(4 of 10)
When her cancer was diagnosed three years ago, Diana Nolan did not need much imagination or prophecy to know what lay ahead. The disease had killed both her parents. Surgeons removed part of her lung, but the cancer spread. Her physician next suggested that she try a potent chemotherapy but warned of the potential side effects -- hair loss, nausea and vomiting. "I wanted a full week to think and pray," she recalls. "I am a person who wants to have a part in the treatment. Let me know what my options are." In the end, she told her doctor she wanted only pain-killers. Her two grown sons supported her decision, but some friends urged that she battle on. "They said, 'Go for it at all costs,' but I had seen my father, my mother and several friends go through this." She preferred to stay at home to die, and summoned her Episcopal priest to administer unction. Nolan hopes she will leave a message for those considering decisions like hers. "I wish people wouldn't be frightened about knowing what they're up against. To have a part in my treatment has been so important. I'm part of the team too."
But when doctors cannot consult the patient directly, the issue becomes much harder. Karen Ann Quinlan's was the most celebrated right-to-die case before Cruzan's, and one that seems almost straightforward by comparison. In 1975, after she had been comatose for seven months, Quinlan's father went to the New Jersey Supreme Court to have her respirator turned off. The court agreed, and the U.S. Supreme Court declined to consider the case further. After the ruling, Quinlan lived nine more years breathing on her own. But Nancy Cruzan is not on a life-support system. Her parents are asking doctors to remove a feeding tube. If that petition is granted, Cruzan is sure to die within weeks, if not days.
When it is not high technology but rather basic care that is being withheld, doctors find themselves on shakier ground. Right-to-life proponents, including some physicians, argue that food and water, even supplied artificially, are not "medical treatment." They are the very least that human beings owe one another -- and that doctors owe their patients. To keep a heart beating after a brain is dead makes no sense. But Nancy Cruzan is not brain dead; like a baby, she survives on her own if fed.
This distinction can put families and health-care workers at odds, as Robert Hayner found when he went to court in Albany to have his unconscious Aunt Elsie's medication stopped and the feeding tube removed. "How can we be expected to provide care if the tube is pulled?" demanded staff members at her nursing home in a court deposition. "How can we stand by and watch her starve to death? We are her family," they said. "We care about her. We cannot walk down the hall knowing we are killing her."