Comparison of Cruzan and Schaivo

Cruzan

o The family all agreed to discontinue the g-tube feedings on Cruzan who suffered permanent brain damage, but the state intervened and kept Cruzan alive because there was no clear and convincing evidence of the intent to refuse care. The state ruled that they had an interest in Cruzan’s life. o Principles established the right to refuse medical treatment is a liberty interest under the 14th
Amendment
The state has a valid interest in protecting all life
A justification for a high standard of proof in evaluating the actually intention of a persistently vegetative patient.
• Cruzan used Addington precedent which established clear and convincing evidence as a constitutional minimum for decisions to discontinue nutrition and hydration.
Belmont Report principles (principles of bioethics ) o Beneficence –requires that the varied risks and benefits of an intervention be weighed.; the duty to do good o Non Maleficence- duty to do no harm o Autonomy -patients are able to exercise free will and free decisions o Justice- Freedom from discrimination; fairness in distribution of medical resources Medical Futility- o The concept that medical care should be deemed futile was one of the 3 fundamental principles that Hippocrates declared for the practice of medicine: to cure, relieve suffering and refuse to treat “those who are overmastered by their disease. o The AMA Code of ethics provides that the decisions should not be based on “futility” because there is no concrete definition for futility. o A quantitative assessment (standard) would invoked futility when a 1 percent or lower of success rate exists in intervening or performing a procedure. o A qualitative assessment suggests that life-prolonging treatment for persistent vegetative states and permanently unconscious patients would be considered futile. o Conflicting cases with futility
Baby K – the court determined that accepting physicians must provide care even without considering the chances of success.
In Gilgunn v. MA General Hospital the family sued the physicians for not resuscitating the patient in light of their judgment on qualitative futility.
Schaivo
o Schaivo, who was diagnosed with a prolong anoxic brain injury, was left in a vegetative state and her husband and parents disagreed on whether to remove
Terri Schaivo’s g-tube. After several years of appeals, the Supreme Court affirmed the order to discontinue Terri’s nutrition and hydration, stating that her husband’s testimony of Terris’s alleged was clear and convincing evidence of

Terri’s intent.