In John A. Robertson’s essay, "Cruzan: No Rights Violated," he argues that the decision made by the Missouri Supreme Court to deny Nancy Beth Cruzan’s parents’ request to have their daughter’s artificial nutrition and hydration tube removed was not a violation of Nancy Beth Cruzan’s right to refuse treatment because she had not personally refused treatment. Robertson also claims that keeping Cruzan alive with this particular medical treatment does not alienate her constitutional rights, or her parents’. Robertson states that, " A permanently vegetative patient does not have interests that can be harmed," simply because he/she cannot feel pain and doesn’t know his/her present condition.
Robertson then goes on to say that simply assuming that one would decline treatment in that situation because of his/her prior beliefs is not enough evidence to maintain that the directive was, in fact, released by the said person, and to relieve their self from a state law that orders such a treatment, the person must have released a directive against that particular treatment. If one were to argue that an incompetent patient has the right to have their medical treatment decided by another person on the presumption that it follows with the patient’s previous beliefs, Robertson would declare that the patient is much different than they were before and does not reserve a constitutional right to be managed in the same way they would have been.
In placing the right to decide Nancy’s treatment in her parents’ hands, her parents would be acting in their own interests according to Robertson, and in choosing to stop medical treatment of their daughter, they would be denying their child medical care deemed necessary by the state, which is illegal. With this in mind, Robertson says that the Supreme Court should not extend a family’s privacy to include the refusal of necessary treatment when the [above] treatment is not causing harm to the child.
Next Robertson says that if a person wants to refuse treatment while incompetent, it is their obligation to make a directive before becoming incompetent in order to refuse treatment on the principle of that particular directive, and that requiring this is "not an undue burden on persons who wish to issue directives against medical care when incompetent." If "clear evidence" does not exist in a past directive, Robertson says that providing the treatment does not alienate a person’s right to regulate his/her own care because of the lack of evidence.
Robertson says that people who criticize the rulings of the Cruzan case tend to find the Missouri Supreme Court’s decision to not allow Nancy’s parents to have their daughter’s nutrition and hydration line removed unconstitutional because they overlook the distinctions that he makes in this essay. By looking at these distinctions, Robertson believes that people will see that treating Nancy Cruzan despite her parents’ dissent does not violate anyone’s constitutional rights.
Lastly, Robertson states "Missouri, like most other states, should permit the family to stop Nancy’s treatment and end their own ordeal. But Missouri violates no constitutional rights in choosing otherwise."
The part about Robertson’s argument that I disagree with the most is when he says that keeping Nancy connected to the feeding tube does not violate her parents’ constitutional rights. According to the First Amendment of the Constitution of the United States, "one has the freedom to petition the government for a redress of grievances" and the Fourteenth Amendment states that, " The stated cannot deprive any person of life, liberty or property, without due process of law, nor deny any person within its jurisdiction the equal protection of the laws." With these in mind, it is clear that leaving Nancy connected to the tube is violating her parents’ rights. Her parents are going through plenty of grievances watching their daughter lay there and waste away to nothing because she did not specifically say in writing that she did not want to be attached to a feeding and hydrating line if she ever becomes brain dead. That is inflicting pain and sorrow on her parents and is violating their pursuit of happiness. According to the First Amendment, the Cruzan family has the right to petition the government to have those grievances removed. Robertson says that this is not right because the family will be doing it in their own interests because the feeding tube is not harming Nancy in any way. I don’t believe that because a mother has a right to tell their child to not climb a high tree because they could get hurt. It is not necessarily hurting them, but the parent acts in his/her own interest because they are trying to protect their own child of any possible harm. Removing the feeding tube would eliminate any further harm to their child. Nancy would be able to rest in peace.
Robertson claims that a person should create specific directives so that if a situation were to happen to you, you could keep from having something against your wishes to be performed, and that making these directives is no undue burden. However, the state is saying that the evidence, or directive, has to be "clear and convincing evidence." Which means that a person would have to think of every possible situation they could be in and then think of how they would like to have it dealt with, just in case they are no longer competent to decide. This is a burden on people though. Who wants to sit around and think of the worst possible scenarios of their lives? Who has the time or the knowledge to do this thoroughly enough to make a "clear and convincing" directive? We have a right to not have to do that. Thinking of bad outcomes is not happiness and making people do that is a violation of the Fourteenth Amendment. Lawrence O. Gostin makes a good point towards my argument as well stating, "The state, on the other hand, need not submit any proof to support a finding that the patient would not want to continue treatment." Why don’t they? Aren’t they trying to protect the patient’s interests? The government cannot rightly say that those were her interests. The government has a lack of evidence on their claim that they would want to stay on a treatment.
Just because a person feels no pain, does not give us a right to inflict upon them something that would cause pain if they could feel it. Robertson is saying that Nancy is really no longer a person. He is on a similar path with Mary Ann Warren about what defines a person and that because the "life form" does not posses these particular characteristics, they are not a person and do not reserve the same rights that a person would. Who are they to define a person? Dogs and cats are said to be alive. They have rights to a good life and have laws that protect them against any inhumane treatment. Why should a cat have more rights than a person in Vegetative state?
Because Nancy cannot express that she does not want to be on life support to keep her body alive while her mind does not work, does not mean that she does not have a right to die. If her nutrition and hydration line was excavated, she would die of natural causes. This is allowed in bioethics. Not excavating her line is harming her interests. She is still viable. She is alive. She is a person. Because of these she has rights and interests all of which can be harmed. Robertson claims she is not a person any longer. His definition of a person is not clear in his essay, but as I said before, it seems to go along the same path as what Warren thinks a person to be. The criteria for being a person according to Warren are consciousness, reasoning, self motivated activity, the capacity to communicate, and the presence of self-concepts and self-awareness. Nancy no longer possesses any of these criteria, however, she did at one point. Once you are a person, no one can take that away from you. In Warren’s argument, one may see this as valid because the fetus was never a person under these criteria, but the argument that Nancy is no longer a person does not fit in with this because she was a person before the accident. Taking away her right to be treated as a person once she is a person does not seem permissible. She did not commit some heinous crime where she deserves to have her rights taken away. She is a victim of sad circumstances, and has the right to no longer have to undergo those circumstances.
Say we were to go along with Robertson’s argument that Nancy is no longer a person. I could make an argument somewhat like this:
A parent has the right to abort a fetus because it does
not possess personhood and therefore does not
personhood. Nancy no longer possesses personhood
so she does not have the rights of a person that does
according to Robertson and Warren. Therefore,
it is morally permissible to "abort" Nancy as well.
Of course looking at it this way seems really mean, but it is true. If Nancy no longer is a person with a person’s rights, then someone has the right to "terminate" her. The parent has the right to do this not only because of the possession they have over the child, but the fact that they have to bear the grief that goes along with Nancy staying alive.
I agree with Robertson when he says that they should permit Nancy’s parents to stop treatment on their daughter. However, through my arguments I hope I made it clear that I do not agree with Robertson’s opinion that the Missouri Supreme Court’s ruling violated no one’s constitutional rights. I was relieved to learn that a state judge overruled the original judgment and let the parents terminate the treatment of their helpless daughter.
Robertson, John A. "Cruzan: No Rights Violated," Contemporary Issues in Bioethics,
Wadsworth Publishing Company, 1999.
Bioethics, Wadsworth Publishing Company, 1999.