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Right to Die Cases
The very public, legal and ultimately political saga of Terri Schiavo brought not only national but international attention to the right to die issues and echoed a similar battle which took place some fifteen years earlier concerning Nancy Cruzan.
In "Cruzan, by her Parents and Co-Guardians v. Director, Missouri Department of Health, 497 U.S. 261,' the United States Supreme Court concurred with the lower court's ruling on June 25, 1990 (Cruzan pp).
Petitioner Nancy Beth Cruzan was rendered incompetent as a result of severe injuries sustained during an automobile accident on the night of January 11, 1983 (Cruzan pp). Paramedics restored her breathing and heartbeat at the accident site when she was discovered without detectable respiratory or cardiac function (Cruzan pp). She was transported to a hospital in an unconscious state where an attending neurosurgeon diagnosed her as having sustained probably cerebral contusions compounded by significant anoxia (Cruzan pp). The Missouri trial court found that permanent brain damage generally results after six minutes in an anoxic state, and it was estimated that Cruzan was deprived of oxygen from twelve to fourteen minutes (Cruzan pp). After approximately three weeks in a coma, she then progressed to an unconscious state, and although she was able to orally ingest some nutrition, surgeons, with the consent of her husband, implanted a gastrostomy feeding and hydration tube in order to ease feeding and further the recovery, however, subsequent rehabilitative efforts proved unavailing (Cruzan pp). When it became apparent that Nancy had no chance of recovering her cognitive faculties, her parents, Lester and Joyce Cruzan and coguardians, sought a court order directing the withdrawal of her artificial feeding and hydration equipment, but the Supreme Court of Missouri held that because there was no clear and convincing evidence of Nancy's desire to have life-sustaining treatment withdrawn under such circumstances, her parents, thus, lacked authority to effectuate such a request (Cruzan pp).
At the time of the U.S. Supreme Court hearing, Nancy Cruzan resided in a Missouri state hospital, (the state bearing the cost of her care) in a persistent vegetative state, a term generally used to describe a condition in which "a person exhibits motor reflexes but evinces no indications of significant cognitive function' (Cruzan pp). The State Supreme Court, adopting much of the trial court's findings, described Nancy Cruzan's medical condition as follows: her respiration and circulation are not artificially maintained and are within normal limits for her sex and age; she was oblivious to her environment except for reflexive responses and painful stimuli; anoxia of the brain resulted in a "massive enlargement of the ventricles filling with cerebrospinal fluid in the area where the brain has degenerated and her cerebral cortical atrophy is irreversible, permanent, progressive and ongoing;" her highest cognitive brain function is exhibited by grimacing in perhaps recognition of painful stimuli, "indicating the experience of pain and apparent response to sound;" she is spastic quadriplegic; her arms and legs are contracted with irreversible muscular and tendon damage; she has no cognitive or reflexive ability to swallow food or water and will never recover her ability to swallow sufficient to satisfy her needs (Cruzan pp). However, the Court found that "she is not dead ... she is not terminally ill," and according to medical experts, "she could live another thirty years" (Cruzan pp).
In recognizing that Cruzan was not dead, the Court referred to the Missouri statute that states:
"For all legal purposes, the occurrence of human death shall be determined in accordance with the usual and customary standards of medical practice, provided that death shall not be determined to have occurred unless the following minimal conditions have been met:
(1) When respiration and circulation are not artificially maintained, there is an irreversible cessation of spontaneous respiration and circulation; or (2) When respiration and circulation are artificially maintained, and there is total and irreversible cessation of all brain function, including the brain stem and that such determination is made by a licensed physician" (Cruzan pp).
Cruzan's respiration and circulation were not being artificially maintained, thus, she fit within the first proviso of the statute (Cruzan pp).
Although the state trial court found that she had a fundamental right under the State and Federal Constitutions to refuse or direct the withdrawal of "death prolonging procedures," and that also found viable her "expressed thoughts to a housemate that she would not want to live in a vegetative state, the…[continue]
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