Prisoners of technology: the case of Nancy Cruzan

Article Abstract:

Preservation of a life filled with suffering, or emptiness, is now possible with modern life-sustaining methodologies, and the case of Nancy Cruzan is an example of the 'dark' side of medicine's technological power. This 32-year-old woman has been in a persistent vegetative state for seven years since a car accident, with a hopeless prognosis. Her cerebral cortex has atrophied; she is not dead; and she can probably live as she is for many years more, at a cost of $130,000 a year to the state of Missouri and immeasurable suffering to her family. In 1987, her parents requested that Nancy's feeding tube be removed so she could die. A lower court granted the request, but the Missouri Supreme Court reversed the decision, based on the state's 'unqualified' interest in the preservation of life. The U.S. Supreme Court is currently debating the case, based on arguments heard in December 1989. The decision on the Cruzan case is crucial for the future of life-sustaining care in the United States. The argument is made that the decision of the Missouri Supreme Court should be reversed; in part, because the lower court applied a formula to the problem without awareness of the complexities that modern technology has introduced. In addition, the state of Missouri has a death penalty, and denies lifesaving bone marrow transplants to some children who cannot afford them - transplants that could be paid for out of the money spent yearly on Nancy. Thus, its position has not been one of unqualified interest in preserving life. Three questions should be considered in treating patients such as Nancy. Would this person, who cannot decide whether to accept a medical treatment, choose to live? If life-sustaining treatments are to be withheld, who should decide? Third, should courts be involved in such decisions? One proposal by Missouri's attorney general suggests authorization of removal of life-sustaining treatments by families for patients who have been in a persistent vegetative state for two to three years, unless the patient previously expressed a wish to be kept alive under all conditions. There are approximately 10,000 patients in a vegetative state in the United States, many of whom are conscious and suffering. No one is sure who has the authority to end these people's lives. Healthy older people may become depressed by the possibility of living in such a condition with no control over its outcome. Surely, the situation where people are more afraid to live than to die is one that cries for remediation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Laws, regulations and rules, Right to die, Bioethics, editorial, Cruzan, Nancy

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Euthanasia in the Netherlands - good news or bad?

Article Abstract:

Two surveys in the Netherlands indicate that euthanasia and physician-assisted suicide have not been abused. A 1990 survey found that only 3,300 deaths out of 130,000 that year were a result of euthanasia. In 1995, most physicians were still reluctant to perform euthanasia. Opponents of euthanasia and physician-assisted suicide are afraid that doctors may start violating guidelines, such as performing euthanasia on patients who have not requested it. This does not seem to have happened in the Netherlands. The US Supreme Court will review the constitutionality of physician-assisted suicide in Jan 1997.

Netherlands, Social policy

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The Supreme Court and physician-assisted suicide - the ultimate right

Article Abstract:

A physician whose father committed suicide rather than die of cancer argues in favor of physician-assisted suicide. Although many Americans and their doctors support physician-assisted suicide for the terminally ill, organized medicine opposes it. However, the right of patients to make their own medical decisions is a fundamental part of the physician-patient relationship. Laws allowing physician-assisted suicide would contain safeguards to prevent its abuse and no physician would be required to participate. In 1997, the Supreme Court considered the constitutionality of physician-assisted suicide.

Terminal care

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