Cruzan Case Summary

The Superior Court of Los Angeles County became a pivotal case in a patient’s right to refuse treatment. In the initial case Ms. Bouvia and her legal team sought a court order to have the NGT removed and to stop all medical treatments she did not consent to. She argued that this treatment would not be a cure for her condition and would not improve her quality of life. The hospital staff argued the interest of the state prevailed over a patient’s right to refuse treatment. They noted that the state and healthcare teams viable interests include: “(1) preserving life, (2) preventing suicide, (3) protecting innocent third parties, and (4) maintaining the ethical standards of the medical profession, including supporting the right of physicians to effectively render necessary and appropriate medical services” (Liang & Lin, 2005). Additionally they sighted Ms. Bouvia’s failed previous attempt to “starve herself to death” in 1983 with the assistance of her medical team. The court denied her request citing these key interests and the fact that medical professionals felt that Ms. Bouvia could live 15-20 additional years with supplemental nutrition justified the state’s interest in preserving her life. The court also stated that any other decision would be condoning a medical team to aid and abet suicide.

.“As medical technology continues to advance and health care choices become more complicated, the preservation of end-of-life autonomy is an increasingly important issue faced by various client populations.” (Galambos, 1998).

As future DNP’s, we will be faced with patients who wish to end their life due to a terminal illness. We have to remember our ethical principles, and we have to be advocates for our patients. Our patients should not be judged for how they want their end of life care to be. Our patient’s safety should not be jeopardized. As future primary care providers, we might take care of patients who clearly states in their advance directives, that if they reach a terminal stage in their disease, they do not want to live anymore. We would have to communicate with our patients and let them know where PAS is legalized. I stand by my statement that PAS is ethical. Healthcare providers are not performing an action that is against the patient’s will.

Sara Gonzales author of the “Texas Death Panel Fights to Remove Coherent Patient from Life Support” quoted “He isn’t just fighting for his life; he’s fighting against the hospital’s plan to terminate his life. Literally fighting a death panel for the right to live”. David Chris Dunn, who was a former EMT and Homeland Security officer passed away at the age of 46 in the Houston Methodist Hospital. Dunn who initially went in to an urgent care facility due to a severe abdominal pain on August of 2015 was found with a mass located in his pancreas. Rather than doing any further tests hospital employees and lawyers marched into Dunn’s hospital room handing Evelyn mother of Chris a notice explaining their plan to end life-sustaining treatment. The Texas Advance Directives Act, is a law that was passed in 1999 when George W. Bush was governor. “Under the TADA, if a hospital or physician decides for any reason they disagree with a patient’s decision about their own personal medical care, they may invoke and override the patient or family’s decision about their medical treatment” (Sara

The story of Nancy Cruzan is a story that may be extremely controversial regarding what is right versus what is wrong, although this woman has changed both the world of medicine and legality since her death in 1990. Cruzan experienced a tragic car accident and was declared to be in a persistent vegetative state by physicians. The controversial part of the story is in regards to whether she should have a tube feeding continued or if it should be discontinued. The purpose of this paper is to further explore Cruzan’s background story, how protestors affected her case, ethical principles, how healthcare has been affected, the meaning of her gravestone, and the impact on her family.

Ethical dilemma may also arise in cases where a patient may feel their right to DNR should be carried out when giving direct order. The DNR process, however, is required to be documented by a physician. Andrew Putnam (2003) presents a case where an eighty-eight year old patient’s code status was DNR; “However, the patient has never signed formal advance directive statement or assigned durable power of attorney for her health care to anyone.” (Putnam, 2003, 2025) Ethics can be simply stated as doing the right thing (Roberts, 2002, 242); but in this case ethics is questioned because the physician was faced with the decision to carry out the wishes of the patient or to make a decision based on legality. In this case, it may have been morally right to carry out the wishes of the patient who wanted DNR orders carried out, but it may have been the right choice to do the legal thing and not carried out due to lack of signed documentation.

This problem first began to surface in the 1980s when the court had to face Cruzan v. Director, Missouri Department of Health. In this case the court had to decide by “clear and convincing evidence” that the comatose patient’s (Nancy Beth Cruzan) desire to terminate her life before the courts would allow her family’s wish of disconnecting her feeding tube be carried out. Unfortunately eight of nine judges said no to the proposition and concluded that the right

Though ethics committees have been helpful, scores of physician-patient disagreements end up in the U.S. court system with inconsistent results. The states adopted individual “statutes regulating DNR orders and their provisions vary in analysis throughout the U.S.” (Bishop, Brothers, Perry & Ahmad, 2010). One ethical dilemma that is constant in emergency rooms, the intensive care unit and terminally ill persons is a futility of treatment. In the case of CPR/DNR, New York State wanted to enact a law that describes the decisive responsibilities of the patient, and the family or surrogate, and physician. “In April 2003, the New-York Attorney General asserted that the DNR law would require a physician to obtain a consent of the patient’s health care surrogate before entering a DNR order, even when the physician

This film explains the legal role of advance directives in end of life issues. An advance directive is “a written document directing how medical decisions are to be made in the future when the patient lacks decisional capacity and is unable to decide and choose” (Hanlon, End of Life Issues, Slide 28, Bullet 1). All three of the cases demonstrate the importance in filling out some form of directive. When there is nothing to go off of, it makes decisions extremely tough for families and medical providers. Having legal documentation of patient wishes helps understand what treatments they would or would not consent to. In cases like

Secondly, the patient should be capable of making and communicating health care decisions for him or herself. Thirdly, the patient must be diagnosed with a terminal illness that will lead to death within six months.  Interested patients must also provide the request for termination in writing to the physician. In addition, physicians are expected to inform patients to alternative means of care including hospice care and other medications. Only after precautions evaluation, the laws then permit patients to make the ultimate life ending decision.

With an increasing aging population and growing numbers of individuals with chronic conditions, it is important for individuals to prepare for end-of-life care. An Advance Directive is a defined as a “legal document that provides data to critical care staff about patients’ wishes, especially when critical illness decreases decision-making ability” (McAdam, Stotts, Padilla, and Puntillo, 2005). An Advance Directive also allows for better communication between the patient and doctor, and preserves the autonomy of patients. It may also alleviate one’s family from any possible burden of uncertainty of one’s wishes. It provides guidance, which may avert arguments with family members concerning treatment choices (Cedars Sinai, 2015). The Patient

Freedom, independence and self-autonomy are fundamental rights of a human, This directly pertains to the central notion of an individual's right to live and right to die. A terminally ill patient should not suffer through excruciating pain and discomfort but rather embrace a timely and dignified death, this is implicit in the concept of liberty and self-determination. Despite rapid advancement in medical technology and modern palliative care, some patients suffer from incurable terminal diseases which inflicts destructive pain upon the patient both physically and mentally. They are unable to seek the compassionate relief of pain and suffering that they wish to

I agree with the court decision that in any condition it is crime to assist a suicide. No one has right to take a decision about other life. This types of situation arises when there is a lack of advance directives paperwork done with the patient when the patient was in a stable condition. The advance directive provides an overview of evolving legal landscape of end- of- life decision making generally, specifically, and identifies the current challenges and opportunity for promoting the goal and advance care planning (Sabatino, 2007). Advance directive not only help to know the patient decision on end of life situation but also help the health care provider to take decision on the following condition.

A study showed that about 20.3 million adults have been diagnosed with cancer, about 8.5% of the population (“Cancer”). This concept of right to die relates to people with terminal diseases. A person’s individual rights should include the right to control when they physically and emotionally cannot prolong their life anymore. While many cases studies have been reviewed over the years, the Cody Curtis, Larry Macafee, Canfield, and Cruzan case have significant stories that heavily dwell on the right to die.

In the medical field, healthcare advance directives play a huge role in improving care for those unable to make or verbalize their decisions. Due to the fact that the patient’s care and justice comes first, advance directives allow people to communicate their decisions in the event that they are incapable of doing so due to an illness or end of life situation. Two main types of advance directives are living wills and a medical power of attorney. These legal documents are very important to nursing and healthcare because it respects the patient’s rights and decisions, despite any bias thoughts or beliefs. In addition, advance directives can be used as a guideline to healthcare providers since living wills may specify the type of medical