“Persistent vegetative state is a specific clinical diagnosis for a patient who is permanently unconscious. All thought, all memory, all ability to interact with the world around them in any way is gone” (LLP). William H. Colby who argued the case for Nancy and her family stated this in his opening statement during the hearing. His petitioners included Nancy herself, and her family and friends. (LLP) Nancy Beth Cruzan was involved in a serious automobile accident in 1983, which left her in a vegetative state. Her life was sustained for a few weeks before the question came to, how do we maintain life?
With no interaction with the outside world, and no signs of getting better, Cruzan’s parents attempted to end her nutrition and hydration tube. (Chicago-Kent College of Law at Illinois Tech 1) However, state hospital officials refused to do so without court approval. When taken to the Missouri Supreme Court, they ruled in favor of the state’s policy over Cruzan’s parent’s plea. (LLP) The family then attempted to take to a higher court, which lead the family and the Director from the Missouri Department of Health, to be tried.
The question many asked, however, is does the Fourteenth Amendment of due process permit Cruzan’s family to terminate life-sustaining treatment for their vegetative state daughter? (Gaudin 1) Nancy Cruzan was left in a vegetative state after an automobile accident, which lead to the question if an unconscious patient has the right to allow her parents or other guardian, to make a life or death choice for her, decisions made by the Supreme Court changed the way we make decisions on medical assisted suicide, as well as shine light to how these questions need to be answered.
Nancy Beth Cruzan suffered a severe car wreck on January 11th, 1983 at 12:50 a. m. She was pronounced lifeless and not breathing. However, by 1:13 a. m. , she was brought back to life, although she had a very faint heartbeat. (Gaudin 2) It was said that Nancy suffered from anoxia, or when the brain is deprived of oxygen. She was without oxygen for more than 12 minutes, the maximum time span to go without oxygen before brain damage is six minutes. Therefore, it was inevitable that she would suffer from brain damage. Chicago-Kent College of Law at Illinois Tech 1) Three weeks after the accident, when recover was still hopeful, the hospital she was residing at asked the parents and her husband at the time, to consent for Nancy to have surgery to insert a feeding tube or gastronomy tube. This tube would be necessary to sustain nourishment, as the records show she was malnourished from forcing vital nutrients through an IV and nasogastric tube.
No one told Nancy’s family, however, that this procedure is irreversible, and that also with this surgical insertion of a feeding tube and hydration tube it would leave her in this vegetative state indefinitely. Gaudin 1) Justice Antonin Scalia asked a very important question. “Could she be fed manually? ” (LLP). Mr. Colby’s response was that with this kind of manual feeding, she would not receive enough nutrition. The main way of getting nutrition at this time was a simple nasogastric tube. Even though she was not on a ventilator, she still was unconscious. Without the parents’ consent to do this operation, common law states that such an act would be considered battery against the doctor. (Gaudin 1) Mr. William H.
Colby also stated that if the guardians, or in this case the parents and husband, had refused, the state would have accepted that refusal, and she would have died not from starvation, but severe brain damage from her accident (LLP). The question, however, is could the state still allow such a procedure if the court believed the family or guardian’s decision is abusive or not acceptable medical procedures? Many tested that because certain religious beliefs and moral standings might cause a family to refuse medical treatment because of what they believe, how could this case be any different? Gaudin 1)
In the defense of Colby, he stated that the state would declare it to be based on personal opinion and not in the best choice for life for the patient. The state’s main goal is to preserve human life, regardless the opinion. In the case of Jehovah’s Witness cases, the state would take steps to override their religious belief, to better the chance of life. His statement is that whether a state can order a person to receive medical treatment when the family does not wish it, when it overrides evidence ab wishes of the patient, and the state has no justification besides their general interest in life.
He also concluded that the Fourteenth Amendment protects the liberty of individuals, whether conscious or unconscious, from such invasion of the state. (LLP) The main argument comes from Nancy’s parents wanting to take her off the life sustaining feeding and hydration tube. Although it was said she could live many more years with machine support, the doctors stated there was no chance of recovery. (Gaudin)
The family also had been paying expensive medical bills because of her need for machine support, and they were struggling financially. Nancy was not the only child of her parents, so expenses were piling high. LLP) Her family believed that they had clear evidence that Nancy would not want to be in the state she was in. Many of Nancy’s friends, including Nancy’s housemate, had verbal proof that a year earlier, she had stated she would not want to live in a vegetative unresponsive state unless ‘she was half normal’. (Chicago-Kent College of Law at Illinois Tech 1) However, to the court this was not enough convincing proof. Justice Sandra O’ Conner stated that this could be considered assisted suicide. It was said that because a competent person cannot refuse food or water in a hospital setting, an irrational person should not be allowed to either. LLP)
However, if a patient had the want to die due to incredible pain, deformity, etc. , they could refuse a feeding tube. The question in term is how we decide if a person is irrational or not. Do specific people decide the severity of the pain or the quality of life? (Gaudin 2) The answer in this case is no. In the ruling of this court case, it was five to four with the Director, the Missouri State Health Department, winning (Chicago-Kent College of Law at Illinois Tech 1). The Court held that while it is a person’s individual right to refuse certain medical procedures, people who are considered incompetent do not have this right.
They decided that there was no clear evidence of Nancy not wanting to live in this vegetative state, therefore the actions of the state were constitutional. (LLP) The maiority stated that along with no concrete evidence, they did not trust the close family. Chief Justice Rehnquist said “Close family members may have a strong feeling- a feeling not at all ignoble or unworthy, but not entirely disinterested, either that they do not wish to witness the continuation of the life of a loved one which they regard as hopeless” (Gaudin 1).
They believed with the state that the preservation of life overruled the personal opinions of the family. On the minority side was Justice Brennan, Justice Marshalls, Justice Blackmun, and Justice Stevens. Their argument was that her right to liberty, or in this case her right to liberty from medical treatment, overruled the states idea of preserving life. (Gaudin 1) Justice Stevens’ stated, “The meaning and completion of her life should be controlled by persons who have her best interests at heart-not by a state legislature concerned only with the “preservation of life” (Gaudin 1).
This decision laid forth the right of documentation of deciding what to do in a tragic accident or injury, similar to Cruzan. With this form of documentation, signed before witnesses, a person has the right of prohibiting tube feeding and mechanical respiration, or resuscitation, which is restarting the heart artificially. Also in many States after this court case, a legal order known as “power of attorney”, allows a friend or family relative to speak on a person’s behalf when a tragic injury occurs. Chicago-Kent College of Law at Illinois Tech 1) Although this decision was made to keep her on life sustaining medical treatment, and gave Missouri the right to demand ‘clear and convincing evidence’, a new hearing was held shortly after in a Missouri court. The State Judge authorized the disconnecting of the tubes. Nancy Beth Cruzan died shortly a few days later. (Gaudin 2) Nancy Beth Cruzan suffered an extreme car accident at a young age. She was left in an unresponsive, vegetative state (Chicago-Kent College of Law at Illinois Tech 1).
When her family attempted to remove her life sustaining nutrition tube, the state refused. They believed this decision would be against the preservation of life and irrational. (LLP) With a five to four vote, it was decided that preserving her life, with what little life she had, was better than assisted suicide. (Gaudin 1) Also with this decision by the Supreme Court, it made a way for ‘power of attorney’. In this form of documentation signed by witnesses, if someone is injured and unable to decide for themselves, a family member or friend can make important life decisions for them (Gaudin 1).