In the early morning of January 11, 1983, Nancy Cruzan’s car slid off of an icy Missouri road and rolled through a field.  Nancy’s car had no seatbelts, and she was thrown from the vehicle into the snow.  While it’s unknown exactly what caused her to slide off the road, what is known is that when paramedics arrived she had no pulse, respiration, or blood pressure.  By anyone’s accounts, she was dead.  However, after working for 47 minutes, the medics were able to revive her and rush her to a hospital.  When she was brought into the hospital, she was so bloody that her own family couldn’t recognize her.  When interviewed later, her father, Joe Cruzan, said, “I kept waiting for them to bring Nancy in.  But it was Nancy.”[1]  The doctors worked all night to return her to normal but it was impossible.  Her brain had gone too long without oxygen and she had entered persistent vegetative state.  This meant that she could stay alive as long as her health remained good, but the only movements she made were involuntary actions such as breathing or blinking.  Since she couldn’t swallow, she was given a feeding tube.  Five years later in the chronic care ward of the Mount Vernon hospital, she had still made no progress.  Neurologists had told the family that her brain could never recover.  It was here that Joe and Joyce Cruzan decided that they wanted to have her feeding tube removed and allow their daughter to die.

The hospital couldn’t remove the feeding tube without court approval, so the Cruzans went to court.  Since they didn’t have enough money to hire a lawyer, they were given one.  The court case itself was unique because, while the courts had granted the right to die to many people being kept alive by a respirator, they had drawn the line at removing feeding tubes, feeling that a respirator actively kept someone alive while a feeding tube was passive.  Respirators were necessary because people couldn’t breathe without them, but in the case of a feeding tube, the person still had the ability to digest food fine, but they couldn’t swallow.  In addition, while patients could die within minutes of removing a respirator, it would take between 3 and 30 days[2] for a patient to die after removing his or her feeding tube.  Since the patient could make no conscious movement, the doctors wouldn’t know if she was in pain.  Also, when a respirator is removed, there’s a chance that the patient can start breathing, but there’s no absolutely no chance of a patient surviving after their feeding tube is removed.  In addition to the important distinction between respirators and feeding tubes, doctors are obliged to follow the Hippocratic Oath, so it’s important to decide whether or not allowing the patient to die violates the oath of nonmaleficence, or doing no harm. The Cruzan’s argument was based mainly on two conversations that Nancy had with her sister, Christy, concerning what she would like done in the event of her being kept alive on life support with no chance of recovery.  In his essay, “Withdrawing Life Support from the Terminally Ill Is Ethically Acceptable” Agata A. Bednarz proposed four conditions that must be met in order for the removal of life support to be legal and ethical[3]:

1.                          It must be virtually certain that further medical intervention will not attain any of the goals of medicine other than sustaining organic life.

2.                          The preferences of the patient are not known and cannot be expressed.

3.                          The quality of life clearly falls below minimal.

4.                          Family members and staff are in accord.

In the case of Nancy Cruzan, the first two conditions are obviously met.  All doctors that examined her agreed that there was no way for her to recover and, since she couldn’t speak or communicate, her preferences could not be known.  The other two conditions are more complicated.  The argument could be made that since she had no ability to think and her life was the same day after day with nothing to look forward to, her quality of life fell below minimal.  In the fourth condition, the family’s views were clearly stated but the staff’s were varied.  If the Cruzan’s were to win the case, they could certainly find a doctor to remove the feeding tube, but, again, it’s important to analyze whether or not it would be violating the Hippocratic Oath.  It’s important to look at not only the nonmaleficence oath but also the benevolence oath, which states that physicians have an obligation to do good.  In his essay, “Physician-Assisted Suicide Is a Constitutional Right” Jack Lessenberry quotes Jack Kevorkian:

                     “You know what the ultimate duty and responsibility of a

                       physician is? To prevent and relieve suffering.  To combat

                       disease, which means just that: dis-ease, an absence of well-

                       being.  What I think a doctor should do is prevent disease…

                       By any means necessary.[4]”

His argument is that the removal of life support isn’t doing harm, because, since it releases the person from unwanted suffering, it actually relieves harm.

            Having addressed the legal implications of Nancy Cruzan’s death, it’s also important to look at the ethical aspects.   In his essay “Physician-Assisted Suicide is Unethical” Catholic priest Peter J. Bernardi argues that simple ethics are left out of such rights as the right to choose physician-assisted suicide.  He says that “morality has been made captive to such legality.[5]”  Kevorkian and the Cruzans would argue this saying that it’s necessary to examine a case before deciding whether or not it’s ethical.  Bernardi is correct when he says that, concerning euthanasia, “Our society is indeed on a slippery slope.”  However, the argument can be made that it’s just as dangerous to absolutely forbid euthanasia as it is to allow it.  Since the cases are so complex, it’s important to examine each one. 

In the case of Nancy Cruzan, the Supreme court ruled that it was legal to remove her feeding tube because she had communicated her wishes previous to her accident.  It’s a more difficult question whether or not the decision was ethical.  There are many arguments for and against the decision to let Nancy die, and the fight over physician-assisted suicide continues to this day.