Chapter 10  : Care of the Dying

Section 1. Case Presentations

1. Karen Ann Quinlan: The right to refuse treatment


2. Terry Schiavo: The right to refuse treatment  READ:

3.  The Cruzan Case(1983): a 25 year old with PVS   1990 US Supreme Court (5-4) Decision- a LIBERTY INTEREST       Nancy Cruzan and the Right to Die  Summary by James Rowe, QCC, 2005

On the January the 11th, 1983, Nancy Cruzan suffered irreversible brain damage from a car accident and which resulted in her falling into a persistent vegetative state, where she remains awake and alive, but without any higher brain function. For years at an annual cost of 130,000 dollars, paid for by the state, she was kept from dying by a surgical feeding tube, which was asked by the parents to be removed. They were refused and thus did the legal battle begin.

            In the subsequent court hearings, Nancy’s family presented a case around their claims to Nancy not wanting to live were she to be in a similar situation, including her sister Cristy testifying that Nancy told her she would not want to live such a life. Ruling in favour of the family, Judge Charles E. Teel of the Jasper County Circuit Court, affirmed in July 1988, that “There is a fundamental 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 cognitive brain function.” Commenting on such, Missouri Attorney General William Webster would proclaim that Judge Teel’s ruling was not within the intended boundaries of the law passed by the legislature and in November 1988, the Missouri Supreme Court ruled 4-3 to overrule the lower court. The court reasoned on the foundation that the living-will laws allow the withdrawal of artificial life-support systems when there was “clear and convincing evidence” to suggest the hopelessly ill would want to end their lives, but that it is forbidden to food or water. In contrast to this, the prior case as ruled by judge Teel, declared the feeding tube as part of medical treatment. The overturning would be appealed by the attorney of the Cruzan’s, and would be heard by the United States Supreme Court.

            In a 5-4 decision, the court ruled on the 25th of June, 19990, that the court would not overturn  the Missouri Law that kept Nancy alive, specifically the very stringent “clear and convincing evidence”. However, alongside this, the court also ruled that living-wills were constitutional, on the foundation that a patient has the right to withhold consent from medical treatment, and no medical treatment can be performed on any competent patient without his concession to it. Significantly, the court would not distinguish food and water from other forms of medical treatment, nor would it proscribe universal standards for state laws regarding how they are to determine the wishes of comatose patients, and due to this legal observers have noted that it is very important to not only have a living will, but also to designate the power of attorney should one cease to have legal competence.

            On December the 14th, 1990, after the State of Missouri withdrew from the case, and the family’s attorney and state-appointed guardian filed separate briefs, the aforementioned judge Teel ruled that her intent was clear that she wanted to die and thus the feeding tube was authorized to be removed. 25 protestors would attempt to barge their way into the hospital room and reconnect the tube but to not avail, as on the 26th of December, 1990, Nancy Cruzan perished.

            The long term ramifications of this case rest mostly with the Supreme Court’s acceptance of a (limited) right to die, which has allowed state governments the power to resolve issues such as this.

4. Federal Patient Self Determination Act- Requires Notice of State Laws for refusal of treatment including Advanced Directives  -Obstacles Preventing the Observance of the Act and Respect for Self Determination READ:

5. Elizabeth Bouvia(1983): Demand for Self Determination and Assistance while starving  READ:

6. Elizabeth Bouvia  case

7. Robert Wendland Case

8. Michael Martin Case

9. Doctors treat Cancer but not the pain

10. The Physician Orders for Life-Sustaining Treatment (POLST)


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© Copyright Philip A. Pecorino 2002. All Rights reserved.

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