The following posting is in reference to a class project regarding the topic of the right to live versus the right to die. Our group of senior nursing students, at the University of West Florida, will be presenting this topic for a healthcare issues course. Please note that any replies may be incorporated in our PowerPoint presentation to elicit group participation. We will present a scenario as well as questions to consider. Please post your responses regarding this matter based on how you feel the situation should have been managed.

The Right to Die
The Issue: Does the Constitution protect the decision to end one's own life,
at least if one is terminally ill or in great pain?

The Court first addressed the issue of the right to die in the 1990 case of Cruzan v. Director, Missouri Department of Health. In Cruzan, the Court considered whether Missouri could insist on proof by "clear and convincing evidence" of a comatose patient's desire to terminate her life before allowing her family's wish to disconnect her feeding tube to be carried out. Although eight of nine justices--only Scalia disagreed--concluded that the right to die was a liberty protected by the Due Process Clause, a bare majority of the Court upheld the state's insistence upon clear and specific evidence that the patient would wish to have intravenous feeding discontinued. The Cruzan decision spurred considerable evidence in "living wills" which clearly express an individuals desire to discontinue treatment or feeding in specified circumstances. (Later, additional evidence of Nancy's wishes was discovered and feeding was discontinued, leading to her death.)

Seven years later the Court faced right to die issues again in two cases involving challenges to laws criminalizing physician-assisted suicide. The lower courts in each case, one involving a Washington state law and another a New York statute, found the laws unconstitutional--at least as applied (the 9th Circuit decision rested on due process right-to-privacy grounds, the 2nd Circuit decision on equal protection grounds.) The Supreme Court reversed in both cases, finding the laws to be constitutional. Although the Court interpreted Cruzan as recognizing a right to refuse medical treatment, the Court found no constitutional basis for a right to assisted suicide. Three justices in concurring opinions (O'Connor, Breyer, Stevens) indicated that they might be willing to uphold "more particularized challenges" to such laws, such as--for example--an as applied challenge to a state's refusal to assist a terminally ill patient in severe pain from ending his or her life.

In 2006, in Gonzales v Oregon, the Court decided another right-to-die case, although this one primarily on administrative law grounds, not constitutional grounds. Voting 6 to 3, the Court ruled that Attorney General Ashcroft exceeded his powers under the Controlled Substances Act when he threatened prosecution against Oregon doctors prescribing lethal drugs under that state's Death with Dignity Act. Writing for the majority, Justice Kennedy concluded that regulation of medical practices was primarily a job for the states and that Ashcroft failed to recognize "the background principles of our federal system."



Questions

1. Doctors examining Nancy Cruzan concluded that she was in a persistent vegetative state, had no awareness of her environment, and had no hope of EVER having awareness of her environment. What reason is there to doubt that any person in Nancy's circumstances would want--if they were capable of even wanting--feeding to be continued? Was there any evidence at all suggesting Nancy would want to continue to "live"?
2. In what sense could Nancy Cruzan even be considered a "person"? What are the essential attributes of a person?
3. Since Nancy could feel neither embarrassment nor pain, isn't it really only the empathetic interests of the family at stake?
4. What if Missouri defined Nancy as dead and ordered her feeding discontinued against the wishes of her parents? Would they have any constitutional claim?
5. Was Missouri using Nancy as a symbol? As a symbol for what?
6. Should it matter whether the decision involved was to discontinue feeding rather than extraordinary treatment such as a ventilator?
7. Could Missouri have prevented the Cruzans from taking Nancy to another state that would allow their wishes to be carried out?
8. If there was a right to assisted suicide, as the 9th Circuit found, why should the right be limited to terminally ill and competent adults? Why would persons in great pain, or who are severely depressed, also have such a right?
9. Does the distinction between passive euthanasia (withdrawal of feeding tubes, for example) and active euthanasia (administration of lethal drugs, for example) make sense to you?
10. What state interests supporting laws against physician-assisted suicide do you think are the strongest?

Linder, D. (2007). Does the constitution protect the decision to end one’s own life, at least if own is terminally ill or in great pain? Exploring Constitutional Law. Retrieved February 22, 2007, from
http://www.law.umkc.edu/faculty/proj...righttodie.htm

Please peruse the above and consider your own position. As nursing students who will be graduating in two months, many of us haven’t had this experience. While we all have individual opinions we, as a group, believe the positions of our peers is of great significance. We welcome responses, from lay persons, pre-nursing students as well as vested clinicians, in the hope that we, as well as you, will take something of consequence from this discussion.

For those of you who have read this posting, please don't feel as though the suggested questions are inclusive. Any comments are welcome!!

People DO have a right to end their OWN life - it belongs to them, not their families, not the government. It should be obvious that people with a vested monetary interest shouldn't be allowed to capriciously "pull the plug". Everyone should have a living will - but I don't. There's a weird psychology operating that tells me if I do, someone will pull the plug on specious grounds.

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Read this post quick before the mods delete it!

Maybe you should be nicer to your family then.
I have power of attorney over my mother's living will. I was given very specific directions on when to use it and how. That is how I will.
If relatives think your money is worth more than your life and decisions... then something is very wrong with the relationship.

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"Man lives in the sunlit world of that which he believes to be reality. But unseen by most is an underworld, a place that is just as real... but not as brightly lit... A DARK SIDE!"
-opening from Tales From the Darkside

If you're being serious, then you need a living will more than ever. You can make it as clear and specific as you want, so the doctors know what you would like to have happen if you are incapacitated. Without it, decisions are generally left up to the family -- those very people you fear will off you for your millions.

Cases like Schiavo are the exceptions. Most such decisions are made quietly and never receive public attention. And the Schiavo fiasco would have been avoided had she had a living will.

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Man up.

It is my belief that people have the right to take their own life and, while we should try to help people solve their problems without suicide, the decision is ultimately theirs.

If however, someone is unable to speak their wishes (someone who is comatose, etc.), then the choice ought to fall on the parents, children, or siblings of the person.

I have had times in my life when I was in intense pain. The only reason I did not eat my pistol was that I could see an end to the pain in the future. If I had not had that light at the end of the tunnel I would have prayed for Dr. Kovorkian (?). (And to hell with my Irish Catholic upbringing.)

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"Civilizations die from suicide, not murder." Arnold Toynbee

It's obvious that people have the right to take their own lives, but it usually leads to friends/family doing the same. I say usually meaning 1 person, not the whole family. At my high school this year one kid shot himself. A close friend of his lost his will to live because of it, and hanged himself. Did the first have the right to do something that took someone else's life? I dunno.

My take on it, I hate suicidalists. One less idiot in society, it takes one's own problems and dumps them tenfold on the people that care about them. This problem would be resolved if we would quit mourning those who kill themselves, but I believe for parents, that's quite impossible.

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Educating the world, one blogger at a time.