Facts: Petitioner Nancy Cruzan was rendered incompetent as a result of an automobile accident. The attending neurosurgeon diagnosed her as having sustained cerebral contusions compounded by significant anoxia. It was determined that permanent brain damage results after 6 minutes in an anoxic state, in her case, Cruzan was deprived of oxygen for 12 to 14 minutes. She remained in a coma in the Missouri state hospital for three weeks. Her surgeons, in order to ease feeding and further the recovery, implanted a gastronomy feeding and hydration tube in her with the consent of her husband. Despite persistent efforts, she was in a condition known as a persistent vegetative state which is a condition in which a person exhibits motor reflexes but evinces no indications of significant cognitive function.
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Thinking that Nancy had had virtually no chance of recovery, her parents asked the hospital employees to terminate the artificial nutrition and hydration procedure that sustains her. The hospital employees refused to do so unless they secure a court approval. The parents then sought from the state trial court authorization for the termination of the nutrition and hydration procedure.
The trial court found that a person in Nancy’s condition had a fundamental right to refuse or direct the withdrawal of death-prolonging procedures. In arriving at this decision, the state trial court considered Nancy’s previous conversations with a housemate that in case she is sick or injured she would not wish to continue her life unless she could live at least halfway normal. To the mind of the court, this suggests that considering her present vegetative state, she would not wish to continue on with her nutrition and hydration.
The Supreme Court of Missouri reversed the trial court’s decision. Although they recognized that a person had a right to refuse treatment under the doctrine of informed consent, they were skeptical about its application in this case. They also ruled that Cruzan’s previous statement to her roommate were unreliable the purpose of determining her intent and was, therefore, insufficient for the purpose of terminating the artificial nutrition and hydration procedure.
Issue: whether there was clear and convincing evidence to allow the termination of life support. Disposition of the Case: Judgment Affirmed
Holding: There was no clear and convincing evidence that will allow the court to order the termination of life support of Cruzan.
Reasoning: In arriving at their conclusion, the Supreme Court declared that a State may apply a “clear and convincing evidence” standard in proceedings where a guardian seeks to discontinue nutrition and hydration of a person diagnosed to be in a persistent vegetative state. The state of Missouri shall decide whether they would limit consideration of evidence to the previously expressed wishes of the incompetent individual, or whether they would allow more general proof of what the individual’s decision would have been
The Supreme Court agreed with the holding of the Supreme Court of Missouri that the testimony presented at trial did not amount to clear and convincing proof of the patient’s desire to have hydration and nutrition withdrawn. It did not solely rely on evidence presented by Cruzan’s parents that in previous conversations of Nancy Cruzan with her housemate she would not want to live should she face life as a vegetable. It agreed with the Supreme Court of Missouri’s observations that this statement did not deal with the withdrawal of medical treatment or of hydration and nutrition.
The Supreme Court refused to give due course to the argument of Cruzan’s parents that it should accept the substituted judgments of the close family members of the patient in making this crucial decision. It ruled that the Due Process Clause will be violated if important decisions such this will be reposed upon a person other than the patient. Although it is true that if the Unite States Constitution decides to grant a right of substituted judgment there will be no one except Cruzan’s parents who should qualify. It bears stressing that even among close family members there is no automatic assurance that their view will necessarily be the same as that of the patient.
Theresa Marie “Terri” Schiavo Case
Facts: Theresa Marie Schiavo suffered a cardiac arrest in February 1990 as a result of a potassium imbalance. She was immediately rushed to the hospital after the arrest and she never regained consciousness. This led to her 15 years of being under hospital care and being diagnosed of persistent vegetative state. Since then she had been dependent on feeding tube for nutrition and hydration. Her husband was appointed as Terri’s guardian. Because of the failure to diagnose the potassium imbalance of Terri Schiavo’s physicians, Michael pursued a malpractice case against them. She was awarded almost $1 million by the courts.
This started the feud between Terri’s husband and her parents. Michael sought a court order authorizing the withdrawal of the feeding tube several years after her cardiac arrest. Terri’s parents alleged that Michael wanted Terri dead so that he could remarry and inherit what remained of the monetary award from the malpractice suit. On the other hand, Michael thought that Terri’s parents wanted to prevent him from seeking that court order because if Terri will be kept alive, he would be prevented from marrying the woman he had been with. Otherwise, he will be forced to seek an annulment from Terri in which case her parents will receive what will be left of the monetary award.
In view of this conflict, Michael Schiavo sought Florida trial court’s jurisdiction and asked the court to decide whether to remove her feeding tube. The trial court concluded that there was clear and convincing proof that Terri would have chosen, if competent, to have the artificial nutrition and hydration withdrawn.
Issue: whether there was clear and convincing proof that based on prior conversations with Terri wanted to have the artificial nutrition and hydration withdrawn.
Disposition of the case: Judgment Affirmed
Ruling: There was clear and convincing evidence that Terri had previously expressed that she would have wanted her artificial nutrition and hydration be removed
Reasoning: The appellate court agreed with the findings of the lower court and found that there was sufficient evidence that will prove that Terri wanted the removal of the artificial nutrition and hydration removed. The court gave due course to the previous conversations between her and Michael Schiavo whereas they were watching a television show about Karen Ann Quinlan, she made a remark that she would not want to be kept alive in a similar condition. The court also considered the previous conversation between Terri and Joan Schiavo regarding Joan’s decision to terminate the life support on the latter’s baby. Terri was alleged to have made the remark that although she was sad about her decision, she would do the same thing. The third incident is her conversation with Scott Schiavo while they were at a funeral of their grandmother. Their grandmother had been on a ventilator at the time she died. Terri was noted to have made a remark in case the same thing happens to her, she would like her relatives to let her go rather than to be kept alive with the help of a machine.
Comparison between Cruzan case and the Schiavo Case
Both cases involve women who were in a condition termed as persistent vegetative state. They both needed the assistance of artificial nutrition and hydration for their continued survival. These cases also settled the question of whether the patients had a right to choose to withdraw his life support system in the affirmative.
One of the essential differences is that these cases went in different direction. In the case of Cruzan, the court ruled that there was no clear and convincing evidence that will prove that the patient, Nancy Cruzan would have wanted that her feeding tube is removed. (Matthew Stonecipher) On the other hand, in the case of Schiavo, the court found that there was clear and convincing evidence that will prove that Terri Schiavo, would have wanted her artificial nutrition and hydration be withdrawn. The second difference is that in the case of Cruzan, there was no dispute between the family members of Nancy Cruzan. Her parents both wanted the feeding tube removed to ease the suffering her daughter had suffered. On the other hand, there was the intra-family conflict between Terri’s husband and her parents insofar as making the decision whether to removing what supports her life. Her parents do not want it removed while her husband wanted it removed. The third difference is that in the case of Cruzan, there was a conflict between the doctors and the family members of Cruzan. The former refused to give in to the request of her parents to have the feeding tube removed while the latter wanted the doctors to have it removed. In the case of Schiavo, there was no conflict between the doctors and the family members of Schiavo.