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Though no one questions the love of Cruzan's parents and their desire to abide by her wishes, what happens when a family's motives are not so clear? The state of Missouri is paying Cruzan's medical bills; but for other families the desire to hasten an inheritance or avoid crushing medical costs could add an ingredient of self-interest to a decision. The Rev. Harry Cole, a Presbyterian minister who faced the dilemma when his wife fell into a coma, admits the complexity of pressures. "If she were to go on that way, our family faced not only the incredible pain of watching her vegetate, but we also faced harsh practical realities." The cost of nursing-home care was likely to top $30,000 a year. "How could I continue to send three kids to college with the additional financial strain?"
The Cole case provides one more reason for courts to be careful about withdrawing life support: medicine is an uncertain science. When Cole's wife Jackie suffered a massive brain hemorrhage four years ago, the blood vessels in her brain ruptured, and she fell into a coma. "The vast majority of patients who have this kind of stroke die within a few hours," Dr. Tad Pula, the head of Maryland General Hospital's division of neurology, told Cole. But Jackie did not die right away; after several crises she stabilized into a vegetative state, which doctors said could last indefinitely. After talking with his children, Cole went to court to remove the respirator. But Baltimore Circuit Court Judge John Carroll Byrnes stayed his decision. Six days later, Jackie Cole woke up.
Today Jackie and Harry still appear on the talk-show circuit. She suffers some short-term memory loss, but otherwise is fully recovered. "When I look back at what the doctors said, I think, 'How wrong they were,' " she says. "What happened to me was truly miraculous." She does not blame Harry for wanting to pull the plug. "I know he loves me. I know he was never trying to do away with me." But the story does highlight the dilemma both judges and family members face. "I thought my decision was well planned, well thought out, responsible," says Cole. "It was what Jackie had asked me to do."
Such situations essentially confront families with a Hobson's choice: either they stand by and allow a loved one to waste away, or else they act to hasten death, with all the guilt and recrimination that entails. A state attorney accused 87-year-old Ruth Hoffmeister of wanting to starve her husband to death. Every evening for the past six years, Ruth has spoon-fed her husband Edward, who has Alzheimer's disease. When he began losing weight, their Pompano Beach, Fla., nursing home would have been obliged by state regulations to force-feed him through a tube. Ruth protested the bureaucratic intrusion. "There is nothing so important to an Alzheimer's patient," she insisted, "as a familiar touch and a familiar voice." She went to court to stop them, and won. "I don't know what the next step will be," she says. "After he had the disease for three years, he said to me, 'I am so tired of dying.' How could I ever justify keeping him alive?"