The Schiavo Litigation: A Case Study for Federalism

Abstract:     
State courts addressing the question of the right of a patient to refuse life-sustaining medical treatment have applied common law principles protecting a patient's bodily integrity and medical autonomy in such disputes. While this question grows more complex when patients lack the capacity to make their own medical treatment decisions, end-of-life cases for incompetent patients are consistently resolved by state courts applying this common law rule and its related statutory codifications.

Given the routine treatment of such right to die cases by state courts, Congress's extraordinary and last-minute intervention into the recent Schiavo litigation attracted nationwide attention. At the conclusion of exhaustive litigation by Florida state courts, which resulted in the removal of life-sustaining treatment from an incapacitated patient pursuant to the directive of her surrogate-husband, Congress authorized federal jurisdiction over the Schiavo dispute. In response to this remarkable authorization, federal courts exercised customary deference to Florida's courts by refusing to issue a preliminary injunction to continue treatment and by declining to re-examine the settled state law issues. While the federal courts' deference to the decisions of the state court precluded an examination of the constitutionality of Congress's allocation of federal jurisdiction, this article explores the unresolved constitutional question with an eye on its applicability to future end-of-life disputes.

Constitutional objections to Congress's enactment characterize the statute as an overly broad exercise of federal jurisdiction, a legislative interference with a final judicial decision, a denial of equal protection to one patient, and a violation of the fundamental right to refuse medical treatment. The article addresses the validity of each of these objections in kind, ultimately finding that Congress, by stopping short of directing federal judicial review of state issues and instead leaving such review to the discretion of federal courts, narrowly managed to preserve the statute's constitutionality, while at the same time virtually ensuring that the federal courts would end up affirming the state courts' actions. While concluding that Congress's action was constitutionally valid by a narrow margin, the article nevertheless maintains that the statute unwisely undermined American federalist principles by conferring federal jurisdiction in disregard of state power. Accordingly, Congress's anomalous action in the Schiavo litigation should be viewed as a mistake not to be repeated in future end-of-life disputes.

Number of Pages in PDF File: 27

Keywords: end-of-life, right to die, right to refuse treatment, incapacity, surrogate, Schiavo, jurisdiction, preliminary injunction, judicial deference, federalism, judicial power

JEL Classification: K10, K13, K41

Accepted Paper Series