Decision Making in End-of-life Circumstances

Decision Making in End-of-life Circumstances

Traveling home on a cold January evening in 1983, a car loses control going around a slippery corner. The car spins, then flips, and the woman inside is thrown into a ditch thirty feet from where the car eventually comes to rest. She sustained numerous injuries and eventually stopped breathing. By the time paramedics arrived, she had not taken a breath for at least 15 minutes, her blood pressure was 0 over 0 and her pulse was 0 beats per minute: This is what is known as a “Code Blue” (PBS Frontline). Twenty minutes had passed before adequate amounts of oxygen had reached her brain. (Permanent brain damage generally results after six minutes without oxygen.) The woman’s name is Nancy Cruzan and her story is considered one of the most important milestones in the development of “right to die” policies in the United States because it is the first right to die case the Supreme Court ever heard.

After extensive evaluation following her accident, Nancy was diagnosed with “probable brain damage compounded by significant oxygen deprivation” (Sisters of Leavenworth). Nancy remained in a coma for approximately three weeks and then progressed to an unconscious state in which she was able to ingest some nutrients orally. However, it soon became too difficult for Nancy to orally ingest the proper amount of nutrition, and it was necessary to implant a feeding and hydration tube. The tube was placed under consent from her father. Nancy’s eyes were open and she could move her mouth, but she did not have an understanding of what she heard or saw and could not speak. Nancy was described as being in a “permanent vegetative state” (American Medical Association).

Ten months after her tragic accident, Nancy was moved to a state hospital, where various treatments and rehabilitative efforts were shown to be unsuccessful. After the realization that Nancy would most probably never regain her mental faculties, her parents Joe and Joyce Cruzan asked for the cessation of the administration of medically assisted nutrition and hydration via the gastronomy tube. The hospital did not feel they were authorized to honor the family’s request without court approval (Sisters of Leavenworth). The family was now faced with the emotional difficulties of requesting the removal of the same tube of which they had authorized the placement just a short time before.