NANCY Cruzan will probably not be alive, in the literal sense, when the new year comes, but in almost every other respect, she departed this life years ago. In 1983 when she was 25, an automobile accident left her brain damaged and in a permanent vegetative state. She has lain since in a hospital bed unable to communicate, subject to seizures and dependent on others for her every need. She has been deteriorating physically and, according to her doctors, will never recover; she has been kept alive by artificial feeding. Her family has been trying since 1987 to end this treatment. Last Friday a Missouri judge found clear and convincing evidence that Nancy Cruzan would not have wanted to go on living like this, and authorized her family to discontinue chemical feeding.
This decision has legal meaning only for the Cruzan family, but in the course of the litigation, ground rules were set out by the Supreme Court broadly governing the decision to die. The justices ruled last June that competent persons have the right to refuse medical treatment, execute living wills and convey a durable power of attorney to others so that their wishes will be carried out if they become incompetent. The problem for the Cruzans was that their daughter, young and in good health, had not taken these specific steps; in their absence the state of Missouri required clear and convincing evidence of her intentions. The Supreme Court ruled that the state had the right to establish this standard, though in some other states much less is required. In the second round of court hearings, three of Nancy Cruzan's friends, who hadn't been heard in the initial proceedings, testified that she had discussed her views on the matter with them and had indicated she would not want to continue to live as she does now. The judge decided that this provided the evidence required by the statute.
This litigation has been a terrible trial for the Cruzan family, but it has served to clarify everyone's prerogatives concerning the refusal of medical treatment and extraordinary, life-sustaining care. These are rights that can only be realized if people take steps in advance to make their own wills known.