Eight years after an automobile accident that left her incapacitated and 12 days after her parents won the Supreme Court battle in removing her feeding tube, Cruzan died peacefully with her family beside her. After being the centerpiece of a bitter debate, the right to live was eventually resolved with emphasis on drafting living wills that highlight future treatments and who would have the authority to decide on life when incapacitated ( Cerminara, 2015). On the other hand, Terri Schiavo suffered a cardiac arrest that left her with permanent brain damage. Amidst endless legal battles and family feuds, she was eventually removed from life support machines ( Cerminara, 2015) . According to the American Hospital Association, nearly 70% of all hospital deaths are negotiated in one way or another. Despite the case setting no uniform national guidelines on having the right to die, current cases are still using it as a benchmark in ruling out similar cases. Building on Cruzan’s case, Terri Schiavo’s explosive case was an indication that significant problems about ending life in incompetency remained. An analysis between Cruzan’s and Terri’s cases will further help to shed light on how legal it is in having the right to live.
Comparative Analysis
Practical Details
Petitioner Nancy Cruzan from Missouri was identified as incompetent after an automobile accident at 25 years where she was thrown out with her face down a ditch that deprived her of oxygen for 12 minutes. Her attending neurosurgeon determined that she had irreversible permanent brain damage ( Rosner, 2016) . Her parents had virtually no chance of recovery and asked the hospital to remove the artificial feeding and hydration system that was sustaining her to starve to death. After a Supreme Court ruling eight years after her accident, Cruzan died peacefully on Dec 26, 1990, by starvation.
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On the other hand, Terri’s Schiavo’s case involved sustaining a cardiac arrest at home in Florida that contributed to the massive brain damage that made her vegetative for 15 years with no evident signs of recovery. In 1998, her Husband, Michael petitioned to have her removed from feeding and hydration systems after revealing that his wife had wished for her life to not be prolonged when incapacitated ( Rosner, 2016). After long court battles and disagreements between Terri’s family and Michael; that even saw the intervention of the then president, Bush, Schiavo died on March 31, 2005.
Legal and Ethical Details
Issue
Both court issues revolved around whether or not there were clear and convincing proof that allows for the termination of life support.
Rule
In Cruzan’s case, the judge affirmed that no evidence would convince the court to order the termination of life support. In contrary, Schiavo’s case saw the judgment affirmed that there was convincing evidence of Terri’s decision to not be supported by life machines ( Mareiniss, 2005) .
Facts Found Significant
In both cases, the involved women were in vegetative states after oxygen deprivation to the brain with no signs of recovery after several physical examination attempts. They both needed assistance from feeding and hydration tubes for their continued survival. In both cases, ending life support was settled as patients having the right to do so ( Larson, 2005) . The persistence of the condition was eventually determined in both cases and both patients had the right to accept or refuse direct withdrawal in the death-prolonging procedures.
However, in Cruzan’s case, her previous statement to her roommate on her intention not to live on life support artificial means was upheld in a trial court before being reversed by the Supreme Court of Missouri. They recognized that under the doctrine of informed consent, her statement was unreliable and inadmissible due to lack of intent ( Mareiniss, 2005) . On the other hand, Schiavo’s case encompassed evidence of malpractice and family disagreements before the final ruling was made. The courts awarded Michael $1 million on grounds of medical malpractice after Terri's doctor failed to diagnose her potassium imbalance that would have likely contributed to her cardiac arrest ( Mareiniss, 2005). Also, Michael argued that that the parents of Terri refused life termination to make him divorce Terri in for them to get the malpractice award. On their defense, Terri’s parents argued that Terri’s decision was based on his quest to remarry and get the award. Precipitated by the feud, the trial court concluded that there was clear proof that Terri would have wanted the artificial nutritional support removed if she was competent.
Reasoning
In arriving at their conclusion in Cruzan’ case, the Supreme Court declared that states might rule on the basis of clear and convincing evidence in the event of persistent vegetative state. The state of Missouri would, therefore, decide on whether to rule on previously expressed wishes or allow for more general evidence. In this case, the withdrawal of life support was observed not to be associated with the previous expressions presented by her parents and her roommate ( Larson, 2005) . The court further argued that allowing the parents to make the crucial decision would be violating the due process clause. Despite this, they ruled that no one except her parents, in this case, would be allowed for substituted judgment . Their emphasis held that no family member would have a similar view with the patient. On the other hand, the appellate court agreed with the findings in Schiavo’s case where they gave due course to previous conversations between the patient and her husband when watching Quinlan’s case ( Larson, 2005) . Additionally, Terri’s conversation with Joan; who terminated the life of her son who was in a similar state and her talk with Scot Schiavo when at the funeral of their grandmother; who had been on a ventilator, was enough proof that she would not want to be kept alive if the same thing happened to her.
Public Opinions
The seven-year case on Terri Schiavo brought unending debates and a great deal of public attention and activism. Given the extensive media coverage on the contentious issue, her family formed a foundation to gather support from the public. The protests were evident with activists keeping vigil outside her hospital even after her death that even saw several arrests where disagreements emerged between people and the police ( Clark, 2005). Two polls conducted after her death revealed that majority of Americans supported that Michael had the authority to make decisions on behalf of the wife ( Clark, 2005) . They also believed that political interventions overstepped their mandate. Still, others were in favor of Terri’s family of prolonging her life.
On the other hand, Cruzan’s case also attracted public outrage with protestors outside the hospice of Cruzan disagreeing with the termination of life. At the same time, the leader of an Atlanta anti-abortion group suggested that he could not sympathize with those who have little disregard for life by allowing euthanasia ( Clark, 2005). In their argument, every life has meaning despite regardless of their capacities. The opponents even tried to reverse the court’s ruling on their decision but were found to have no legal standing in association with the case .
Conclusion
Building on the previous case on Cruzan, Schiavo’s case was allowed the right-to-die clause to be heeded given the intentional wishes from the subject. However, even though Cruzan’s parents; who were the petitioners, did not have substantive evidence that showed her will of not prolonging life, both cases were founded on legality. Despite Florida’s Supreme Court rulings on previous cases with respect to the right of choosing death over artificial interventions that sustained life, it is was not clear in Schiavo’s case whether it was right for her to be removed from feeding and hydration tubes. Nonetheless, unlike Cruzan’s case, there was clear and convincing evidence from past conversations that Teri wanted no artificial life support in the event of incapacitation. The judge affirmed to this with the appellate courts agreeing with the findings of several assertions made with regards to life on supporting machines.
What the public fails to understand is the pain and suffering that family members go through when their loved ones are helpless. Even though no one has the legal authority to decide over how valuable life is, incapacitation would in most cases render end of life legal and justifiable that would not only see a reduction in medical costs but also enough period to peacefully mourn while allowing their loved ones to get away from pain and discomfort for life support.
References
Cerminara, K. L. (2015). Law, Perception, and Cultural Cognition Near the End of Life. Washburn LJ , 55 , 597.
Clark, A. E. (2005). The right to die: the broken road from Quinlan to Schiavo. Loy. U. Chi. LJ , 37 , 385.
Larson, E. J. (2005). From Cruzan to Schiavo: similar bedfellows in fact and at law. Const. Comment. , 22 , 405.
Mareiniss, D. P. (2005). A comparison of Cruzan and Schiavo: the burden of proof, due process, and autonomy in the persistently vegetative patient. The Journal of legal medicine , 26 (2), 233-259.
Rosner, F. (2016). Death by Withdrawal of Nutrition and Hydration. Einstein Journal of Biology and Medicine , 20 (2), 81-84.
