Apa Format With 3 Sources: Step 1 Locate Case United States

Apa Format With 3 Sourcesstep 1 Locate Caseunited States Supreme

APA Format with (3) sources Step 1 – Locate case United States Supreme Court case of Cruzan v. Director, Missouri Department of Health, 497 U.S. ). The full text of this case, along with numerous case briefs, commentaries, summaries, etc., may be found by simply entering the full name of the case into any major online search engine of your choosing. Step 2 – Read case. Review the following questions: • What was the ultimate numerical vote of the court? • When and how can life support be withdrawn? • How does death by refusal of treatment differ from suicide? • How does a living will work and when does it become of legal effect? • What is a health care directive and how does it work? Step 3 – After completing your research, summarize your answers, and, along with any other sources, if any, address and support your particular position/view on the following specific issues, and, specifically, how you would apply the Saint Leo University Core Values of Community, Respect, and Integrity into your actions. Be sure to use proper APA format for citations. 1. What are the potential foreseeable financial, psychological, and medical, yet unintended, harmful consequences to one’s family and friends in failing to provide a properly executed will and living will prior to one’s final illness and death? 2. What are the fundamental distinctions between recuperative medical care and palliative care? Who should be included in the decision to modify care from recuperative to palliative? When, if ever, is the right to refuse any and all medical care appropriate when such virtually ensures the death of the patient? 3. What professionals, medical or otherwise, should be involved in advising decisions concerning end-of life wishes? How does euthanasia differ from a simple cessation of treatment? Who should make end of life decisions for those who are without a family member to take on such a role? 4. What measures can be taken to ensure the quality of ongoing family and social relationships, individually and as a group, to end-of-life patients? What pitfalls are to be avoided in ensuring maintenance of these relationships? What actions may be taken to ensure the spiritual and existential dimensions of the process are respected and integrated? U.S. Supreme Court Cruzan v. Director, MDH, 497 U.S. ) Cruzan by Cruzan v. Director, Missouri Department of Health No. Argued Dec. 6, 1989 Decided June 25, U.S. 261 Syllabus Petitioner Nancy Cruzan is incompetent, having sustained severe injuries in an automobile accident, and now lies in a Missouri state hospital in what is referred to as a persistent vegetative state: generally, a condition in which a person exhibits motor reflexes but evinces no indications of significant cognitive function. The State is bearing the cost of her care. Hospital employees refused, without court approval, to honor the request of Cruzan's parents, copetitioners here, to terminate her artificial nutrition and hydration, since that would result in death. A state trial court authorized the termination, finding that a person in Cruzan's condition has a fundamental right under the State and Federal Constitutions to direct or refuse the withdrawal of death-prolonging procedures, and that Cruzan's expression to a former housemate that she would not wish to continue her life if sick or injured unless she could live at least halfway normally suggested that she would not wish to continue on with her nutrition and hydration. The State Supreme Court reversed. While recognizing a right to refuse treatment embodied in the common-law doctrine of informed consent, the court questioned its applicability in this case. It also declined to read into the State Constitution a broad right to privacy that would support an unrestricted right to refuse treatment and expressed doubt that the Federal Constitution embodied such a right. The court then decided that the State Living Will statute embodied a state policy strongly favoring the preservation of life, and that Cruzan's statements to her housemate were unreliable for the purpose of determining her intent. It rejected the argument that her parents were entitled to order the termination of her medical treatment, concluding that no person can assume that choice for an incompetent in the absence of the formalities required by the Living Will statute or clear and convincing evidence of the patient's wishes. Held: 1. The United States Constitution does not forbid Missouri to require that evidence of an incompetent's wishes as to the withdrawal of life-sustaining treatment be proved by clear and convincing evidence. Pp. 497 U. S. . (a) Most state courts have based a right to refuse treatment on the common law right to informed consent, see, e.g., In re Storar, 52 N.Y.2d 363, 438 N.Y.S.2d 266, 420 N.E.2d 64, or on both that right and a constitutional privacy right, see, e.g., Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 370 N.E.2d 417. In addition to relying on state constitutions and the common law, state courts have also turned to state statutes for guidance, see, e.g., Conservatorship of Drabick, 200 Cal. App. 3d 185, 245 Cal. Rptr. 840. However, these sources are not available to this Court, where the question is simply whether the Federal Constitution prohibits Missouri from choosing the rule of law which it did. (b) A competent person has a liberty interest under the Due Process Clause in refusing unwanted medical treatment. Cf., e.g., Jacobson v. Massachusetts, 197 U. S. 11, 197 U. S. 24 -30. However, the question whether that constitutional right has been violated must be determined by balancing the liberty interest against relevant state interests. For purposes of this case, it is assumed that a competent person would have a constitutionally protected right to refuse lifesaving hydration and nutrition. This does not mean that an incompetent person should possess the same right, since such a person is unable to make an informed and voluntary choice to exercise that hypothetical right or any other right. While Missouri has in effect recognized that, under certain circumstances, a surrogate may act for the patient in electing to withdraw hydration and nutrition and thus cause death, it has established a procedural safeguard to assure that the surrogate's action conforms as best it may to the wishes expressed by the patient while competent. Pp. 497 U. S. , (c) It is permissible for Missouri, in its proceedings, to apply a clear and convincing evidence standard, which is an appropriate standard when the individual interests at stake are both particularly important and more substantial than mere loss of money, Santosky v. Kramer, 455 U. S. 745, 455 U. S. 756. Here, Missouri has a general interest in the protection and preservation of human life, as well as other, more particular interests, at stake. It may legitimately seek to safeguard the personal element of an individual's choice between life and death. The State is also entitled to guard against potential abuses by surrogates who may not act to protect the patient. Similarly, it is entitled to consider that a judicial proceeding regarding an incompetent's wishes may not be adversarial, with the added guarantee of accurate factfinding that the adversary process brings with it. The State may also properly decline to make judgments about the "quality" of a particular individual's life, and simply assert an unqualified interest in the preservation of human life to be weighed against the constitutionally protected interests of the individual. It is self-evident that these interests are more substantial, both on an individual and societal level, than those involved in a common civil dispute. The clear and convincing evidence standard also serves as a societal judgment about how the risk of error should be distributed between the litigants. Missouri may permissibly place the increased risk of an erroneous decision on those seeking to terminate life-sustaining treatment. An erroneous decision not to terminate results in a maintenance of the status quo, with at least the potential that a wrong decision will eventually be corrected or its impact mitigated by an event such as an advancement in medical science or the patient's unexpected death. However, an erroneous decision to withdraw such treatment is not susceptible of correction. Although Missouri's proof requirement may have frustrated the effectuation of Cruzan's not-fully-expressed desires, the Constitution does not require general rules to work flawlessly. Pp. 497 U. S. . 2. The State Supreme Court did not commit constitutional error in concluding that the evidence adduced at trial did not amount to clear and convincing proof of Cruzan's desire to have hydration and nutrition withdrawn. The trial court had not adopted a clear and convincing evidence standard, and Cruzan's observations that she did not want to live life as a "vegetable" did not deal in terms with withdrawal of medical treatment or of hydration and nutrition. P. 497 U. S. 285. 3. The Due Process Clause does not require a State to accept the "substituted judgment" of close family members in the absence of substantial proof that their views reflect the patient's. This Court's decision upholding a State's favored treatment of traditional family relationships, Michael H. v. Gerald D., 491 U. S. 110, may not be turned into a constitutional requirement that a State must recognize such relationships in a situation like this. Nor may a decision upholding a State's right to permit family decisionmaking, Parham v. J.R., 442 U. S. 584, be turned into a constitutional requirement that the State recognize such decisionmaking. Nancy Cruzan's parents would surely be qualified to exercise such a right of "substituted judgment" were it required by the Constitution. However, for the same reasons that Missouri may require clear and convincing evidence of a patient's wishes, it may also choose to defer only to those wishes, rather than confide the decision to close family members. Pp. 497 U. S. . 760 S.W.2d 408 , affirmed. REHNQUIST, C.J., delivered the opinion of the Court, in which WHITE, O'CONNOR, SCALIA, and KENNEDY, JJ., joined. O'CONNOR, J., post, p. 497 U. S. 287 , and SCALIA, J., post, p. 497 U. S. 292 , filed concurring opinions. BRENNAN, J., filed a dissenting opinion, in which MARSHALL and BLACKMUN, JJ., joined, post, p. 497 U. S. 301. STEVENS, J., filed a dissenting opinion, post, p. 497 U. S. 330 . Disclaimer: Official Supreme Court case law is only found in the print version of the United States Reports. Justia case law is provided for general informational purposes only, and may not reflect current legal developments, verdicts or settlements. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or information linked to from this site. Please check official sources.

Paper For Above instruction

The Supreme Court case Cruzan v. Missouri Department of Health (1990) addresses crucial ethical, legal, and medical issues surrounding end-of-life decision-making, particularly the rights of incompetent patients to refuse life-sustaining treatment. This case highlights the intersection of constitutional rights, state interests, and individual autonomy, offering a perspective on how society balances respect for personal dignity with the preservation of life. This essay explores the fundamental principles derived from the case, the potential implications for families and healthcare providers, and how core values of community, respect, and integrity can guide ethical decisions in such sensitive situations.

Introduction

The case of Cruzan v. Missouri Department of Health is a landmark Supreme Court decision that delineates the limits of a patient's right to refuse medical treatment. Nancy Cruzan, an incompetent patient in a persistent vegetative state, became the focal point of debates surrounding autonomy, state interests, and ethical medical practices. The rulings in this case underscore the importance of clear evidence of a patient's wishes and the role of legal safeguards to prevent potential abuses. This case serves as a foundational reference in discussions about end-of-life care, informed consent, and the legal rights of patients.

The Core Issues and Court's Rationale

The Supreme Court's decision, delivered by Chief Justice Rehnquist, affirmed the Missouri Supreme Court's ruling that required clear and convincing evidence of Cruzan’s wishes to withdraw artificial nutrition and hydration. The Court emphasized that the Privileges and Immunities of the Due Process Clause in the Fourteenth Amendment afford a competent individual the constitutional right to refuse unwanted medical treatment. However, for incompetent patients like Cruzan, this right is not absolute and must be demonstrated through reliable evidence, respecting the state's interest in preserving life and preventing potential abuses.

Most notably, the Court upheld Missouri's specific procedural safeguards, including the requirement of clear and convincing evidence, which aligns with the state's substantial interest in safeguarding life and avoiding wrongful determinations. The decision clarified that states could legitimately impose such standards, balancing individual rights against societal values. The Court also recognized that while family members' substituted judgment is convenient, it is not constitutionally mandated unless supported by substantial evidence of the patient's autonomous wishes.

Implications for Family, Medical, and Legal Decisions

The Cruzan case illuminates the vital importance of advance directives, including living wills, which enable individuals to articulate their preferences regarding life-sustaining treatment. The absence of such directives can lead to complex legal battles and emotional distress for families, as families may struggle to make decisions aligned with the patient's desires.

Financially, families may face significant medical expenses without clear guidance, potentially leading to prolonged suffering or unnecessary interventions that strain resources (Miller et al., 2017). Psychologically, family members may endure guilt, grief, or conflict if they differ in opinions about withholding or withdrawing treatment. Medically, uncertain or ambiguous wishes can result in treatments that prolong suffering without benefit (Hacker & Moorman, 2019).

Legal clarity, through properly executed wills and living wills, fosters respect for patient autonomy and reduces the risk of disputes. From the perspective of core values—community, respect, and integrity—such documents uphold respect for individual dignity, support familial harmony, and maintain societal trust in healthcare and legal systems.

Differentiating Recumbent and Palliative Care

Recuperative care aims at curing disease or restoring health, involving aggressive treatments and interventions, while palliative care prioritizes comfort and quality of life, often focusing on symptom management (World Health Organization, 2020). Deciding when to transition from recuperative to palliative care should involve multidisciplinary teams, including physicians, nurses, social workers, and, importantly, the patient or surrogate decision-maker, in accordance with patient preferences and medical prognosis.

Refusal of all medical treatment, which would lead to inevitable death, is ethically permissible when the patient’s autonomous decision is respected, especially if informed and voluntary. Ethical principles such as respect for autonomy, beneficence, non-maleficence, and justice guide these decisions (Beauchamp & Childress, 2019). The right to refuse treatment becomes especially vital when interventions only extend suffering or are deemed futile.

Professional and Ethical Considerations in End-of-Life Decisions

Physicians, nurses, social workers, chaplains, and legal professionals all play essential roles in advising and supporting end-of-life decisions. These professionals must communicate complex medical information compassionately and transparently, respecting patient dignity and cultural values. Euthanasia, involving active steps to end life, differs fundamentally from the cessation of treatment—it is a direct act with ethical controversies surrounding it (Quinn, 2018).

Decisions for those lacking family members should involve healthcare proxies, ethics committees, or court-appointed guardians who are trained and qualified to make decisions that reflect the patient's best interests and prior wishes (Sulmasy & Snyder, 2019).

Maintaining and Respecting Family and Social Relationships

Effective measures, such as family conferences, open communication, and spiritual support, help preserve relationships during end-of-life care. These efforts reinforce the patient's social identity and provide emotional comfort. Pitfalls to avoid include neglecting cultural sensitivities, suppressing honest conversations, or imposing treatment plans without regard for patient or family values (Smith & Williams, 2021).

Integrating spiritual care into medical practice, respecting existential concerns, and fostering community support uphold the core values of community, respect, and integrity. Recognizing the spiritual and existential dimensions helps address the holistic needs of patients and families, promoting dignity and peace.

Conclusion

The Cruzan case exemplifies the complex balance between respecting individual autonomy and safeguarding societal interests. Proper legal safeguards, advance directives, and compassionate communication are essential in navigating end-of-life decisions ethically and responsibly. Upholding the core values of community, respect, and integrity ensures that patients' dignity is preserved while societal and medical standards are maintained. As healthcare advances, continuous dialogue, legal clarity, and ethical vigilance remain critical to honoring the humanity of those facing life's final moments.

References

• Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
• Hacker, K., & Moorman, P. (2019). End-of-life decision-making: Medico-legal issues. Journal of Medical Ethics, 45(4), 251–255.
• Miller, F. G., Emanuel, E. J., & Lipkin, M. (2017). The importance of advance care planning. New England Journal of Medicine, 376(2), 119–121.
• Quinn, S. (2018). Ethical issues in euthanasia and assisted suicide. Journal of Palliative Medicine, 21(4), 392–396.
• Sulmasy, D. J., & Snyder, L. J. (2019). Ethical challenges in assessing decision-making capacity. Journal of Clinical Ethics, 30(3), 209–216.
• Smith, J., & Williams, R. (2021). Family dynamics and end-of-life care planning. Journal of Family Nursing, 27(1), 34–45.
• World Health Organization. (2020). Palliative care. https://www.who.int/news-room/fact-sheets/detail/palliative-care
• American Medical Association. (2019). Decisions near the end of life. AMA Journal of Ethics, 21(5), E421–E429.
• Hale, M., & Koenig, H. G. (2020