Beyond the Cruzan case: The U.S. Supreme Court and medical practice

Article Abstract:

The Nancy Cruzan case has been widely publicized. Ms. Cruzan was in an automobile accident in 1983 that left her in a persistent vegetative state; she had certain reflexes, but no conscious and cognitive function. One month after her accident, when her prognosis was still uncertain, a feeding tube was surgically implanted through the abdominal wall into her stomach. In 1986, her parents requested that her tube feedings be stopped, as it was clear that she would never recover. The hospital refused, and after the state of Missouri ruled against the Cruzan family, the case was ultimately heard by the Supreme Court. The Court ruled that a state could require that a patient provide clear and convincing evidence regarding his wishes before life support treatment could be discontinued at the request of others, even family members. Eventually, the state of Missouri withdrew its opposition to discontinuation of the tube feedings, allowing Ms. Cruzan's parents to have the feedings stopped, and she died 12 days later. The Supreme Court's ruling holds significance for the medical and legal communities, as well as for patients. Because of the strict standards the Court now permits states to require before withdrawal of life-sustaining treatment, physicians may alter their medical practice for fear of legal reprisals. The Cruzan decision suggest that a state's interests may outweigh the wishes of a patient's family. The decision could have some positive effects if it encourages states to pass laws to permit patients to designate surrogates who can make health care decisions for them should they be incompetent to do so themselves. The decision might also encourage more physicians to discuss the issues of life support with their patients well in advance of life-threatening illnesses. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Social policy, Capacity and disability, United States. Supreme Court, Persistent vegetative state

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Life, death, and the American College of Physicians: the Cruzan case

Article Abstract:

Nancy Cruzan is a patient who lapsed into a persistent vegetative state resulting from injuries suffered in a car accident more than six years ago. Her parents have requested the removal of her feeding tube, which provides her with nutrition and hydration, and without which she would die. The Missouri Supreme Court has denied their request, declaring that the patient has no right to refuse artificial feeding and that the state of Missouri has an "unqualified interest" in life. In addition to legal and moral aspects, the issue of refusing life-sustaining treatment has raised medical questions. The American College of Physicians has presented medical facts about nutritional support techniques and sustenance through the use of a feeding tube, as well as the definition of a persistent vegetative state. This group argues that the right to die should be interpreted as the right to refuse have something done to you, or as a right to bodily integrity. This right to bodily integrity has been applied to drug testing, medical care of prisoners, defining the rights of involuntarily committed mental patients, and self-determination in childbearing and contraception. It is argued that the right to refuse medical treatment may be considered a right to bodily integrity. For patients in a persistent vegetative state, the decision to refuse medical treatment can be made by family members and should be based on the consideration that the vegetative state is associated with a poor quality of life. The United States Supreme Court is currently evaluating the right to refuse life-sustaining treatment based on the facts presented in the Cruzan case. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Evaluation, Reports, Medical ethics, Right to refuse treatment, Treatment refusal, editorial, American College of Physicians

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Selling Products Out of the Office

Article Abstract:

Doctors should be aware of the ethical issues that may arise when they sell products to patients in their office. They should provide the products at a reasonable cost to the patient and disclose their financial interest in selling them. They should also tell patients whether similar products are available from other sources.

Marketing, Physicians, Medical professions, Medical offices

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