IS ANYBODY surprised that the death vigil for the woman who became a symbol of the right to die was marred by protesters holding a vigil for her right to life?
The protesters arrived this week at the Missouri Rehabilitation Center, where on Dec. 14 the feeding tube that was keeping Nancy Cruzan alive had been removed. Earlier that day, a county probate judge had ruled that new evidence presented by the Cruzan family fulfilled Missouri's law requiring "clear and convincing" evidence for determining what an incompetent patient's wishes would be.
That law was upheld by the Supreme Court last summer, but in the ruling the court also affirmed that Americans do have a right to refuse life-prolonging medical treatment -- in other words, there is a "right to die." At issue in this case was the standard for determining those wishes when there is no written evidence of a person's intent.
When the decision was handed down, one abortion opponent responded by saying the tragedy that produced the Cruzan ruling was "never truly a 'right to die' case, but a 'right to make dead' case" -- a reaction widely shared in the movement.
Sooner or later, then, a confrontation was inevitable between those who place an absolute value on life at any stage, in any condition, sustained by any artificial means and those who see the feeding tube implanted in Ms. Cruzan's stomach as a fruitless, even cruel way of postponing her death. Unfortunately, the competing vigils this week at the Missouri Rehabilitation Center will probably not be the last such scenes.
As the nation moves further into medical frontiers, patients who would otherwise be dead still breathe because of technological advancements -- in Ms. Cruzan's case, a mixture of chemical nutrients that did not exist 20 years ago. The line between life and death, which once seemed so clear, is more and more often a blur.
At the same time, this society has not yet found a way to balance a reverence for life with a healthy respect for its limits. Until that happens, the ability of patients and their families to retain some control over the end of their lives will be vulnerable to political pressure and emotional harassment from those who see no difference between murder and allowing nature to take its natural course.
The people outside the Missouri Rehabilitation Center this week were not relatives or friends of Nancy Cruzan. They hadn't watched her deteriorate from the vibrant young person whose brain was deprived of oxygen for 15 to 20 minutes almost eight years ago to the comatose woman whose arms and legs were curling up with disuse, who suffered from seizures, diarrhea, incontinence, nausea and infections. Most tellingly, they are not the people who will visit her grave in the years to come.
Their concern is for a principle, for life in the abstract. But life has a way of complicating our neat abstractions.
Dr. James C. Davis, who has been Ms. Cruzan's physician at the rehabilitation center, is evidently a conservative man, one who may well sympathize with some of the protesters' views. Three years ago he opposed the family's wish to remove the feeding tube. This time around, he not only endorsed the request, but also said in court that he considered Ms. Cruzan's condition "a living hell."
It's one thing to believe in life at any cost, physical, emotional or financial. It's another to come to terms with what "life" means for a person in a persistent vegetative state.
The protesters are correct that the power to withdraw a feeding tube is also the power to bring a formal end to another person's life. But I suspect that the majority of Americans will say they are wrong that the "right to die" pushes the country further down "the slippery slope of the death ethic," as the president of the National Right to Life Committee has said.
Now that the Cruzan tragedy is drawing to a close, the important issue for state legislatures and for individual Americans is not whether these life-and-death decisions can be made, but who will make them, and how.