The Death of Nancy Cruzan
Air Date: March 24, 1992
ANNOUNCER: Tonight on FRONTLINE, the intimate and powerful story of one family's struggle with life and death.
CHRISTY CRUZAN: I really didn't know that such life existed as what Nancy's lived these last four and a half years.
ANNOUNCER: For five years FRONTLINE followed the Cruzan family as they fought to disconnect the life support that kept their daughter Nancy alive.
JOE CRUZAN: If the decision's wrong, if we're playing God, then I'll have to live with that, and I'm willing to.
ANNOUNCER: In two previous programs we tracked the legal battle from local Missouri courts all the way to the United States Supreme Court and heard the arguments in its first right‑to‑die case.
C. EVERETT KOOP, Former U.S. SURGEON GENERAL: Every patient in this country today could have a life that hangs in the balance on the basis of what the Supreme Court decides about this.
PROTESTER: Oh, God, hear our voice and intervene by the power and the spirit of God. Glory to God, work a miracle on her behalf.
ANNOUNCER: But tonight we tell a different story, of the private struggle behind that public battle, the story of one family's love and commitment to their daughter.
Mr. CRUZAN: We don't need the preachers. We don't need the spectators or the--this, that or the news media or anyone else. We can pull together and we can--well take care of her.
CHRISTY CRUZAN: It was 2:25 on a Tuesday morning when the phone rang. I picked up the phone and I just felt like it couldn't be. There had to be some mistake.
JOE CRUZAN: And Christy called us and then Joyce and Christy and I went on to--to Freeman Hospital in Joplin.
CHRISTY: There was a head injury and that was really all I knew.
Mr. CRUZAN: We were in the emergency room area, waiting area right there, and then when they brought Nancy in--
CHRISTY: I knew it couldn't be her because this person on this stretcher was--was not Nancy, until I saw her socks.
Mr. CRUZAN: And I thought--I kept waiting for them to bring Nancy in. I thought, "What's going on here?" and--but it was Nancy.
JOYCE CRUZAN: And we waited and she was in surgery quite a while and when the nurse finally came out and said, "She's going to be all right."
Mr. CRUZAN: When the nurse came out and said that she was going to be all right, I turned, I believe, to Joyce and I said, "I feel like I can breathe again."
She was going east and she went off on this side of the road about 300 feet down from that mailbox. I imagine the car came to rest right about in-- oh, along in here. It was upside down. It was on this side of the lane and Nancy was lying face down on the other side about--oh, just on the other side of the lane and about 20 feet down from the car that way. And they said it was approximately 35 feet from the car, probably being there just about where the lane curves.
I went down and talked to the trooper that worked the accident and then I also got a copy of the accident report from the state. "Vital signs on arriving--blood pressure, 0 over 0. Pulse, 0. Respiration, 0." On the report it said, "Code blue. Clinical save." But I asked them what a clinical save was and they said they have maybe two or three times a year, and it's when someone has gone into cardiopulmonary arrest, I think is the term they use, and that they're able to bring them back. And sometimes it works and sometimes it doesn't.
CHRISTY: Through the first month or so they did a lot of tests, CAT scan and EEGs, trying to determine the amount of injury and what--how permanent it might be. It looked like she'd gone without breathing for quite some time and as time progressed, the prognosis looked worse and worse.
I really didn't know that such life existed as what Nancy's lived these last four and a half years. She would have been 30, or will be 30 on Monday.
[clip from birthday party] Hi. Happy birthday--the big 3‑0 We have presents. Look what Gran made for you.
Mr. CRUZAN: I remember her as a baby and as a toddler. Almost everything the kid did was funny. She was kind of impish and everybody teased her a lot because she egged it on. And she had a lot of friends. She got along well with her peers. She never saw a stranger. She was a lot more outgoing than I ever was or than the other kids ever were.
CHRISTY: Sometimes I think she worked to embarrass me and that was her main goal in life when we were younger, was to give me a hard time.
Mr. CRUZAN: She was a twirler. She was--in her junior year in high school she was co‑captain and we'd go to parades everywhere and I'd take pictures of her. And I'm kind of emotional and particularly with music, marching band music and my--you know, my eyes would fill up. I couldn't hardly see through the camera.
Mr. CRUZAN: And she had fun. She--I think she enjoyed life as much as anybody I ever have been around.
CHRISTY: Then in the later years, especially after I had the girls, she was a second mother to them. She spent a lot of time with them. They dearly loved her to come over and to spend time with her.
MIRANDA YOKUM: She's just the greatest aunt anybody could ever have in the whole world. She's funny. She'll let you do anything, but to where you won't get hurt.
ANGIE YOKUM: She was ornery and she was funny to be around and she was a good aunt. I think it was just a couple of years ago that we really realized that Nancy wasn't going to get any better and that she wasn't--that this had happened and, you know, all the stuff with it, and it wasn't going to get any better.
MIRANDA: It is an experience that nobody wants to know. It's--all like, you don't--you don't want your mother to die. You think, "Oh, that'll never happen and it won't happen," and it does. That's just nature, I guess. I guess she was so good, God wanted her early.
CHRISTY: Oh, we found some birthday cards. Here's a special one. It's got a little chipmunk and a little bird and pretty flowers. "To a very special aunt. To lovingly tell you it's certainly true, Aunts just don't come any nicer than you. Happy birthday, with love, Angie and Randa," and lots of X's and O's.
I've never, since the accident, thought that she was aware that I was there. I talked to her as though she would know and God knows, I've looked because I wish I could say, Yeah, I've seen it but I've never seen any kind of--of thought process in her.
Mr. CRUZAN: I wanted to see something that I knew--that I knew was a response, not something that, you know, you might see something once, but it couldn't be repeated. Well, I thought, "When Nancy gets up and says, 'Hi, Dad,' then I'll know she's better."
Mrs. CRUZAN: And we would sit sometimes and hold hands and touch her and will strength into her body from ours. I mean, it just had to work because, you know, it just couldn't be this way. And frankly, I mean, we begged her, pleaded, you know, tried to bribe her, this kind of thing. You know, "We'll do anything, anything. Just respond. Just--you've got to. We need you. You can't do this."
Mr. CRUZAN: Trade places with her.
Mrs. CRUZAN: Right.
CHRISTY: I begged her. I told her I would give her my car. I would do anything if she would just come back. One of the last things she said to--to people that saw her, that she had to take care of me and I felt that if--if she could some back at all, she would come back to me, to help me, to be there for me. But it's never been. No matter how much I needed her, she just couldn't do it.
SUE ROWELL, Nurse: This particular floor is very unique because this floor has a lot of life support patients on it. We usually get them after they've been ill for a very long time and there's no other place for them. We've had patients here up to 10 years. We have to deal with the aftereffects of what heroics are done on the roadside and in other hospitals. We get the aftereffects.
Dr. HISH MAJZOUB: In her case, I think she was without any oxygen, or adequate oxygen, for about 20 minutes and that really led to her severe brain injury. And this is a state that we call a "vegetative" state, you know. When you are in a vegetative state, you don't understand what people say to you. You open your eyes, look around, but you don't really react to stimuli, you know? And this is where she is, in that state where she doesn't really understand or hear. She can hear, but doesn't understand. She can see, but it has no meaning to her, you know?
Once you are in a state, a vegetative state, there's no way of recovery. You know, as far as the lifespan of the patient, they usually--unfortunately they can live as long as you can prevent their infections. If you treat all their infections, you give them good nutrition, good support, you know, life support, they can live for years and years.
Mr. CRUZAN: What are you having today, steak?
Mr. CRUZAN: Boy, she sure responds to that voice.
NURSE: Yeah, she does. I can come in here and--
Dr. MAJZOUB: In a state like that, you know, unfortunately the patient has to be tube fed, as we put a tube in their stomach or in their upper intestine to feed them daily. They remain in that state, you know, permanently and with no further improvement.
Mr. CRUZAN: I signed the consent form to begin the artificial feeding of Nancy, to have the tube implanted. Looking back on it, I would like to have let her go that night because Nancy died-- our Nancy died that night. We've got her body left, but she has no dignity whatsoever there and she was a very, very proud, independent person and you would see what was left there and you wondered why. Why? What's the purpose in this?
Mrs. CRUZAN: It's like when Nancy would get real sick. She was sick, pretty sick a couple of times, had pneumonia, high temperature. And I don't know that I prayed that she would die, but I hoped she would and that's backwards, you know? When they're sick, you want them to get well and yet I don't want her to be sick, but I--you know, I--I wished she'd die.
SUPPORT GROUP LEADER: Now then, does anyone else have anything that we may have missed that you--that you'd like to talk about or--
1st PARENT: When our daughter was in the nursing home, seizures was her problem and her heart stopped beating. And they said she had started changing colors before they got it going again.
2nd PARENT: Our daughter, after a three hour seizure in Cox Hospital in Springfield, as they put her on the machine and fortunately she did come out of it, to a certain extent, but for the last two years she's gotten worse.
SUPPORT GROUP LEADER: I wonder sometimes if that doesn't make the smaller stresses of everyday living even harder for you to bear when you have this tremendous thing that you're trying to cope with. It always hovered over and above everything else.
Mr. CRUZAN: Do you think I'd be out of place if I touched a little bit on our--
SUPPORT GROUP LEADER: Not at all. That's what this period is for. We're here to support you.
Mr. CRUZAN: Well, probably most of you know that--or have heard that we have--well, I didn't think this would happen this way. Joyce and I have begun a procedure to--
Mrs. CRUZAN:--to have the life support for Nancy withdrawn. We've asked the hospital to do it and they are not able to without some kind of a court order, which we understand. So what we're going to have to do is go through a legal procedure to get permission to withdraw the life support, which in Nancy's case is hydration, nutrition, rather than a respirator.
Mr. CRUZAN: As far as being able to give you a reason why we--why we're doing this, I--the only thing I can say that--is if you knew Nancy the way we did--I wish it wasn't this way--that you would understand why we feel like we are doing what she would have us to do.
BILL COLBY: Joe?
Mr. CRUZAN: Yes.
Mr. COLBY: Bill Colby.
Mr. CRUZAN: Glad to know you.
Mr. COLBY: Good to meet you. Joyce--
Mrs. CRUZAN: Glad to meet you.
Mr. COLBY:--nice to meet you. Come on in.
Mr. CRUZAN: All right. It was going to be a very expensive procedure and frankly, we couldn't afford to do it. We have our attorney in Joplin that we've dealt with. Well, they suggested that we go try the American Civil Liberties Union in Kansas City, so I contacted them and they in turn contacted a firm that's Shook, Hardy and Bacon.
Mr. COLBY: What I thought we'd do this morning, other than just--
Mr. CRUZAN: Get acquainted.
Mr. COLBY:--get acquainted, was just to get a little bit of the factual background. We've talked on the phone and--the big case that everybody knows something about was the Karen Quinlan case, but here with the Cruzans, this is the first case in Missouri and it's not something, and it shouldn't be something, that our courts or our legislature resolves lightly or without a full hearing on what both sides of the question are.
Are you in contact now with her doctors? Have you talked with any of them about what would happen if the G‑tube is removed?
Mr. CRUZAN: We talked with our physician, our personal physician, about that.
Mr. COLBY: And what did he tell you?
Mr. CRUZAN: He--we--the main thing we asked him was about her death, if it would be traumatic. And he said, "In my opinion, for her, no, For you and your wife, yes." And by that, I--I'm not really sure what he meant, except maybe having to watch her die and the process that we'd have to go through to bring it about.
Mr. COLBY: We have to establish somehow that this is in the best interest of Nancy. You do that by looking at statement she made in her life. If she made clear statement that she wouldn't want these kinds of things, then that's strong evidence to the court. You do that by looking to the substituted judgment of loved ones and people close to her, say to them, "You knew Nancy. You know what she was like. She's not able to tell us now what she would have wanted. What do you think she would have wanted?"
Mrs. CRUZAN: I don't remember the first time it was brought up or brought up with Christy. I remember Christy saying, "I know exactly--if we could call Nancy up and ask her, I know what she'd say."
CHRISTY: She would say, "Look, I realize it's hard on everyone else, but let me go. I've got other things to do. I've got other places to go, so turn me loose."
DONALD LAMKINS, Hospital Administrator: The Cruzans had sent the letter officially asking that this be done. This was discussed with the Department of Health attorney and the answer came back that the law says, No, we can't do it. We know that we can unplug a machine. That's been talked about in so many places. TV shows have shown that. That isn't nearly hard for us to accept. But the fact that we starve somebody to death--we don't do that. That's--that's beyond our ability to think, even, at this point, in Missouri."
Mrs. CRUZAN: You have company. You look like you need your hair brushed.
Mr. CRUZAN: Nancy, we brought a fellow by the name of Bill Colby up with us. He's the one that's going to represent us in this thing that we talked about.
Mr. COLBY: Hi, Nancy.
Mrs. CRUZAN: I don't think she's real impressed.
Mr. COLBY: Is this how she appears each time you come?
Mr. CRUZAN: Yeah, this is it.
Mr. COLBY: Does her facial expression ever change?
Mr. CRUZAN: Not unless, you know, there's pain or something like that.
Mr. COLBY: Is it possible to see the tube without--I'd never seen a person in a persistent vegetative state before. I knew from talking with Joe and Joyce that she wasn't in a completely still, closed-eyed comatose state and that she had certain reflexive brain stem functions. That, in the abstract, thinking of it medically, is one thing. To walk in and see her with eyes open, her eyes blinking--it was a very sobering experience for me to go there and see her and it made me appreciate all the more what this family is going through.
Mr. LAMKINS: They're pushing for something that many people, I think people even around them here today, are telling them, "No, you can't do that," because we haven't faced that situation. Nobody has been willing to make that decision in a case like Nancy's.
1st PATIENT'S FAMILY MEMBER: I wouldn't want to hold back food or liquid. Never. I want to come out of this without a guilt complex and I think--Ill do everything--I think nature will take care of that. Time will take care of it. And we'll just keep the course.
2nd PATIENT'S FAMILY MEMBER: I couldn't do that because every time I think of sitting down to a meal, I'd think of my daughter laying up there not having anything to eat, you know, and that would bother me. You know, it would bother me a lot.
Mr. CRUZAN: There have been times that, you know, I've thought, How can you murder your own child?" Our decision was based on what we felt like that Nancy would want and that's all we have to justify. What--if the decision's wrong, if we're playing God, then I'll have to live with that, and I'm willing to.
CHRISTY: [March 1988, opening day of trial at probate court] I'm jumpy. I don't know why. I just hope we can get our point across.
Mrs. CRUZAN: Oh, we will.
CHRISTY: And they care enough.
Mrs. CRUZAN: Well have today to just kind of sit back and watch.
CHRISTY: She'd be armed and ready today.
Mr. CRUZAN: I can just see her, walking in there like she owns the courtroom.
Mrs. CRUZAN: Just daring anybody to look cross-eyed at her.
Mr. CRUZAN: The first correspondence that we had from the Department of Health, it seemed it was going to be a friendly suit, but then when the attorney general's office got into it, I can't say that they became adversarial, but it took a different tone, I felt.
WILLIAM WEBSTER, State Attorney: We think in this case, to the extent that the state law speaks in Missouri, it speaks of a policy which will not deny food or water. We believe the legislature has spoken and that the public policy that they have articulated is one which would not allow this family to do what they're seeking to do.
Mr. COLBY: May it please the court--if Nancy could come before this court today, she would say to you, "Stop what is happening to me. Stop what is happening to the family that I love. I don't want to be preserved on this machine any longer. Let me die with dignity." She has a fundamental right to be free from that kind of medical treatment if she--
Mr. CRUZAN: If he said, "No, you can't do this," then it would be a continued fight. If he said, "Yes, you can," then Nancy would have to die. We would have to go through that process. I really felt like we couldn't win either way.
Mr. CRUZAN: [July 1988, decision from probate court] This will be all right. You want me to read all of it, or go through it--
Mrs. CRUZAN: No, just read the part that tells what it is first.
Mr. CRUZAN: Well, let's see. Do you want me to just find what--
Mrs. CRUZAN: Just find that first and see--I thought it'd be at the front. We still haven't found it. OK.
Mr. CRUZAN: [reading] "It is a fundamental right expressed in our constitution, the right of liberty, which permits an individual to refuse or direct the withholding or withdrawal of artificial death prolonging procedures. The employees of the state of Missouri are directed to cause the request of the guardians to withdraw nutrition and hydration to be carried out, such a request having court approval, shall be taken the same as a request for discontinuation of any other form of artificial life support systems. The care and compassion of the respondents and their associates have already shown our ward and her guardians incomparable by any standards are in keeping with the overwhelming tragedy that has been visited upon all of us." So what does it say?
Mrs. CRUZAN: It says that she does--
Mr. CRUZAN: It say they are directed to cause the request of the co-guardians to withdraw nutrition or hydration to be carried out. If that's winning, we won.
Mr. LAMBKINS: Well, we were surprised that here in extremely conservative Southwest Missouri where nothing ever happens first, the judge came out with a decision like that. I talked to one nurse last night who was one of the nurses that directly is responsible for her care and I mentioned that I was a little surprised and she said, "I was shocked. I just never thought it would happen."
CARRIE OETKER, Nurse: To me, it's very inhumane to do and I can't believe that any judge or any human would take it within their self to say, "We're going to take this feeding away from this human being." I just can't believe that anybody would do that.
SHARON ORR, Nurse: To take away that life that you've saved, somebody's making some decisions that I don't feel should be in their hands.
Mrs. CRUZAN: Well, Nancy, we got the decision from Judge Teel today. He ruled that you do have constitutional rights to determine your own treatment, so it was all favorable.
Mr. CRUZAN: I don't think that you know what we're talking about. I don't have any way of knowing that. But if you do, why we talked about this a lot before and you know why we're doing it. We've still got a ways to go. But at least we won the first round.
Mr. CRUZAN: [two months later] I really didn't realize that this could go on and on and on and on, and I really didn't think it would.
Mr. WEBSTER: Well, we think that this is a good case for the state of Missouri to be involved in and I think that, win or lose, we will be involved in an appeal until we get an ultimate determination on what this family can do.
CHRISTY: I don't think that it's fair that--that it has to be public debate. These are decisions that I feel like families should make privately, with the help of their doctor. But unfortunately, at this point in time in the state of Missouri, that's not an option that's available and Nancy wouldn't be the kind of person to just sit back and do nothing.
REPORTER: Judge Robertson kept asking you, though, for a legal basis to go shead and use [unintelligible] statute. [unintelligible] and how you see that applying in this case.
Mr. WEBSTER: I don't think it does apply.
ANGIE: I don't like having people shove cameras in my face and wanting to take pictures, because you're not--you're not--you know, you think--am I supposed to be happy or am I supposed to be standing here looking real depressed? Or, you know, what am I supposed to do, you know? So I just kind of stood there, thinking UI hope I'm doing the right thing."
MIRANDA: Obviously, I hope they go in our favor, but I'm just kind of dreading the day that we'll have to do, you know, or the days, became, you know, that'll just be, like, we're losing Nancy, but I think--I think well probably see her somewhere else, so--you know, and shell look like Nancy. Shell act like Nancy. Shell be Nancy. So that's--you know, that's what I hope will come out of this.
ANGIE: But I hope they--they say OK so we can get this over with.
CHRISTY: [November 1988, decision from Missouri Supreme Court] Bill Colby called about 4:00 o'clock. I had just gotten off work and I was running some errands. And when I got home, when I came home, the girls were here and my mom was here and when I opened the back door, I could tell something was wrong and I wouldn't step on into the house. I asked them what was wrong and they all looked at me and I asked them again and by that time, I was crying. And I thought perhaps Nancy had died. I just didn't know. It never occurred to me that they had ruled against us, that they had overturned Judge Teel's decision.
Mr. CRUZAN: The reason they stated was that we did not have the right as guardians to make that decision for Nancy. And, I mean--in other words, where did they get the authority to make that decision? Because they did make a decision. There had to be a decision made to let her live or to let her die. We wanted to let her die. They made the decision that she should live.
Mrs. CRUZAN: She would not want that and yet somebody out here says it doesn't matter what she wants. It doesn't matter what you want, as her family. The state says life is precious, therefore it doesn't matter what you want. It doesn't matter at all. Nancy doesn't matter.
Mrs. CRUZAN: It's cold out there. My hands are probably cold, aren't they? She just--I don't know. To me she looks worse all the time and she would be very upset by the way she is.
Mr. CRUZAN: It's getting more and more and more difficult to go up and see her because that's not Nancy up there. It doesn't even look like Nancy any more.
CHRISTY: My dad has always been a fixer. He's always wanted to make things right. And I think he feels so helpless.
Mr. CRUZAN: It's made a very pessimistic, angry person out of me, frustrated in that I really feel like that what I was doing or trying to do is what Nancy would want us to do. But I mean, I--you know, I feel like I'm in a sack and I want to get out of it, but I don't know where to hit. I don't know--you know, I don't know which way to turn. I don't know what to do. I've even--sometimes I've wondered, is my obsession for me now, that I'm not going to take no for an answer, or is it for Nancy? And in reality, I know that it's not for Nancy. It's for everyone that's in this condition. And to have the state come in and say, "No, you can't do this"--
Mrs. CRUZAN: It's not over till it's over, and it's not over yet. We still have the U.S. Supreme Court and I'm hopeful that they will have the courage, fortitude, foresight, whatever you want to call it, to see that this needs to be : "addressed.
Mr. COLBY: [December 1989, United States Supreme Court] Every court in the country that has addressed this issue would allow them to have that tube removed and allow them to die with dignity. Missouri certainly is out there marching by itself against the trend of decisions everywhere.
PROTESTER:--and that life is sacred and that we should not indiscriminately take away life. Who are we to play God? We are not qualified to play God.
Mr. WEBSTER: [to reporters] Good morning My name is Bill Webster, or William Webster, Missouri attorney general's office. I think the argument went well. Frankly, we're all treading on fairly new ground here and there's no other federal law which has ever suggested there is a right that goes this far.
Mr. COLBY: The Constitutional right is the right to not have the state intrude into your body unless they give a good reason for doing it. They've given no reason here.
Mr. CRUZAN: I keep thinking, "How"--you know, "What am I doing here? Why me?" I feel like that I'm at the Superbowl game and they've got me clear back up in the highest bleacher in the poorest seat in the house and these other two teams are playing and they're playing with my football and there's not a damn thing I can do about it, except just watch.
ANNOUNCER: [June 25, 1990] Fro