By Kathie Newell
As citizens of the United States, we relish many freedoms -- Freedom to vote -- Freedom of speech -- Freedom to worship as we choose. Now, we can have another freedom -- the right to decide, while we're alive and competent, whether we wish to die naturally by rejecting life-sustaining treatment.
Nancy Cruzan, a young woman in her 20s who suffered severe brain damage in an automobile accident in 1983, had no choice. Neither did her family -- at first. Feeding tubes were attached to Nancy, sustaining her life while she remained in a vegetative state for almost nine years.
Nancy was hospitalized in Missouri, where it was required by law that there be "clear and convincing" evidence of the patient's desire not to have life sustained by artificial means, such as a feeding tube, before any treatment can be withdrawn. The case went before the U.S. Supreme Court, which eventually denied their request, holding that there was not "clear and convincing" evidence of Nancy's desires. There was nothing written by Nancy expressing her desire, and the only evidence before the court was a statement by a friend of Nancy's that stated that she and Nancy had once discussed terminal illness and that Nancy had said that she would not want to be on life support. Eventually, the feeding tube was removed, but not before a substantial amount of time, expense and anxiety had been incurred by Nancy's family. (Nancy Cruzan died on Dec. 26, 1990, 13 days after her feeding tube was removed.)
Before the rise of medical technology, people usually died "naturally" at home. Prolonging life through medical intervention was neither a possibility nor a problem. Following WWII, with explosive growth of medical technology, death became an enemy to conquer. New techniques -- implants, transplants, kidney machines, artificial breathing, artificial feeding -- made it possible to prolong life.
This brought new problems. As medical technology and ability to control the length of human life grew, new legal and ethical questions came up.
Following the Cruzan case, the U.S. Congress passed the Patient Self-Determination Act, which went into effect Dec. 1, 1991. This act ensures that every adult patient admitted to Northern Montana Hospital, or any other hospital in the country, will receive information of their rights as a patient to accept or refuse medical or surgical treatment and their right to establish an advance directive to make their wishes known concerning the providing for or withholding of medical care.
Legally, medically and ethically, there has come to be some general agreement -- the best person to make the decision about how far to prolong life is the patient, and the best time to make that decision is in advance, while the patient is still healthy and able to communicate. The increased focus on helping patients understand their rights is aimed at improving patient knowledge about their freedom of choice and at fostering better communication among the patient, family and attending physician.
More information about and free copies of living will and durable power of attorney for health care forms can be obtained by calling the Northern Montana Hospital Social Services Department at 262-1557. If you file a copy of your living will with Northern Montana Hospital, it is made a permanent part of your medical record, and you will be designated as having an advance directive on file.