GBA231 Term Paper

Posted: December 22nd, 2022

GBA231 Term Paper

Student’s Name

Institutional Affiliation

GBA231 Term Paper

Introduction

            Over time, new situations continue to challenge existing regulations and set a precedent for the amendment of more effective rules. The rapid and significant discoveries in medicine create new scenarios that challenge the authority of the current laws. Cruzan v. Director, Missouri Department of Health, was a landmark case that highlighted the use of advance directives and living wills. The lawsuit may have provided support the right to die movement, while influencing the implementation of regulations regarding the use of a proxy. On the one hand, the court contested terminating the patient’s life as it was unethical and against the Hippocratic Oath. Conversely, the family argued about the deterioration of the victim’s quality of life and her lack of consciousness. An examination of how this case unfolded will provide insight into the significance of the living will, palliative care, and end-of-life decisions.

Overview of the Case

            Nancy Cruzan, then 25 years old, got into a car accident in 1983. The paramedics managed to resuscitate her when they arrived, but she remained in a coma. Three weeks later, the doctors declared that she was in a persistent vegetative state and placed her in long-term care. Five years later, her parents requested to have her feeding tube removed. However, the medical professionals involved noted that they required a court order for the removal of the feeding tube as this would imply ending Nancy’s life. Eventually, Cruzan’s parents received the court order from the trial court. The judge ruled that from a constitutional standpoint, all individuals have a right to request the withdrawal of end-of-life procedures if the patient does not have cognitive brain function. The approval was made possible due to Nancy’s friend, who testified that Nancy had told her that she did not want to live in a vegetative state in case she was critically injured (US, 1990). Nancy

            The State of Missouri, however, appealed to the Supreme Court of Missouri and argued that it would be unethical to terminate Nancy’s life without her consent. Since she could not make that choice herself, the state argued that she could not give consent and thus her parents did not have the right to make the decision for her. The court, in a 4-3 decision, reversed the initial ruling and concluded that no individual can decline treatment on behalf of someone else in the absence of a living will (US, 1990). In addition, the court ruled that the friend’s statement was not an adequate living will to prove Nancy’s end-of-life decision. Her parents then appealed this decision to the US Supreme Court in 1989.

            In 1990, the US Supreme Court enforced the state court’s ruling, explaining that it was vital to have clear and convincing evidence regarding the patient’s wishes. In passing this decision, the majority opinion held that only people who still have cognitive function could decline medical treatment. However, otherwise disabled individuals are not in a position to make decisions. Thus, the Supreme Court decided to require higher evidence standards regarding their living will. Furthermore, the judicial body noted that upholding the higher standards was within the constitution since family members might make decisions contrary to the desires of the incapacitated individual (US, 1990). Decisions like these might result in irreversible consequences, primarily death.

The Necessity of the Will and Living Will

            A living will is a document outlining an individual’s medical treatment in case they become incapacitated (Cheeseman, 2019). While this document varies based on the law of the state, it allows the individual to explain their desires for life-sustaining measures or if such actions should be halted. Life-sustaining treatment involves the use of intravenous approaches and medical techniques and equipment to extend a person’s life. A living will is only applicable if the patient is incapable of making medical decisions independently and when their medical condition is incurable. In many states, people have the choice of selecting their preferences regarding the course of treatment to be implemented in the event of their incapacitation.

            From a financial standpoint, a living will allows the individual to control how they receive care without placing the burden on family members. In the absence of a living will, the state transfers power of attorney to the family or spouse. These individuals are given the responsibility of overseeing all medical decisions. However, they might make the wrong decisions and incur high financial costs on legal and medical expenses. For example, Nancy Cruzan’s family fought a long legal battle to terminate their daughter’s life while still covering her medical costs for more than 5 years. They eventually lost their last appeal and had to find convincing evidence before the removal of Nancy’s feeding tubes.

            The lack of a living will could also have detrimental psychological effects on the family. Family members must persevere through the challenge of watching their loved ones pass on without the ability to change the outcome. Cruzan’s parents notably underwent a challenging time following the extensive legal process and the publicity it attracted. At the same time, they still had to pay for their daughter’s palliative care 5 years after her accident. More specifically, Cruzan’s father underwent depression due to losing his daughter and ultimately committed suicide in 1996. In the presence of a living will, it would have been better for the family to grant their daughter’s wishes and manage their loss more effectively.

Differences Between Recuperative and Palliative Care

            Thomas, Lobo, and Detering (2017) define recuperative care as the case management and provision of critical care to homeless people suffering from acute illnesses. This type of care is provided to people who do not require hospitalization, although their living conditions on the streets might worsen their disease. The program functions to help homeless people receive vital care, thereby reducing overall healthcare costs. It also helps in ensuring that the homeless have access to the essential care required to improve their quality of life while reducing the rate of readmission. In a general context, recuperative care involves providing the most effective course of treatment to guarantee an improvement in the patient’s health. This approach is most effective when there is a known treatment plan and resources necessary to mitigate the effects of the illness.

            Palliative care, on the other hand, is specific long-term care provided to people with chronic illnesses. This type of care focuses on alleviating the adverse effects of the symptoms and improving the patient’s quality of life. The ultimate goal is to ensure the patient’s comfort and to reduce the family’s mental and financial strains. In many cases, palliative care is provided to terminally ill patients to ease their suffering before death. Providing adequate care requires the collaboration among the clinicians, the patient, and the involved family members. Once a patient is diagnosed with a terminal disease, Beard (2018) recommends palliative care in conjunction with different therapies aimed at prolonging the patient’s life. For example, cancer patients could benefit from radiation therapy or chemotherapy while still in palliative care.

            Medical professionals should also work toward developing practical solutions to mitigate potential clinical complications. Generally, patients should choose to modify their care from recuperative to palliative. However, for incapacitated patients, the decision lies with their family or guardian ad litem. The right to refuse any medical care lies with the patient, and it is dependent on the extent of the illness. If death is imminent, the patient might choose to end their suffering and discomfort with the support of their loved ones.

Professionals Involved in End-of-Life Decisions

            End-of-life decisions are complicated and often emotional. As such, patients and their families require the support of medical professionals to guide them on their alternatives and the associated risks. The primary physician plays an essential role in highlighting the gravity of the situation and in explaining the different ways in which the patient’s life could be terminated. In some states, the patient could seek to be euthanized, or they could request for the termination of treatment. The family should also seek legal guidance on implementing the living will or deciding on the correct course of action in the absence of a will.

            Euthanasia and physician-assisted suicide involve facilitating the patient’s death using medical procedures under the guidance of a qualified physician. While these practices are legal in most states, the patient could choose the cessation of treatment, thereby dying a natural death. The main difference between these two practices is the physician’s level of involvement. In assisted suicide, the physician is responsible for prescribing the medication that would ultimately terminate the patient’s life. In the recent past, assisted suicide has become a worrying trend in the country, leading to rising concerns over its morality and its impact on society.

            In the absence of a family member, the court assesses the patient’s mental health and their ability to make cognitive decisions. If the patient is incapacitated, the court appoints an officer as guardian ad litem, who has power of attorney over the patient’s end-of-life decisions. The court forbids the patient’s primary physician or other involved medical professionals from having power of attorney. The ultimate aim is to protect the patient’s interests and to ensure that their needs are met accordingly.

Improving Social and Family Relationships

            Understanding the patient’s needs comprehensively and providing a safe environment for their comfort is necessary. Some patients would prefer to spend most of their time alone, while others would require their family’s support. The physician should be responsible for regulating the patient’s interactions to avoid upsetting them and to offer the emotional support needed in the final days. The healthcare facility could also contribute in counseling the patient’s loved ones on what to expect when interacting with the patient. Counseling also prepares family members for the difficult task ahead by equipping them with the essential psychological skills.

            A major pitfall to avoid in maintaining these relationships is restricting access to the patient. It is crucial for the patient to feel loved and cared for through the social relationships that they may have established over the years. The healthcare facility should also work towards guaranteeing the patient’s comfort by providing pain medication and using other medical approaches to ease the patient’s symptoms. A spiritual guide should also be readily available should the patient require one. The spiritual leader also plays an essential role in supporting the family and helping them through difficult times.

            Integrating and respecting the patient’s spiritual and existential beliefs is integral in end-of-life processes. Healthcare organizations should determine the patient’s faith upon admission and incorporate it into the treatment plan. They should also carry out spirituality assessments by asking patients to express their emotions. Beard (2018) notes that spiritual beliefs are integral in helping these patients cope with pain, depression, and their eventual death. Spirituality also gives the patients a positive outlook on life despite the outcome, thereby improving their quality of life. The physician could also work with the patient to develop a suitable coping mechanism to help them address their fears and their concerns. It is also vital to have a counselor present. This professional is in charge of aiding the patient in strengthening their faith and coming to terms with reality.

Conclusion

            End-of-life processes are challenging and often controversial due to the ethics and morals involved. The case of Cruzan v. Director, Missouri Department of Health,highlighted the challenges encountered by family members and loved ones in making end-of-life decisions in the absence of a living will. In addition to financial costs, these decisions could have adverse psychological effects on loved ones. In their role, physicians have the responsibility of meeting the patient’s physical, emotional, and spiritual needs to help them in their final stages. They should also respect the patient’s requests and provide them with the spiritual guidance they would require. Families and loved ones should also undergo counseling to help them cope with the challenging times and the eventual passing of their loved one.

References

Beard, R. L. (2018). Gale Researcher Guide for: Death and Dying. Gale, Cengage Learning.

Cheeseman, H. R. (2019). Business law: legal environment, online commerce, business ethics, and international issues (10th ed.). Boston: Pearson. ISBN: 9780134729060

Thomas, K., Lobo, B., & Detering, K. (Eds.). (2017). Advance care planning in end of life care. Oxford: Oxford University Press.

US, S. C. (1990). Cruzan v. Director, Missouri Department of Health. West’s Supreme Court reporter110, 2841.

Expert paper writers are just a few clicks away

Place an order in 3 easy steps. Takes less than 5 mins.

Calculate the price of your order

You will get a personal manager and a discount.
We'll send you the first draft for approval by at
Total price:
$0.00