Nancy Cruzan lost her life January 11, 1983. She was finally set to rest in peace after being pronounced dead on December 26, 1990. In the intervening eight years she lay in a permanent vegetative state.
She lost control of her car near Carthage, Missouri going home from work at 1:00 am. She had been thrown clear and landed in a water-filled ditch face down unable to breath for the 15 minutes before the paramedics arrived. Her heart successful was successfully restarted, though she remained unconscious. The hospital inserted a feeding tube through which she received nutrition. For the next eight years she would be in a permanent vegetative state (PVS), body rigid, limbs contracting and bending unnaturally. She never regained consciousness or awareness of the world around her, except she would apparently react to pain.
Five years had elapsed when her parents, recognizing that Nancy herself would not want to exist that way, requested the feeding tube be removed. The hospital refused barring a court order.
Although the lower court granted the request stating there was enough evidence that Nancy’s would not want to be kept alive, the hospital appealed and won. Reversing the lower court’s decision, the Missouri Supreme Court found there was lacking “clear and convincing evidence” of Nancy’s desires, so Nancy continued to receive nutrition.
The fight continued to the U.S. Supreme Court, which again found in favor of the hospital and the Missouri Department of Health. Without more evidence, they ruled, the feeding tube would remain in place. Following the decision, the Cruzan’s found other of Nancy’s friends who confirmed conversations with Nancy that she would not want to be kept alive under the circumstances. With the new information the State of Missouri, the Department of Health and the hospital withdrew their objections and the feeding tube was removed on December 14, 1990. She was declared dead December 26, 1990.
Her headstone reads:
Nancy Beth Cruzan
Most Loved
Daughter – Sister – Aunt
Born July 20, 1957
Died Jan 11, 1983
At Peace Dec 26, 1990
The Court’s ruling resulted in four findings:
- The U.S. Constitution does not guarantee a right to die
- The right-to-die or medical-aid-in-dying is determined by the individual states
- The state’s interest in preserving life supersedes a patient’s right to refuse treatment (assuming an inability to communicate otherwise) without a living will, or other clear evidence of a patient’s desires
- A patient unable to speak for him- or herself (i.e., an” incompetent person”) should designate a medical proxy (aka granting a medical power-of-attorney)
Fewer than four in ten Americans have an Advance Directive. In the nearly thirty years since the passing of the Patients’ Self-Determination Act, surprising few have taken advantage of documenting their wishes at the end-of-life.
Four in ten people.
The number is mystifyingly stable—four in ten people with terminal diseases have an Advance Directive.
Four in ten adults in the general population.
Four in ten elderly people, even including those in retirement homes, nursing homes, and long-term care facilities.
Certainly, the numbers vary a bit, but very little.
Anyone of us could be a Nancy Cruzan without an Advance Directive, connected to tubes, in ICU, with no prospect of any return to a meaningful semblance of living, much less a full recovery.
The lack of an Advance Directive may forebode a painful, desirable, expensive, dying, resulting in undue suffering for both patient and loved ones.
The Art of Dying Well is working for better.