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January 1992

Withdrawing Life-Sustaining Treatment: Lessons From Nancy Cruzan

Author Affiliations

Pulmonary and Critical Care Division Department of Internal Medicine Medical College of Virginia Richmond, VA 23298

Arch Intern Med. 1992;152(1):25-27. doi:10.1001/archinte.1992.00400130051003

Life is a journey, and the end of the journey has, for many people, become more difficult. Clinical conditions that just 25 years ago would have signified imminent death now prompt "life-sustaining treatment." On occasion, such treatment permits dramatic recovery. At other times, "life sustaining" becomes "death prolonging"; patients do not recover, nor do they die. Instead, they become prisoners of technology, despite the intentions of physicians, the hopes of families, or the fears of patients. Consider Nancy Cruzan.

In January 1983, an automobile accident on a deserted Missouri road almost ended Nancy Cruzan's life. A state police officer declared her dead, and when emergency personnel arrived she had no pulse. Cardiopulmonary resuscitation restored her respirations and heartbeat, but not consciousness. She existed in a persistent vegetative state supported by food and water given through a gastrostomy tube. After several years, all of her physicians and consultants agreed that she