As Nancy Cruzan is laid to rest at last and her family...

COPING: MORTAL MATTERS

January 05, 1991|By Sara Engram | Sara Engram,Evening Sun Staff Universal Press Syndicate

As Nancy Cruzan is laid to rest at last and her family regains its privacy, it's worth reviewing the landmark case that resulted in the Supreme Court's first ruling on the right to die.

Almost eight years after an automobile accident left Cruzan permanently unconscious, a county probate judge declared on Dec. 14 that her parents, Joe and Joyce Cruzan, had presented clear and convincing evidence that their daughter would not have wanted to be kept alive in that condition.

Within hours, the order was delivered to the Missouri Rehabilitation Center, and the feeding tube that had kept Cruzan alive was withdrawn. Her family and the medical staff then began a vigil, waiting for her death, which came Dec. 26.

Her legal death, that is. Throughout this long ordeal, her family has pointed out that the Nancy they knew was "gone" already.

Since this family tragedy first became a court case, the legal VTC issue centered on the standards for "substituted judgment." If Nancy Cruzan was permanently unconscious, who then could make life-or-death decisions for her and what evidence would they need to show that their judgment conformed with what she would want?

Missouri law calls for "clear and convincing" evidence, the strictest legal standard. When the same county judge who issued the recent decision first gave the Cruzans permission to remove their daughter's feeding tube almost three years ago, the state's attorney general challenged the order, saying that the evidence presented -- the family's testimony, together with a friend's report of a conversation with Cruzan -- was not clear and convincing. The state's highest court agreed.

The Cruzans then appealed to the U.S. Supreme Court, which last summer upheld the Missouri law. But in doing so, a majority of the justices also gave explicit support to the notion that a person has the right to refuse life-prolonging treatments.

The decision pointed up the importance of a living will or other advance directive. These documents, the court said, would meet the "clear and convincing" standard of evidence. But like the vast majority of Americans, Nancy Cruzan, who was 25 at the time of her accident, left no such instructions. At the time, Missouri did not even have a living will law.

The ruling meant that Nancy Cruzan would remain attached to her feeding tube until the family could present better evidence of her wishes.

Fortunately, the publicity spurred three more friends to come forward to report conversations in which Cruzan expressed abhorrence of living like a vegetable.

In addition, her medical condition continued to deteriorate, to the point that her physician described her existence as "a living hell." Meanwhile, the state dropped its opposition to withdrawing the tube. All these factors contributed to the recent ruling.

That didn't satisfy right-to-life protesters, who appeared at the hospital as the Cruzan family waited for their daughter's death.

In legal terms, these people had no standing to contest the decision. But their protests did point out the absolute value they attach to the term "life" in any condition, preserved by whatever uncomfortable artificial means.

In the kindest light, their own "vigil" was a misguided reflection of the Cruzans' grief. This clash between the "right to life" and the "right to die" is not over.

In the meantime, Nancy Cruzan leaves an important legacy to her fellow citizens -- not just the right to make decisions about their treatment in advance, but also the duty to give these unpleasant possibilities some serious thought.

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

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