Introduction
According to the ethical standards, the decisions that the society and the family members of the patient who depends on life-supporting devices makes should take into account the wishes of the patient. This is to imply that is those decisions that id in coming to a mutual understanding before terminating or progressing with the medical attention the patient receives. Taking into account the moral views of the clinical ethicist, the extent at which the brain injury the patient has is the one which can aid in understanding the appropriate medical step to take (Calabresi, 2006). When a legal case evolves, it is recommended to analysis the earlier wishes of the patient so as to come into a moral conclusion.
A large percentage of the patients who relies on life-supporting devices are said to be in an exclusive clinical state. It is, therefore, the initial views of the patient involved that mainly assists in coming to a conclusion regarding terminating or progressing with his or her medical procedures. The reason for that is because therapeutic ethics mainly begins with high-quality clinical medicine and not with the discipline of ethics. Furthermore, appropriate moral or ethical judgments regarding clinical treatment decisions cannot be implemented without the need of understanding the applicable therapeutic medicine (Darr, 1991)
Nancy Cruzan case
Facts: Nancy Cruzan, as the petitioner, was rendered incompetent because of the automobile accident she went through. The neurosurgeon who diagnosed her stated that she had developed cerebral contusions that were compounded with significant anoxia. As a result of that, it was determined that it is the permanent brain damage which resulted after six minutes was the one which made her to be in an anoxia condition. Considering Nancy Cruzan’s case, there was the need of depriving her oxygen for a period of twelve to fourteen minutes (Larson, 2005). Because of that deprivation, Nancy Cruzan remained in coma for a period of three weeks in the Missouri state hospital. So as to be in the position of easing her feeding as well as boosting her recovery, her attending surgeons decided to implant her with hydration and gastronomy feeding tube in her with the approval of her husband. Regardless of the persistent efforts they had, she ended up developing a condition termed as a persistent vegetative state. Clinically, this is a state in which an individual end up exhibiting motor reflexes which does not evince any indications of profound cognitive function (Rouse, 1991).
Assuming that she had o chance of recovering, Nancy Cruzan husband instructed the hospital workers to get rid of the artificial hydration and nutrition procedures that used to sustain her dear life. Despite that, the hospital workers declined refused to remove it because they did not have court’s approval. This forced her parents to seek the state trial court approval for the hydration and nutrition procedure. Later, the trial court found out that an individual having the same condition as her have basic the rights of refusing or directing the withdrawal or termination of death-prolonging procedures. In the process of arriving at this judgment, the trial court regarded her earlier conversations with their housemate that if she gets injured or falls seek she will not desire to end life unless she would survive at least halfway normal (Darr, 1991). The court, taking into account Nancy Cruzan’s current vegetative state, concluded that there was no need of continuing administering her with hydration and nutrition procedures.
As the case continued, Missouri’s Supreme Court reversed the decision made by the state trial court. Despite the fact that they acknowledged that an individual had the right of refusing treatment under the doctrines of informed authorization, they became skeptical about its application. Their ruling was that the previous statement of Cruzan to her roommate was unreliable in determining her intent. As a result of that, such a statement was found to be insufficient in arriving at the decision of terminating her hydration and nutrition procedure.
Issue: With regard to her case, the issue the court had in mind was whether there was a clear and persuading evidence to support the need of terminating her life supporting machine (Rouse, 1991).
Disposition of Cruzan’s case: Judgment confirmed
Ruling: From the perspective of the state trial court, it was found that there was no convincing and clear evidence that could guarantee the court to approve the termination of the hydration and nutrition supporting procedures from her.
Reasoning: In the process of arriving at that decision, the Supreme Court ended up declaring that the state had the opportunity of applying apparent convincing confirmation standards in the its court proceedings. The reason for that is because it is the one which was to assist the guardian to seek discontinuation of nutrition and hydration an individual undergoes once in a persistent vegetative condition. Therefore, it was the responsibility of the state of Missouri to decide whether to limit considerations of evidence to the earlier whish expressed by her or whether to give room for more proof of what the decision of the individual could have been (Rouse, 1991).
As the hearing of the case continued, the Missouri’ Supreme Court accepted with their holding that the evidence presented at the state trial court did not provide a convincing and clear proof of the desires of the patient to have nutrition and hydration procedures withdrawn. The reason for that is because it was not based on the early evidence that was presented by Nancy Cruzan’s parents regarding the conversation she had with her roommate. Such a confirmation complied with the observation made by the Missouri’s Supreme Court that such a statement did not involve the termination her hydration and nutrition or medical treatment procedures (Darr, 1991).
At the end of the day, the Missouri’s Supreme Court declined to provide a due route to the argument of Nancy Cruzan’s parents that they ought to acknowledge the considerable judgments of her close relatives in arriving at that crucial decision. The court ended up ruling that the Due Process Clause will end up being violated in case major decisions such as this were to be based on an individual’s desires other than that of his or her parents. Despite that fact that it is true that in case the constitution of the United States decided to offer the right substituted judgment, it was only Cruzan’s parents who would have qualified to approve the termination of her life (Larson, 2005). It implies that regardless of the judgments provided by her close relatives, there was no automatic assurance their observations were to be the same as that of her parents.
Terri Schiavo case
Facts: In February 1990, Terri Schiavo started suffering from cardiac arrest that was brought about by potassium imbalance. Immediately after the arrest, she was rushed to the nearby hospital. Despite the medical attention she was given, she never revived her consciousness. It is this state that made her to be hospitalized for fifteen years as well as being diagnosed of persistent vegetative condition. During all those years, she relied on feeding tube for hydration and nutrition. In order to ease her medical attention, her husband was appointed to be her guardian (Hoffmann, 2005). Taking into account the failure to diagnose her potassium imbalance, her husband (Michael) filled a malpractice case against the physicians who were attending her.
It is this scenario which ended up developing a feud between Terri’s parents and her husband. As time went by, her husband decided to seek the court authorization to withdraw or terminate her feeding tube procedure. Because of that, her parents alleged that her husband wanted her dead with the motive of remarrying as well as inheriting all that had remained of the financial award from the misconduct suit. Conversely, her husband thought that the intention her parents entailed preventing him from seeking the court order. Michael’s reasoning was that their parents wanted their daughter to be kept alive so that he will not have the opportunity of marrying the lady he had been with before she developed that condition (Calabresi, 2006). Otherwise, her husband would have had no option other than seeking an annulment from her in which Terri’s parents were to receive what was to be left of the financial award.
In the act of reviewing this argument, Michael Schiavo approached the jurisdiction of the Florida trial court so as to assist him in deciding whether to withdraw Terri’s feeding tube. The conclusion of the trial court was that there was a clear and persuading evidence that his wife could have preferred, if capable, to have her artificial hydration and nutrition terminated (Dute, 2005).
Issue: Determining whether there was a clear and persuading evidence that was based on his earlier conversation with Terri Schiavo to have her artificial nutrition and hydration procedures terminated.
Disposition of Terri Schiavo’s case: Ruling affirmed
Ruling: The court found out that there was a comprehensible and persuading proof that Terri Schiavo had initially expressed her views that she could have desired her artificial nutrition and hydration procedures removed.
Reasoning: After hearing the case, the appellate court acknowledged the judgment of the lower court. They approved that there was enough evidence to prove that Terri’s desire was to guarantee the removal of her artificial nutrition and hydration tube. Because of that, the court offered a due course to her earlier conversation with her husband while they were both enjoying watching a television show concerning Karen Ann Quinlan. It is during this show that Terri stated that she would not have wished to be kept in such a life-supporting machine (Hoffmann, 2005).
Later on, the appellant court also regarded the initial conversation Terri had with Joan Schiavo about Joan’s decision to withdraw the life support procedures on the latter’s child. Terri Schiavo was, therefore, alleged to have made such a remark that despite the fact that such a decision was painful, he had no option but to do it. The last incident was the remarks that Terri made with Scott Schiavo when they attended the interment of their grandmother. Before dying, their grandmother was on a ventilator (Calabresi, 2006). During that time, the remarks Terri Schievo had was that if such an incident could have occurred to her, it was logical for her family and relatives to let her go instead of keeping her alive using the life-supporting machine or tube.
Comparison between the two cases
In these two cases, the women involved were considered to be a condition regarded as persistent vegetative state. Both of them required the aid of the artificial hydration and nutrition so as to sustain their survival. Furthermore, the two cases assisted in settling the question regarding whether their parents or close relatives had the right of choosing to terminate their life-supporting machine in the affirmative.
Despite that, what made the two cases to differ is that the reasoning of the court went into different direction. Considering the case of Nancy Cruzan, the ruling of the Supreme Court was that there was no clear and persuading proof that will confirm that she wished her life-supporting tube to be withdrawn (Larson, 2005). On the contrary, in the case of Terri Schiavo, the Supreme Court discovered that there existed a clear and persuading evidence that assisted in proving that her remarks she wished her artificial nutrition and hydration tube to be terminated or removed (Calabresi, 2006). Another difference that exists in Cruzan’s case is that there was no dispute that evolved between her family members. The reason for that is because her parents too wanted the life-supporting procedure to be withdrawn so as to ease her suffering. Conversely, an intra-family disagreement evolved between her husband and her parents regarding the decision of removing her life-supporting tube or not. Ideally, Terri’s husband wanted it withdrawn while her parents did not acknowledge that decision (Darr, 1991).
The last difference found amongst the two cases is that in Nancy Cruzan’s case, a conflict evolved between her family member and the surgeons attending her. The former declined to approve the request of Cruzan’s parents to remove her life-supporting machine while the latter wanted the physician to remove it. Considering the case of Terri Schiavo, there was no disagreement that evolved between her family members and the doctors attending her (Calabresi, 2006).
Conclusion
In the process of analyzing the situation of a person who relies on life-supporting device, the decisions the treatment team and the patient’s family members comes up with should be made ethically. It is those moral considerations that can assist in ensuring that there is no conflict that arises from the patient’s family members and the treatment team. In order to make this possible, it is the responsibility of the surgeons involved to make arrange clinical consultations with the patient’s parents before seeking court ruling. The motive here entails trying to ease the psychological suffering of the patient. Taking that into consideration will aid in ending any conflict that might evolve between the parties involved in such cases. Despite that, seeking court ruling is equally vital in case the efforts the parties involved uses do not assist solving the conflict.
Nevertheless, after making some of the medical, moral, and ethical considerations, it should be understood that the decisions to be made regarding terminating or continuing with the life-supporting procedure an individual receive is not easy. Therefore, the society, family members, and the patient involved should be aware that it is the true wisdom usually evolves from the acknowledgment of the uncertainty of such cases.
References
Calabresi, S. G. (2006). The Terri Schiavo Case: In Defense of the Special Law Enacted by Congress and President Bush. Northwestern University Law Review, 100(1), 151–170. Retrieved from http://165.193.178.96/login?url=http%3a%2f%2fsearch.ebscohost.com%2flogin.aspx%3fdirect%3dtrue%26db%3daph%26AN%3d20307602%26site%3deds-live
Darr, K. (1991). After Cruzan, hospitals and the right to die. Hospital Topics, 69(4), 4. https://doi.org/10.1080/00185868.1991.10545763
Dute, J. (2005). The Terri Schiavo case in a comparative perspective. European Journal of Health Law, 12(4), 317–319. https://doi.org/10.1163/157180905775088531
Hoffmann, G. (2005). Symbolism and the Terri Schiavo Case. ETC: A Review of General Semantics, 62(3), 323–326. Retrieved from http://165.193.178.96/login?url=http%3a%2f%2fsearch.ebscohost.com%2flogin.aspx%3fdirect%3dtrue%26db%3daph%26AN%3d17533873%26site%3deds-live
Larson, E. J. (2005). From Cruzan to Schiavo: Similar Bedfellows in Fact and at Law. Constitutional Commentary, 22(3), 405–417. Retrieved from http://165.193.178.96/login?url=http%3a%2f%2fsearch.ebscohost.com%2flogin.aspx%3fdirect%3dtrue%26db%3daph%26AN%3d22097006%26site%3deds-live
Rouse, F. (1991). The Cruzan case. The Lancet, (8733), 105. Retrieved from http://165.193.178.96/login?url=http%3a%2f%2fsearch.ebscohost.com%2flogin.aspx%3fdirect%3dtrue%26db%3dedsgao%26AN%3dedsgcl.9393826%26site%3deds-live
