Introduction
Today’s healthcare paradigm has become highly dependent on the notions of ethics and respect for individual freedom and world perception. Despite decades of continuous struggle for adequate healthcare ethics application, there still exists a variety of issues both public and government are to reconsider in order to create an ethical and satisfactory healthcare pattern. However, not many people trace the history of human rights in healthcare to the very genesis of the movement in order to reflect upon what has already been achieved in the field.
When speaking of US healthcare and law in particular, only a few decades ago, the concept of a guardian’s right to decide upon the patient’s will to live on his or her behalf was not even considered as relevant to the state law. In fact, the possibility of patients’ autonomous decision to end life was neglected by the legislature due to the fact that it was not common to raise the topic of death in general (Mayo, 2020). Moreover, the overall concept of healthcare ethics presupposed abiding by one’s oath to save lives under any circumstances, making it unacceptable to voluntarily give up on human life.
As a result, years of ongoing debate were aimed at identifying how the desire to preserve life shall not interfere with the human right to autonomy and treatment refusal. Hence, the state of affairs the US observes today was eventually shaped by two law cases concerning the assisted suicide of Nancy Cruzan and Terry Schiavo, who had won the right to die with the permission of their guardians. The following contrastive analysis is aimed at defining the major characteristics of the aforementioned cases and their influence on the overall healthcare ethical context.
Comparative Analysis
Practical Details
Cruzan v. Director, MDH
- Who? The following legal case concerns the trial between the petitioner Nancy Cruzan represented in Court by her legal guardians – Nancy’s parents, and the Director of the Missouri Department of Health.
- What? The legal case concerned Nancy Cruzan’s petition to allow her legal guardians to obtain the right to terminate the patient’s artificial nutrition and hydration. The health condition of the petitioner was extremely severe due to the received injuries in a car accident – Nancy struggled with the persistent vegetative state (PVS).
- When? The case’s background traces back to 1983 – the years of the car accident. The case proceedings started in 1988 when the patient’s parents asked the medical employees to remove the feeding tube for the first time. The case was officially resolved in 1990 by the US Supreme Court’s decision.
- Where? The case took place in Carthage, Missouri.
- Why? The process was initially commenced by the co-guardians statement of performing their daughter’s will to terminate her life once she would not be able to function without assistance (Cruzan v. Director, MDH, 1990).
Schiavo v. Bush, Schiavo Schindler v. Schiavo
Who? The major participant of the cases is the patient Theresa Schiavo, a woman with irreversible PVS. In the process of this “right-to-die” legal case, two major court processes could be identified: the case involving Michael Schiavo, Terri’s husband and guardian, and Florida governor Jeb Bush, and the case concerning Michael and Terri’s parents – Robert and Mary Schindler, who appealed the husbands’ plead of assisted suicide to perform the incompetent’s will.
What? The legal case concerned Terri’s Schiavo petition issued by her husband-guardian to voluntarily terminate her life by removing the feeding tube. The health condition of the patient was severe and irreversible, emerging from cardiac arrest and serious brain damage. The concomitant petition was issued by the patient’s parents, who believed assisted suicide not to be their daughter’s choice.
When? The first petition to the Florida Supreme Court was issued by Michael Schiavo in 1998, with the last proceeding decided in 2005, including the hearings concerning Schiavo Schindler v. Schiavo’s case.
Where? The situation took place in St. Petersburg, Florida.
Why? The process was initiated by the patient’s guardian claiming that Terri discussed the possibility of such a situation with him prior to the accident, asking Michael to assist her natural death in case she was incapable of autonomous functioning (Bush v. Schiavo, 2004; Schiavo Schindler v. Schiavo, 2005).
Legal and Ethical Case Details
Issues Prior to the Court
Human life has always been considered to be an asset that could never be taken when not considering extreme cases of capital punishment. However, the right to exercise the autonomy of one’s decisions presupposes the ability to express the will to terminate life as far as severe health conditions are concerned. Over the past years, much attention has been dedicated to the issue of human rights recognition on the level of the legislature, emphasizing the aspects of human dignity and compassion (Vulliermet, 2020). However, despite all the emerging tendencies to comply with one’s intention to terminate life, the final decision could never be made easily without considering all the precedents and evidence related to the specific situation.
Thus, when speaking of the issues that happened prior to the aforementioned court proceedings, it is important to outline some of the similar issue features, as both cases are based upon a single yet significant ethical issue, i.e., the “right-to-die” execution. The convergent issues of the cases are as follows:
- The incompetent state of both petitioners. Whereas all the residents are entitled to have control over their life duration and quality, the state of unconsciousness makes it considerably harder to identify the actual person’s will. Thus, the following decisions could be only presented in the guardians’ interpretation, which may not be considered as a substantial reason for assisted suicide.
- Medical employees’ inability to define the legitimacy scope. It goes without saying that over the past decades, human life has gained a higher recognition in the world, pooling the international efforts towards equal respect for one’s decisions. However, when it comes to the process of euthanasia justification, medical workers frequently struggle where the line between privacy and preserving human life should be drawn. As a result, the Court’s intervention is required in order to establish the distinction between breaching medical ethics and respecting human will.
- Lack of substantial evidence. In both cases, the major argument in favor of assisted suicide was claimed by the patient’s prior statements about the possible actions done in such a situation. In Schiavo’s case, the conversation was held between the patient and her husband and co-guardian. Nancy Cruzan, in her turn, discussed the possibility of assisted suicide with her friend, who was not involved in the process of caregiving.
Considering the following issues, it might be concluded that the situation could not have been resolved without direct judicial intervention that managed to find the arguments in favor of respect for the petitioner’s wishes. The only significant distinct precedent of the following cases concerns the disagreement that emerged within Terri Schiavo’s family that led to some severe limitations in terms of the rapid Court’s decision on the matter.
Rules and Tests Applied
Considering the notoriety of the cases mentioned in the analysis, it would be safe to assume that, at some historical point, these cases became catalysts of some serious legal modifications in terms of the “right-to-die” paradigm and the overall euthanasia legalization tendency. Thus, the legal cases on Nancy Cruzan and Terri Schiavo became some of the first “right-to-die” cases in the history of the US. Thus, in order to define the rules and tests applied to the case, it is necessary to dwell upon the diachronic development of the “right-to-die” legal incidents in the state.
A distinctive feature of both cases is the absence of relevant legal data to make a reasonable decision based on the patterns of previous proceedings. Although the question of physician-assisted suicide and the overall right to terminate one’s life emerged in Ohio at the beginning of the 20th century, its significance was significantly undermined after World War II (Earle, 207). As a result, when the following cases were considered in Court, there was barely any specific legal laws to be applied in the setting apart from the fundamental human right bills.
Thus, some of the major laws that were exploited in both cases included the Ninth and the Fourteenth Amendments to the US Constitution (Bush v. Schiavo, 2004; Cruzan v. Director, MDH, 1990). The content of these documents is focused on the significance of fundamental rights retained by people despite the absence of their explicit indication in the Constitution and people’s equity in the face of the law. The significance of the following cases lies in the fact that they became the first incidents to concern the “right-to-die” law that had not been secured by the state government prior to the following investigations.
Legally Significant Facts
When dealing with an almost unprecedented legal case, it is important to note that the slightest details recorded in the course of the investigation are to be considered in order to make a legally ethical decision. Such cautiousness should be especially applicable to cases with irreparable consequences. As it was already mentioned in the analysis, both cases on Terri Schiavo and Nancy Cruzan, despite having some differences in the very case flow, have many convergent features in terms of case precedents and influence on the healthcare ethics development. Thus, the case facts that eventually influenced the Court’s decision have a striking resemblance as well, including the following statements:
- The level of health condition severity. In the course of the proceeding, it had been established prior to the hearing that the petitioners’ conditions were irreversible. That is, regardless of the decision adopted, both Terri Schiavo and Nancy Cruzan would not be able to function properly without artificial assistance like a feeding tube or lung ventilation. This fact contributed to the decision to allow to terminate the patients’ lives according to their primary wishes.
- The relevance of pre-accidental petitioners’ intention. One of the major deciding factors in terms of the following cases was the presence of the petitioners’ oral claims concerning the willingness to terminate life in case such a situation happened to them. In Terri Schiavo’s case, the evidence was practically non-negotiable by the Supreme Court, as the statement was witnessed by Terri’s legal guardian. In the Cruzan v. Director, MDH, the oral intention was proved with the help of testimony given by Nancy’s friend, who participated in the following conversation prior to the accident.
Court’s Reasoning
The notion of life can be generally perceived differently according to the context in which it is employed. Such a difference was explicitly evident in the examples of both legal cases, placing an ethical dilemma amidst the decision-making process. In the case of Nancy Cruzan, the dissonance primarily concerned the governmental and personal aspects. With the state being interested in saving human life, the idea of legally approved suicide seemed quite irrational. However, in terms of one’s right to privacy, such a decision should only be made by the one who, indeed, lives this life. As a result, the Court’s reasoning process appealed to the human right to control personal life duration. Terri Schiavo’s case, on the other hand, was also concerned by personal ethical issues that questioned the guardian’s intentions within the petitioner’s family, while the government eventually allowed the medical employees to remove the feeding tube officially. As a result, the Court’s reasoning was primarily focused on the legal aspect of guardianship and its competencies.
Public Response
Any legal case that required the Supreme Court’s intervention presupposed the active participation of the public, influencing the overall perception of the case and its possible social implication. Such interference is, by all means, one of the most efficient external tools that might potentially contribute to the final decision. In Terri Schiavo’s case, the public response was extremely influential in terms of the number of people opposed to the Court’s unreasonable intervention in one’s fundamental rights. As a result, activism managed to accelerate the process of decision adoption. In its turn, Nancy Cruzan’s case showed how important publicity was in the context of further law promotion through a rapid increase in the informal discussions of the issue. The major publicity’s contribution, however, is related to the eventual adoption of the full-scale legislation pattern concerning the “right-to-die” issue. Such a step towards ethical legislature was encouraged once the authorities realized how many people were affected by the inability to exercise their will once not competent enough to justify personal intentions.
Conclusion
The adoption of the “right-to-live” legislation has become one of the most significant milestones on the way to secure full-scale respect for human life across the US. Despite the years of the issue discussed at the beginning of the 20th century, it was a few legal cases that managed to raise the question on both judicial and legislative levels. Thus, the case Cruzan v. Director, MDH, concerned the right of Nancy Cruzan, a Missouri resident, to terminate her artificial life support and let finish the struggle. Another important case was the trial process of Schiavo v. Schiavo Schindler, which was primarily focused on terminating the life of Theresa Marie Schiavo, whose life had been artificially supported for years without any chance of recovery. Considering the following cases, the following crucial points should be outlined:
- One’s right to control life duration is not to be interfered with by other individuals, whether it concerns the influence of the legislature or other society members;
- The ethical principles and human rights paradigm must not be violated by one’s determined intention to save a life when there is substantial evidence to believe that it is not the individual’s primary intention.
Thus, the following analysis demonstrates the significance of these cases in the process of the formation of the model ethical healthcare model. Therefore, it became evident that the healthcare facilities and legislation are allowed to execute their freedoms as long as they do not concern with one’s right to privacy and personal will. Although much has already been made in the field, there are still many modifications to be made in order to secure equal respect for human rights nationwide.
References
Bush v. Schiavo, [2004] SC04-925.
Cruzan v. Director, MDH, [1990] 497 U.S. 261, 358.
Earle, M. (2017). A short history of euthanasia – a brief look into the centuries old debate over an individual’s right to die. Memorial University of Newfoundland.
Mayo, T. W. (2020). Cruzan and the “right to die”. SMU Law Review., 73, 3-6.
Schiavo Schindler v. Schiavo, [2005] 05-11556.
Vulliermet, F. (2020). To live is to die: a virtue account of arguments for the right to die. Ethics & Bioethics, 10(1-2), 20-29.