Missouri Court Says Family Can Let Woman Die

Bringing to an end the nation’s foremost right-to-die case, a judge in southwestern Missouri ruled Friday that the parents of 33-year-old Nancy Cruzan, who has been comatose since a January, 1983, automobile accident, may stop her artificial feedings and let her die.

The parents, Joe and Joyce Cruzan, immediately met with her doctors at the Missouri Rehabilitation Center in Mt. Vernon. They were expected to stop the feedings within 24 hours.

“We will abide by the judge’s order,” Donald Lamkins, the hospital administrator, said in a telephone interview. “Nancy will continue to get the good quality care she has received up to now.”

Physicians estimate that Cruzan may die in about two weeks, Lamkins said.

The Cruzans thanked the judge and others in a statement read by their attorney at a press conference in Carthage, Mo., where the ruling was handed down.

“I think most of all I’m proud of Nancy,” the statement said. “She was our bright, flaming star who flew through the heavens of our lives. Though brilliant, her flight was terribly short-lived. But she left a flaming trail, a legacy that I do not think will be shortly forgotten.”

The decision ends a three-year legal fight that was highlighted by a landmark U.S. Supreme Court decision in July. The decision affirmed that a person whose wishes are clearly known has a constitutionally protected right to reject life-sustaining treatment. But it said also that states, as Missouri had done, may limit the common medical practice of allowing families to make such decisions for members whose wishes are not clearly known.

Although they were initially frustrated by the Supreme Court ruling, the Cruzans and their attorney were able to produce additional evidence of their daughter’s wishes, as well as new medical testimony.

This led Judge Charles E. Teel Jr. to decide that the criteria set by the Supreme Court had been satisfied.

“The court, by clear and convincing evidence, finds that the intent of . . . (Nancy Cruzan), if mentally able, would be to terminate her nutrition and hydration,” Teel, of the Jasper County Circuit Court in Carthage, wrote in a brief decision.

“There is no evidence of substance to cause belief that (Cruzan) would continue her present existence, hopeless as it is, and slowly, progressively worsening,” Teel added.

The new evidence, presented to Teel in November, included testimony from two women who had worked with Cruzan at a small school for deaf and blind children in 1978. They learned of her plight through the publicity generated by the case.

Both women told of specific conversations they had had with Cruzan about death and dying, including one in which she agreed that, if she became a “vegetable,” she would not want to be fed by force or kept alive by machines.

Also, her physician, Dr. James C. Davis, testified that he had changed his belief that her tube feedings should be continued. When asked if he could imagine himself in Cruzan’s state, Davis replied: “I think it would be a living hell.”

The state of Missouri, which had fought the feeding-tube removal all the way to the Supreme Court, unexpectedly withdrew from the new court proceedings in October. State health officials said they would abide by the decision, whichever way it went. The state’s withdrawal left no official opposition to the family’s request.

It was the second time that Teel had ruled for the family, which first sought court approval to remove the feeding tube in 1987. His first ruling, in July, 1988, was appealed directly to the state Supreme Court, where it was reversed in a 4-3 decision. That decision was then upheld by the U.S. Supreme Court by a 5-4 vote.

“There comes a time when things should end,” said Thad C. McCanse, a Carthage attorney who was appointed to represent Nancy Cruzan’s interests in court. “It doesn’t make any sense to keep this litigation going or to maintain her indefinitely in this limbo.”

McCanse had also supported the family’s earlier request to stop the feedings.

But James Bopp Jr., general counsel for the National Right to Life Committee, disagreed. The ruling “is very distressing” and “is not lawful,” Bopp said in a telephone interview from Terre Haute, Ind. “It is clear that the evidence does not support denying her food and water.” Bopp filed a brief in the case on behalf of several groups.

For nearly eight years, Cruzan has lain unconscious, kept alive by round-the-clock care and feedings through a tube surgically implanted in her stomach.

Since she nearly suffocated in an early morning automobile accident, she has been in a “persistent vegetative state,” a form of permanent unconsciousness in which she is able to breathe on her own but has no awareness of her self or her surroundings.

Her face is red and bloated; her arms and legs are severely contracted; when she is awake, her eyes move randomly in all directions. Although there is no hope for recovery, her life expectancy with artificial feedings was considered normal. Her care has cost the state about $130,000 a year.

Cruzan left no specific instructions about what she would want done if she became incapacitated. As a result, her parents relied on their sense of her values and what they considered best for her.

Several experts in medical ethics praised Teel’s ruling.

“It is about time,” said Albert Jonsen, a professor of medical history and ethics at the University of Washington School of Medicine in Seattle. “The ethics community has long found that this case was protracted far beyond its merits.”

Alexander Capron of the USC Law Center in Los Angles said that “Nancy Cruzan, like Karen Ann Quinlan (the subject of a landmark New Jersey right-to-die case in 1976), will be remembered in history as a great educator. Through her tragedy, a lot of people have been brought to think about this issue.”

Capron added: “Every time the Cruzan case is in the newspapers, it should be a reminder to people that they should be talking to their families and physicians about their wishes (for life-sustaining treatment). The need for that conversation is as great for 20-year-olds as it is for 80-years-olds and for people in good health as it is for people who are already very sick.”