Nancy Cruzan, who lay in a coma for eight years while a national debate over treatment of the hopelessly ill raged around her, is dead.
Cruzan's parents fought a prolonged and nationally publicized legal battle for the right to let their severely brain-damaged daughter die, arguing before two Missouri courts and ultimately the U.S. Supreme Court that she would not have wanted to live indefinitely in what doctors called "a persistent vegetative state."
Thirteen days ago, the family finally received permission from a state court to disconnect the tube that supplied their daughter with food and water; and yesterday at 3 a.m., while anti-euthanasia protesters sang carols outside the hospital, the 33-year-old woman died of dehydration.
"She remained peaceful throughout and showed no sign of discomfort or distress in any way," the Cruzan family said in a statement. "Knowing Nancy as only a family can, there remains no question that we made the choice she would want."
The Cruzan case, the first of its kind to come before the Supreme Court, brought national attention to right-to-die issues and prompted national legislation requiring that patients be informed of their right to refuse life-sustaining treatment.
"The legacy of Cruzan is that it made people at the bedside feel that they had to listen more carefully to what patients said about treatment preferences," said Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota. "It gave a boost to living wills. It gave a boost to the idea that the stopping of treatment should be discussed before someone becomes incompetent or impaired and made doctors and nurses more attentive to the idea that the tubes they put in could be also be removed."
The case also prompted an angry outburst from anti-euthanasia groups which contended that Cruzan's parents were in no position to judge whether their daughter was better off dead and that cutting off her food and water was tantamount to murder.
Throughout the 12 days leading to Cruzan's death, people associated with the antiabortion group Operation Rescue maintained a vigil outside the rehabiliation center in Mount Vernon, Mo., where Cruzan was hospitalized. At one point, they stormed the clinic in an attempt to reattach her feeding tube.
"This is a tragedy and a travesty," said James Bopp Jr., president of the National Legal Center for the Medically Disabled. "The Nancy Cruzan case challenged us as to how we are prepared to respect the lives of people with disabilities. . . . People talked about her as if she was not alive, saying she was just a shell, judging her on her disability and not as a person."
"The concept of a 'life not worthy of being lived' already has a long and violent track record in this century," said Gary Bauer, president of the Washington-based Family Research Council. "If our culture applauds the forced starvation of a human being because of third parties' substituted judgment as to the desirability of her continued life . . . it will show that we are blind to some very clear warning signs of a slippery slope."
Cruzan sustained severe brain damage in a automobile accident Jan. 11, 1983. Although she could breathe without an oxgyen tent or respirator, her body was rigid, her eye movements erratic and she was kept alive only by means of the tube to her stomach.
Her ailments included bleeding gums, vomiting, seizures and diarrhea. Her care at the public hospital where she was treated cost Missouri taxpayers $112,000 a year.
In 1987, Cruzan's parents asked a state court for permission to have the tube disconnected, arguing that their daughter would never have wanted to be kept alive when she had no consciousness and no hope of recovery. A lower-court judge approved their request the following July.
That decision was reversed, however, by the Missouri Supreme Court, which held that the Cruzans had to present "clear and convincing evidence" that, under the circumstances, their daughter would have wanted to die. In a landmark ruling last June 25, the U.S. Supreme Court upheld the Missouri decision.
In November, the Cruzans returned to the Missouri court, and several of their daughter's former co-workers testified that she had told them she never wanted to live "like a vegetable." The state court ruled that this met the "clear and convincing evidence" standard, and it gave permission Dec. 14 for removal of the life-sustaining tube.
Jan. 11, 1983: Nancy Cruzan, 25, is thrown from a car in an accident on a country road southeast of Carthage, Mo. Paramedics restart her breathing, but her brain is without oxygen for so long that she never regains consciousness.
Feb. 5, 1983: Doctors implant a feeding tube in Cruzan's stomach; she is not on any other life-support system.
Oct. 19, 1983: Cruzan is moved to the Missouri Rehabilitation Center in Mount Vernon.
Oct. 23, 1987: Joe and Joyce Cruzan ask Jasper County Probate Judge Charles Teel for permission to remove their daughter's feeding tube so she can die as they believe she would want.
March 9, 1988: A three-day hearing begins on the family's request. The Cruzans say Nancy has a common-law right to be free from unwanted medical treatment as well as state and federal constitutional rights to privacy that protect her right to refuse unwanted medical treatment.
July 27, 1988: Teel approves the request.
Aug. 3, 1988: Missouri Attorney General William Webster files notice that the state will appeal to the state Supreme Court.
Nov. 16, 1988: Voting 4 to 3, the state Supreme Court overturns the lower court. The family appeals to the U.S. Supreme Court.
Dec. 6, 1989: The U.S. Supreme Court hears arguments; it is the first time the high court has considered a right-to-die case.
June 25, 1990: Voting 5 to 4, the Supreme Court blocks removal of the tube, saying the state can keep a patient on life support in the absence of "clear and convincing" evidence that the person wants to die.
Aug. 30: The Cruzans ask Teel for a second hearing, saying they have new evidence that Nancy once indicated to three people that she would rather die than live in a vegetative state.
Sept. 17: Webster, saying the state no longer has a "recognizable legal interest" in the case, asks Teel to drop the state Health Department and the director of the Missouri Rehabilitation Center from future litigation.
Oct. 23: Teel drops the state as a defendant.
Nov. 1: Three former co-workers tell Teel that they recall conversations with Cruzan in which she said she never would want to live "like a vegetable" on medical machines. Cruzan's physician, who had opposed removing the feeding tube, terms her life "a living hell" and testifies that she should be allowed to die.
Dec. 5: Cruzan's court-appointed guardian recommends that the feeding tube be removed so she may die.
Dec. 14: Teel approves.
Dec. 18-24: State and federal courts deny various injunction requests by anti-euthanasia groups.
Yesterday: Cruzan dies in the Missouri Rehabilitation Center.
SOURCE: Associated Press