TIME: Almanac 1990/1990 Time Magazine Compact Almanac, The (1991)(Time).iso/time/121189/12118900.016

Text File | 1990-09-22 | 6KB | 109 lines

ETHICS, Page 80

Whose Right to Die?

The Supreme Court will finally wrestle with the ultimate question


    The nightmare began nearly seven years ago. In the
early-morning hours of Jan. 11, 1983, Nancy Cruzan's car swerved
on an icy and deserted Missouri country road. The car flipped and
crashed. The 25-year-old woman tumbled out and landed facedown in
a ditch. Medical help arrived promptly enough to save her life but
not fast enough to save her oxygen-deprived brain.

    Nancy Cruzan never regained consciousness after that accident,
and doctors say she never will. Now 32, she lies in a condition
known as a persistent vegetative state, awake but totally unaware,
at the Missouri Rehabilitation Center at Mount Vernon. Her body is
stiff and severely contracted, her knees and arms drawn into a
fetal position, her fingers dug into her wrists. Some nurses report
that Cruzan can turn toward persons who speak to her and that she
has cried on several occasions, once when a valentine card was read
to her. But doctors say she is oblivious to the environment except
for reflexive responses to sound and painful stimuli. "We have
literally cried over Nancy's body, and we've never seen anything,"
says her anguished father Joe Cruzan. "Sometimes you swear she is
looking right at you, but then you move three or four steps. She
has no awareness of herself."

    A tube to Cruzan's stomach provides all the food and water that
keep her on this side of existence. The cost of her care, $130,000
annually, is borne by the state (since she is not a minor, her
parents are not held responsible for her debts). Doctors say her
heart could beat and her lungs could breathe for 30 more years,
but her parents want the feeding stopped so that she can die in
peace now.

    This week the family will direct its plea to the U.S. Supreme
Court, and for the first time draw the nation's highest court into
the murky legal and ethical seas that surround the notion of a
right to die. What the Justices decide will directly affect Cruzan.
It will also set some legal boundaries for addressing the plight
of the 10,000 other people in the U.S. lingering in a persistent
vegetative state. Ultimately, the ruling could have an impact on
the 7 out of 10 Americans who can someday expect to confront
questions of life-sustaining medical care for themselves or their
loved ones.

    The Cruzan case dramatically evokes many of the primal emotions
and fundamental uncertainties of life, death and love. Even the
simple question at the heart of the Cruzan case -- who is to decide
on ending a life -- defies an easy answer. The Missouri Supreme
Court ruled last year that the state must decide. And in Cruzan's
case, the court concluded, the state's interest in preserving life
was not offset by any clear or convincing evidence of Nancy
Cruzan's own wishes or by any demonstration that the feeding tube
was "heroically invasive" or burdensome. "We choose to err on the
side of life," declared the court.

    Cruzan's parents believe the decision to end her life, painful
as it is, should rest with them, based on their intimate knowledge
of Nancy's personality, views and preferences. "My daughter would
say, `Help, get me out of this,'" insists Joe Cruzan. The Cruzans'
lawyers argue that the guarantee of liberty in the Constitution's
due process clause protects individuals -- including helpless
patients -- against unwarranted bodily intrusions by the state, and
that a loving family is the best surrogate to decide what medical
course an incompetent relative would choose. In 1983 a presidential
medical-ethics commission endorsed the principle of family
surrogate decision making, and so have many state courts since the
1976 landmark Karen Ann Quinlan case, in which the New Jersey
Supreme Court permitted the Quinlan family to remove her from a
respirator. Although who decides and what proof is required have
differed, most state courts have found a way to accommodate those
who seek to let a death proceed.

    Right-to-die questions generate powerful sparks of moral
friction. They clash against two basic values, says Daniel
Callahan, director of the Hastings Center, an ethics think tank.
"One is the sanctity of life, with its religious roots; the other
is the technological imperative to do everything possible to save
a life. Put together they are like a locomotive running at 100
miles an hour." The sweep of that force troubles many experts. Says
George Annas of Boston University's School of Medicine: "The
technological imperative obliterates the person altogether. It acts
as if the person doesn't exist -- that she has no personality, no
family, and that no one who loves her can make decisions about
her." But other experts believe that advocates of
self-determination often skip over a basic question in
incompetent-patient cases. Asks University of Michigan law
professor Yale Kamisar: "Whose rights are being fought for, Nancy
Cruzan's or her parents? Whose preferences are being advanced?"

    Cases that involve the withdrawal of a feeding tube, as opposed
to a respirator or heavy mechanical support, pose particular
problems. The American Medical Association and many ethicists
believe even artificial nutrition and hydration is a medical
treatment that may be withdrawn from terminally ill or irreversibly
comatose patients. But others disagree; to them, food and water,
even through a tube, represents the necessities of life and
constitutes basic care. Some experts also debate whether there is
a clear or a blurred line between withholding nourishment and the
next step, injecting death-inducing drugs. Many worry about a
slippery slope that could lead to legalized euthanasia and suicide,
and a general devaluation of life, particularly of those who are
incompetent or elderly.

    The issues in the Cruzan case are ultimately both profound and
perplexing. "If only the ambulance had arrived five minutes
earlier," muses Joe Cruzan, "or five minutes later." But even as
he muses, and as the Supreme Court ponders, other ambulances are
reaching other patients at that same fateful juncture of too late
and too soon.