Long goodbye 

Legal lessons from life's precipice

At 2:47 a.m. on Dec. 26, 1990, twelve days after doctors in a Missouri state hospital removed her feeding tube, the life of 33-year-old Nancy Cruzan came to an end. For nearly eight years she had existed in a state of persistent vegetative coma, the result of injuries sustained when her car careened off a dark country road in rural southwestern Missouri. The decision to remove her from life support was made by her family and voiced by her father, Joe Cruzan. It was a wrenching choice, made only when all hope for recovery was extinguished. But the decision, it turns out, was only the beginning, for when the Cruzan family requested in May of 1987 that Nancy’s life support be removed, doctors refused. And when, in 1990, her body was at last allowed to pass from life, the action was the culmination of a long and painful struggle, one that followed a path through the bastions of the U.S. legal system against fierce and powerful opposition, including Missouri Gov. John Ashcroft, and U.S. Solicitor General Kenneth Starr. Ultimately, the Cruzan case became the first “right-to-die” argument ever heard by the United States Supreme Court.

This is the story told in Long Goodbye: The Deaths of Nancy Cruzan, by William H. Colby. Colby was a young attorney at a prominent Kansas City law firm when he first met the Cruzan family and agreed to represent them. Within two years, he stood before the U.S. Supreme Court and argued on behalf of Nancy Cruzan—and anyone who receives medical care in this country—a fundamental issue of liberty and freedom. At stake was the right of guardians of an incapacitated individual to refuse life-sustaining medical treatment on that individual’s behalf.

In a 5-4 margin, the Supreme Court actually ruled against Colby and the Cruzan family, upholding, instead, the state of Missouri’s requirement for “clear and convincing” evidence of a patient’s desire to die. But the Court worded its decision with room for interpretation, and for the first time in U.S. history recognized, as Colby writes, “a constitutional right to liberty for competent people to refuse medical treatment.”

Under this ruling, the Cruzans received a new trial in Missouri in which they were able to produce conclusive evidence showing that Nancy would never have wanted, in her own words, to “live like a vegetable.” The state of Missouri accepted this evidence and at last granted the family’s request. But by this time the case had reached national prominence and was generating heated debate. Strong objections were lodged along many fronts, and on that wintry December night, even as Nancy’s body died, a mob of protestors besieged the hospital in which she lay.

The opportunity to hear a first-hand account of Nancy Cruzan’s story and the issues surrounding it will be offered Thursday, Jan. 16. Author Colby will be in Missoula to give a presentation and signing of his book. An engaging speaker who has appeared on the Today Show, Good Morning America, The MacNeil Lehrer Report, and in numerous national venues, Colby holds a degree in creative writing and graduated top of his class from the University of Kansas School of Law. He uses his background and intimate knowledge of the Cruzan case to unfold a fascinating narrative of this compelling real-life drama. Colby’s prose style is relaxed and casual, yet riveting as he negotiates complex legal issues in easy-to-understand language.

Colby’s reading is part of the “Choices Bank Week” promotion taking place in Missoula Jan. 11 through 19. Established in October 2002, Choices Bank is the nation’s first community-based repository for “advance directives”—documents that combine living wills and powers of attorney for health care to convey an individual’s wishes for medical treatment in the event of temporary incapacitation or terminal illness. In essence, advance directives speak for those who cannot speak for themselves.

The week is sponsored by the nine local organizations that created the Choices Bank, led by the Life’s End Institute. Formerly known as the Missoula Demonstration Project, Life’s End Institute is a nationally recognized community organization working to improve the quality of life for dying people and their loved ones. Like Long Goodbye, Life’s End Institute, their community partners, and the events of the Choices Bank Week deal directly with issues explored by the Cruzan family’s seminal legal battle.

“The Cruzan case is really the pivotal patients’ rights case,” says Linda Tracy, Choices Bank Project Director. “It’s a landmark case that affirms our right to accept or reject medical treatment.” Tracy believes the lessons of the Cruzans’ struggle as retold in Long Goodbye are poignant reminders of the importance of signing advance directives about the kind of medical care we do or don’t want. “The Cruzan case reminds us of the human toll that can occur when this kind of planning hasn’t been done,” Tracy says. “And not only the obvious toll on the individual, but also on the family.”

Other “Choices Bank Week” offerings include information booths, a free public lecture by the Institute’s co-founder, Dr. Ira Byock, and many other free presentations conducted by Life’s End Institute staff, volunteers and partners.

Colby’s Long Goodbye tells a powerful tale of tragedy, resilience, courage and devotion. It’s a story that Colby, the Cruzan family and Life’s End Institute would have us consider carefully. For however difficult it may be, the reality is there for all to face: whether coming silently out of the ether, or down a lonely road in the dark of night, there’s a bullet speeding toward each one of us. And the decisions we make before we are struck can greatly help those who remain in our stead.

William Colby speaks Thursday, Jan. 16 at 7 p.m. in the Conference Center at St. Patrick Hospital and Health Sciences Center, 500 W. Broadway. A book signing will follow. The event is free and open to the public. For more info, phone 329-2707.

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