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Comatose Woman Dies After Artificial Feedings Are Halted : Courts: Nancy Cruzan was the center of a landmark right-to-die case. Protesters in Orange County and elsewhere in U.S. call her death a form of mercy killing.

TIMES MEDICAL WRITER

Nancy Cruzan, a 33-year-old automobile crash victim who remained comatose for nearly eight years as a landmark right-to-die case involving her went all the way to the U.S. Supreme Court, died Wednesday in southwestern Missouri.

Cruzan died at the Missouri Rehabilitation Center in Mt. Vernon with her family at her bedside and about 20 “right-to-life” protesters huddled in subzero temperatures outside.

The cause of death was listed as “shock, due to dehydration, due to severe head injury,” a hospital spokesman said.

“Knowing Nancy as only a family can, there remains no question that we made the choice she would want,” her parents, Joe and Joyce Cruzan, said in a statement read by Donald Lamkins, the hospital administrator. “Nancy, we will always love you and hold your memory in our hearts.”

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The statement added: “She remained peaceful throughout and showed no sign of discomfort or distress in any way.”

Since she nearly suffocated in a January, 1983, early morning automobile accident, Cruzan had been in a “persistent vegetative state,” a form of permanent unconsciousness in which she was able to breathe on her own but had no awareness of her self or her surroundings. Her face was red and bloated; her arms and legs were severely contracted. Her medical care had been estimated to cost the state about $130,000 a year.

Cruzan died 12 days after Judge Charles E. Teel Jr. of Jasper County Circuit Court in Carthage, Mo., ruled that her parents could stop her artificial feedings. The feedings, through a tube surgically placed into Cruzan’s stomach, were stopped within hours.

Subsequently, right-to-life groups tried seven times, without success, to get other courts to order Cruzan’s feeding tube reconnected. In addition, 19 protesters were arrested on Dec. 18, after they stormed the hospital, vowing to reconnect the feeding tube.

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“The family will continue to suffer, but at least Nancy is at rest,” said Thad C. McCanse, a Carthage attorney who was Cruzan’s court-appointed legal guardian and who supported the family’s request to stop the feedings. “It is not something I am going out and celebrate, but I am relieved.”

Teel’s Dec. 14 ruling ended a three-year legal fight that resulted in a landmark U.S. Supreme Court decision in July. The high court ruled that a person whose wishes are clearly known has a constitutionally protected right to reject life-sustaining treatment.

But the court said also that states, as Missouri had done, may limit the practice of allowing families to make such decisions for persons whose wishes are not clearly known and who are so disabled that they are unable to speak for themselves.

The Supreme Court decision led to a nationwide surge of interest in “living wills” and “durable powers of attorney for health care,” legal documents that can be used to indicate a person’s wishes or to authorize someone else to make medical decisions if an individual is unable to do so. Other people have simply discussed their wishes with their physicians, which is generally considered a good medical practice.

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Nancy Cruzan’s predicament “has caused people to think about making plans for something that, before, nobody ever wanted to talk about--what to do if there is no hope and I am hooked up to machines,” McCanse said in a telephone interview. “In this way, her life has had a positive effect on a lot of people.”

The Cruzans were initially frustrated by the Supreme Court decision. But the family and its attorney produced additional witnesses who testified that Nancy Cruzan had indicated that she would not want to be fed by force or kept alive by machines.

In addition, Nancy Cruzan’s physician, Dr. James C. Davis, who had believed that the tube feedings should be continued, changed his mind. When asked to imagine himself in Nancy Cruzan’s state, Davis testified that “it would be a living hell.”

This new testimony led Teel 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 medically able, would be to terminate her nutrition and hydration,” Teel wrote in a brief judgment.

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During a two-hour interview with a Times reporter in July, 1989, the parents and older sister of Nancy Cruzan described her as a fiercely independent, upbeat woman who was much loved by family and friends. They said she particularly enjoyed animals, children, holidays and the outdoors.

“So much of it (the family’s belief that Nancy would not have wanted to go on living in her current state) stems from who she was before the accident. She was so vibrant, so vital, so alive,” her sister, Christy, said.

Right-to-life groups have depicted the decision to halt Nancy Cruzan’s feedings as a form of euthanasia, or mercy killing.

“In this season of hope, Nancy Cruzan’s death by starvation and dehydration diminishes hope for thousands of medically dependent people nationwide,” said David O’Steen, executive director of the National Right to Life Committee in Washington.

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Susan Finn, a spokeswoman for Operation Rescue in Anaheim, said: “I feel that this was an unprecedented case where a woman was allowed to starve herself, and I think we’re going to see a flood of similar cases now. It’s terrifying to think about where our nation is going.”

Some medical ethicists, however, dispute claims that the Cruzan case will lead to widespread euthanasia.

“I feel very comfortable with the Cruzan case,” said Dr. Jerome Tobis, chairman of the bioethics committee at UCI Medical Center in Orange. “There is always the risk of a slippery slope . . . that may lead to abuses, but with caution, I don’t think there’s any basis to think so.”

However, he added: “The Cruzan case should not sanctify active euthanasia, a very important thing that we in the medical profession and ethicists in this country are certainly opposed to.”

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Protesters had camped in the parking lot of the hospital for the last nine days. One of their signs referred to the facility as the “Missouri Euthanasia Center.”

Major medical organizations, including the American Medical Assn. and the American College of Physicians, and leading medical ethicists viewed Cruzan as a prisoner of modern medical technology, kept alive with no hope of recovery and against her apparent wishes. They argued that life-sustaining treatments, such as a respirator or a feeding tube, may be withdrawn from such individuals if appropriate safeguards against abuses are adhered to.


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