Articles

Long Goodbye: The Deaths of Nancy Cruzan
Written by William Colby, Published by Hay House
A Book Review from Last Acts Quarterly, Volume 11

Long Goodbye tells the story of a family’s struggle to free their daughter from an artificially supported, comatose state. Bill Colby was the Cruzan family’s lawyer, a man not long out of school who guided them through a protracted legal journey that ultimately led to the U.S, Supreme Court. In the process, Colby witnessed the emotional toll the entire experience exacted upon the Cruzan family.

Much of this story’s power comes from the fact that it could have happened to anyone. The Cruzans were an ordinary, close-knit family who lived in the small town of Carterville, Missouri. One day in 1983, 25-year old Nancy, an attractive and strong-willed woman (who was prone to fast driving) careened off the road, flipped over, and was thrown the length of two football fields from her 20-year old Rambler. Nancy hadn’t breathed for at least 15 minutes before paramedics found and revived her—a triumph of modern medicine that nevertheless launched the family’s seven-year nightmare to free Nancy from a persistent vegetative state.

Colby eloquently and honestly tracks the hellish experience of a family unquestionably devoted to Nancy. After her accident, they worked tirelessly to help bring her back to consciousness without success (talking to her, touching her, reading and singing to her.)

After five years, the family finally accepted that Nancy’s condition would never improve. Already worn from losing the fight to bring Nancy back to life, the Cruzans began a painful, and very public, legal battle to have the state hospital remove her feeding tube and let her die.

Colby recounts a legal story as riveting as the Cruzan’s personal struggle with Nancy’s condition. The Cruzan’s went to court to seek exception from a specific rule in Missouri’s living-will law, which allowed for withdrawal of medical treatment when a patient is brain dead, but specifically ruled out feeding [tubes] as medical treatment. Nevertheless, the judge ruled in favor of the Cruzans, finding grounds in Nancy’s constitutional right to liberty, which, he stated extended to freedom from unwanted medical treatment.

Yet in a strange twist, the judge recommended that the state appeal. After hearing the case, the Missouri Supreme Court ruled against the Cruzans, finding no clear evidence that Nancy would have wanted to have the tube removed. This time, the Cruzans appealed, and the U.S. Supreme Court agreed to hear its first right-to-die case.

In a 5-4 decision, the Cruzans lost. Buried in hundreds of pages of the Supreme Court’s opinion, Colby found the key that would allow them to retry the case back in Missouri—and win.

Long Goodbye personalizes the many ethical and medical gray areas surrounding the point (if one exists) when quality of life is so diminished that it isn’t worth living; a threshold the public has yet to define. This book forces questions about the definition and moral validity of euthanasia and raises many unanswered questions over the value of life that have emerged in the wake of medical advances.

Colby also masterfully shows the emotional torture these issues bring to bear on a family. He writes, “The Cruzans’ story was a tragedy played out on many stages—societal, medical, legal, personal. Most of all, it was Joe’s tragedy.” Joe Cruzan, a sheet metal worker, was crazy about his daughter and for her, he combed through medical and legal textbooks, took on the right-to-life movement and pleaded his case to the national media. And Joe sat with Nancy in her last moments, as protesters shouted on the lawn outside beneath her hospital window.

Much has changed in the 12 years since Nancy’s death. The federal government passed a law requiring that all persons entering a hospital in the United States be told about living wills. Most states have laws governing advance directives, durable powers of attorney and health care proxies.

But the lines between withdrawal of life support and euthanasia are still blurred. Nancy Cruzan’s sister Chris now speaks at conferences as an advocate for families faced with the horrible choice between hastening the death of a relative by denying care and condemning them to life in a vegetative state. Her message is that it’s crucial to let your family members know how you want to be cared for before you cannot speak for yourself.

“I think institutions are still extremely careful, as they should be, about stopping any treatment when the result will be the death of a patient,” said Colby in an interview. “I hope the book can do what the case did back then, that more people are having these discussions” about end-of-life care. “You learn and act from hearing a story. If more people share the story, it’s a great service to the Cruzan’s legacy,” he said.

On Friday, December 28, 1990, the Cruzans buried Nancy in the Carterville cemetery, about a mile outside of town. A tribute Joe wrote appeared in much of the news coverage:

“Today, as the protestor’s sign says, we give Nancy the gift of death. An unconditional gift of love that sets her free from the twisted body that no longer serves her. A gift I know she will treasure above all others, the gift of freedom. So run free Nan, we will catch up later.”

Nancy’s grave marker, adapted from a political cartoon by Steve Benson that someone sent the Cruzans from Tacoma, Washington, had three dates:

Born: July 20, 1957
Departed: January 11, 1983
At Peace: December 26, 1990

Etched above the dates, as in the cartoon, the spikes of an EEG printout formed the words “thank you” before trailing off into a flat line. Nancy’s sister Chris said that when she saw the cartoon, it was as if Nancy was somehow trying to get word to them.

“Few people are more central to changing the shape of how we die in America, than Bill Colby, the attorney that brought the case of Nancy Cruzan to national attention. This book is a must-read for the Cruzan’s story could happen to any of us.”
- Marilyn Webb, author of The Good Death