however, to conclude that the right to privacy encompasses euthanasia. As Justice Jackson once pointedly noted, the enduring nature of precedent gives judicial opinions a force all their own.35

The principle then lies about like a loaded weapon .... Every repetition imbeds that principle more deeply in our law and thinking and expands it to new purposes. All who observe the work of courts are familiar with what Judge *391Cardozo described as “the tendency of a principle to expand itself to the limit of its logic.”[36]

Defendant urges us to pick up the loaded weapon of the right to privacy cases. He asks us to use this weapon to resolve the situation faced by a person who suffers from literally unbearable pain and who wishes to end that pain by dying. As Justice O’Connor described it: “Death will be different for each of us. For many, the last days will be spent in physical pain and perhaps the despair that accompanies physical deterioration and a loss of control of basic bodily and mental functions.”37

We decline, however, to pick up this loaded weapon for three basic reasons. First, we can find no meaningful precedent for expanding the right to privacy to include a right to commit euthanasia so that an individual can be free from intolerable and irremediable suffering. To our knowledge, no court of last resort in this country has ever recognized such a right. Even in the assisted suicide cases dealing with an asserted “right to die,” courts have steadfastly refused to expand the right to privacy to include the right to commit or receive euthanasia. As Chief Justice Cavanagh and Justices Brickley and Griffin explained while describing the boundaries of the right to privacy in end-of-life cases:

We do not discern in Cruzan and its historic roots an indication that the federal constitution protects a right more expansive than the right to refuse to begin or to continue life-sustaining medical treatment. Neither do we find in [Planned Parenthood of Southeastern Pennsylvania v Casey, 505 US 833; 112 S Ct 2791; 120 L Ed 2d 674 (1992)] *392or in the precedent from which it evolved an intent to expand the liberty interests identified by the Court in such a manner.[38]

Similarly, in Glucksberg, a majority of the United States Supreme Court concluded that the asserted “right” to assistance in committing suicide “is not a fundamental liberty interest protected by the Due Process Clause.”39 Instead, the Court determined that a state has legitimate and countervailing interests in preserving life,40 preventing suicide,41 protecting the integrity and ethics of the medical profession, protecting vulnerable groups from abuse, neglect, and mistakes,42 and acknowledging the equal value of all people.43 Most importantly, the Glucksberg majority noted that states “may fear that permitting assisted suicide will start it down the path to voluntary and perhaps even involuntary euthanasia.”44 In commenting on the Ninth Circuit Court of Appeals decision in the underlying case,45 the majority of the Court said:

*393The Court of Appeals’ decision, and its expansive reasoning, provide ample support for the [state of Washington’s] concerns. The court noted, for example, that the “decision of a duly appointed surrogate decision maker is for all legal purposes the decision of the patient himself;” that “in some instances, the patient may be unable to seli-administer the drugs and . . . administration by the physician . . . may be the only way the patient may be able to receive them;” and that not only physicians, but also family members and loved ones, will inevitably participate in assisting suicide. Thus, it turns out that what is couched as a limited right to “physician-assisted suicide” is likely, in effect, a much broader license, which could prove extremely difficult to police and contain. [The state of] Washington’s ban on assisting suicide prevents such erosion.[46]

The majority then turned, directly, to the “slippery slope” argument. The majority cited United States v 12 200-ft Reels of Super 8 MM Film,47 for the proposition that “ ‘[e]ach step, when taken, appear[s] a reasonable step in relation to that which preceded it, although the aggregate or end result is one that would never have been seriously considered in the first instance.’ ”48 The majority referred to Physician-Assisted Suicide and Euthanasia in the Netherlands49 as suggesting that

despite the existence of various reporting procedures, euthanasia in the Netherlands has not been limited to com*394petent, terminally ill adults who are enduring physical suffering, and that regulation of the practice may not have prevented abuses in cases involving vulnerable persons, including severely disabled neonates and elderly persons suffering from dementia.50

Here, expanding the right to privacy would begin, as the steps in the progression of defendant’s argument supporting voluntary euthanasia clearly indicate, the slide down the slippery slope toward euthanasia. No court of final jurisdiction has so expanded the right to privacy. As a state court of intermediate appellate jurisdiction, neither will we.

Second, we conclude that by expanding the right to privacy as defendant suggests, we would, to a great extent, place the matter outside the arenas of public debate and legislative action.51 Whatever the life experiences or the policy preferences of the members of this Court might be, we must exercise the utmost care to assure, when asked to break new ground, that the liberty protected by the Due Process Clause of the Fourteenth Amendment not be subtly transformed into an expression of personal belief rather than an adherence to the rule of law.52 If society is to recognize a right to be free from intolerable and irremediable suffering, it should do so through the action of the majority of the legislature, whose role it is to set social policy,53 or by action of the people through ballot initiative. As the Michigan Supreme Court observed when analyzing the constitutionality of the prohibition of assisted suicide:

*395We are keenly aware of the intense emotions and competing moral philosophies that characterize the present debate about suicide in general, and assisted suicide in particular. The issues do not lend themselves to simple answers. However, while the complexity of the matter does not permit us to avoid the critical constitutional questions, neither does it, under the guise of constitutional interpretation, permit us to expand the judicial powers of this Court, especially where the question clearly is a policy one that is appropriately left to the citizenry for resolution, either through its elected representatives or through a ballot initiative under Const 1963, art 2, § 9 [54]

Third, we observe that by expanding the right of privacy to include a right to commit euthanasia in order to end intolerable and irremediable suffering we would inevitably involve the judiciary in deciding questions that are simply beyond its capacity. There is no court that can answer the question of how much pain, or perception of pain by a third party, is necessary before the suffering becomes intolerable and irremediable. The role of the courts is to serve neither as physicians nor as theologians. In Glucksberg, Justice Stevens briefly discussed the United States Supreme Court’s changing attitude toward the death penalty, noting that “there is no absolute requirement that a State treat all human life as having an equal right to preservation.”55 Though other jurisdictions may not value all life equally, that is not true in Michigan.56 In a state that constitutionally prohibits *396putting to death the convicted perpetrator of even the most heinous of crimes,57 courts are simply unsuited to make that decision with respect to the innocent. No judge, no matter how learned, can assess the quality of human life and determine, as a matter of law, that putting an end to suffering is justifiable in one case while in another case it is not. This sort of subjective determination would be unavoidable if we begin, through judicial intervention, to decide who shall live and who shall die.

Rather, the role of the courts is to apply the rule of law. As Chief Justice Burger once eloquently explained:

It is often observed that hard cases make bad law. I suspect there is some truth to that adage, for the “hard” cases always tempt judges to exceed the limits of their authority ... to reach a “desirable” result. Cardozo no doubt had this type of case in mind when he wrote:

“The judge, even when he is free, is still not wholly free. He is not to innovate at pleasure. He is not a knight-errant, roaming at will in pursuit of his own ideal of beauty or of goodness. He is to draw his inspiration from consecrated principles. He is not to yield to spasmodic sentiment, to vague and unregulated benevolence. He is to exercise a discretion informed by tradition, methodized by analogy, disciplined by system, and subordinated to ‘the primordial necessity of order in the social life.’ Wide enough in all conscience is the field of discretion that remains.” The Nature of the Judicial Process, 141 (1921).

What Cardozo tells us is beware the “good result,” achieved by judicially unauthorized or intellectually dishonest means on the appealing notion that the desirable ends justify the improper judicial means. For there is always the danger that the seeds of precedent sown by *397good men for the best of motives will yield a rich harvest of unprincipled acts of others also aiming at “good ends.”[58]

Simply put, the courts are not free to create new rights out of whole cloth. We will not do so here.

(3) “A MORE PARTICULARIZED CHALLENGE”

The structure of the Glucksberg opinion reflects the complexity of the assisted suicide issue, an issue certainly less complex than euthanasia. In Glucksberg, Chief Justice Rehnquist wrote the opinion announcing the Court’s decision. Justices O’Connor, Scalia, Kennedy, and Thomas joined this opinion, constituting a solid five-person majority. Nevertheless, Glucksberg consists of more than the majority opinion. Justice O’Connor wrote a concurrence, which Justices Ginsburg and Breyer joined. At the same time, Justices Stevens, Souter, Ginsburg, and Breyer each wrote their own concurring opinions. Thus, while the majority opinion in Glucksberg is plainly identifiable, the nine individual justices’ views on the assisted suicide issue are far from uniform.

Defendant seizes on these concurrences in Glucksberg as evidence that the United States Supreme Court would find a constitutional basis for assisted suicide if presented with “a more particularized challenge.” Defendant’s assumption is that this is the perfect test case; this is the “more particularized challenge”59 that will bring sweeping changes to constitutional law affecting not only assisted suicide, but creating a right to commit euthanasia. As we have *398already outlined, assisted suicide is not at issue here; rather, the fundamental question here is whether there is a right to commit euthanasia. Defendant’s observation that the concurring justices in Glucksberg each expressed, in varying degrees, their reservations about the sweep of the majority opinion is accurate. However, as is profoundly clear from each of their concurring opinions, there is not a hint in any of the language that any of the concurring justices used that any of them would recognize a right to commit euthanasia.

Justice O’Connor attempted to avoid dealing directly with the limits on a patient’s right to avoid suffering, writing:

[T]here is no need to address the question whether suffering patients have a constitutionally cognizable interest in obtaining relief from the suffering that they may experience in the last days of their lives. There is no dispute that dying patients in Washington and New York can obtain palliative care, even when doing so would hasten their deaths. The difficulty in defining terminal illness and the risk that a dying patient’s request for assistance in ending his or her life might not be truly voluntary justifies the prohibitions on assisted suicide we uphold here.[60]

However, she also agreed with the majority that “there is no generalized right to ‘commit suicide,’ ”61 and that the “State’s interests in protecting those who are not truly competent or facing imminent death, or those whose decisions to hasten death would not truly be voluntary, are sufficiently weighty to justify a prohibition against physician-assisted suicide.”62

*399Justice Ginsburg’s concurrence consisted of the single statement that she “concur[red] in the Court’s judgments . . . substantially for the reasons stated by Justice O’Connor . . .

Justice Breyer disagreed with the way the majority framed the issue on appeal as the right to assisted suicide, instead preferring to examine whether a “ ‘right to die with dignity’ ” existed.63 Despite reframing this issue, as “rough”64 as it was, Justice Breyer ultimately adopted a tack quite close to that of Justice O’Connor, stating:

I do not believe . . . that this Court need or now should decide whether or not such a right [to die with dignity] is “fundamental.” That is because, in my view, the avoidance of severe physical pain (connected with death) would have to constitute an essential part of any successful claim and because . . .the laws before us do not force a dying person to undergo that kind of pain. .. .

Were the legal circumstances different — for example, were state law to prevent the provision of palliative care, including the administration of drugs as needed to avoid pain at the end of life — then the law’s impact upon serious and otherwise unavoidable physical pain (accompanying death) would be more directly at issue. And . . . the Court might have to revisit its conclusions in these cases.[65]

Thus, Justice Breyer’s concurrence implies that he, too, believes that the state has a legally cognizable interest in preventing death, even when it is desired, as long as the state does not bar other efforts to alleviate suffering.

*400Justice Souter’s concerns were somewhat different. He drew parallels between the right to “bodily integrity” and patients’ insistence that they not merely be drugged into a “stupor” to make them unaware of their pain, but that they had a right to exercise their autonomy by dying, in the process avoiding “helplessness” and “dependency.”66 In this regard, he noted that a physician is not just a “mechanic of the human body,” but one who “ministers” to patients as whole individuals.67 Justice Souter reflected on the complexity and necessity of the patient-physician relationship in times of great suffering, refusing to minimize the individual interests at stake.68 Justice Souter did not close forever the doors to the Court regarding the assisted suicide issue. However, in the end, he concluded that the legislature, not the Court, had the “institutional competence” to address this issue.69

Nevertheless, Justice Souter emphasized time and again the risk that acknowledging a right to assisted suicide would lead to legalized euthanasia. He clearly saw euthanasia as having “dangers [that] are concededly within the State’s authority to address.”70 Justice Souter, in a telling statement, also noted that “the barrier between assisted suicide and euthanasia could become porous [if there were a right to assisted suicide], and the line between voluntary and involuntary euthanasia as well.”71 Thus, while Justice Souter was able to see many shades of gray in the assisted suicide issue, he saw euthanasia as pure darkness.

*401Justice Stevens distinguished between challenging a statute as facially unconstitutional and challenging the constitutionality of its application when framing the issues in the appeal,72 stating:

[J]ust as our conclusion that capital punishment is not' always unconstitutional did not preclude later decisions holding that it is sometimes impermissibly cruel, so is it equally clear that a decision upholding a general statutory prohibition of assisted'suicide does not mean that every possible application of the statute would be valid. A State, like Washington, that has authorized the death penalty,- and thereby has concluded that the sanctity of human life does not require that it always be preserved, must acknowledge that there are situations in which an interest in hastening death is legitimate. Indeed, not only is that interest sometimes legitimate, I am also convinced that there are times when it is entitled to constitutional protection.[73]

Of all. the justices, Justice Stevens’ view in this and other passages came the closest to reflecting on the notion that a possible constitutional right to commit euthanasia might exist. However, we cannot forget that Justice Stevens, in fact, concurred in the majority’s opinion. He readily acknowledged the majority’s conclusion that there were principled reasons for “refusing to recognize an open-ended constitutional right to commit suicide,” including assistance in committing suicide.74 He also found persuasive John Donne’s famous statement that “ ‘No man is an island,’ ” commenting:

The State has an interest in preserving and fostering the benefits that every human being may provide to the com*402munity — a community that thrives on the exchange of ideas, expressions of affection, shared memories, and humorous incidents, as well as on the material contributions that its members create and support. The value to others of a person’s life is far too precious to allow the individual to claim a constitutional entitlement to complete autonomy in making a decision to end that life.[75]

Further, Justice Stevens clearly expressed his views in the context of the right to end the life of a person for whom death is relatively imminent. In fact, after delineating the state’s legitimate interests in preventing assisted suicide, Justice Stevens not only declined to say “as a categorical matter that these state interests are invalid,” he made the statement with respect to “the entire class of terminally ill, mentally competent patients.”76 More importantly, nowhere in his concurrence did Justice Stevens consider whether a right to commit euthanasia exists. Even if in the future Justice Stevens would hold that the United States Constitution grants a right to physician-assisted suicide, it appears that he would limit the right to the terminally ill and would not extend it to euthanasia.

These five concurring justices held in common a concern that the states neither bar adequate treatment for pain and suffering in the name of prohibiting assisted suicide nor force patients to receive unwanted medical treatment. Here, defendant asserts that “no pain medication would suffice” and that “there was no other beneficial medical alternative that would have aided Thomas Youk.” Defendant’s *403own words take him well beyond the possible purview of the concurring justices in Glucksberg.

(4) THE “DUTCH CURE”

Finally, defendant urges us to recognize that his prosecution “for helping Thomas Youk put an end to his suffering at the request of Mr. Youk" is unconstitutional on its face. He arrives at this position by asserting, first, that Youk had a constitutional right to be free from intolerable pain and, second, that defendant’s provision of “Constitutionally guaranteed medical services” allows him to assert Youk’s rights.

There is no authority whatsoever for the proposition that a right to be free from intolerable and irremediable suffering, if it exists, somehow migrates to an “individual,” such as defendant, who provides assistance to a patient who is suffering interminably. The thin reed on which defendant apparently relies is Justice Stevens’ concurrence in Glucksberg-.

There may be little distinction between the intent of a terminally ill patient who decides to remove her life support and one who seeks the assistance of a doctor in ending her life; in both situations, the patient is seeking to hasten a certain, impending death. The doctor’s intent might also be the same in prescribing lethal medication as it is in terminating life support. A doctor who fails to administer medical treatment to one who is dying from a disease could be doing so with an intent to harm or kill that patient. Conversely, a doctor who prescribes lethal medication does not necessarily intend the patient’s death — rather that doctor may seek simply to ease the patient’s suffering and to comply with her wishes. The illusory character of any differences in intent or causation is confirmed by the fact that the American Medical Association unequivocally endorses the practice of terminal sedation — the administration of sufficient dosages of pain-killing medication to terminally ill *404patients to protect them from excruciating pain even when it is clear that the time of death will be advanced. The purpose of terminal sedation is to ease the suffering of the patient and comply with her wishes, and the actual cause of death is the administration of heavy doses of lethal sedatives. The same intent and causation may exist when a doctor complies with a patient’s request for lethal medication to hasten her death.[77]

We first note Justice Stevens’ equivocal language: “[t]here may be little distinction” between the intent of a terminally ill patient who decides to remove life support and one who seeks the assistance of a doctor to end her life; a doctor “may seek simply to ease the patient’s suffering;” “[t]he same intent and causation may exist when a doctor complies with a patient’s request for lethal medication . . . .” Such language is worlds away from a justification for euthanasia.

Second, we note that Justice Stevens’ references are entirely within the context of a doctor treating a patient. Defendant is not licensed to practice medicine in Michigan. Therefore there was not, and could not be, a doctor-patient relationship between defendant and Youk. Defendant’s argument can only be construed to mean that an individual can, if requested by another person, kill that person.

This is the mercy killing argument — the argument for the “Dutch cure” — taken beyond the position of even its most extreme advocates. Under defendant’s theory, if one who is not a doctor became convinced that one’s dear friend was suffering from a painful, incurable disease and that the friend wished to die, one could at the request of that friend shoot him between the eyes with a .45 caliber pistol and not be *405guilty of murder. Indeed, under defendant’s theoiy, the same result might well be obtained if one’s friend were severely depressed, or perhaps simply unhappy with his lot in life. This is the slippery slope with a vengeance and we will not take a single step down it, into the abyss.

G. CONCLUSION

We conclude by noting that the jury, no doubt influenced by the gritty realism of the videotapes defendant made as well as his flat statement of culpability in the 60 Minutes interview, convicted defendant of second-degree murder as well as delivery of a controlled substance. Defendant has on the record before us compared himself to Margaret Sanger, Susan B. Anthony, and Dr. Martin Luther King, Jr., all of whom risked imprisonment for their beliefs. How history will view defendant is a matter this Court can neither predict nor decide. Perhaps in the brave new world of defendant’s “enlightened” society, acts such as the one he committed in this case will be excused. Still, we find it difficult to hypothesize a rule of law under which this might be so.

We deal here, however, with the application of the law as it currently exists to the facts of this case. While defendant has carefully skirted the label of murder in his past actions, he cannot do so now. Justice Levin once stated that “[defendant] is not a murderer.”78 Here, defendant in essence convicted himself of a murder he surely committed. We will not now reverse that conviction on due process grounds. *406The trial court did not abuse its discretion in refusing to dismiss the charges.

IV. DEFENSE COUNSEL

A. FACTS AND ARGUMENTS

Before trial, defendant retained Gorosh to serve as his defense attorney. However, at the December 9, 1998, preliminary examination, defendant indicated that he was waiving his right to represent himself “[a]t this hearing[.]” Consequently, Gorosh and attorney Lisa Dwyer79 entered their appearances in the trial court on defendant’s behalf. Later, however, at a proceeding in the trial court’s chambers, there was some indication that defendant might seek to proceed in propria persona. Indeed, on March 19, 1999, Gorosh informed the trial court that he believed defendant intended to “say he’s going to conduct the trial in its entirety on his own in pro per.”

In any event, while defendant did file one motion on his own behalf, it is apparent that Gorosh and Dwyer represented defendant at all times through the first day of trial on March 22, 1999. On that day, both Gorosh and Dwyer placed their appearances on the record on behalf of defendant. However, Gorosh then stated to the trial court that defendant “does want to represent himself in the trial in its entirety.” In response to the trial court’s questioning, defendant first stated that he was dissatisfied with Gorosh and Dwyer, prompting a colloquy in which he completely revised this statement:

*407The Court: And do you have any reason for this dissatisfaction?

[Defendant]: There’s no dissatisfaction. This is what I planned all along.

The Court: You planned all along to represent yourself?

[Defendant]: To represent myself, yes.

The Court: And so you have no independent dissatisfaction with your attorney?

[Defendant]: None.

After clearing up this point, the trial court explained to defendant that he could spend the rest of his life in prison and that a criminal trial is a formal, complex, and dynamic proceeding. Further, the trial court noted, the rules of evidence applied, as well as “certain decorum and certain ways in which there are presentations made to the jury and certain things that you can say and you can’t say.” The trial court asked defendant whether there was a specific reason that he wished to represent himself and he answered, “Yes.”

The Court: What is that, sir?

[Defendant]: There are certain points I could bring out better than any attorney. Certain questions I can ask that are more pertinent.

The trial court informed defendant that, with respect to jury selection, opening statements, and closing statements, he would be bound by the rules of the court and that there would be a permanent record that might be used in other proceedings. The trial court stated that counsel could be present at the table with defendant in order to consult with, but that such advisors “can’t get up and speak.”

[Defendant]: No, I said as advisors, consultation and advice. That’s what I meant.

*408The Court: And that’s what you wish to do?

[Defendant]: Yes.

The Court: You’re aware of all of these dangers?

[Defendant]: Very much so.

The Court: You understand we’re talking about something that could carry a sentence of life imprisonment without any possibility of parole?

[Defendant]: Yes.

The Court: And do you -understand that you may not disrupt or inconvenience the Court?

[Defendant]: I’m here by my own invitation. I’ll act like the guest I am.

The Court: And that means you will follow my orders and procedures?

[Defendant]: As a guest.

The Court: Well, it’s more than a guest. You’re here as a defendant, sir.

[Defendant]: But as a guest, propriety will be observed.

The Court: Has anyone promised you or threatened you in any way that makes you want to do this?

[Defendant]: No, not at all. It’s my own free will.

In light of this exchange, the trial court determined that defendant had unequivocally, knowingly, intelligently, and voluntarily waived his right to counsel. Defendant then represented himself during jury voir dire and gave his own opening statement. On March 23, 1999, the second day of trial, before any witnesses were presented, the trial court again asked defendant if he still wished to proceed in propria persona. Defendant indicated that he still wished to represent himself, and did so by examining and cross-examining the witnesses. During a conference on the record in chambers on that day, the trial court again pointed out the difficulties of self-representation, to which defendant replied:

*409I don’t want you to agonize, I really don’t. Do what you know is right, do it forcefully and definitely. It won’t offend me and if you think I’m making mistakes or I don’t know what I’m doing, I’ll do the best I can with my advisers here. I made this choice. I don’t blame anybody else, and I don’t want you to agonize over it. And I don’t want you to jeopardize your position.

The trial court again raised the specter of punishment with defendant:

The Court: ... I just want you to understand that if you’re convicted of this offense it’s the rest of your life.

[Defendant]: I go to jail. I go to jail, yes. I go to jail.

The Court: Mandatory.

[Defendant]: If I’m convicted, Your Honor, we get a shot at the Supreme Court. Not that they’ll accept it, but we get a shot at it with what they want, a particularized case. They said that, we got their quotes. They want a particularized case. Four of them said we want to revisit this issue again. Now two or three years may be too quick, but when you’ve got someone starving to death in prison who you know is not a criminal and you know what he’s doing is not a crime, maybe they’ll look at it — maybe.

But if not, who cares. In 15, 20 years, they’ll say well, he was right. He’s dead now, but he was right. I’ve got to do what I know now is right and I can’t let the law, which is often immoral, block me. If Margaret Sanger did that, if Susan B. Anthony did that — look at Martin — look at all these people. I’m not saying I’m like them, but they certainly — I’m certainly going to act like them. I mean, I know this is not a crime. So do you. Everybody with sense does. Your religion may say it’s a sin, but that doesn’t make it a crime. All these people broke the law and went to jail. I am willing to do the same.

But the Supreme Court has got to decide this on- the Ninth Amendment where there is no equivocation, there is no stretching due process. They’ve got to do that. And if they do and break all these laws down, then we can have a better society, an honest society. I’m willing to risk that. Because at age of 71, I cannot go on living a hypocritical *410life when I can’t do what I know is right, and the world knows I’m right. Everybody does. Every nation the majority is for what I’m doing. How come it’s illegal? That’s why I’m doing this.

On March 25, 1999, the third day of trial, defendant rested and gave his closing argument, during which he stated several times that he was acting as his own attorney. The trial court instructed the jury that defendant had a constitutional right to represent himself and that they, the jurors, must not give any negative consideration to defendant’s decision to do so.

The following morning, while the jury was deliberating, defendant told the trial court that he would “take your well-advised comments and withdraw in favor of my two attorneys’ advice.” Gorosh, Dwyer, and defendant’s appellate counsel represented him at sentencing. Subsequently, defendant moved for a new trial, alleging that he had been denied the effective assistance of counsel. The trial court denied this motion.

On appeal, defendant asserts that the trial court erred in denying his motion for a new trial because the assistance that Gorosh provided fell below the constitutional standards required for effective assistance of counsel. Defendant also asserts that the trial court erred in denying his motion for a new trial based on the doctrine of “serious mistake of counsel.”

B. STANDARD OF REVIEW AND LEGAL STANDARD

We review a trial court’s decision regarding a motion for a new trial for an abuse of discretion.80 However, with respect to the underlying question *411whether Gorosh was ineffective, our review is de novo.81

As this Court explained in People v Knapp:82

To establish a claim of ineffective assistance of counsel, a defendant must show that counsel’s performance fell below an objective standard of reasonableness and that, but for defense counsel’s errors, there was a reasonable probability that the result of the proceeding would have been different. People v Stanaway, 446 Mich 643, 687-688; 521 NW2d 557 (1994). A defendant must affirmatively demonstrate that counsel’s performance was objectively unreasonable and so prejudicial as to deprive him of a fair trial. People v Pickens, 446 Mich 298, 303; 521 NW2d 797 (1994). The defendant must also overcome the presumption that the challenged action might be considered sound trial strategy. People v Tommolino, 187 Mich App 14, 17; 466 NW2d 315 (1991), citing Strickland v Washington, 466 US 668; 104 S Ct 2052; 80 L Ed 2d 674 (1984).

C. GOROSH’S REPRESENTATION BEFORE MARCH 22, 1999

(1) OVERVIEW

Defendant’s briefs on appeal contain a litany of complaints aimed at Gorosh. At various places, defendant argues that Gorosh did not provide him with “appropriate advice or advocacy;” that Gorosh was “not qualified” to handle his defense; that Gorosh lacked “personal competence to handle the case;” that Gorosh “completely shut out” Dwyer; that Gorosh “prepared no defense;” that Gorosh “withheld advice during the trial in hope of causing [defendant] to feel helpless and turn over all aspects of the case *412to Gorosh;” that Gorosh “put his own interests ahead of those of his client;” that Gorosh “sat idly by as inappropriate comments were made in the presence of the jury;” that Gorosh “allowed the relationships among co-counsel to deteriorate to such a point that it was impossible for them to provide effective assistance to [defendant];” that Gorosh “allowed his relationship with his client ... to deteriorate to such a point that it was impossible to provide effective assistance;” that Gorosh “did not maintain adequate communication” with defendant; and that Gorosh’s behavior in the courtroom was “totally inappropriate.” Indeed, at one point, defendant actually suggests that Gorosh did not allow Dwyer to sit next to defendant at trial “so that she could provide advice.” Further, defendant alleges that Gorosh threatened to tell the trial court that Dwyer’s pretrial motion to quash the murder count was “ridiculous.”83

Lost in this corrosive barrage of verbiage is the simple fact that on March 22, 1999, the relationship between defendant and Gorosh changed completely. Before March 22, Gorosh and Dwyer represented defendant as trial counsel; from March 22 through March 25, defendant represented himself with Gorosh and Dwyer serving as standby counsel. With respect to the period before March 22, as nearly as we are able to determine, defendant claims that Gorosh was ineffective because he moved to quash the assisted suicide charge and because he was unqualified and incompetent.

*413(2) THE MOTION TO QUASH THE ASSISTED SUICIDE CHARGE

There is no question that Gorosh represented defendant when the defense filed a pretrial motion to dismiss the assisted suicide charge. Had the jury been presented with the assisted suicide charge and decided to convict him of that charge rather then murder, then defendant would have had a prison term no longer than four years and a fíne not exceeding $2,000. By removing this charge, the jury was forced to consider convicting him of first-or second-degree murder, both of which carry much stiffer prison terms.84

In denying defendant’s motion for a new trial regarding this claim, the trial court stated:

Defendant argues ineffective assistance of counsel due to trial counsel’s alleged error in moving to dismiss the assisted suicide charge despite the urgings from co-counsel as well as others, to refrain from making such a motion. Defendant’s argument is without merit, evidencing neither harm to Defendant nor a claim for ineffective assistance of counsel. The Court, in fact, denied counsel’s motion to dismiss the assisted suicide charge in the Court’s Opinion and Order dated March 9, 1999 and further, the People dismissed said charge on their own motion.

We fully agree with the trial court. Even if Gorosh performed deficiently by bringing the motion, defendant cannot demonstrate that doing so caused him any prejudice. The trial court itself protected what defendant now contends was an essential component of his defense by denying the motion. Moreover, on *414March 12, 1999, the prosecutor declined to proceed on the assisted suicide charge, pursuing only the charges of first-degree murder and delivering a controlled substance. Gorosh had no influence over the prosecutor’s decision to take this action. There is no possibility that, but for Gorosh’s decision to move to dismiss the assisted suicide charge, the outcome would have been different in this case.

Further, Gorosh’s decision to seek dismissal of the assisted suicide charge may have been a matter of trial strategy. Dining the motion hearing, Gorosh argued for dismissal of the first-degree murder charge and, in the alternative, the assisted suicide charge. Gorosh presented a lengthy and coherent argument that the first-degree murder charge should be dismissed because defendant’s conduct fell within the “participation language” in the assisted suicide statute. In the alternative, he explained that if the participation language did not encompass the facts of this case, the assisted suicide charge should be dismissed. Gorosh pursued dismissal of the murder charge, which clearly was a good strategy that would have benefited defendant had it succeeded. The request to dismiss the assisted suicide charge was merely an alternative Gorosh crafted, at least in part, because of the possibility that the trial court would allow the prosecutor to proceed on the murder charge; in fact, Gorosh stated as much during the motion hearing. This Court does not substitute its judgment for counsel’s judgment regarding trial strategy.85 That the strat*415egy Gorosh chose ultimately failed does not constitute ineffective assistance of counsel.86

Although defendant relies on Dwyer’s affidavit averring that she urged Gorosh not to file the motion, Dwyer herself signed the pleading immediately below Gorosh’s signature. Defendant also filed his own motion to dismiss all the charges against him, including the assisted suicide charge. This was, evidently, a strategy to which every member of the defense acceded. Defendant cannot now claim that this strategy denied him his right to effective assistance of counsel. To allow him to do so, to use the well-worn adage, would permit him to “harbor error as an appellate parachute.”87

(3) GOROSH’S QUALIFICATIONS AND COMPETENCE

Defendant also claims that Gorosh was not qualified to handle his defense. In making this argument, defendant relies on the affidavits from Dwyer and Michael Schwartz, a former partner at the law firm where Gorosh was employed. According to Schwartz, Gorosh had been practicing for only three years, had limited experience, and had never tried a homicide case. As defendant put it, “Gorosh was running the show, despite his lack of competence to do so alone.”

This claim does not warrant a new trial on the basis of ineffective assistance of counsel. Inexperience alone is not enough to conclude that a defense counsel acted deficiently or in a manner that prejudiced the defendant. As the comment following MRPC 1.1 notes:

*416A lawyer need not necessarily have special training or prior experience to handle legal problems of a type with which the lawyer is unfamiliar. A newly admitted lawyer can be as competent as a practitioner with long experience .... Competent representation can also be provided through the association of a lawyer of established competence in the field in question.

Indeed, Gorosh was, before this trial, associated with a law firm and lawyers who had substantial experience with this defendant and the similar prosecutions instituted against him. Further, defendant never brought any dissatisfaction with Gorosh to the trial court’s attention, nor did he seek to end his relationship with Gorosh until after his sentencing. On the first day of trial after defendant indicated that he wished to represent himself, the trial court asked him whether he was dissatisfied with counsel. Defendant stated, “There’s no dissatisfaction.” In fact, defendant said that he had “planned” to proceed in propria persona “all along.” The trial court again asked defendant whether he was dissatisfied with counsel and he responded that he was not, but that there were certain points that he could bring out better than an attorney. Further, during jury deliberations, defendant again chose to have Gorosh represent him during sentencing. Moreover, defendant has failed to demonstrate that, but for Gorosh’s alleged deficiencies, the outcome of the trial would have been different.

D. GOROSH’S REPRESENTATION AFTER MARCH 22, 1999

(1) OVERVIEW

Defendant argues that Gorosh’s performance during the trial itself was so deficient and prejudicial that it constituted ineffective assistance of counsel, assert*417ing that Gorosh was unprepared, withheld advice, ignored his wishes, “shut out” Dwyer, and was concerned only with his own reputation. Inherent in this argument is the assumption that we should evaluate Gorosh’s performance as standby counsel in accordance with the same legal standards that we would use in connection with the evaluation of full-blown trial counsel. This assumption is unwarranted. However, even if we were to apply the standards in the line of cases following Pickens to evaluate Gorosh’s performance as standby counsel, we would still conclude that defendant was afforded the representation the constitution guarantees.

(2) THE RIGHT TO SELF-REPRESENTATION

The United States Constitution,88 the Michigan Constitution,89 and MCL 763.1 each guarantee a criminal defendant the right to represent himself.90 As the United States Supreme Court noted in Faretta v California,91 the right of self-representation is deeply rooted in English legal history:

In the long history of British criminal jurisprudence, there was only one tribunal that ever adopted a practice of forcing counsel upon an unwilling defendant in a criminal proceeding. The tribunal was the Star Chamber. That curious institution, which flourished in the late 16th and early 17th centuries, was of mixed executive and judicial character, and characteristically departed from common-law tradi*418tions. For those reasons, and because it specialized in trying “political” offenses, the Star Chamber has for centuries symbolized disregard of basic individual rights. The Star Chamber Court not merely allowed but required defendants to have counsel. The defendant’s answer to an indictment was not accepted unless it was signed by counsel. When counsel refused to sign the answer, for whatever reason, the defendant was considered to have confessed. Stephen commented on this procedure: “There is something specially repugnant to justice in using rules of practice in such a manner as to debar a prisoner from defending himself, especially when the professed object of the rules so used is to provide for his defense.” The Star Chamber was swept away in 1641 by the revolutionary fever of the Long Parliament. The notion of obligatory counsel disappeared with it. [92]

In upholding a criminal defendant’s right to represent himself, the Court recognized that there was a tension between the right to self-representation and the right to assistance of counsel:

There can be no blinking the fact that the right of an accused to conduct his own defense seems to cut against the grain of this Court’s decisions holding that the Constitution requires that no accused can be convicted and imprisoned unless he has been accorded the right to the assistance of counsel. For it is surely true that the basic thesis of those decisions is that the help of a lawyer is essential to assure the defendant a fair trial. And a strong argument can surely be made that the whole thrust of those decisions must inevitably lead to the conclusion that a State may constitutionally impose a lawyer upon even an unwilling defendant.

But it is one thing to hold that every defendant, rich or poor, has the right to the assistance of counsel, and quite another to say that a State may compel a defendant to accept a lawyer he does not want. The value of state-*419appointed counsel was not unappreciated by the Founders, yet the notion of compulsory counsel was utterly foreign to them. And whatever else may be said of those who wrote the Bill of Rights, surely there can be no doubt that they understood the inestimable worth of free choice.[93]

Here, defendant made a free choice to represent himself. He clearly and unequivocally waived his right to counsel. Indeed, defendant does not claim that he somehow retained his right to counsel at trial or that the trial court failed to comply with the necessary requirements regarding a proper waiver. As the Court also noted in Faretta, a defendant who exercises the free choice to represent himself faces certain consequences:

The right of self-representation is not a license to abuse the dignity of the courtroom. Neither is it a license not to comply with relevant rules of procedural and substantive law. Thus, whatever else may or may not be open to him on appeal, a defendant who elects to represent himself cannot thereafter complain that the quality of his own defense amounted to a denial of “effective assistance of counsel.” [94]

Therefore, defendant cannot now suggest that his free choice to represent himself, standing alone, denied him effective assistance of counsel. As the trial court accurately put it, defendant cannot use his waiver of trial counsel as both a sword and a shield in order to achieve the outcome he desires.

(3) “HYBRID” REPRESENTATION

Defendant suggests, however, that he actually proceeded with a type of “hybrid” representation. This *420argument is wholly unconvincing. In denying defendant’s motion for a new trial, the trial court stated that it had denied defendant’s request to proceed with a hybrid defense. In his brief, defendant even acknowledges that the trial court denied this request. Further, contrary to defendant’s suggestion, there is no constitutional right to a hybrid defense and, thus, a trial court is not required to order hybrid representation.95

Defendant, however, argues that “hybrid representation can be and has been allowed in appropriate situations.” In support of this assertion, he cites two Michigan cases, People v Ramsey96 and People v Griffen97 In Ramsey, this Court cited Faretta for the proposition that “ ‘standby counsel’ may be appropriate to assist a defendant who represents himself.”98 Again referring to Faretta, as well as Chief Justice Burger’s concurrence in Mayberry v Pennsylvania,99 this Court went on to say that “these cases do not stand for the proposition that a defendant has a right to share trial defense responsibilities with an attorney.”100 Only in a footnote did this Court suggest that hybrid representation “might be appropriate in some cases[.]”101 Even then, this Court still noted that “the administrative difficulties inherent in such a scheme *421are apparent.”102 Though making this vague and definitely hedged statement, this Court in Ramsey still affirmed the trial court’s decision to deny the defendant a form of hybrid representation. This dictum in Ramsey provides no basis for us to conclude that the trial court erred here in denying defendant’s request for hybrid representation.

The very short discussion of representation in Griffen provides no more support for defendant’s argument. In Griffen, the

[defendant requested that his assigned counsel be dismissed. This request was granted but at the judge’s request, counsel remained to help defendant, if needed. Counsel conducted the voir dire examination of the jury and cross-examined some witnesses. Defendant’s claim of reversible error because he was denied his right to proceed in propria persona is not sustained on this record.[103]

Thus, Griffen stands for the negative proposition that allowing hybrid representation does not compromise a defendant’s right to proceed in propria persona. It certainly does not stand for the affirmative proposition that a failure to allow hybrid representation constitutes error requiring reversal.

Defendant fares no better in citing federal precedent. He refers us to United States v Hill104 and to United States v Tutino.105 In Hill, the United States Court of Appeals for the Tenth Circuit interpreted numerous federal opinions as “not foreclos[ing] a trial judge from allowing hybrid representation in appropriate cases; rather, they indicate no right to hybrid *422representation exists.”106 In Tutino, the court wrote that “[t]he decision to grant or deny ‘hybrid representation’ lies solely within the discretion of the trial court.” Tutino, which explicitly noted “that a criminal defendant has no constitutional or statutory right to represent himself as co-counsel with his own attorney,” plainly did not reach the holding defendant wishes us to reach in this case.107 Whatever “appropriate” circumstances might explain a trial court’s decision to allow a defendant to proceed with hybrid representation, defendant has failed to demonstrate that they existed here.

(4) STANDBY COUNSEL

Defendant also claims that he was denied the effective assistance of counsel when Gorosh functioned as standby counsel. A defendant who asserts his right to self-representation has no absolute entitlement to standby counsel.108 As the Michigan Supreme Court explained in People v Dennany,109 “[A] defendant has a constitutional entitlement to represent himself or to be represented by counsel — but not both.” Consequently, the Court held in Dennany that Const 1963, art 1, § 13 “permits the use of standby counsel as a matter of grace, but not as a matter of right.”110

The defendant in McKaskle v Wiggins111 placed the proper role of standby counsel squarely in front of the United States Supreme Court. In McKaskle, defen*423dant Carl Wiggins vacillated between asserting his right to represent himself and his right to assistance of counsel at both of his trials.112 On appeal, Wiggins claimed that his standby counsel impinged on his right to present his own defense, as Faretta guaranteed.113 As Justice O’Connor put it, Wiggins contended that his right to represent himself “was impaired by the distracting, intrusive, and unsolicited participation of counsel throughout the trial.”114

The Court agreed with Wiggins’ underlying premise that a defendant who represents himself “must be allowed to control the organization and content of his own defense, to make motions, to argue points of law, to participate in voir dire, to question witnesses, and to address the court and the jury at appropriate points in the trial.”115 However, the Court concluded that Wiggins had been “accorded all of these rights.”116 Further, the Court noted that the right to self-representation “must impose some limits on the extent of standby counsel’s unsolicited participation.”117 Consequently, the Court held that a defendant who represents himself “is entitled to preserve actual control over the case he chooses to present to the jury” and that “participation by standby counsel without the defendant’s consent should not be allowed to destroy the jury’s perception that the defendant is representing himself.”118

*424Applying its holding to the facts of the case, the Court noted that the performance of Wiggins’ standby counsel “should not serve as a model for future trials,” but the Court nevertheless determined that standby counsel's participation at trial “fell short of infringing on Wiggins’ [Faretta] rights.”119 In essence, the Court held that while the standby counsel may have been rather assertive and somewhat obnoxious, he did not do too much.

Here, defendant asserts the opposite. He claims that Gorosh did too little. Defendant placed himself in the unenviable position of suggesting that, in light of his own inadequacies in representing himself at trial, Gorosh should have done more to help him. McKaskle stands for the proposition that a defendant who represents himself is entitled to maintain actual control over the case, which standby counsel cannot destroy by altering the jury’s perception that the defendant is representing himself. In other words, “the right to appear pro se can lose much of its importance if only the lawyers in the courtroom know that the right is being exercised.”120 Conceptually, it is difficult to conceive of a situation in which a reticent, rather than an assertive, standby counsel could wander into either of these two protected areas. In the absence of a right to standby counsel or even a right to hybrid representation, McKaskle provides an intellectual foundation for the proposition that a defendant who chooses to represent himself does so at his own peril. With no constitutional right to an attorney, a defendant proceeding in propria persona has no basis to claim that the attorney must abide by constitutional standards.

*425Two federal opinions support this view. In United States v Schmidt,121 the defendant claimed that the attorney appointed to serve as standby counsel at trial was “so deficient and prejudicial to her that it constituted ineffective assistance of counsel.”122 This was a mirror image of the argument in McKaskle; the defendant in Schmidt asserted that her attorney did too little rather than too much. The Schmidt court rejected this argument for three reasons. First, the defendant had waived her right to counsel when she asserted her right to represent herself.123 Second, the defendant did not have the right to hybrid counsel.124 Rather, “[ajbsent a constitutional right to standby counsel, a defendant generally cannot prove standby counsel was ineffective.”125 As the court remarked:

As might be expected, a standby counsel’s duties are considerably more limited than the obligations of retained or appointed counsel. . . . Although [the defendant’s standby counsel’s] role expanded as the case continued, he did not play the same role that defense counsel normally would in preparing the strategy for a criminal defense. Perhaps in a case where standby counsel held that title in name only and, in fact, acted as the defendant’s lawyer throughout the proceedings, we would consider a claim of ineffective assistance of standby counsel. This is not such case. Because [the defendant] proceeded pro se, she may not now assign blame for her conviction to standby counsel[126]

*426Third, the court concluded that even if the traditional test for evaluating ineffective assistance of counsel claims was applied, the defendant’s standby attorney passed the constitutional threshold for performance and there was no evidence of prejudice.127

The more recent decision in United States v Morrison128 interpreted Schmidt-.

As we held in Schmidt, without a constitutional right to standby counsel, a defendant is not entitled to relief for the ineffectiveness of standby counsel. While we stated in Schmidt that we might entertain a claim for ineffective assistance of standby counsel if standby counsel “held that title in name only and, in fact, acted as the defendant’s lawyer throughout the proceedings,” the record indicates that Morrison retained control of his own defense throughout the proceedings, so that his standby counsel was in reality, as well as in name, only that.

Going one small step beyond Schmidt, the court in Morrison concluded that this rule of law did not require the additional, and therefore superfluous, process of determining whether standby counsel was effective.

We find this reasoning in Schmidt and Morrison persuasive. From March 22 through March 25, defendant represented himself. During this time, Gorosh was his standby counsel in reality as well as in name. Because defendant chose to represent himself during this period, he may not now assign blame for his conviction to Gorosh. Further, Gorosh did nothing to interfere with defendant’s right to control the case or to alter the jury’s perception that defendant was rep*427resenting himself. In short, during this period, Gorosh was not acting as counsel within the meaning of the Sixth Amendment or Const 1963, art 1, § 13 and, therefore, cannot be held to the standards of effective assistance required of trial counsel. In any event, Gorosh’s performance as standby counsel did not fall below an objective standard of reasonableness and defendant has made no showing that, but for Gorosh’s alleged errors, the result of the proceedings would have been different.

E. THE “SERIOUS MISTAKE” DOCTRINE

Defendant claims that he is entitled to a new trial under the common-law “serious mistake” standard for evaluating ineffective assistance of counsel claims. Substantively, he claims that Gorosh’s failures, described in his traditional ineffective assistance of counsel argument, also constituted a violation of this serious mistake doctrine. The cases defendant cites129 as announcing this serious mistake doctrine rely on People v Garcia.130 In Garcia,131 the Michigan Supreme Court relied on the statement in People v Degraffenreid,132 that

“[a] claim that an adequate lawyer made a serious mistake does not raise the constitutional issue of the right to counsel; it does not involve the concept of ‘effective assistance of counsel,’ it should not be measured against the sham trial standard which circumscribes the constitutional right.”

*428Thus, the Court in Garcia held that

even where assistance of counsel satisfies the constitutional requirements, defendant is still entitled to a fair trial. Defendant can be denied this right if his attorney makes a serious mistake. But a court should not grant a new trial unless it finds that but for this mistake defendant would have had a reasonably likely chance of acquittal.[133]

Subsequently, the United States Supreme Court set forth the federal standard for determining whether a defendant received the effective assistance of counsel in Strickland, supra, which the Michigan Supreme Court adopted in Pickens.134 Having moved away from the “sham trial” test previously used to analyze effective assistance of counsel claims, which was the basis for the comment in Degraffenreid regarding an attorney’s serious mistake,135 the Pickens Court reexamined Garcia:

Our Court of Appeals . . . has interpreted this Court’s decision in Garcia as requiring the reversal of a conviction even if defense counsel's ineffective assistance did not prejudice the defendant. While we recognize that the opinion is less than a model of clarity and might be so interpreted, such a procedure is not mandated by federal law. Garcia essentially relied on Sixth and Fourteenth Amendment jurisprudence, and did not formulate the standard from the intentions, history, or common law undergirding the Michigan Constitution. Garcia, therefore, does not stand for the proposition that the Michigan Constitution was intended to grant stronger protections than federal authority with regard to the standards applied to the issue of ineffective assistance of counsel.[136]

*429Thus, in Pickens, the Michigan Supreme Court put to rest any notion that there is an alternative, common-law test for effective assistance of counsel. Again, defendant has failed to provide any persuasive authority to disprove this clear decision in Pickens, which excuses us from engaging in an exhaustive search of our own.137 As the First Circuit Court of Appeals so aptly put it, “It is not enough merely to mention a possible argument in the most skeletal way, leaving the court to do counsel’s work, create the ossature for the argument, and put flesh on its bones.”138 Moreover, even if there were such a standard for an attorney’s conduct, the same flaws in defendant’s reasoning concerning Gorosh’s performance apply in this context, especially because he wholly relies on his arguments concerning ineffective assistance to outline what he considers serious mistakes. Thus, there is no merit to this issue.

V. DEFENDANT’S CLOSING STATEMENT

A. FACTS AND ARGUMENT

Defendant gave his own closing argument to the jury on March 25, 1999. Although he did not testify at the trial, at several points in his closing argument defendant injected what would appear to be first-person testimony:

[Defendant]: Next time he [the prosecutor] uses the word “kiU” or “murder” please ask yourselves, please — why? Did you ever ask him why I did that, why I did this act he calls killing? He says just to murder Thomas Youk that’s all, to *430kill him .... Next time he [sic] you hear him utter kill, say why, and when.

Why then? Why on the 17th of September? Why not a month earlier or three years earlier? Ask him why not earlier didn’t he call me to kill him. Those are unanswerable questions. He can’t answer those. Why did Tom Youk call name [sic] on the 15th of [sic] 16th? Why did he call me? Because he had—

[The Prosecutor]: Well, objection, Judge. He can’t testify now. He can’t tell the facts now. That portion’s over.

The Court: You have something in evidence. We don’t know whether he’s going to talk about what’s in evidence.

* *

[The Defendant]: I staged the whole thing. Really. I’m not much of a producer or a director in movies. We — I wanted to protect the family from possible charges—

[The Prosecutor]: Objection, objection. Again, he’s testifying. He can’t put facts into—

[The Defendant]: I’m trying to show why I did it.

[The Prosecutor]: He cannot put facts before the jury which might not have been proven before or through testimony or other evidence. He cannot testify now.

[The Defendant]: There were no witnesses there. Now can I say why?

[The Prosecutor]: I’m objecting.

The Court: Well, sir, it depends on how you phrase it.

[The Defendant]: There were no witnesses there because I didn’t want anyone else—

[The Prosecutor]: Objection.

[The Defendant]: — implicated.

[The Prosecutor]: Objection.

[The Defendant]: Well, that’s — can I say why?

[The Prosecutor]: Judge, you know, he could have gotten on — you know, he didn’t—

*431[The Prosecutor]: — He didn’t — he can’t testify now. He cannot testify now.

[The Defendant]: Why — why I took so much time with the needle down here. Can I say that?

The Court: You can comment about what is in evidence. You can comment about what is on the tape.

[The Defendant]: I took my time down here in this one vein, trying to get a small vein, trying to keep—

[The Prosecutor]: Your Honor, I’m going to object again. He’s now testifying. He’s putting new facts before the jury. He can’t do that

[The Defendant]: Okay. The covering up of the needle sticks was to try to keep this—

[The Prosecutor]: Objection.

[The Defendant]: Well, you talked about the needle sticks.

[The Prosecutor]: You can’t say — Judge, he’s giving reasons for these things. That has to come through testimony. It can’t be presented through his closing argument to the jury.

The Court: You may make argument about what they saw, but you can’t introduce something new. Okay?

[The Defendant]: After they saw the slip of paper on the floor with my name on it, this became known. It became known. Why didn’t I come forward immediately after I did it? It became known only after they discovered my name on it and then I know — everyone knew it would become known. It wasn’t done for staging, it wasn’t done to show. It wasn’t videotaped for that purpose. And why was a narration, which he brings up? Can I give reasons for the narration?

[The Prosecutor]: I object.

[The Defendant]: That’s the implication given by the prosecutors and other — other antagonists, implying that it’s very cursory, that I don’t really know these patients, I don’t know anything about them. No doctor who’s got integrity and is competent would proceed without definitive medical *432information on the patient. The only point is they don’t have that information. I do.

[The Prosecutor]: Well, objection. The jury doesn’t have that, either. Again, I’m going to object to him putting in facts that didn’t come in during trial.

The Court: Let’s see if we can break this down. You may comment about anything that’s in evidence. You may not comment about anything he said. You just can’t introduce something.

The next day, while the jury was deliberating, defendant moved for a mistrial on the basis of the prosecutor’s comments. The trial court denied the motion.

Defendant now contends that the prosecutor, while objecting to his closing arguments, several times improperly referred to defendant’s decision to exercise his right to remain silent. Although defendant later moved for a mistrial, he failed to object to the prosecutor’s comments at the time the prosecutor made them. According to Gorosh, this was a calculated decision not “to disrupt the flow of closing” and an effort “to get a copy of the transcript” of the prosecutor’s comments to be used for the motion for a mistrial.

B. PRESERVATION AND STANDARD OF REVIEW

Defendant failed to preserve this issue for appeal by objecting to the prosecutor’s allegedly improper comments in a timely fashion.139 Accordingly, our review is limited to determining whether the comments were plain error that affected defendant’s substantial rights.140

*433C. RIGHT NOT TO TESTIFY

Neither a prosecutor nor a trial court may comment on a defendant’s decision to exercise his constitutional right not to testify.141 Published state precedent does not address the precise situation presented in this case. The cases that defendant cites are distinguishable because they do not involve a defendant who proceeded in propria persona. However, People v Marcus Jones142 is instructive.

In Marcus Jones, while the prosecutor was giving his closing argument to the jury, the prosecutor described a piece of trial testimony, prompting the defendant to interject, “ ‘They didn’t say that.’ ”143 The trial court admonished the defendant, stating, “ ‘If you want to testify, sir, your chance to do that is over with you [sic]. You can’t sit there — listen Mister — you had an opportunity to testify. You can’t testify now.’ ”144 Defense counsel then objected, prompting the trial court to ask: “ ‘Objection to what? He’s out now speaking, [defense counsel] [sic]. He had that opportunity. The jury knows that. He can’t have it both ways, sir.’ ”145

Though this Court reversed the defendant’s conviction in an unpublished opinion per curiam, issued July 10, 1992 (Docket No. 127207), the Michigan Supreme Court, in lieu of granting leave to appeal, peremptorily vacated the judgment of this Court and remanded the matter to this Court for reconsidera*434tion.146 After acknowledging that “neither the prosecutor nor the trial court may comment on the defendant’s exercise of his constitutional right not to testify,” the Supreme Court nevertheless concluded that the trial court’s remarks were a proper response to the defendant’s interruption. Further, the Court noted, “[t] hough awkwardly phrased, the judge’s statements were consistent with his obligation to maintain orderly proceedings and proper decorum in the courtroom.”147 Finally, the Court concluded that the defendant was not entitled to a new trial, having not been denied a fair trial in the first instance.148

The Mississippi Supreme Court reached a similar conclusion in Larry Jones v State.149 The defendant in Larry Jones did not testify during trial, but chose to argue the sentencing phase of his capital murder prosecution.150 During his argument, the defendant referred to facts that were not in evidence.151 Consequently, the prosecutor objected in the presence of the jury:

That’s testifying and there’s no way to contradict that and it’s not fair, Judge, if he doesn’t take the stand and let the State cross examine him on this but to stand up here and to be able to do something that the State does not have a right to cross examine him on is not proper .... The State didn’t have a right to call him, Judge. We couldn’t put him on the stand [152]

*435The Mississippi Supreme Court acknowledged that defendants must make a difficult choice between arguing their own case and invoking the right not to testify.153 However, the court remarked that

[a] criminal defendant who takes advantage of his right to argue his case to the jury must not be permitted to say all the things he might have testified to had he chosen to call himself as a witness. When he does so, he will be deemed to have waived the right not to have his failure to take the stand commented upon.[154]

Though the court noted that a defendant representing himself still had to follow the court rules, it nevertheless indicated that trial courts should give these defendants some “leeway” in arguing their case.155 However, the court cautioned:

[I]n those instances where a defendant, arguing pro se, clearly goes beyond the evidence in the record on a material point, as he did in this case, he must accept as a consequence the prosecution’s comment on his failure to swear to the testimony. The defendant’s remarks in this case cannot be dismissed as a failure to grasp “legal niceties.” They are unsworn testimony, and as such, constitute a partial waiver of the constitutional privilege against self-incrimination and the prohibition against a district attorney from commenting on his not taking the stand.

We do not say that every defendant who argues pro se loses the privilege against prosecutorial comment on his failure to testify. Only when the defendant’s remarks go beyond the evidence does he waive this privilege.[156]

*436Thus, as did the Michigan Supreme Court in Marcus Jones, the Mississippi Supreme Court in Larry Jones concluded that there was no error requiring reversal because the “defendant’s own statements which were exculpatory and self-serving in nature, not under oath and not supported by the record,” prompted the prosecutor to make the comment at issue.157

The Missouri Supreme Court used a variation of this “proper response” rationale in State v Brannson158 to reject the defendant’s contention that the prosecutor’s objections and remarks improperly referred to his decision not to testify though proceeding in propria persona. Describing the context in which the references to the defendant’s decision not to testify arose, the Brannson court explained:

This is not a case in which a defendant sits mute at counsel table and the prosecution points up the defendant’s failure to testify. On the contrary, this is a case in which defendant undertook his own defense and during his protracted trial participation effectively injected himself into the mainstream of the evidence. He attempted not only to argue the various points in issue but in the presentation of evidence through his lengthy interrogation of the State’s witnesses, sought repeatedly to state as facts items not otherwise in evidence and in certain instances to establish as fact matters of which the witnesses had no knowledge. Clearly these were points which defendant considered vital to his case and on which he was apparently otherwise unable or unwilling to obtain proof. In effect he was attempting in that manner to testify to these otherwise unproved “facts.” The objections of the prosecutor to those attempts of defendant, some of which were successful, some not, accurately pointed out what defendant was trying to do — and lodged the objections in those terms (e.g., defendant “is *437attempting to testily to that.” “He’s trying to testify.” “Defendant is again trying to testify.”). The objections went to the form of the questions and in several instances were sustained. .. . [T]his is not a case in which defendant failed or refused to testify and in which comment was made on that fact. Indeed it is the opposite. Defendant sought in the jury’s presence to state as evidence matters not in proof and in so doing he sought to testify without having been sworn and the prosecutor objected for that reason in those terms [159]

The Brannson court then described a rule that was easy to apply:

The orthodox standard prohibiting comment by the prosecution on the failure of the accused to testify is applicable when the accused is silent, but when the accused conducts his own defense and attempts — innocently or otherwise — to testify or to inject facts not in evidence into the case, a different problem arises. For then it is defendant’s “attempt to testify” to which objection is made [160]

In the absence of a “direct and unequivocal” reference to the defendant’s right not to testify, the court held that there was no error requiring reversal.

Here, the prosecutor’s objection to defendant’s failure to testify fits squarely within the reasoning of both Jones cases and Brannson. Defendant’s decision to testify to the jury during closing arguments rather than commenting on the evidence admitted at trial prompted the prosecutor’s response. Defendant’s comments can only be characterized as repeated and improper attempts to present the jury with facts not in evidence. The prosecutor’s comments were properly focused on preventing defendant from continuing *438down this wrong path. The prosecutor’s comments certainly were not the sort of “direct and unequivocal” reference the court in Brannson would have found plain error requiring reversal. To defendant’s benefit, the trial court also instructed the jury that every defendant has an absolute right not to testify, that the jurors must not consider the fact that defendant did not testify, and that this fact must not affect their verdict in any way. In sum, given the circumstances of this case, we conclude that defendant has failed to demonstrate a plain error requiring reversal. We note that our conclusion does not hinge, as did the Mississippi Supreme Court’s decision in Larry Jones, on the notion that the defendant partially waived his constitutional privilege against self-incrimination when his remarks went beyond the evidence. We simply conclude that the prosecutor’s objections and comments did not constitute direct and unequivocal references to defendant’s failure to testify. Rather, they merely amounted to objections to defendant’s repeated and improper attempts to inject facts not in evidence into his closing statement.

VI. TESTIMONY OF TERRENCE AND MELODY YOUK

A. FACTS AND ARGUMENT

Before trial, the prosecutor moved to preclude defendant from asserting the defenses of consent and euthanasia and from introducing any irrelevant testimony regarding Youk’s medical condition, pain and suffering, and quality of life and to prevent a jury nullification argument. In its opinion and order, the trial court granted the prosecutor’s motions, but allowed evidence of Youk’s pain and suffering and quality of *439life where such evidence related to the assisted suicide charge that was still pending at that time. When the prosecutor decided not to pursue the assisted suicide charge, defendant asked the trial court to reconsider its decision to exclude evidence of Youk’s pain and suffering, among other things. The trial court denied this motion.

When defendant submitted his witness list, however, it included Melody and Terrence Youk. The trial court instructed defendant that he needed to make an offer of proof concerning the two witnesses. On the second day of trial, defendant made an offer of proof indicating that Terrence Youk would testify that defendant did not intend to murder Thomas Youk. With regard to Melody Youk, defendant indicated that her testimony was relevant to Thomas Youk’s background and his own intent.

The trial court made a special record regarding defendant’s offer of proof. Melody Youk testified that when she met with defendant, she explained Youk’s condition and she indicated that they understood that defendant may be able to “assist [them] in relieving his pain and suffering.” According to Melody Youk, in a subsequent conversation, she, Terrence Youk, and defendant discussed what defendant could do “to bring an end to this situation.”

Defendant argued that Melody Youk’s testimony was relevant to establish Thomas Youk’s state of mind and defendant’s perception. In response, the prosecutor argued that Melody Youk’s testimony related to consent and euthanasia, which were not recognized defenses to murder, and that Melody Youk’s testimony did not concern defendant’s state of mind. The trial court then allowed defendant to question Melody Youk further. She testified that she never told defen*440dant that her intent was to have defendant kill Youk and that they never discussed the words “kill or murder.” Defendant again argued that Melody Youk’s testimony was relevant to show that he did not intend to kill Youk.

Following arguments of the parties, the trial court ruled that Melody Youk’s testimony was not appropriate. The trial court stated that defendant was attempting to introduce evidence of a mercy killing, which is not cognizable under state laws, and that his proffered evidence related to the law and a legal argument or debate, which do not go before a jury. The trial court also stated that the fact that Melody Youk did not want defendant to “do something” was not relevant to defendant’s state of mind. The trial court reiterated that any consent to defendant’s action was irrelevant.

With regard to Terrence Youk’s testimony, defendant argued that he had a constitutional right to kill a patient. The trial court ultimately ruled that Terrence Youk’s proposed testimony was hearsay and irrelevant. The issue was again raised during defendant’s motion for bond pending appeal and the trial court again ruled that the offer of proofs indicated that the witnesses would only testify concerning euthanasia and consent, which were not legally cognizable defenses.

Defendant now argues that the trial court erred in barring him from calling Terrence and Melody Youk to testify at trial. Defendant contends that Terrence and Melody Youk were res gestae witnesses because they were listed on the police report and were familiar with certain circumstances surrounding Youk’s death. Further, defendant asserts, Terrence and Melody Youk could have testified about Youk’s death, the *441effect of his disease, his daily life conditions, and his consent, as well as rebutting the prosecutor’s argument that defendant’s purpose was to seek publicity and to advance his own agenda.

B. STANDARD OF REVIEW

The trial court has discretion when considering whether to admit evidence.161 Thus, we review the trial court’s decision to exclude this evidence for an abuse of that discretion.162

C. RES GESTAE WITNESSES

Defendant states that because Terrence and Melody Youk were res gestae witnesses, “the Prosecutor himself was obligated to call [them] to the stand.” In making this claim, defendant apparently relies on MCL 767.40a163 as it appeared before the Legislature amended it in 1986,164 as well as the cases interpreting that former version of the statute. However, under the current version of the statute, the prosecutor no longer has a duty to produce res gestae witnesses.165 Instead, the prosecutor has a continuing duty to advise the defense of all res gestae witnesses that the prosecution intends to produce at trial.166 “Put in other terms, the prosecutor’s duty to produce res gestae witnesses was replaced with the duty to provide notice of known witnesses and to give reasonable assistance in the locating of witnesses if a defendant *442requests such assistance.”167 Thus, even if Terrence and Melody Youk could be considered res gestae witnesses, the prosecutor had no duty to produce them to testify.

D. RELEVANCE

We have a separate, and further, rationale for affirming the trial court’s decision to exclude this evidence. As the trial court noted repeatedly, the two witnesses simply had no relevant testimony to offer to the jury. “ ‘Relevant evidence’ means evidence having any tendency to make the existence of any fact that is of consequence to the determination of the action more probable or less probable than it would be without the evidence.”168 A variety of factors, including the elements of the charged crimes, the theories of admissibility, and the defenses asserted all help determine whether any particular piece of evidence is relevant.169

The testimony Terrence and Melody Youk would have provided to the jury concerned Youk’s medical condition, pain, suffering, and the conditions of his daily life, as well as his consent. By proffering such evidence, defendant sought to justify killing Youk. In fact, although defendant claims that he proffered their testimony for other reasons, the crux of his claims consistently relate to consent and euthanasia. Simply put, consent and euthanasia are not recognized defenses to murder. As the trial court noted, “[a] trial court may exclude from the jury testimony *443concerning a defense that has not been recognized by the Legislature as a defense to the charged crime.”170 Thus, Terrence and Melody Youk’s testimony was inconsequential to the determination of this case.

Within this issue, defendant also suggests that he was prejudiced because the prosecutor discussed “lack of consent” and defendant’s political and personal agenda. Defendant asserts that the testimony of Terrence and Melody Youk could have contradicted those claims. This argument is entirely unpersuasive. The trial court allowed defendant to argue that Youk consented to defendant’s actions. Further, the jury saw the videotape of Youk consenting to defendant’s actions. Similarly, defendant himself stated on the videotape and during his closing argument to the jury that his motive in killing Youk was to relieve Youk’s pain and suffering and to bring the issue of euthanasia to the forefront. Accordingly, we conclude that the trial court did not abuse its discretion in precluding Terrence and Melody Youk from testifying.

Affirmed.