Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990), was a landmark United States Supreme Court case involving a young adult incompetent. The first "right to die" case ever heard by the Court, Cruzan was argued on December 6, 1989 and decided on June 25, 1990. In a 5–4 decision, the Court affirmed the earlier ruling of the Supreme Court of Missouri and ruled in favor of the State of Missouri, finding it was acceptable to require "clear and convincing evidence" of a patient's wishes for removal of life support. A significant outcome of the case was the creation of advance health directives.