Nancy Cruzan: the Right to Die Debate

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On January 11, 1983, Nancy Cruzan was in a car accident.[1] She was driving down Elm Road in Jasper County, Missouri, when her car flipped.[2]  A state trooper found Nancy laying face down in the snow in a ditch. Nancy showed no vital signs, but paramedics resuscitated her. She suffered from oxygen deprivation for twelve to fourteen minutes, when only six minutes of oxygen deprivation causes permanent brain damage. Nancy Cruzan was also in both cardiac and respiratory arrest.[3]

Once Nancy Cruzan was in the hospital, she was said to be in Persistent Vegetative State, also know as PVS, because of the brain damage that she had she suffered from during oxygen deprivation.[4] As described by Dr. Fred Plum, the creator of the term “Persistent Vegetative State” and a well renowned doctor on the topic of PVS, describes it by saying “Vegetative state describes a body which is functioning entirely in terms of its internal controls. It maintains temperature. It maintains heartbeat and pulmonary ventilation. It maintains digressive activity. It maintains reflex activity of muscles and nerves for low-level conditional responses. But there is no behavioral evidence of either self-awareness or awareness of the surroundings in a learned manner.”[5]

Although PVS is very serious, Nancy showed some small improvements in her condition, and doctors said that she would be able to live for another thirty years in her Persistent Vegetative State.[6] She was showing signs of feelings such as when someone would enter or leave her room and she showed signs of recognition of pain by crying. Nancy Cruzan also showed acknowledgement when the nurse would open up a can of food according to her father, Joe Cruzan.[7] Although Joe Cruzan saw these small signs of improvements in Nancy’s condition, he came to a tough conclusion: although his daughter’s body was still breathing in the hospital, she was dead.[8] While Nancy Cruzan was a married woman, her parents remained her legal guardians. “Under Missouri law, guardians are required to provide for the ward’s care, treatment…support and maintenance including insuring that the ward receives medical care and promoting and protecting the care, comfort, safety, health, and welfare of the ward.”[9] Because of this, Joe Cruzan had the authority to decide to end Nancy Cruzan’s earthly life by removing her from the ventilator and hopefully end the stressful times that her family had been going through while she was in the hospital.  After Nancy was taken off the ventilator she continued breathing. This was not as the Cruzan family had hoped. Although this seems like a great feet, the facts were the same; Nancy was in a Persistent Vegetative State and she showed no signs of a great recovery. The next step that Joe decided he had to do was to get permission in a Missouri trial court for Nancy Cruzan’s feeding tube to be removed after she had been in a Persistent Vegetative State for seven years. However, Joe couldn’t have her feeding tube removed because Nancy didn’t have a living will that stated that she would want her feeding tube removed if she were ever in a vegetative state.[10]

Joe Cruzan easily received permission from the Missouri trial court to withdraw Nancy Cruzan’s feeding tube, but this was only the beginning of a long process. The State and court appointed guardian ad litem appealed the Missouri trial court’s decision and the case was brought to the Missouri Supreme Court.[11]

The Missouri Supreme Court shut down the hopes of Joe Cruzan being able to let his daughter die anytime soon. In a four to three decision, the Missouri Supreme Court denied Joe Cruzan permission to withdraw the feeding tube through which Nancy received based on the argument that life itself mattered, not the quality of the life. The state supplied many reasons for not permitting the removal. One was that there was no constitutional right to die. Another was that this was not simply a case where someone would be allowed to die; it would be a case allowing the starvation and dehydration of someone until they died. One concern the judges had with this case was that the verdict may be expanded to allow the euthanasia of handicapped individuals in the future, so Judge Blackmar said that the state should not be involved in a case as complicating and as possibly monumental as this case’s verdict could end up being in the future. Joe Cruzan denied the fact that if there became a verdict of allowing the removal of the feeding tube would be able to be used in cases of euthanasia of severely handicapped people and he appealed the Missouri Supreme Court.[12]

The case was then brought to the United States Supreme Court in December of 1989[13] and “Of the more than fifty ‘right to die’ cases considered by state courts since 1976, Cruzan [became] the first to be heard by the U.S. Supreme Court.”[14] The Supreme Court stated, “As state appointed guardians of Nancy Cruzan under Missouri Law, Nancy’s parents are required to act in her best interest of their ward… The central issue then is whether or not feeding Nancy Cruzan is in her best interests.”[15] The Supreme Court agreed that the constitution required convincing evidence that Nancy Cruzan would not want to be kept alive by a feeding tube while in a vegetative state and to take her off of life support, and the state of Missouri requires the judgment of Nancy Cruzan, herself. This was shown through the Due Process Clause of the Fourteenth Amendment, which stated that no state could deprive someone “of life, liberty, or property, without due process of law,” and the law required very convincing evidence. Justice Brennan admitted that the requirements for the evidence had too high of standards, and Nancy Cruzan’s family lacked this convincing evidence that would lead to the allowance of her feeding tube being removed. The U.S. Supreme Court came down to a five to four decision to not let Nancy Cruzan’s feeding tube be removed.[16]

Everything in this long, drawn-out process changed when three of Nancy’s friends came forward saying that she had expressed feelings to them that she would not want to be kept alive by feeding tubes prior to her accident.[17] Joe Cruzan then brought this evidence to a Missouri trial court and on December 14, 1990. Nancy’s friends quoted her saying, ”death is sometimes not the worst situation you can be in when compared to being sent to the point of death and then stabilized without hope of ever really getting better.”[18] The court ruled that this was convincing evidence that Nancy Cruzan did not want to be kept alive through life support and the Cruzan family was finally allowed to remove Nancy’s feeding tube.[19]

Two hours after the ruling of the Missouri circuit court’s verdict, Nancy’s feeding tube was removed. Nancy’s close friends and family held a twenty-four hour vigil until she had finally passed eight years after her accident on December twenty-sixth, almost two weeks after the feeding tubes were removed.[20]

The experience didn’t stop there; Joe Cruzan admitted that he had doubts about whether getting Nancy’s feeding tube removed was the right thing to do and said, “I've wondered sometimes if we have finally accomplished for God what he set out to do. People say that's blasphemy, but I don't mean it that way. I mean it as, `Where does God fit into the equation?’ “ On August eighteenth 1996, Joe Cruzan was found dead after committing suicide at the age of sixty-two.[21]



[1] Library Index, .

[2] Supreme Court. (UMKC School of Law, 1990). 2.

[3] Library Index

[4] Library Index

[5] Supreme Court. (UMKC School of Law, 1990). 2.

[6] Library Index

[7] Christian Life Choices. .

[8] Library Index.

[9] Bopp. . (The Hastings Center Report, 1990). 43.

[10] Library Index

[11] Library Index.

[12] Library Index

[13] Library index

[14] Wolf. . (The Hastings Report, 1990). 38.

[15] Bopp. . (The Hastings Center Report, 1990). 42.

[16] Library Index.

[17] Library Index

[18] Wolf. . (The Hastings Report, 1990). 38.

[19] Library Index

[20] Library Index. .

[21] Seattle Times Obituaries. . (The Seattle Times, 1996).