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logoWho is the Dean of Death?

Alex. Evans

            Living life at age twenty-eight is an amazing adventure.  People are at their prime – being active and living life to the fullest.  However, for Nancy Cruzan, a terrible car accident took that all away.  One night, driving on a quiet road in Missouri, Nancy’s car rolled off the road and into a ditch.  For twenty minutes she lay there alone and lifeless.  Then, a paramedic car drove by and saw the car in distress.  They pulled Nancy out, and miraculously revived her back to life.  However, she had damaged her cerebral cortex, the vital end of the brain that gives humans all motor functions, senses, and communication.  Nancy was left in what is called a persistent vegetative state (PVS), which “is a legal term defined in 765.101 (12) Florida statutes as: ‘a permanent and irreversible condition of unconsciousness in which there is – a) the absence of voluntary action or cognitive behavior of any kind; and b) an inability to communicate or interact purposefully with the environment.” (Snow 3).  Many people refer to this state as being a “vegetable.”  After contemplating the situation for a long while, Nancy’s family decided that it would be best to remove the feeding tube that was focibly keeping her alive.  However, Nancy had no living will or health care power of attorney which was needed by law to remove the tube.  Does her family have the right to make the decision to end her life, when she cannot make that decision herself?  Who does have that right? Do people have the right to die?

            This incident started many people thinking about what they believe about the issue of the right to die and physician assisted suicide.  The story of Nancy Cruzan is only single scenario out of many that people have to decide where they stand on the issue.  There are so many other possible cases and situations that there is no way this can be defined as a ‘black and white’ issue.  People are all over the board in their approach to the issue of the right to die.  There are many factors that affect one’s approach to this issue - their occupation, religion, experience with the issue, their values and morals, etc.  There are three main approaches to the issue of the right to die and physician-assisted suicide.  First, a religious or moral approach that deals with people arguing their side because of their beliefs or values they hold in high regard.  Second, a political and legal approach that deals with what the laws state and the reasons behind them.  And third, a personal approach that explains peoples’ opinions who have dealt with the issue.

            Although grouped together as having the same approach, not all religious people and those who argue their opinion based on their moral beliefs, have the same stance on the issue.  These people look at the right to die and physician-assisted suicide in the same way, but they do not see the same thing.  There are many people coming from a religious or moral approach who have a strong commitment to preserve life.  They believe that above all else, life should be valued, and that our actions as humans should exemplify that.  Some trace this back to their faith in a creator, and argue that s/he is the one who gave people life, and so only s/he should have the power to take it away.  People need to let their bodies and others’ bodies take their natural course in death.  The gift and preciousness of life needs to be valued and upheld in the actions humans take, and people do not have the right to end their life when they please. (The Perspectives 1)

            Other religious people, however, disagree.  There are many people who believe that when someone is in a PVS, such as Nancy Cruzan, there is no real life to hang on to.  A writer for the Tampa Bay New Times, Constance Snow, gives the reasoning, “without a functioning mind and body we lack consciousness as we know it.  Human consciousness is the mechanism by which we know our creator, recognize spirit and embody and express that which is holy.” (Snow 1)  There are many who agree and believe that at this state, there is no point in keeping someone alive.  There is no room for spiritual growth or action, and without that, many religious people say that it is time to let that person pass on.  There was a theological study done in 1950 called “The Duty of Using Artificial Means of Preserving Life,” written by Jesuit moralist Fr. Gerald Kelly.  This Catholic priest researched this subject in many Catholic teachings to look for a religious answer to the case of Hugh Finn, a case similar to Nancy Cruzan’s, in which he was in a PVS and being forcefully fed by a tube.  Father Kelly found that “no remedy is obligatory unless it offers a reasonable hope of checking or curing a disease.”  From this, he concluded that taking away Hugh Finns feeding tube would not be actively killing him and therefore not be against the teachings of the Catholic Church. (Paris 2)  Not all people in the Catholic Church would agree with this, just as there is dissention among religious people on the issue of the right to die.  There are arguments from all sides in the religious and moral approach.

            The second main approach to the issue of the right to die is the political and legal approach.  The people who take this approach either use law as support for their stance or are people looking towards others to make laws concerning the issue.  The people who use law as their support have many court cases they look to, to find official rulings that judges have handed down on the numerous circumstances they’ve been presented with.  Each state has different cases and rulings to support a variety of opinions on the issue.  Many people look to the story of Nancy Cruzan and the court case dealing with her situation for support in arguments.  The Cruzan case came to be known as the right to die case.  There are also the many lawsuits and cases against Dr. Jack Kevorkian, a medical doctor who has helped people commit suicide in Michigan, which people look to for legal back-up.  Laws are the backbone of our country, so taking an approach from a legal standpoint is a very valid way to look at the issue of the right to die.

            Also taking a political and legal approach are lawmakers and those involved with legalization of physician-assisted suicide.  In summary, there are four main arguments in support of legalization of physician-assisted suicide.  One, “the mercy argument,” which says that it is inhumane to make people suffer immense pain when they would rather end their life.  Two, “the patient’s right to self-determination,” which argues that people own their lives and they should be able to treat themselves the way they want to.  Three, “the economics argument,” which discusses the high cost of keeping someone alive whose physical state will never change for the better.  And four, “the reality argument,” which says, ”let’s face it, people are already doing it.”  There are many arguments to the contrary of this legal debate as well.  “Medical doctors are not trained psychiatrists.  How will physician-assisted suicide be regulated?  The ‘slippery slope’ argument (is strong as well as) the sacred view of life.  What about the doctors who don’t believe in killing?” (Newman Part Five 1) These are all common arguments against the legalization of physician-assisted suicide.  There are lawmakers on both sides of the legalization issue as well as citizens who support them.  Many lawmakers are concerned with up-holding the value of life in law because that is the one place where the answers are concrete and stand for what Americans believe.  At the same time though, there are many lawmakers interested in the rights of the people, and believe that included among the other freedoms is the right to die.  There is much contention in the political and legal approach as well.  Not all people, even with the same purpose, hold the same view on the issue.

            The third approach to the issue of the right to die and physician-assisted suicide is one of personal experience or attachment to the issue.  This includes family members who have dealt with the issue first-hand, the people who have terminal illnesses, and the doctors who care for them.  First, a man named Derek Humphry “helped his wife commit suicide at age 42 during the last stages of her battle with breast cancer.  Five years later he founded the National Hemlock Society, an organization dedicated to the cause of legalizing doctor assisted suicide for the terminally ill.” (Newman Part Three 1)  After seeing his wife’s suffering, he understood her desire to end her life and supported her decision.  Humphry is still in support of this, and argues that people should not have to unnecessarily suffer and that they should have the choice to decide for themselves what they want to do about their life and their death.  The people that are making the laws aren’t the ones suffering, so they shouldn’t be able to tell those people who are in pain what they can and can’t do.  The Cruzan family is a good example of people in a slightly different situation, but who agree with Humphry in his stance on the right to die.  Just as he saw his wife suffering with cancer, the Cruzan family saw Nancy suffering in a PVS.  They both chose the same route of wanting to end their loved one’s life.  Not all family members of people who have chosen to die agree with Humphry and the Cruzans.  There are many who believe that taking their loved one away is a mistake, mostly because there could be some miracle that could save their life and keep them around longer.  But for the most part, family members who have experienced making this decision, seem to support the right to die and physician-assisted suicide.

Meg Green is a 75 year-old cancer patient and “is glad that the option exists.”  “When you can’t function, what’s the use of living?  Or if the pain gets too great, what’s the use of living?  And I think you have a right to the final say,” she said.  Author of Compassion in Dying, Barbara Coombs Lee says that physician-assisted suicide is good way to go.  The whole thing is self administered by the patient, the people requested can be there, and all the good-byes are said.  She realizes the difficulty of the situation for the family, but also sees it as liberating for them that not only the physical suffering for the patient is over, but also the family’s own emotional suffering.  One hospice nurse, Steve Sehm, who witnessed an assisted suicide said of the patient, “‘He never wavered, never once, with all the people whom he interacted. He was always very clear.’  He remembers the man smiled as he drank form a coffee cup a bitter prescription flavored with cherry.  In 30 seconds, the man was asleep.” (Hochberg 1)  It seems to be that many people taking a personal approach to this issue believe that people do have a right to die and that physician-assisted suicide is a good option.  There are many family members and doctors who wouldn’t feel the same, but for the most part, people who have already had personal experience with the issues support it.

There are many ways of approaching the issue of the right to die and physician-assisted suicide.  Using the story of Nancy Cruzan, people can look at it from an ethical standpoint and say a variety of things.  Some people would argue that it is the moral thing to keep her alive and wait for nature or a higher being to take her when it’s ‘her time.’  Other people would argue that the right thing to do would be putting her out of her misery and removing the feeding tube that was sustaining her life, which wasn’t really a life anyway.  The fact is though, what was to be done about this case is a legal issue, another important approach and component to this issue.  The Cruzan family took the issue to trial.  There was a statute in the state of Missouri that said no assisted suicide.  At the trial court, the Cruzans won, and the court ordered that yes, the tube could be removed.  The appeal to the Missouri Supreme Court reversed that and said no, there is absolutely no right to die.  The case went one appeal further to the United States Supreme Court.  Here, the ruling was once again over-turned, and based on the 4th Amendment – the right to liberty - people do have the right to die.  However, there must be a doctrine of informed consent.  This meant that the patient had to understand the situation in its entirety and consent to the action.  In a persistent vegetative state (PVS), such as in Nancy’s case, there needed to be a living will or health care power of attorney.  Nancy did not have either.  However, in the state of Missouri, a living will or health care power of attorney was “clear and convincing evidence” stating the patient’s desire to die.  The Cruzan family took the case back to trial court and gave testimony from friends and family saying that Nancy would want to die in this situation.  The judge found this to be sufficient “clear and convincing evidence,” and ordered the removal of Nancy’s feeding tube once and for all. 

Although, there is law regulating the right to die in America and in each state, the issue does not end there.  People are always entitled to their opinions in America even if it goes against law.  Every action that government takes, there will always be someone who disagrees or has a different opinion.  With the issue of the right to die, there are many different opinions and approaches, all valid in their own right.  There is no right or wrong answer to such a complex and individual question.

Works Consulted

Dororquez, David.  “Cruzan and the Right to…”  (2001).  <http://www.doroquez.com/arts/tesp01.htm>

Hochberg, Lee.  Interview with various players.  Rec. 24 November 1998.  Video.  Right to Die.  Public Broadcasting System, Oregon.

Newman, Ed.  “Part Five: Making The Final Choice: Should Physician-Assisted Suicide Be Legalized.”  The Truth Seeker  121.5 (1992).  15 October 2002 


Newman, Ed.  “Part Three: Local Perspectives on the Right to Die Debate.”  Detroit Free Press FREEP  15 October 2002  <http://www.cp.duluth.mn.us/~ennyman/DAS-3.html>

Paris, John.  “Hugh Finn’s Right to Die.”  America (1998).  15 October 2002  <http://www.americapress.org/articles/ParisFinn.htm>

Snow, Constance.  “The Right to Die?”  Tampa Bay New Times  May/June (2000).  23 October 2002  <http://www.altnewtimes.com/e03csn.html>

 “The Perspectives in Brief.”  Public Agenda Online (2002).  13 October 2002  <http://www.publicagenda.org/issues/debate_brief.CFM?issue_type=right2die>