Episode 22: What Every Parent Needs to Know When Their Child Turns 18
Episode 22
Host: Jill Mastroianni
What Every Parent Needs to Know When Their Child Turns 18
Your child becomes a legal adult at 18, but what if something happens, and they can’t speak for themselves? Would you be allowed in the room? Would you know what they’d want?
In this episode, Jill shares the powerful real-life stories of Nancy Cruzan and Terri Schiavo, and explores the legal right to terminate life-sustaining treatment.
Whether your teen is heading to college or still living at home, Jill walks you through the essential documents and conversations that can protect your child’s autonomy and give your family peace of mind.
What We Cover in This Episode:
Why the law treats your child differently the moment they turn 18
The story of Nancy Cruzan, and how a lack of documentation led to a prolonged legal battle all the way to the U.S. Supreme Court
The story of Terri Schiavo, the national debate that followed, and what it revealed about end-of-life decision-making
What “persistent vegetative state” and “clear and convincing evidence” mean
The difference between a guardian and a guardian ad litem
Why advance healthcare directives and healthcare powers of attorney matter, not just for older adults, but for your 18-year-old
Conversation starters for talking to your child about medical wishes
Jill’s personal story and why she chose her husband as her agent
Resources + Links:
Connect with Jill:
Website: DeathReadiness.com
Email: jill@deathreadiness.com
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Jill Mastroianni: (00:00)
Your child becomes a legal adult at age 18. But what if something happens—and they can’t speak for themselves?Would you know what they’d want? Would anyone even let you in the room?
Today, I’m sharing the stories of two young women whose families faced unimaginable decisions—and the one document that could have changed everything.
This isn’t just for aging parents. It’s for every family with an 18-year-old.
I’ll tell you the one thing your teen can do to make sure their voice is heard—even if they can’t speak.
(00:33) Welcome to the Death Readiness Podcast. This is not your dad’s estate planning podcast. I’m Jill Mastroianni, former estate attorney, current realist, and your guide to wills, trusts, probate and the conversations no one wants to have. If your Google search history includes, “Do I need a trust?” “What exactly is probate?” and “Am I supposed to do something with mom’s Will?” you’re in the right place.
I’ve worked with so many families over the years who ask: “What do I need to do to help my parents?”But almost no one asks: “What about my 18-year-old?”Not until something happens.
Back when I was at Dartmouth, I trained to be an EMT. I saw how quickly things could change for young, healthy students when something went wrong on a ski slope.
I didn’t see as much as others—because I never actually became an EMT.Turns out, the sight of blood and bone is a bad combination… not just for the patient. I got lightheaded just standing in the room.
(01:35) Still, what stuck with me wasn’t the emergencies themselves—it was how fast everything could change, and how often families weren’t prepared for what came next.
And that’s why this episode matters.It’s for anyone with a teenager on the cusp of adulthood—because the law changes at 18, whether you’re ready or not.
This week’s Tuesday Triage question comes from Susan, a mom of 18-year-old twin girls in Missouri. They’re heading off to college this fall, and she asked:
“Is there anything important they should sign before they leave?”
The answer is yes.And not only will I tell you the most important document they should sign—I’ll also share the conversations I recommend having before they go.
(02:17) But first, I want to take you back to Missouri—Susan’s home state—and to the story of a young woman named Nancy Cruzan.
On the evening of January 11, 1983, driving home from her shift at a cheese processing factory in Carthage, Missouri, Nancy Cruzan, then 25 years old, lost control of her car.
The first responder found Nancy face-down in a ditch. She wasn’t breathing and she didn’t have a heartbeat. Although it was estimated that Cruzan was deprived of oxygen for at least 14 minutes, paramedics were able to restore her breathing and heartbeat at the accident site.
Prior to her accident, Nancy did not have an advance healthcare directive or healthcare power of attorney.
An advance healthcare directive is a document where you state your preferences for medical care if you're unable to speak for yourself—especially in cases of serious illness or injury.
A healthcare power of attorney is where you name someone to make medical decisions for you if you can’t make them for yourself.
(03:18) After the accident, Nancy’s husband—who, under Missouri law, had the legal authority to make medical decisions for her—consented to the surgical implantation of a feeding and hydration tube to support her recovery.
But after more than four years with no meaningful change in Nancy’s condition, her parents, Joe and Joyce Cruzan, asked the state hospital to remove the tube and allow her to die naturally.
Let me pause for a moment to define what it means to be in a persistent vegetative state.
According to Dr. Robert Fine of the Baylor University Medical Center, the vegetative state is best described as “eyes-open unconsciousness.” The patient may appear awake but has no awareness of themselves or others. They can't interact, comprehend language, or express themselves meaningfully. Facial expressions like smiling or grimacing may occur, but they aren't tied to specific stimuli. When this condition lasts more than a month, it’s referred to as persistent.
As a reminder, Nancy had been in a persistent vegetative state for nearly five years by the time her parents made their request.
(04:33) Now, you might remember that her husband initially consented to the feeding tube, and then years later, it was her parents who requested it be removed.
According to a 1990 article in The Seattle Times, Nancy’s parents were granted court permission to replace her husband, Paul Davis, as her guardian. At their request, the court also dissolved the marriage.
Generally, absent a healthcare power of attorney to the contrary, a healthy spouse has decision-making authority over an incompetent spouse rather than the incompetent spouse’s parent.
Yet, the hospital refused to follow Joe and Joyce Cruzan’s directive to remove Nancy’s feeding tube without a court order.
So the Cruzans petitioned the Missouri state trial court for approval.
On July 27, 1988, the trial court granted their request and authorized the removal of Nancy’s feeding tube.
But the story didn’t end there.
(05:21) Nancy’s court-appointed guardian ad litem, along with the Missouri Department of Health, appealed the decision to the Missouri Supreme Court.
Let’s pause here and talk about what a guardian ad litem is—and how that role differs from a guardian.
Joe and Joyce Cruzan were Nancy’s legal guardians, meaning they were responsible for making everyday decisions on her behalf. But because the decision to withdraw life-sustaining treatment was so significant, the court also appointed a guardian ad litem—a neutral third party tasked with protecting Nancy’s best interests. His job was to review the situation independently and provide a recommendation to the court.
So why did the guardian ad litem appeal?
That’s the confusing part—he didn’t disagree with the trial court’s decision. He believed it was in Nancy’s best interest to remove the feeding tube. But because this was the first case of its kind in Missouri, he felt a responsibility to bring it before the highest court for further review.
On appeal, the Missouri Supreme Court reversed the trial court’s decision.
(06:32) The Court ruled that in order for Nancy’s parents to make a decision that would result in her death, there had to be clear and convincing evidence that removal of the tube was what Nancy would have wanted.
Let me explain what “clear and convincing evidence” means.
It’s a legal standard that falls between “more likely than not” and “beyond a reasonable doubt.” It means the evidence is strong enough to make you firmly believe that something is true, but it doesn’t remove all doubt.
Nancy’s parents presented testimony from a roommate who recalled Nancy once saying she wouldn’t want to live unless she could “live at least halfway normally.”
But the Missouri Supreme Court found that this single conversation wasn’t enough to meet the clear and convincing standard.
The Cruzans appealed that decision to the United States Supreme Court.
(07:22) The core question was this: Under the Fourteenth Amendment, can a guardian refuse life-sustaining treatment on behalf of an incapacitated person?
The Fourteenth Amendment says no state shall deprive a person of “life, liberty, or property without due process of law.” The U.S. Supreme Court assumed—for the sake of this case—that a competent adult has a constitutional right to refuse life-sustaining treatment, including food and water.
But Nancy wasn’t competent. She couldn’t express her wishes. And that right—if it existed—could only be exercised by someone else on her behalf.
Missouri law said that someone could only make that decision if there was clear and convincing evidence of the patient’s own wishes.
On June 25, 1990—by a 5–4 vote—the U.S. Supreme Court upheld Missouri’s position. The Court ruled that in the absence of clear and convincing evidence, the state was within its rights to preserve life.
(08:22) The Missouri trial court hadn’t used the clear and convincing standard.
So, two months later, the Cruzans returned to the trial court with new evidence—testimony from three of Nancy’s former co-workers who recalled conversations about her preferences.
This time, the judge found that the new testimony met the clear and convincing standard. Nancy’s feeding tube was ordered removed.
There was no appeal. The state had withdrawn from the case and did not try to stop the decision.
On December 14, 1990, Nancy's feeding tube was removed.
She died twelve days later on December 26, 1990.
From Nancy’s second-floor room, Joe and Joyce Cruzan could see the protesters outside.
And they could read their signs:
“Please Feed Nancy”
“How Would You Like To Be Starved to Death?”
In spite of this, Joe even took a coffee pot out to a group holding a 24-hour prayer vigil.
Joe once commented, “I would have gladly traded places with any one of them protesting down there. But I wouldn’t have been out trying to influence their decisions. I’d be home enjoying my daughter.”
(09:39) How did Nancy’s health and the legal battle affect her parents, Joe and Joyce?
I don’t know for sure.
But, on August 17, 1996, less than 6 years after Nancy’s death, Joe Cruzan died by suicide at age 62, having hanged himself in his family’s carport. Joe and Joyce were still married at the time of his death.
Joyce died less than 3 years later on March 20, 1999. I did not find her cause of death.
The Cruzan story was one of family unity, at least as far as I could tell.
And still, it was so very hard and so very sad.
(10:23) The second person I want to tell you about is Terri Schiavo. Her name might sound familiar.
On February 25, 1990, at just 26 years old, Terri suffered severe brain damage following a cardiac arrest.
Like Nancy Cruzan, Terri was young. And like Nancy, she didn’t have an advance healthcare directive or a healthcare power of attorney.
But unlike Nancy, Terri lived in Florida.
Terri was married to Michael Schiavo, who was appointed as her legal guardian by the court in June 1990.
Florida, like Missouri, required clear and convincing evidence of a person’s intent before allowing life-sustaining treatment to be withdrawn—unless those wishes were documented in an advance directive.
Michael initially pursued a range of treatments to try to improve Terri’s condition, even taking her to California for experimental procedures, including the surgical implantation of a thalamic stimulator.
But by May 1998—more than eight years after her cardiac arrest—Michael petitioned the court for permission to remove Terri’s feeding tube, stating that she would not want to continue living in that condition.
(11:35) The Florida trial court agreed, finding clear and convincing evidence in Terri’s past statements that supported her wish not to be kept alive artificially.
Terri Schiavo’s parents didn’t agree with Michael, and the legal battle over her fate began.
The case gained national attention—and political involvement.
Florida’s then-governor, Jeb Bush, stepped in, along with the state’s House and Senate.
In October 2003, the Florida legislature passed what became known as “Terri’s Law.”
It gave the governor one-time authority to stop the removal of nutrition and hydration from a patient if, as of October 15, 2003:(a) the patient had no written advance directive,(b) had been found to be in a persistent vegetative state,(c) had already had nutrition and hydration withheld, and(d) a family member objected to that withdrawal.
The governor’s authority under this law was limited to 15 days.
(12:32) On October 21, 2003, Governor Bush issued an executive order directing medical personnel to immediately resume feeding Terri Schiavo through a tube.
But Terri’s law didn’t hold. On September 23, 2004, Florida’s Supreme Court ruled that “Terri’s Law” was unconstitutional.
The U.S. Supreme Court declined to hear the case on January 24, 2005, letting the state ruling stand.
Terri’s feeding tube was removed for the final time on March 18, 2005.
She died thirteen days later, on March 31, 2005.
Her brass grave marker in a Clearwater, Florida, cemetery is inscribed with the words:"I kept my promise."
It’s a powerful line.But to keep a promise like that, you have to know what the promise is.
(13:23) That’s why these conversations matter.
Before there’s a crisis.
Talk to your kids. Whether they’re still living at home or heading off to college, they deserve to be heard—and you deserve to know how to show up for them in the way they would want.
Here’s what I suggest for Susan and other parents. Listen to this podcast with them. Talk about what YOU want. Ask them what THEY want.
The conversation doesn’t have to be formal or heavy. It can start with something as simple as:
“I’ve been thinking about what I’d want if something ever happened to me—and it made me realize I don’t actually know what you’d want.”
(14:02) It’s okay to share your own wishes, too. Modeling that openness can make it easier for them to respond.
For example, I might say, “I’ve made some decisions about my care if I’m ever in that situation. I trust your dad to honor them—and I want the same for you. I want someone to step in who knows what matters to you.”
If your teen is willing, help them put their choices in writing—with an advance healthcare directive and a healthcare power of attorney.
It’s not just paperwork. It’s a way of saying, This is who I am. This is what I need. And here’s who I trust to speak for me.
And that’s a gift—to them, and to you.
(14:44) I’ll include links in the show notes where you can find the appropriate documents for your state of residence. If your child is in school, I suggest having them fill out a form for the state where their permanent residence is and a form for the state where their school is located.
And if you're wondering what this actually looks like in practice—I'll share my own example.
I trust my husband Jeremy to make decisions for me. That’s why I’ve named him as my agent on my healthcare power of attorney.
And, on Michigan’s advance directive, I signed my name to the following statement.
I expressly authorize my patient advocate to make decisions to withhold or withdraw treatment which would allow me to die, and I acknowledge such decisions could or would allow my death. My patient advocate can sign a do-not-resuscitate declaration for me. My patient advocate can refuse food and water administered to me through tubes.
Jeremy, I hope you’re never in a position where you have to make those decisions.But if you are, know that—with my love—I’m giving you full permission to let me go.
(15:52) If you found this episode helpful, I’d love for you to share it with someone you think could benefit from it.
If you have a question you’d like me to answer on a future Tuesday Triage episode, whether related to today’s episode or something totally different, send me an email at jill@deathreadiness.com or visit deathreadiness.com/TuesdayTriage. I’d love to hear from you.
This is Death Readiness, real, messy and yours to own. I’m Jill Mastroianni and I’m here to help you sort through it, especially when you don’t know where to start.
Hi, I'm April, Jill's daughter. Thanks for listening to The Death Readiness Podcast.
While my mom is an attorney, she’s not your attorney.
The Death Readiness Podcast is for educational and entertainment purposes only.
It does not provide legal advice.
For legal guidance tailored to your unique situation, consult with a licensed attorney in your state.
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