Although the story and lifelong journey of Nancy Cruzan was both an ethical and legal struggle, ultimately her life was a debatable portrayal of the concept of “Right to Die.” Who has the right to decide whether someone should continue living or not? Should only family members be allowed to decide, or should the government and physician have extreme influence on the decision? More and more each year people are being forced to answer these questions, and the solution never gets any easier.
On December 11, 1983, 25 year-old Missourian Nancy Cruzan was in a serious car accident and after being thrown from her car laid helplessly on an isolated road in Southwest Missouri. For several minutes she laid face down in the snow, struggling for her life. After an ambulance had been called and had worked “for a long time,” Nancy’s heartbeat was restored and she was taken to a hospital clinic and then to Freeman Hospital in nearby Joplin, Missouri. Nancy had been unconscious for a while and the paramedics were becoming worried. Nancy’s parents, Joyce and Joe Cruzan , had been waiting at the hospital for several hours and when Nancy finally arrived they didn’t believe that she was truly their daughter because of the wretched condition she was in. Eventually, Joe and Joyce recognized Nancy because of the yellow socks she was wearing.
At first, with help from family, friends, and medical staff, the Cruzans sought rehabilitation for Nancy in the hope of restoring her consciousness. After being told by many doctors that Nancy would recover, Joe Cruzan “felt like he could finally breathe again.” The entire Cruzan family felt like a giant weight had been lifted off their backs. But after two years and with little progress made by Nancy, she was moved to a state hospital in Mount Vernon, Missouri for brain-injured patients. There Nancy was found to have suffered little injury to her brain stem- controlling involuntary actions- but great damage to her cerebral cortex , the thinking, loving, and relating part of the brain. The damage found to Nancy’s brain was so severe that there was little hope that she would recover. Nancy was left unable to talk, see, think and perform many other basic human functions. She was left in a condition known as a “persistent vegetative state” and had to be fed through a feeding tube. While many patients within the hospital depended on respiratory machines for survival, Nancy was given life support in the form of artificial hydration and nutrition with the hope that her body would restore some of its cerebral function.
The state that Nancy was in deeply affected her entire family. Joe and Joyce Cruzan’s marriage began to hit rough patches as they debated and argued over what to do about Nancy. They sought counseling four times a week, trying to release their inner emotions and capture a peaceful state of mind. Christy Cruzan, Nancy’s sister, fell into a deep depression and struggled to deal with the situation. “She begged [Nancy]. She told Nancy that she would give her her car. She would do anything if Nancy would just come back.” With the state that Nancy was in, a giant hole seeped into the Cruzan family. In August of 1988, the Cruzans sought to have Nancy’s life support removed because it was not helping her recover. The entire Cruzan family felt that Nancy would have said, “I realize it's hard on everyone else, but let me go. I've got other things to do. I've got other places to go, so turn me loose.” Usually, “hope of benefit” and “excessive burden” are key criteria that guide the decision making process. The purpose of removing life support is not to kill the patient, but rather to avoid something that is useless and hindering to family members. But, in the case of Nancy Cruzan, the administrators of the state rehabilitation hospital in Mount Vernon declined to remove the life support without a court order.
When the Cruzans were found to be unable to afford a lawyer, the state of Missouri assigned William Colby as their lawyer. Colby would guide the Cruzans through the court system of Missouri and then to the Supreme Court of the United States. Colby argued that Nancy had expressed a desire to her parents in the past not to live if a serious accident occurred which left her unable to function normally. Many of the justices felt that there was “no automatic insurance that the view of close family members [would] necessarily be the same as [Nancy’s] would have been had she been confronted with the prospect of her situation while competent.” The Missouri Supreme Court found Nancy Cruzan’s intent unclear on the issue and refused to allow the removal of Nancy’s life support. However, the Cruzan’s continued to seek to have Nancy’s treatment discontinued and to “try to set her free from the hopeless condition she was trapped in.”
The Nancy Cruzan case dwindled throughout the court system for a long time, and many of the justices had differing opinons. One felt that the federal courts have no business in the medical field and that the court should not “inject itself into every field of human activity where irrationality and oppression may theoretically occur, and if it tries to do so it will destroy itself.” Others felt that there was no “clear and convincing evidence” of what Nancy would truly want and that “ even a dog in Missouri can not be legally starved to death.” After much debate and skepticism, it was decided that no state interest could outweigh the rights of an individual in Nancy Cruzan’s position. There was no good to be gained by the state of Missouri with the continuation of life support for Nancy after deciding that society as a whole would not benefit from Nancy’s receiving medical treatment.
After three years of legal struggles, on December 14, 1990 Chief Justice William J. Brennan Jr. announced that “Nancy Cruzan has a fundamental right to be free of unwarrated artificial nutrition and hydration, which right is not outweighed by any interestsof the state, and because I find that the improperly biased procedural obstacles imposed by the Missouri Supreme Court impermissibly burden that right, I respectfully dissent. Nancy Cruzan is entitled to choose to die with dignity.” The feeding tube keeping Nancy alive was soon removed and many argued that every life has a meaning and starving Nancy to death devalues life. However, the Cruzans felt that “there was no question [they] made the choice [Nancy] would want” and felt contempt and at ease with their decision. Twelve days later, Nancy Cruzan died at the age of 33 in Mount Vernon, Mo, with her family at her bedside.
The story and struggle of Nancy Cruzan personifies the ethical and medical uncertainties of when has one’s life become so diminished that it is not worth living. The moral validity of euthanasia raises many questions about medical advances and their influence on the value of life. The case of Nany Cruzan has influenced the federal government into passing a law requiring all persons entering a hospital in the United States to be told about living wills. The legacy of Nancy Cruzan will always hover over conflicts and arguments dealing with the idea of “Right to Die.”
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