There is some hopeful news on the right-to-die front.
For the family of Nancy Beth Cruzan, there is a good chance that Missouri courts will now grant permission for her feeding tube to be removed and allow her to die.
For the rest of the country, Congress has provided an important boost to encourage Americans to make known in advance their wishes about life-prolonging medical treatment.
On Nov. 1, the Cruzan family was in a Missouri court again, requesting permission to have the feeding tube withdrawn from the 32-year-old woman who gave her name to the first Supreme Court ruling on the right to die. Issued in June, that decision upheld a state's right to set strict standards for determining a comatose patient's wishes in regard to life-prolonging treatment. But the ruling also stated that Americans do have a "right to die."
This time around, there seems to be no opposition to removing Cruzan's tube and allowing her to die after more than seven years in a persistent vegetative state. William Webster, Missouri's attorney general who defended the state's rigid standard for determining a patient's wishes in such circumstances, has withdrawn from the case, and Thad C. McCanse, Cruzan's court-appointed guardian, sides with the family.
So it looks as though this tragic case may soon be resolved at last, allowing the Cruzan family to bury their daughter, mourn her loss and begin the process of recovering from their grief.
Meanwhile, similar cases continue to bedevil Americans in hospitals, nursing homes and courts around the country. Despite the enormous publicity surrounding the Cruzan case, which chillingly illustrates the need for people to make their wishes about these medical choices known beforehand, only 10 percent to 15 percent of Americans have drawn up living wills or other advance directives. (That sounds insignificant until you realize that only about one-third of adult Americans have drawn up a regular will.)
But hidden away in the enormous budget bill passed by Congress in the hectic final days of the session is a new law that should give a big boost to efforts to encourage Americans to pay attention to these questions while they are competent to do so.
Sponsored by Sen. John Danforth, R-Mo., and Sen. Daniel Patrick Moynihan, D-N.Y., and Rep. Sander Levin, D-Mich., in the House of Representatives, the law is designed to assure that health-care providers respect patients' rights to participate in decisions affecting their treatment.
When it goes into effect a year from now, the law will require hospitals, nursing homes and other Medicare and Medicaid providers to inform patients of their rights to accept or refuse treatment under state law.
Adults receiving medical care in or through the organization will receive written notice of state laws in regard to living wills and durable powers of attorney. They must be asked whether they have a living will or other advance directive, and the information must be noted in their records.
If a hospital has a policy against withdrawing life-sustaining VTC treatments, patients must be told about that as well.
Guidelines for enforcing the law will be drawn up during the next several months, and these regulations will have much to do with the law's effectiveness.
With good guidelines, however, the new law can help a great many Americans come to terms with questions that too many people successfully avoid until it's too late.
*Send your comments and questions about death and dying to Sara Engram, Mortal Matters, The Evening Sun, P.O. Box 1377, Baltimore, Md. 21278.
* *Universal Press Syndicate