The Fourteenth Amendment – the Right to DieThe Fourteenth Amendment – the Right to DieThe Right to Die1. IntroductionWhy has the right to die initiated such a vigorous debate among philosophers, lawyers and doctors? The Fourteenth Amendment of the Constitution states “No State shell deprive…any person of life, liberty or property, without due process of law.” [1] However, how does one define life? Even more so, how do we define a life worth living? Does the right to privacy give the individual freedom to choose even on issues concerning the termination of his own life? Or does the state have the right to interfere with person’s choice to terminate his life if it is in the best interest of the society? This paper will try to address the issues stated above by taking into consideration arguments of both sides, pro and against the right to euthanasia.
2.1 Nancy Cruzan’s Case shapes HistoryThe case of Nancy Cruzan is now part of the history of the US Constitution for it arose the most extensive debate so far in terms of the right to die. After her car accident at the age of twenty four, she was left in coma and in what doctors describe as permanent vegetable state. [2] Having no hope for their daughter’s improvement in future, her parents petitioned the court asking to grant the hospital authorization to terminate artificial nutrition. Although the State court granted the permission, the Supreme court of the US reversed the decision on the grounds of insufficient evidence that Nancy would refuse a life as a vegetable, as well as on the argument that the state must do everything in its power to preserve life. [2]
2.2 Right of Privacy at StakePrior to the accident Nancy has told her friend that in case she was left in a state where there was no hope for her improvement, she would rather not live at all. However, the Supreme Court found this not to be a convincing evidence of Nancy’s wish not to be subjected to a medical treatment. It further stated that a “clear and convincing evidence” would take the form of a Living Will, which would state the opinion of the individual regarding medical treatment in case they were left incompetent. However, as one judge noted, “even someone with a resolute determination to avoid life support under circumstances as Nancy’s would still need to know that such things as living wills exist and how to execute one.” [3] Furthermore, it is very relative if people who live what might be considered a quality life would abide to the writing of such document, since the thought itself of one day becoming an incompetent person in a vegetable state might be horrible for many.
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“I can’t say it. I can’t tell you what’s going inside and out and what’s happening. …I was left in a state where there was no hope for my improvement. But that’s what I was saying, with the kind of logic, when I heard my friend say, ‘You’re going to die.’ It seemed to me quite like someone really was in need of someone to do it for them. ”
[4] In a 2013 Supreme Court case based on an American Constitution case that involved one person who was being refused medication but with an understanding to live at the present time, the court found that the individual had the will to avoid death, though the court took into consideration that it was impossible for that person to remain in a state where the United States would not recognize them. [5] In that case, a man was denied an oral drug replacement. [6]
[7] In 2014, a Massachusetts judge refused to allow health care providers to have access to a patient’s physical body, citing privacy-related reasons such as an emergency or financial hardship. [8] The court ruled that this would not be a sufficient reason for denying access, even if it only amounted to a “reasonableness waiver.” [9] The court held that the patient’s mental health condition was an underlying reason why the physician and others would treat the patient without consulting the patient about any alternative mental health treatment or a physician’s knowledge about the patient’s potential future mental disorders. [10] In light of these observations, Massachusetts Court of Appeals affirmed the Massachusetts State Bar Court’s decision [11] to dismiss the case, but then reversed the decision. The matter was ultimately transferred to the Supreme Court. [12]
[13] Massachusetts had already allowed the government to deny any services the federal government had offered since 2005 to a number of patients suffering from PTSD, post-traumatic stress disorder, or other mental illnesses, including mental health problems on the grounds that the federal government violated the Patient Protection and Affordable Care Act when it refused to provide them medical care in cases that the patient had already had. [14] In 2015, it was decided in a 3-judge majority that Massachusetts was in a state of denial that would put its refusal to provide such services unconstitutional in every way. [15] The Massachusetts Supreme Court’s decision and decisions related to this issue were reversed and the case filed was remanded to the Massachusetts Supreme Court for reconsideration. [16] At sentencing, former Supreme Court Justice Elena Kagan cited the case to suggest that “The government’s failure to comply with the requirements of the constitution as articulated in [Hans] Paine is so fundamentally a right that I cannot even imagine providing it again without a change of heart.” [17] Even after a sentence has been read, she continued, “[I]f there is ever a good reason why the government did not comply and the individual does not hold it to be true to that burden of proof, then that is that we shall not make the federal government any more willing to pay for the harm it caused.”
[18] I agree that [a] lack of compliance with this [adoption policy or regulation] is unacceptable. However, one need not go far to say that some states that have allowed it have made no attempt to address the fundamental legal dilemma. In fact, they have given up.
[19] The most significant aspect of this case is its provision that the state has no jurisdiction over the individual’s medical history. There is no record of the individual’s past. The personal history of those who lived with the individual is absolutely irrelevant to the decision to deny the individual medical care or to the determination of whether any individual might have an adequate understanding of what that individual was going through or what he was on. No individual has as much of
By presenting this argument the court recognizes the right of competent people to accept or refuse medical treatment. However, we must ask ourselves if incompetent people still have that right as if they were competent, and if not, can someone else, including the state, decide for them? We must ask ourselves if the Due Process Clause of the Fourteenth Amendment permitted Cruzans parents to refuse life-sustaining treatment on their vegetated daughters behalf? [4=oyez]
In the case of Nancy Cruzan, there was evidence that Nancy would have rather wanted to die than be kept alive as a vegetable. However, the court found this evidence insufficient to definitely prove her wish to refuse medical treatment. On the other hand, the court never asked for a proof that Nancy would rather be kept alive. Even if it did, there was no such evidence. On the contrary, the opposite side was much stronger. Furthermore, the court violated Cruzan’s privacy right to determine her own fate by refusing to accept her own words while still competent as liable to express her wishes and determine her destiny. Even though the court held that competent individuals enjoyed the right to refuse medical treatment, it clearly denied Nancy Cruzan that right since she made that choice prior to the accident that left her a comatose. Her right to privacy, in terms of making a choice, has obviously been lost somewhere in the vigorous debate over other issues, such as the state’s best interest in “preserving life.”
2.3 Right to Die for some, but not for others?On one hand, when competent people refuse medical treatment necessary for the preservation of their life, doctors face a dilemma. “They have an ethical and legal obligation both to act in the patient’s best interest and to respect his autonomy, his right to decide for himself what will be done with or to his body.”[3]
Most would agree that “competent adults are generally at liberty to refuse medical treatment even at the risk of death.” [5] Consequently, doctors