Academic journal article Issues in Law & Medicine

Is the Continued Provision of Food and Fluids in Nancy Cruzan's Best Interests?

Academic journal article Issues in Law & Medicine

Is the Continued Provision of Food and Fluids in Nancy Cruzan's Best Interests?

Article excerpt

Due to an automobile accident, Nancy Cruzan is in a permanently unconscious condition. She has been in this condition since 1983. She is not terminally ill, and experts suggest that she may live another thirty years. No clear and convincing evidence exists as to her intentions regarding refusal of food and fluids. Nancy Cruzan's guardians have requested court authorization to cause Nancy's death by withholding food and fluids from her, leaving her feeding tube in place, but unused, except for medications. They are requesting the recognition of a constitutional right to choose death for Nancy Cruzan.(1)

The Missouri Supreme Court in Cruzan v. Harmon summarized the issue this way:

This is a case in which we are asked to allow the medical profession

to make Nancy die by starvation and dehydration. The

debate here is thus not between life and death; it is between quality

of life and death. We are asked to hold that the cost of maintaining

Nancy's present life is too great when weighed against

the benefit that life conveys both to Nancy and her loved ones and

that she must die.(2)

This statement cuts to the heart of the issues in this case. The issue is death. Does the United States Constitution require a state to authorize a court appointed guardian to cause the death of a dependent ward by denying the ward food and fluids when she is not terminally ill and when there is no clear and convincing evidence of her intent?

The purpose of this article is to show that the decision of the Missouri Supreme Court is in the best interests of persons who are incompetent, whose diagnoses indicate the likelihood of permanent unconsciousness, and who are unable to receive nutrients by mouth. The article has five parts. First, the decision and the Missouri Supreme Court is supported by the legal analyses and conclusions of other courts and jurists in cases involving similar circumstances. Second, the decision is supported by the medical facts, which demonstrate that feeding by tube is in the ward's best interest. Third, the decision is supported by philosophical distinctions which demonstrate that feeding by tube constitutes ordinary care, not medical treatment. Fourth, the decision is supported by traditional health care ethics, which demonstrate that withholding food and fluids without informed consent constitutes nonvoluntary euthanasia. And fifth, the decision is supported by the alarming effects of legalized euthanasia as observed in the Netherlands.

Other Courts Have Reached Similar Conclusions

The decision of the Missouri Supreme Court has correctly identified the issue as involving the guardians' right to choose death for Nancy Cruzan. Its analysis is supported by the legal analyses and conclusions of other courts and jurists in cases involving similar circumstances.

Beginning in 1976 with In re Quinlan,(3) there have been more than one hundred cases involving the withdrawal of life-sustaining medical treatment or food and fluids for incompetent and, in a few cases, competent patients. The majority of states have had at least one case: twelve cases have reached the highest state courts. The number of cases has accelerated in recent years.

Beginning in 1988 those in favor of the treat in these cases were proclaiming that a "consensus" had arisen in favor of withdrawing life-sustaining food and fluids from incompetent patients. By the end of 1988, however, a counter trend emerged with roots in previous lower court opinions, in dissents in recent right to die appellate opinions, and culminating in the decisions of the Supreme Court of Washington in In re Grant,(4) the New York Court of Appeals in In re Westchester County Medical Center,(5) and the Missouri Supreme Court in Cruzan v. Harmon.(6) In these three cases state supreme courts refused to authorize the withdrawal of food and fluids from incompetent patients who were not terminally ill, absent in informed refusal of care by the patient while the patient was competent. …

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