Cruzan, Nancy

On January 11, 1983, Nancy Cruzan, then twentyfive years old, was involved in an automobile accident. Her body was thrown thirty-five feet beyond her overturned car. Paramedics estimated she was without oxygen for fifteen to twenty minutes before resuscitation was started. As a result she experienced massive, irreversible brain damage. However, she could breath on her own. Attending doctors said she could live indefinitely if she received artificial nutrition and hydration, but they agreed she could never return to a normal life. Cruzan had not left advance directives—instructions how she wished to be treated should such a physical and mental state occur. A feeding tube enabled her to receive food and fluids. Over the ensuing months, Cruzan became less recognizable to her parents. They began to feel strongly that if she had the opportunity she would choose to discontinue the life-supporting food and fluids. After five years of artificial feeding and hydration at the annual cost of $130,000, and with increasing physical deterioration, Cruzan's parents requested that the feeding tube be removed so that their daughter could die a "natural death." In early 1988 their request was granted by Judge Charles E. Teel of the Probate Division of Jaspar County, Missouri.

Judge Teel's decision was met by a very strong reaction from persons who expressed concern that removal of the feeding tube would not be in accord with Cruzan's wishes under the doctrine of "informed consent." Others argued that removal of the life-support feeding tube would constitute an act of homicide. The state of Missouri appealed Judge Teel's decision. In November of the same year, the Missouri Supreme Court overruled Judge Peel's decision and therefore refused the Cruzan petition to make a decision on behalf of their daughter by stating that the family's quality-of-life arguments did not have as much substance as the state's interest in the sanctity of life. The Cruzan family appealed the Missouri Supreme Court decision to the U.S. Supreme Court. In their pleading to the U.S. Supreme Court, the state of Missouri asked that they be provided clear and convincing evidence of a patient's wishes regarding a will to die before granting the request to discontinue life support for persons in a persistent vegetative state. On June 25, 1990, the U.S. Supreme Court recognized the right to die as a constitutionally protected civil liberties interest. At the same time, the U.S. Supreme Court supported the interests of Missouri by declaring that it was entirely appropriate for the state to set reasonable standards to guide the exercise of that right. Thus, the U.S. Supreme Court sided with the state and returned the case to the Missouri courts.

Following the Supreme Court hearing, several of Cruzan's friends testified before Judge Teel, recalling that she stated preferences for care if she should become disabled. In addition, the doctor who was initially opposed to removing her feeding tube was less adamant than he had been five years previously. On December 14, 1988, the Jaspar County Court determined that there was sufficient evidence to suggest that Cruzan would not wish to be maintained in a vegetative state. The following day the feeding tube was removed and she died before the end of the year.

See also: Advance Directives; Do Not Resuscitate; Euthanasia; Natural Death Acts; Persistent Vegetative State; Quinlan, Karen Ann

Bibliography

Gordon, M. Singer P. "Decisions and Care at the End of Life." Lancet 346 (1995):163–166.

WILLIAM M. LAMERS JR.