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Cruzan v. Director was one of the crucial Supreme Court decisions in modern American jurisprudence, as it was the first case where the patient’s right to die was being argued. It set up numerous legal implications for the American system in regard to the patient’s rights and provided the authority to decide the end-of-life procedures on the state level. The court decision was made with a numerical vote of 5 in accordance and 4 in dissent, thus making the decision valid (“Cruzan v. Director”). Its implications are as follows:
- Withdrawal of life support. It was ruled that competent individuals in clear mind and conscience can request the withdrawal of their own life support (“Cruzan v. Director”). Incompetent or incapacitated individuals, on the other hand, would require a higher standard of evidence to do so, with the ability of their relatives to make decisions for them severely limited.
- Differences between withdrawal of treatment and suicide. The judges were concurrent on this notion, as the difference between the two processes is mostly verbal (“Cruzan v. Director”). In modern medical practice, however, withdrawal of treatment allows for naturally-occurring processes to take place, whereas suicide suggests purposeful administration of actions to end one’s life.
- Living wills. The living will is a type of advance care directive comprised of a set of instructions for medical professionals to follow should the patient become incapable of giving informed consent towards certain treatments that serve to postpone, rather than prevent death (Cheeseman 881). It becomes legal when the physician decides that the patient is no longer in the capacity to make one’s own healthcare decisions.
- Advance healthcare directives. This document comprises a wider set of instructions for healthcare personnel in the event of a person’s incapacitation (Cheeseman 881). Unlike the living will, it can incorporate treatments that do not seek to postpone the event of death. This type of directive also covers the “Do not resuscitate” order as well as the organ donation form.
The purpose of the paper is to evaluate the effects of that decision on American end-of-life medicine in general in relation to Saint Leo’s core community values.
Consequences of Failing to Provide a Living Will
The consequences of not providing a patient’s living will include financial, psychological, and medical issues in regards to the patient’s family and friends. The financial consequences are the most obvious ones, as end-of-life treatments are typically expensive (Cheeseman 882). With the patient being unable to manage their private finances due to being incapacitated, the burden of financial support lies upon the shoulders of immediate relatives. Psychological strain for the family can be derived not only from that but also from the realization of their loved ones suffering against painful and incurable diseases. Medical conditions derived from psychological consequences include absenteeism and depression, which have the potential to hamper an individual’s life severely. Without a properly executed will and a living will, the interest of the state in keeping the patient alive supersedes their family’s desires to act in the incapacitated individual’s best interest (Cheeseman 882). The lack of a proper will also complicate the process of inheritance after the person dies.
Distinctions Between Different Types of Medical Care
Recuperative care is fundamentally different from palliative care in its purpose in regard to the patient. Recuperative care seeks to restore a patient’s individual autonomy in the aftermath of suffering from a difficult yet curable disease. Palliative care, on the other hand, seeks to minimize the suffering of the patient and is usually associated with either chronic or incurable diseases, as well as other ailments that accompany the old age (Dunn and Hope 121). The decision to modify care from recuperative to palliative should involve the patient, the physician, and, in some cases, the family as well. The latter is involved if the patient cannot make the decision for themselves and does not have a living will or an advance directive to guide the healthcare providers in their decision-making. Based on the of Cruzan v. Director, the right to refuse any and all medical care can be made by an individual in good conscience, but only after all of the alternatives have been explained and exhausted (“Cruzan v. Director”).
The Difference Between Cessation of Treatment and Euthanasia
There is usually a council of doctors consisting of no less than 3 members that are involved in advising decisions regarding end-of-life wishes and care. Additional professionals that might be involved include legal and spirituals counselors in order to handle the patient’s respective affairs. Euthanasia differs from cessation of treatment, primarily in the causes of death (Cheesman 883). Cessation of treatment results in death because of the natural processes of the disease crippling the patient, whereas euthanasia suggests the use of medication or mechanisms that artificially end the patient’s life. Another distinction lies in the intent to kill – cessation of treatment does not necessarily suggest a lethal outcome, whereas, in euthanasia, the probability of death is absolute. In an event where a patient is incapacitated, and there is no family member to make decisions for them, the decision is being made in relation to state interest, which typically means the continuation of treatments.
Quality of Life Measures
The primary action that could be taken to ensure the quality of ongoing family and social life relationships in regards to end-of-life measures revolve around respecting the dignity, autonomy, and self-sufficiency of end-of-life patients (Dunn and Hope 157). They are not to be considered less than recuperative care patients because their time in this world is nearing an end. Nurses should respect their decisions and provide them with the capacity for self-care, ensure the full availability of services and activities available, and unimpeded access to family members. The family should not bring up the end of life in a negative light, if possible.
Instead, it is best to enjoy the remaining time together, instead of being depressed about it. Some of the common pitfalls include treating the patient and their desires as uninformed or insignificant, thus impeding their freedom and capacity to make decisions about their own health. In order to incorporate the spiritual and existential dimensions of the process, the nurses must work close to the spiritual counselor of the patient’s choosing – either a priest or a leader of the religious community the patient is part of.
Applying Saint Leo University Core Values into Action
Saint Leo University’s Core values revolve around excellence, personal development, respect, integrity, community, and responsible stewardship. Its framework is informed by the spirit of Jesus Christ. Since an important distinction is made between the cessation of treatment and euthanasia/suicide, the practice does not contradict Christian values, as the patient gives their lives and fate into the hands of the Lord. I will apply the core in order to inform my medical practice, providing the patients with respectful treatment at the end of their life’s journey, council their family, work in close coordination with the priest or other religious authority and ensure that the patient’s stay would be as pleasant and painless as possible.
Cheeseman, Henry R. Business Law: Legal Environment, Online Commerce, Business Ethics, and International Issues. 10th ed., Pearson, 2019.
Dunn, Michael, and Tony Hope. Medical ethics: A Very Short Introduction. Oxford University Press, 2018.