Case Analysis Involving Medical Ethics Using IRAC Method

 

Scenario
Analyze ethical and legal implications of cases involving bioethics. Two examples of highly publicized cases are listed below.

1. The national discussion concerning decision making for incompetent patients began with the 1976 case of Karen Ann Quinlan. Because she had been left in a persistent vegetative state after two periods of anoxia, her parents sought court authorization to remove her from a ventilator. The New Jersey Supreme Court, in a landmark, unanimous decision, authorized the removal on the basis of Quinlan’s constitutional right of privacy, which the court concluded would be lost unless her parents were given authority to exercise it on her behalf. In the 15 years since Quinlan, courts in almost 20 states have reviewed disputes regarding treatment for incompetent patients. Courts in all these states have recognized the general right of competent people to refuse treatment, and in all but two states have also ultimately found that the U.S. Constitution, state constitution, or common law permits a surrogate to make treatment decisions on behalf of an incompetent person (Annas, 1990).

2. The case of Nancy Cruzan is essentially identical to that of Karen Ann Quinlan, with one exception: Nancy Cruzan, a young woman in a persistent vegetative state as a result of a 1983 automobile accident, requires only tube feeding (rather than a ventilator and tube feeding) to continue to survive. Her parents firmly believe she would not want to have tube feeding continued under such circumstances, in part on the basis of her own statement that she would not want to continue to live if she could not be “at least halfway normal.” For this reason, a trial judge authorized her parents to have their daughter’s tube feeding discontinued (Annas, 1990).

Instructions
Select a case for which you are familiar or have an interest that involves medical ethics. Prepare a case analysis using the IRAC method. The analysis must be in IRAC format. Your analysis should address the following:

Provide an Introduction before the IRAC format. (Simply discuss what the case involves) 1-page

IRAC should be 2-pages

The Issue (What is the question present to the court?)(Must be in question format)
Rule (What are the applicable rules to be used in the decision process?)
Analysis ( What does the court consider to be the relevant facts given the rules?)
Conclusion (What was the final outcome?)

 

Sample Solution

Case Analysis: Nancy Cruzan (IRAC Method)

Introduction

The case of Nancy Cruzan, a young woman left in a persistent vegetative state after a car accident, ignited a national debate about the right to die and the role of family decision-making in end-of-life care. This analysis will dissect the legal and ethical issues surrounding Ms. Cruzan’s case using the IRAC method.

  1. Issue

Did Nancy Cruzan, an incompetent patient in a persistent vegetative state, have the right to refuse life-sustaining treatment (tube feeding) through her parents acting as her surrogate decision-makers?

  1. Rule

The legal and ethical considerations in this case revolve around several key principles:

  • Right to Privacy: The Fourteenth Amendment’s right to privacy potentially extends to decisions regarding medical treatment and bodily autonomy, including the right to refuse unwanted medical interventions.
  • Substituted Judgment: This principle allows surrogates to make decisions based on the patient’s previously expressed wishes or presumed best interests if the patient is incompetent.
  • State Interest: States have a legitimate interest in protecting the sanctity of life and preventing suicide. However, this interest needs to be balanced against an individual’s right to self-determination.
  1. Analysis

The court considered several key factors in its analysis:

  • Nancy’s Wishes: While Nancy had never executed a formal living will, her parents testified that she had expressed a desire not to be kept alive on machines if she were ever in a similar situation.
  • Medical Condition: The court acknowledged the permanence of Nancy’s vegetative state and the minimal invasiveness of tube feeding compared to a ventilator.
  • Quality of Life: The court considered the potential for subjective interpretations of Nancy’s desired quality of life, but ultimately recognized the burden of continued existence in her condition.
  • Role of the Family: The court recognized the emotional and ethical burden placed on Nancy’s parents and their role in advocating for her presumed best interests based on their understanding of her wishes.
  1. Conclusion

By a narrow 5-4 margin, the U.S. Supreme Court affirmed the lower court’s decision, authorizing Nancy’s parents to have her tube feeding discontinued. The court’s reasoning hinged on the right to privacy and the concept of substituted judgment, acknowledging Nancy’s presumed right to refuse life-sustaining treatment based on her parents’ testimony about her wishes. This landmark decision established a legal framework for surrogate decision-making in the context of incompetent patients and their right to refuse medical interventions.

 

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