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But the laws are so unsettled that even in states where the statutes are strict, they may not necessarily be enforced. Judges and juries across the country have been remarkably lenient on family members who become mercy killers. Rudy Linares, a Chicago landscaper, held off hospital workers with a .357-cal. pistol while he unplugged his baby son's respirator. The 15- month-old boy died in his father's arms. Linares was charged with first- degree murder, but a Cook County grand jury refused to indict him. In fact, out of some 20 U.S. cases of "mercy killings" in the past 50 years, studied by Leonard Glantz of Boston University, only three defendants have been sentenced to jail.
The Cruzan case may finally provide the lower courts with some clear guidance in striking a fundamental balance between the rights of individuals and the duties of the state. If they chose, the Cruzans' lawyers could have suggested that Nancy's "life" is so faint that it does not meet a minimum standard of protection under the law; that, unaware as she is, she has none of those qualities and prospects and experiences that give life its value. But such an argument would require setting some line above which lives are protected, below which they are not. "In the public realm we need general rules that everyone in an institutional setting will follow," says Harvard political philosopher Robert Nozick. "And any line they draw will look arbitrary." Instead the case is being argued on the grounds of liberty and privacy.
The Cruzans' lawyers are asserting that Nancy's constitutional right to liberty has no meaning if it does not protect her from having a feeding tube surgically inserted in her stomach and being force-fed. Though she is unable to refuse the treatment, her parents could act on her behalf. Since the Karen Ann Quinlan case, 50 courts in 17 states have considered the right to have treatment withdrawn. Nearly all have come down on the side of privacy and limited the power of the government to dictate medical care. In a peculiar legal irony, many states make it illegal to assist in suicide; yet again and again, the courts have upheld the rights of conscious but paralyzed patients to have their ventilators and feeding tubes disconnected. In the most recent, highly publicized case, quadriplegic Larry James McAfee, still paralyzed five years after a motorcycle accident, petitioned the Georgia Supreme Court to allow him to disconnect his own ventilator using a special mouth-activated switch. Upholding McAfee's privacy rights, the court granted his petition. But McAfee subsequently decided not to end his life after all.
Unlike Georgia and many other states, however, Missouri has strong pro-life language in its statutes, which the state supreme court invoked in throwing out the lower-court decision. Though Cruzan had the right to refuse treatment, said the Missouri justices, her parents did not prove to the court that this is what she would have wanted. The "vague and unreliable" recollections by family and friends about Nancy's wishes were not deemed sufficient reason to stop feeding her. "The state's interest," wrote the judges, "is not in quality of life . . . Were quality of life at issue, all manner of handicaps might find the state seeking to terminate their lives. Instead, the state's interest is in life; that interest is unqualified."