Comparing and Contrasting Two Right to Die Cases

Right to Die Cases

The very public, legal and ultimately political saga of Terri Schiavo brought not only national but international attention to the right to die issues and echoed a similar battle which took place some fifteen years earlier concerning Nancy Cruzan.

In "Cruzan, by her Parents and Co-Guardians v. Director, Missouri Department of Health, 497 U.S. 261,' the United States Supreme Court concurred with the lower court's ruling on June 25, 1990 (Cruzan pp).

Petitioner Nancy Beth Cruzan was rendered incompetent as a result of severe injuries sustained during an automobile accident on the night of January 11, 1983 (Cruzan pp). Paramedics restored her breathing and heartbeat at the accident site when she was discovered without detectable respiratory or cardiac function (Cruzan pp). She was transported to a hospital in an unconscious state where an attending neurosurgeon diagnosed her as having sustained probably cerebral contusions compounded by significant anoxia (Cruzan pp). The Missouri trial court found that permanent brain damage generally results after six minutes in an anoxic state, and it was estimated that Cruzan was deprived of oxygen from twelve to fourteen minutes (Cruzan pp). After approximately three weeks in a coma, she then progressed to an unconscious state, and although she was able to orally ingest some nutrition, surgeons, with the consent of her husband, implanted a gastrostomy feeding and hydration tube in order to ease feeding and further the recovery, however, subsequent rehabilitative efforts proved unavailing (Cruzan pp). When it became apparent that Nancy had no chance of recovering her cognitive faculties, her parents, Lester and Joyce Cruzan and coguardians, sought a court order directing the withdrawal of her artificial feeding and hydration equipment, but the Supreme Court of Missouri held that because there was no clear and convincing evidence of Nancy's desire to have life-sustaining treatment withdrawn under such circumstances, her parents, thus, lacked authority to effectuate such a request (Cruzan pp).

At the time of the U.S. Supreme Court hearing, Nancy Cruzan resided in a Missouri state hospital, (the state bearing the cost of her care) in a persistent vegetative state, a term generally used to describe a condition in which "a person exhibits motor reflexes but evinces no indications of significant cognitive function' (Cruzan pp). The State Supreme Court, adopting much of the trial court's findings, described Nancy Cruzan's medical condition as follows: her respiration and circulation are not artificially maintained and are within normal limits for her sex and age; she was oblivious to her environment except for reflexive responses and painful stimuli; anoxia of the brain resulted in a "massive enlargement of the ventricles filling with cerebrospinal fluid in the area where the brain has degenerated and her cerebral cortical atrophy is irreversible, permanent, progressive and ongoing;" her highest cognitive brain function is exhibited by grimacing in perhaps recognition of painful stimuli, "indicating the experience of pain and apparent response to sound;" she is spastic quadriplegic; her arms and legs are contracted with irreversible muscular and tendon damage; she has no cognitive or reflexive ability to swallow food or water and will never recover her ability to swallow sufficient to satisfy her needs (Cruzan pp). However, the Court found that "she is not dead ... she is not terminally ill," and according to medical experts, "she could live another thirty years" (Cruzan pp).

In recognizing that Cruzan was not dead, the Court referred to the Missouri statute that states:

"For all legal purposes, the occurrence of human death shall be determined in accordance with the usual and customary standards of medical practice, provided that death shall not be determined to have occurred unless the following minimal conditions have been met:

(1) When respiration and circulation are not artificially maintained, there is an irreversible cessation of spontaneous respiration and circulation; or (2) When respiration and circulation are artificially maintained, and there is total and irreversible cessation of all brain function, including the brain stem and that such determination is made by a licensed physician" (Cruzan pp).

Cruzan's respiration and circulation were not being artificially maintained, thus, she fit within the first proviso of the statute (Cruzan pp).

Although the state trial court found that she had a fundamental right under the State and Federal Constitutions to refuse or direct the withdrawal of "death prolonging procedures," and that also found viable her "expressed thoughts to a housemate that she would not want to live in a vegetative state, the State Supreme Court reversed that decision, expressing skepticism about the application of that doctrine in this particular case and doubt as to whether such a right existed under the United States Constituion (Cruzan pp). "It then decided that the Missouri Living Will statute, Mo Rev. Stat. § 459.010 et seq. (1986), embodied a state policy strongly favoring the preservation of life" (Cruzan pp). The court also found that Nancy's statements to her roommate "unreliable for the purpose of determining her intent ... And thus insufficient to support the co-guardians' claim to exercise substituted judgement on Nancy's behalf" (Cruzan pp). The court concluded that "no person can assume that choice for an incompetent in the absence of the formalities required under Missouri's Living Will statues or the clear and convincing, inherently reliable evidence absent here" (Cruzan pp).

United States Supreme Court Chief Justice Rehnquist delivered the opinion of the court stating, "We cannot say that the Supreme Court of Missouri committed constitutional error in reaching the conclusion that it did. The judgment of the Supreme Court of Missouri is Affirmed" (Cruzan pp).

The same year as the Cruzan U.S. Supreme Court decision, Terri Schiavo suffered severe brain damage from cerebral hypoxia caused by cardiac arrest (Terri pp). She was in a coma for two and a half months and then spent the next fifteen years in a condition that was diagnosed as an irreversible persistent vegetative state, PVS (Terri pp). It was this diagnosis that was the source of major dispute, which led to numerous court cases over the course of several years, between Terri's parents, Robert and Mary Schindler, and her husband, Michael Schiavo, who was Terri's legal guardian (Terri pp). A total of eight doctors examined Terri (Terri pp). Six, which included her family physician, three doctors selected by the courts, and two selected by Michael, diagnosed her to be in a persistent vegetative state (Terri pp). Moreover, two guardians ad litem concurred with this decision, however, the two remaining doctors, both of whom were selected by Terri's parents, disagreed that she was in a PVS (Terri pp). The court determined that she was in a PVS, and this ruling was upheld on every appeal, by nineteen different judges, both in state courts and later in federal courts (Terri pp).

The efforts by the Schindlers to prevent the disconnection of her gastric feeding tube created enormous media coverage during the last few weeks of Terri's life and generated a fierce debate concerning bioethics, legal guardianship, federalism, and civil rights (Terri pp). Although Terri did not have a living will, Michael Schiavo declared that it was his wife's wishes not to be kept alive in a condition such as a PVS, however, her parents disagreed, and this became the source of the dispute (Terri pp). The Schindlers appealed the judicial decisions, leading to the reinsertion of the tube on two separate occasions after its removal, yet the courts all ruled in favor of Michael, and the tube was removed a third and final time in mid-March 2005 (Terri pp). During the last few weeks, having exhausted their legal options, the Schindlers continued a mass media campaign, bringing their pleas to Florida Governor Jeb Bush, the U.S. Congress and President George W. Bush (Terri pp). Terri Schiavo died on March 31, 2005 (Terri pp).