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Comparative Case Analysis: Nancy Cruzan and Terri Schiavo

Abstract

This paper is aimed at comparing the cases of Nancy Cruzan and Terri Schiavo. Both patients slipped into a deep coma, and there was virtually no chance of their recovery. These women left no advanced health care directives that could help medical workers select the most optimal approach to treatment. It is often difficult for the relatives of a patient to provide convincing evidence illustrating the real intentions of this person. Apart from that, there is always a risk of conflicts between the guardians of this individual. Under such circumstances, legal professionals assume that the prolongation of a person’s life should be the top priority of the state. Therefore, they stress the need to assess the evidence that could be offered by the relatives of a patient. It is important to mention that the cases of Nancy Cruzan and Terri Schiavo invited the attention of journalists, medical workers, and lawyers.

Introduction

A person’s right to die is one of the most disputed legal and ethical questions. This argument is particularly relevant to those circumstances when an individual cannot explicitly express his/her wishes about the actions that medical workers should take. Very often, such people suffered from severe brain damages, and the chances of their recovery are minimal or even non-existent. The complexity of this issue can be illustrated with the help of two cases that continue to attract the close attention of policy-makers, journalists, and various religious organizations. In particular, one can mention Nancy Cruzan and Terri Schiavo who were both struck by this tragedy. Overall, the comparison of these two cases shows that the existing laws set very high standards for the evidence that can legitimize the termination of life-sustaining treatment. In particular, it is necessary to provide “clear and convincing evidence” indicating that a person would not want his/her life to be prolonged (Tong, 2007, p. 265). These challenges become even more complicating if the relatives of a person disagree on the possible wishes of the individual. Under such circumstances, there can be disputes about the right to guardianship. As a result, relatives, medical workers, and legal professionals can encounter considerable challenges. On the whole, both cases highlight the benefits of using advanced health care directives that can be useful for minimizing the risk of conflicts and legal disputes. Thus, one should discuss these questions in greater detail.

Comparative Analysis

The Practical Details of Each Case

At first, it is necessary to summarize the facts of each case. Nancy Cruzan who was the resident of Missouri met with a car accident in 1983. Medical workers were able to resuscitate her, but she fell into a coma. Later, it was diagnosed that she was in a persistent vegetative state (Tong, 2007, p. 265). Her condition did not change for more than seven years. Nancy’s parents decided to terminate life support. In their opinion, their daughter would not be willing to exist in such away. However, their request was denied by the staff of the medical institution. It should be noted that in the eighties, medical workers adopted a very conservative attitude toward such cases and they preferred not to terminate treatment even if there was no chance of recovery (Lo & Steinbrook, 1991, p. 895). Furthermore, local courts supported the position. In this case, judges noted that there had been no will or directive that could tell what medical workers need to do under such circumstances. Therefore, this decision gave rise to a series of legal disputes tried by various courts including the Supreme Court. Nancy Cruzan died only in 1990 (Lo & Steinbrook, 1991, p. 895).

In turn, Terri Schiavo who lived in Florida slipped into a coma after a cardiac arrest in 1984. It was believed that her heart problems could be caused by her imbalanced diet (Tong, 2007, p. 267). She suffered from brain damage because she was deprived of oxygen for a long time. Her life could be sustained only by a feeding tube. Her husband, Michael Schiavo insisted that the feeding tube should be removed. He stated that Mary would prefer death to the existence in a vegetative state. In contrast, Terri’s parents, Mary and Robert Schindler disagreed with this decision. They believed that their daughter was opposed to any form of suicide including euthanasia (Tong, 2007, p. 267). They referred to her strong religious beliefs to justify their arguments. Furthermore, they tried to disprove the diagnosis, according to which Terri’s brain damage was irreversible. In addition, they said that Michal Schiavo could not act as Terri’s guardian. They were convinced that he had been interested in Terri’s death. This disagreement resulted in various disputes between Terri’s husband and her parents. Along with that, the parents insisted on trying various experimental methods of treatment that could help people come out of a coma. They alleged that Terri’s husband was trying to gain access to money that was supposed to be spent on the patient’s treatment. Terri Schiavo was declared to be officially dead only in 2005.

Overall, there are two common details that can be distinguished. In both cases, the patients were incapable of expressing their wishes about the treatment that should be offered to them. Furthermore, it was rather unlikely that one could establish any contact with them. In addition, there were no formal statements that could guide the actions of medical workers. However, one should not overlook considerable differences between the cases. In particular, in the case of Nancy Cruzan, her relatives were unanimous in their beliefs about possible intentions of the patient. In contrast, Terri Schiavo’s guardians had conflicting opinions about her wishes (Darr, 2004, p. 28). Additionally, there were disputes about the right to guardianship. It is critical to recognize these differences while analyzing these cases. They are helpful for explaining why Terri Schiavo attracted the close attention of the mass media.

Legal and Ethical Aspects

The Issues that the Court Had to Examine

In both cases, the judges had to decide if it was possible to select the course of treatment without a patient’s consent or will. In particular, judges had to determine whether they should focus on the need to preserve a person’s life or his/her right to liberty (Lo & Steinbrook, 1991, p, 895). Along with that, they had to set the standards for the quality of evidence could be used to determine possible wishes of the individual. They paid close attention to the standards adopted by Florida state courts (Lo & Steinbrook, 1991, p, 895). As a rule, these institutions relied on the so-called “clear and convincing standard” that required a close evaluation of evidence offered by a witness (Finkelman, 2013, p. 389). In turn, the Supreme Court had to assess the applicability of these standards to medical cases and the testimony offered by the relatives of a patient.

However, the case of Terri Schiavo was more complex because judges had to decide how to act under the circumstances when relatives of an individual had conflicting opinions on the treatment that should be offered to a patient. Finally, they needed to ascertain the degree, to which this individual could retain her consciousness. Thus, they needed to consider such a concept as the futility of care. Thus, this situation was far more complex and the court had to consider the interests of different stakeholders who could be hostile to one another.

The Rule Applied by the Court

The court attached the importance to two criteria. In particular, the judges argued that life-sustaining treatment could be ended if two prerequisites were present. At first, they required the diagnosis of a terminal illness or a permanent injury that could completely incapacitate an individual (Tong, 2007, p. 265). The diagnosis had to be confirmed by several physicians. This precaution was required for eliminating the risk of medical errors. In fact, this standard was particularly relevant to the case of Terri Schiavo because her parents did not accept the diagnosis made by physicians. Furthermore, they required clear evidence indicating that a patient would prefer the termination of life-sustaining treatment. This concept is usually used to describe formal and written statements (Bartee, 2006).

Unfortunately, in many cases, relatives cannot provide such documents. Often, people prefer not to think about such situations. Additionally, much attention should be paid to oral statements that could be made by this individual. In particular, legal professionals need to determine if a person clearly expressed his/her views on passive euthanasia. Along with that, the statements of this person had to apply specifically to the situation when a disease incapacitates a person both mentally and physically. Thus, the references to oral statements should be thoroughly assessed by the court. The judges assumed that the task of the state was to protect the life of an individual even if he/she was in a permanent vegetative state. Therefore, they set the burden of proof on the guardians of a person, especially if they insisted on the use of passive euthanasia.

The Facts that the Court Found Significant

In regard to Nancy Cruzan’s case, the judges eventually accepted the testimony of the patient’s friends. These people stated that Nancy would not want to live in a vegetated state (Tong, 2007, p. 265). The court accepted their testimony. It should be mentioned that under such circumstances, there is no opportunity for verifying the allegations of witnesses. Nevertheless, the judges accepted them because the witnesses were not interested in providing false testimony. Furthermore, legal professionals accepted the diagnosis determined by medical workers. As a result, Nancy Cruzan’s parents were allowed to remove the feeding tube.

The court had to take a slightly different approach to Terri Schiavo’s case because the patient’s husband and her parents came into conflict with one another. At first, legal professionals had to ascertain if Terri was really beyond remedy (Johnson, 2006, p. 163). Therefore, a panel of five physicians was asked to monitor her state for a certain period. These healthcare professionals confirmed that her health would not improve. In their opinions, the existing methods of treatment could not bring any significant improvement. Apart from that, the court accepted Michael Schiavo’s allegations, according to which she did want to live in a coma. Thus, they did not question his guardianship rights. They disregarded the allegations, according to which he was interested in causing Terri’s death. However, they did not take into account the opinions of her parents. Thus, this situation suggests that the conflicts between a patient’ relatives cannot always be resolved.

The Reasoning of the Court and its Ruling on the Case

The decision-making of judges was based on several principles. In particular, they focused on the liberty interests of an individual. This principle implies that the government could not impose treatment on a person provided that he/she does not want it. At the same time, they emphasized that the prolongation of life was an inherent interest of a person. In their opinion, it was necessary to provide evidence that could cast a light on the intentions of a person. In addition, they accepted the testimony that could be provided by coworkers, friends, or relatives. Therefore, the parents of Nancy Cruzan were allowed to remove the feeding tube. In turn, while examining the case of Terri Schiavo, legal professionals relied on the assumption that there was no reason for suspecting Michael Schiavo’s of any dishonesty (Tong, 2007, p. 267). As a result, they accepted his choice.

Public Responses to the Cases

The case of Nancy Cruzan set a legal precedent that could guide the decisions of legal professionals and healthcare professionals. It helped to legitimize passive euthanasia because the relatives of a patient were not required to provide only a formal statement that could reflect the intention of a person. As it has been said before, it is often difficult to obtain such a document. Therefore, this case led to the development of national standards guiding the work of various courts. The legal struggles of Nancy Cruzan’s parents were widely discussed in newspapers as well as academic journals. Additionally, this case was debated by legal professionals. Finally, this case illustrated the importance of medical ethics. As a rule, healthcare professionals are expected to make everything possible to prolong the life of a patient. Nevertheless, very often, they cannot achieve this goal. Unfortunately, sometimes, the prolongation of treatment does not promote the meaningful and fulfilled life of a person. In addition, it can badly hurt the relatives of a child. Therefore, under certain circumstances, healthcare professionals need to depart from the existing conventions. Thus, its impacts should not be overlooked. Nevertheless, this case was not widely publicized.

The reaction of the public to Terri Schiavo’s case was different. To a large degree, it polarized the society into two groups. For example, one can mention right-to-life advocates. People believed that even despite the physiological conditions, medical workers had no right to terminate the treatment, without a patient’s consent. However, they were opposed by the supporters of euthanasia. Some individuals even tried to reinsert the feeding tube although the orders issued by the court prohibited such actions. Furthermore, the representatives of religious institutions expressed their opinions about this case. As a rule, they did not accept the use of passive euthanasia.

Along with that, this case was of great concern to the organizations that represented people with disabilities. They believed that the termination of treatment offered by Schiavo could be compared to eugenics. In addition, they assumed that such medical practices could discriminate against people whose physical or mental health was impaired in some way (Johnson, 2006, p. 163). Therefore, they adopted a pro-life attitude to this case. They stressed the idea that no individual can be insured against an incapacitating injury.

Additionally, many people chose to make written statements that could provide guidelines for medical workers. They have to be used if a person is not able to express his/her views about the desired course of treatment. This decision can be helpful for avoiding potential conflicts involving relatives or medical workers. At the same time, this case was often discussed by policy-makers. They suggested various laws that could be applied under such circumstances.

In part, this difference can be explained by the fact that the case of Terri Schiavo was more complex. It demonstrated that the relatives of a patient did not necessarily have the same views on the possible wishes of a patient. This case also showed how traumatic the experiences could prove for families. Thus, one can argue that this case had more significant implications.

Conclusion

The above analysis shows that in many cases, medical workers cannot clearly determine the most optimal course of treatment that should be offered to people who cannot express their wishes in an explicit way. As a rule, these professionals attach importance to the informed consent of a person. In addition, they require a formal statement that can safeguard them against the risk of any lawsuits. Unfortunately, in many cases, they do not have this opportunity. Furthermore, it is often difficult for legal professionals to assess the validity of the evidence provided by the relatives of a victim. The case of Terri Schiavo and Nancy Cruzan indicate that sometimes, healthcare professionals need to rely on the statements that can be made by close relatives of a patient, his/her friends or colleagues. The key difficulty is that the guardians of a person can dramatically disagree with one another. The main implication of these cases is that individuals should specify their intentions in advanced health care directives.