Ethical frameworks applied to the Nancy Cruzan right-to-die case

¶ … Cruzan Case through a variety of medical ethical perspectives

The Consequentialist Paradigm

The ethical paradigm of consequentialism, as its name suggests, is the view that "normative properties," in other words, ethical actions in the world, should be judged upon and "depend only" upon their resultant consequences. (Sinnott-Armstrong, 2003) The Nancy Cruzan case is famous legal a 'right to die' case whereby, after Nancy Cruzan was almost killed in a car crash, "years later, Cruzan's parents wanted to withdraw the artificial hydration and nutrition that kept their daughter alive," whom was deemed 'brain dead' or in a permanent vegetative state, at the time (Healthcare ethics, 2004)

The general approach of consequentialist ethics could be applied in this case regarding the moral rightness of acts, holding that "whether an act is morally right depends only on the consequences of that act or of something related to that act (such as the motive behind the act or a general rule requiring acts of the same kind)." So long as the act, in other words, to preserve their daughter's wishes and will, even though she can no longer articulate her wishes, has good intentions, thus the will of Nancy's parents should be carried out. A consequentialist might also ad because Cruzan is in a vegetative state, because she has a poor quality of life, overall her body should be allowed to die and fulfill its natural cycle and course, regardless of the legal implications of the case. (Sinnott-Armstrong, 2003)

But "on June 25, 1990, the U.S. Supreme Court affirmed the right of the State of Missouri to demand clear and convincing evidence of a person's expressed wishes made while competent." (Healthcare ethics, 2004) Cruzan was only a young woman when she died, and had never enacted a living will, not foreseeing what could have occurred. The majority opinion of the court also held that competent patients have a constitutionally protected liberty" and interest in refusing "unwanted medical treatment" under the narrower uses of the term, but because Cruzan's own wishes could not be determined, the court feared that the case could be used to justify withdrawing support from victims who could not speak for themselves, and whose parents or legal guardians might not be so willing to uphold the unspoken interests of the patient.

Consequentialism's exclusive focus on consequences would counter that one must focus on the immediate implications of this one decision, and not extrapolate more from this one deicision, to other cases -- namely that all that matters is the consequences, ethically, of what happens to Cruzan and her family.

The Alternative Buddhist Paradigm

In such a quandary, Buddhist ethics may provide the most feasible alternative to both tautological ethical strategies of consequentialism and moral relativism. The philosphy and religious ideation of Buddhism denies the mind-body dualism of Western philosophy. Thus, for a Buddhist, for Cruzan to be dead, merely because her brain has ceased to function, although her body is still alive, is profoundly troubling. A Buddhist would deny the very existance of brain death at all, as the brain and body both are merely symptoms of the never-ending cycle of death and rebirth that all human beings are trapped in, in the cycle of life or human suffering. Buddhism likewise denies the centrality of the individual in the individual decision making process, stressing that the dead cannot exercise control over the living through such legal stringienceies as wills, or expressed desires, as there is no true external existance of an individualistic self, and thus consistent desires are illusionary and mutable from one state of being from another. (Hughes, 1995)

Thus, would a Buddhist state that Cruzan should continue to remain attached to life support? Not necessarily, for Buddhism would also stress that one must have an eye upon the physical and medical needs and finite resources for the larger community, and the efforts expended to extend Cruzan's life against the wishes of her living parents might be better used in other venues.