The modern medicine has not only perpetuated living but also has perpetuated dying. Earlier patients used to die naturally, however, now it can be doctors, hospital administration, relatives or courts that make decision if, how and when to let them pass away. The more inventions about the brain are discovered, the more difficult is to come to a decision. The truth is that people begin to apprehend death differently. It is no more something painful, disgusting and unexpected. There are a lot of cases when persons get tired of the disease and they find it easier to let themselves die instead of continuing the battle. The technology of killing people is far above the morality. Humanity turns away from its religion and neglect law of nature and its destiny. The question of death and dying in the USA nowadays is tightly connected with concepts of self-determination, advance care planning, right to die, and physician assisted suicide (Bustillos, 2012).
The concept of self-determination is the entitlement of people to be in charge of their lives. It acquires independence and freedom to be self-governing and make the own decisions concerning their health and lives. As a result, their decision must be respected during the time that they do not represent any threat and harm for surrounding. The right of self-determination includes various medical, including death. This concept allows patients with lethal illnesses to die in their own way by means of special drugs. In such a way, they dispense themselves from eternal tortures and relieve their mind of the idea of being a constant burden for everybody. The concept of self-determination also gives a possibility for patients to choose a painless unexpected death over intolerable pain and despair (Bustillos, 2012).
Advance care planning can be performed at any age; it is not only about an old age. It is concerned someone who is suffering from lethal disease, and wants to release himself from sufferings. It is considered to be vital to make a healthcare plans for those who are not sick, just to be sure that they will get an appropriate medical care. Advance care planning includes various types of decisions that might need to be taken and an advance directive. The latter is a legitimate document that comes on stream only when person becomes unable to speak for himself. The reasons can be different: disease or injury, without age restrictions. This type of planning was created in order to know what kind of medical care the person needs (Bustillos, 2012).
The patient’s right to resort to passive euthanasia has been initiated in the USA in the beginning of twentieth century. In 1914, in one of the New York’s hospitals, a patient refused the treatment, after which Justice Benjamin Cardozo announced that every adult sound mind has a right to take his/her own decision regarding his/her body. In the 1970s, this rule was extended, and it was said that everyone with a communicable disease, who poses a threat for other human beings, can terminate treatment even if it causes death.
The right to die is a moral and organized denomination of a person to commit suicide or to perform euthanasia. This right is mostly understood as permission for those who suffer from terminal illness to commit suicide or assisted death or to refuse lifelong treatment. It is sometimes happens that doomed patients, rather than choose a slow and miserable death, ask for taking away the life support.
Physician assisted death (PAD) is a comparatively contemporary locution in the American medical dictionary. It is widespread law in two states of the USA: Oregon, starting from 1994, and Washington State, beginning with 2008. The essence of this term is that terminally ill patients living in these states – competent and with clear sense – may request and get from the doctor a prescription for drugs that are able to terminate life. However, PAD is not the same as euthanasia. Euthanasia leads the medical practitioner to supply the patient with the fatal amount of the medicine. Unlike euthanasia physical assisted death only leads the doctor to recommend what to do and how to do that (Ball, 2012).
This program was initiated by two euthanasia enthusiasts – Dr. Jack Kevorkian, a pathologist, and Derek Humphry, a founder of a Hemlock Society USA. Kevorkian used to help his patients to commit a suicide with the help of his own death device, called Thanatron. Humphry, instead, started aiding people to perform suicides because of the painful death of his wife who was suffering from cancer. As a result, he founded a Hemlock Society that gave people necessary information how to avoid the pain from incurable diseases, such as cancer and amyotrophic lateral sclerosis (ALS).
This paper is going to present three cases regarding death, dying and law in the USA. The first modern right-to-die case was the case of Karen Ann Quinlan, who was born on March 29, 1954, in Scranton, Pennsylvania. In a few months after her birth, she was adopted by Joseph and Julia Quinlan. In 1975, she moved from her parents’ house and started living with two roommates. As soon as she left parents’ house, she resorted to a serious diet, since she wanted to fit a dress she had bought earlier. As a result of starvation, her weight was 115 pounds, and she got in the hospital.
The name Karen Ann Quinlan resembles the predicament of many terminally ill patients, who were kept alive by special mechanical procedures that helped to sustain the life essential functions. She turned twenty one when she entered a coma after experiencing two episodes of apnea while being at friends’ party. The reasons of Karen Ann no breathing still remains unknown. Every episode was about fifteen minutes long, and they happened before she got in the hospital. The doctors were trying to keep her alive for about three months, nevertheless, she did not show any hopes. As a result, physicians put her on a mechanical ventilator, supported her with the best nutrition, and performed a physical therapy to help her with the muscles. Finally, after four months of medical care the doctors announced about Karen Ann persistent vegetative state without any chance for recovery. She has no longer looked like a young woman pictured in her high school album, her body curled into a fetal position, she lost approximately 65 pounds and her eyes were still and dull (Stryker, 1996).
Being fully desperate in decisions, Karen’s family insisted on disconnecting their daughter from the ventilator to release her from pain and sufferings. In consideration of the hospital being catholic, doctors needed a thorough consultation with the hospital administration about disconnecting her from ventilators. After few days of consideration, the hospital refused Karen’s family wish. Consequently, the Quinlans started the legitimate fight in the courts to obtain Karen’s removal from the life support. In 1976, Karen’s family achieved the desirable results, only after a year Karen fell into coma. The doctors released her from life support; however she lived nine more years before she died from pneumonia in 1985 (Stryker, 1996).
The case of Karen Ann Quinlan was decided as a very debatable topic of that time. Her accident drew national attention on the issues of life and death that were not often discussed earlier. The Quinlan’s case appeared to be not ineffectual. According to The New York Times, after continuous debates more than 50% of Americans agreed that the terminally ill patient and his/her family have the right to reject medical treatment (Stryker, 1996).
Another example of death and dying was an accident with Terri Schiavo (Theresa Marie Schindler). She was born on December 3, 1963. She was an obedient shy child but with a good sense of humor. She was fond of music, arts and animals. Although she had a small circle of friends, everybody who knew her, loved her very much. She attracted people with her sincerity, mercy and openness. In 1983, she met Michael Schiavo, who became her husband in a few months after the first date.
At the age of 26, in 1990, Terri suffered from a sudden cardiac arrest, the cause of which has never been determined. Some friends of Terri were talking about her eating disorders. However, there was no mentioning about the bulimia in the news. The doctors diagnosed her with a hypoxic encephalopathy that was the result of lack of oxygen to the brain. Terri spent two and a half month in coma being connected to the ventilator, nonetheless, after some time she started breathing without assistance and keeping up life functions. Her state was considered as unstable which is why she was provided with a PEG tube in order to secure the safe supply of nourishment and hydration (Cline, 2007).
The case with Terri Schiavo lasted from 1998 to 2005. It was a legal battle for prolonged life support. Doctors were trying to bring her back to life with the help of speech and physical therapy. Unfortunately, she was diagnosed with a persistent vegetative state (PVS) and the issue was whether to bring a life support to an end or to continue her treatment. In 1998, Michael Schiavo appealed to Sixth Circuit Court of Florida to disconnect her feeding tube. He tried to convince everybody that Terri asked him earlier to save himself and her family from such tortures as taking care of her. Nevertheless, Terri’s parents were against; moreover, they claimed that their daughter was conscious. On April 24, 2001, her feeding tube was removed the first time since the court established that Terri would not want to carry on the life-prolonging measures. However, in a few days, Terri’s parents achieved tube’s return.
There are many video clips revealing the truth about Terri Schiavo’s case. The truth is that Terri was not a “vegetable” or “comatose,” as her husband said. Subconsciously, she responded almost every gesture and motion: she was crying, vocalizing, comprehending the words, following simple commands, and moving her eyes. In other words, Terri was clearly aware of the environment. If it was not her husband, Terri might have had a chance to continue her life. Michael did not want any changes to be done to his wife since he lost every hope for Terri’s recovery. On March 31, 2005, Terri died after the feeding tube was disconnected completely. Concerning such problems, caused by bulimia and cardiac arrest, the case of Terri can become a big lesson for those who has an obsession with food and theirs body images (Lynne, 2005).
The case of Terri Schiavo was established numerous times in many lawsuits in the state of Florida. A lot of people thought of her case as the morally incorrect actions that contradict with faith and religion. Still, some of them believe that people like Terri deserve painless death without tortures. Notwithstanding, the federal government had no right to follow the wishes of Schiavo’s family.
One more accident happened on January 11, 1983, with Nancy Cruzan, a twenty five years old woman who lost control of her car, bumped into a tree and fell into a ditch. She was found lying face down in the ditch without any vital signs. She was seriously injured with cardiac and respiratory arrest and never became consciousness again. The doctors stated that she had cerebral contusions together with a serious anoxia (lack of oxygen). The hospital administration announced that a permanent brain damage arises after 6 minutes in an anoxic state; however Nancy had a lack of oxygen for approximately 12-14 minutes. She was lying in coma for three weeks and then her state changed to unconscious. She was one of those who were living in a persistent comatose state. Firstly, she was not in the persistent vegetative state, she was able to swallow some nutrition and her medical status was a seriously handicapped person. The only life support she needed was the gastrostomy feeding and hydration tube, which was implanted in her stomach. With the help of that tube, the process of nourishment was considerably simplified. That meant that she was not terminally ill and had at least minor chances for survival. Unluckily, further efforts of rehabilitation were ineffectual. The doctors complied with the fact Nancy was in the persistent vegetative state meaning that she was able to express basic reflexes, but there were no signs of cognition. Nevertheless, the State of Missouri kept financing the costs indispensable for her living (Nachtigal, 1990).
In Cruzan’s case, the Missouri Supreme Court was interested in prolongation of her life. The Court announced that decision since Nancy was not terminally ill and could continue the life by means of regular nourishment. Truly, the Court was not interested in quality of life. The state was afraid that the Cruzan’s case would lead to the numerous equal cases, and it was dangerous to perform such amount of life terminations. Moreover, the Court did not have any proves that Nancy wanted to end her life (Nachtigal, 1990).
The State Supreme Court had several extrinsic evidences for Nancy to be alive and described her condition as follows:
- her breathing and circulation of blood were performed naturally and were in accordance with the regular norms of a young woman;
- she was unaware of the surrounding, despite the fact she reflectively responded to sounds and extrinsical irritants;
- Nancy suffered from anoxia of the cerebrum which resulted into a huge expansion of the ventricles. Those ventricles filled with cerebrospinal fluid in the section where the brain deteriorated and the cerebral cortical emaciation was irreparable, lasting, growing and constant;
- her cognitive intellectual abilities were demonstrated by her scowling and frowning in response to extrinsical stimuli and various sounds;
- she was a spasmodic paralyzed;
- her four limbs were affected with irreparable muscular and sinew impairment;
- she had no cognitive or reflexive capacity to ingest food or drinks in order to comply herself with the daily needs (Nachtigal, 1990).
On the whole, Nancy was neither dead nor terminally ill. She was diagnosed with a persistent vegetative state. Additionally, the doctors agreed that she was able to live thirty more years in that condition. According to the Missouri statute, the case with the human death can be established only on the authority of the norms of medical practice. The first norm stated that the patient’s death could not be determined unless his/her breathing or blood circulation are artificially performed. That is why, considering that standard, the State Supreme Court could not undertake anything with Nancy’s case (Nachtigal, 1990).
The cases mentioned above have raised many debates over the role and need of medicine in the ambiguity of life and death. This subtle line between life, death and the medicine is now a very disputable area. Some people assume that death must be reevaluated and apprehended in a modern way, like a new step in the human life or like a challenge that needs to be overcome. The rest of majority are held to the opinion that every human in this world has its own life cycle that cannot be broken. That is why the question of death, dying and the law in America and all over the world remains unsettled since many people have disharmony in their opinions and actions.
