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Nancy Cruzan & Life Support: Ethical Case Study

Instructor: Adrianne Baron

Adrianne has a master's degree in cancer biology and has taught high school and college biology.

There are many considerations to account for at the end of someone's life. Legal, ethical, and moral issues come into play when deciding to remove a person from life support. We will look at those concerns based on what happened with Nancy Cruzan.

Life Support

There are few things harder than seeing someone you love on life support. Life support refers to the treatments and machines used to maintain life in a person whose vital organs are no longer working on their own.

While life support is associated with caring for someone, particularly in late stages of terminal illness, sudden injuries and illnesses may also be the cause.

Who Is Nancy Cruzan?

Nancy Cruzan was a 25 year old woman in 1983 when she was in a terrible car accident. She suffered traumatic injuries and had no vital signs such as breathing or heartbeat when she was found. The emergency responders did CPR to resuscitate her.

At the hospital she was put on ordinary care life support, which involves a feeding tube and hydration. Within about a month, her doctors determined that she was in a persistent vegetative state (PVS), and would not recover. This meant she had no brain function and could not respond to her environment. This is the point when several issues were raised.

Moral and Ethical Concerns

Unfortunately, loved ones are often faced with making decisions about continuing life support or not. This decision is sometimes made a tad bit easier when the person's wishes are known through an advance directive. This is a document that outlines what medical interventions the person would want and who can speak for them in the event that they cannot speak for themselves.

The document includes allowances or cessations for resuscitation and life support. Without an advance directive, loved ones are forced to request what they believe to be the wishes of the person who is on life support.

In Nancy's case, there was no advance directive, but the family and many of her friends felt they knew her wishes. Her parents requested to have her removed from life support because they knew she did not want to exist in a vegetative state and 4 years had already passed since her accident with no change in her condition.

Her doctors refused, as they were just giving her the basic of needs: food and water. They insisted that removing these would kill her and could be seen as immoral and illegal since she would then die of starvation and dehydration.

What a debate! The ethical problem here was whether someone can make the decision to end another person's life by removing life support. There wasn't anything written to prove what Nancy would want. Doctors are held to an oath to improve life, and not to take it away. The burden fell on the family to prove what Nancy would want since Nancy was clearly unable to do so from a vegetative state.

Legal Concerns

These ethical and moral concerns turned into legal concerns. Our Constitution gives us the right to refuse medical treatment, but it does not outline whether the right still exists in the event that someone is incompetent, meaning unable to make decisions for themselves. This means that courts are left to make this decision based on their understanding of the constitution and rights outlined by the constitutions of their individual states.

The legal issue becomes even bigger when determining if it is legal or not to allow someone else to make that decision, and determining where the differentiation exists between murder and causing death by withholding the basic needs of life. Who can make that decision and what proof do they need to show they are acting on the patient's wishes?

Court Decision

Nancy Cruzan's parents went to the Missouri court system to petition the court to give the doctors a protective order to allow them to take Nancy off of life support. The state trial court granted the request based on Nancy's housemate testifying that Nancy told her that she would not want to live in a vegetative state. The court decided that the statement was enough since it was made when Nancy was competent.

Cruzan

The state supreme court disagreed and reversed the decision, requiring ''clear and convincing'' evidence of an incompetent person's wishes in such a case. More than just a housemate's evidence was therefore required in order to grant the request for Nancy's death. In 1990, the US Supreme court upheld this decision.

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