Chapter 10  : Care of the Dying

Section 2.  Social Context


This section was organized, prepared and written by Mark Riddagh (SCCC, 2006) using Ronald Munson's Intervention and Reflection as a guide.

Social Context: The National Impact of Nancy Cruzan

On a cold January morning, Nancy Cruzan became the unwitting participant in an event that would bring a formerly unaddressed subject into the chambers of the Supreme Court. Although it took nearly eight years, this unfortunate 25-year old made the "right to die" an issue that state and federal courts alike, could not ignore.

Following a tragic automobile accident, Nancy was admitted to the Missouri Rehabilitation Center without her higher–brain functions required for recognition, comprehension, memory, and other cognitive abilities. Indefinitely unconscious, Nancy’s condition was considered a "persistent vegetative state" and she was showing little hope for recovery. To keep her alive was the best the physicians could hope to achieve. Nancy lingered from 1983, the year of the accident, to 1990. These years were racked with sorrow for her parents as they watched their daughter lie in a fetal position, unaware of their presence or her own, day after day, year after year. The physicians concluded that she could linger for another 30 years without any chance for even the slightest recovery.

This prognosis helped Nancy’s parents come to one of the hardest decisions they would ever have to make. They agreed that her death would be the best course of action for Nancy and they informed the physician’s of their decision to have her feeding tube removed. The staff at the rehabilitation center refused their request and the case ended up in the Jasper County Circuit Court. Although the court ruled in favor of the Cruzan’s, the Missouri Attorney General appealed the decision, which unfortunately for the Cruzan’s, was overruled. The court stated that one must provide "clear and convincing evidence" that the decision to withhold nutrition was the will of the patient. The court further stated that the family had failed to provide this required piece of evidence during the hearing and therefore it would be unlawful to remove Nancy’s feeding tube.

Although the Cruzan’s attorney appealed to the Supreme Court, the ruling of the state was upheld and the feeding tube was required to keep Nancy nourished as long as she remained alive. The Supreme Court ruled that the state was right to "err on the side of life" and that without "clear and convincing evidence" as to a patient’s wish to withhold treatment, the state has the authority to decide such matters. The decision came as a disappointing blow to the Cruzans, however for the first time, the Supreme Court acknowledged a constitutional basis for living wills and the designation of a person to make decisions on one’s behalf should they become incapable of making them for themselves.

Despite the ruling against the Cruzans, the entire litigation brought some powerful consideration to light. In the 14 Amendment of the Constitution, something known as the "Liberty Interest" was cited as a basis for the freedom to decline medical treatment. The Court acknowledged this as a Constitutional right on the same grounds that if one touches another without their consent and the touch is unwanted, then the touching is in effect considered battery. Thereby, even if a patient doesn’t give consent, the withholding of consent is still considered non-consent. Unfortunately, the Court was unable to make a decision concerning those who were unable to give consent due to coma or other condition stifling one’s ability to communicate. In such a situation, how can one be sure of the patient’s desires concerning treatment?

Ultimately, the Supreme Court failed to decide whether assisted suicide was supported by the Constitution, which leaves the decision where it initially resided, in the hands of the state. Fortunately for the Cruzans, the Jasper County Circuit Court withdrew their case. Another appeal was entered by the family’s attorney and on December 14, 1990, the state ruled in favor of the removal of Nancy’s feeding tube. The decision came after Judge Charles Teel concluded that Nancy’s intent, "if mentally able, would be to terminate her nutrition and hydration." (Munson – 198)

Although public protesters objected, the tube was removed and on December 26, 1990, Nancy Cruzan died. During her nearly eight years of unconsciousness, Nancy’s was able to bring the issue of autonomy and self determination for those unable to make their own decisions all the way from Jasper County Missouri to the U.S. Supreme Court and for the first time, the Judicial Branch recognized a person’s Constitutional "right to die".

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© Copyright Philip A. Pecorino 2002. All Rights reserved.

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