Speaker stresses choices at life's end
By GINNY MERRIAM of the Missoulian
Nancy Cruzan's family's story began in an ordinary way, with a car wreck on a dark road on a January night in 1983. It took them on a public journey that included the U.S. Supreme Court. It shaped our thinking about our right to die, and it should serve as a cautionary tale: Tell your loved ones what to do for you should you lose your ability to voice your medical wishes, attorney William Colby said Thursday evening in Missoula.
The Cruzans' case, argued by Colby, was the first right-to-die case heard by the Supreme Court. Its resolution helped set legal precedent, but the issues and the discussion continue.
"It's not black and white," Colby told an audience at St. Patrick Hospital. "It's massive gray. The law is very gray."
"What 'Cruzan' did," he said, "was cause us all to talk about these things."
Colby is the author of a just-published book about the legal odyssey, "Long Goodbye: The Deaths of Nancy Cruzan." He spoke in Missoula as part of the Life's End Institute's week of events surrounding advance directives for health care and Missoula's new electronic depository for such documents, among the first in the country.
Nancy Cruzan was 25 years old when her car left the road near home in southwest Missouri, hit mailboxes and trees and threw Nancy out. It was 30 minutes before resuscitation by rescuers began.
"Every part of her brain that made her uniquely Nancy was gone by the time they got there," Colby said.
Five years later, Nancy was still in a persistent vegetative state, her hands curled into her forearms, with no hope of recovering.
"Doctors said she could live 30 years like that," Colby said.
After discussing it over Sunday dinner, her family decided she would not want to live that way; they would ask to have her feeding tube removed.
But the state hospital where Nancy was cared for told the family they had to have a court order. That began the family's legal odyssey. Colby was only 32, and his argument before the U.S. Supreme Court was only his second appellate argument.
The court, and others before it, said there must be "clear and convincing" evidence that the patient would want treatment to end. It supported the Missouri Supreme Court in ruling that a state could a adopt a standard requiring that evidence.
The case and the issue caused a wave of national protest from people who opposed the Cruzans. Some said life is to be absolutely preserved. Some saw a frightening precedent that would allow people who are no longer seen as viable to be disposed of.
Sent back to the Missouri court, the Cruzans and Colby were able to provide that "clear and convincing" evidence. The feeding tube was removed, and Nancy stopped breathing the day after Christmas 1990. "By the end, there was nothing ordinary about this," Colby said. "It was amazing."
The case affected Colby in "profound ways," he said. He is now a fellow at the Midwest Bioethics Center in Kansas City. The center has brought end-of-life issues to the fore in Kansas City, much as the Life's End Institute: Missoula Demonstration Project has in Missoula.
"You don't realize that people in other cities don't talk about these issues," he said. "We are way at the front of the choir."
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