Published on March 31, 2019

Advance health care directive

Difficult conversations: Event at Lawrence Public Library to offer help with advance directives

By Jessica Brewer, LMH Health

Nancy Cruzan’s parents never thought their world would turn upside down as it did in 1983. Their daughter, Nancy, had been injured in a one-car accident, leaving her without cognitive brain function.

So the family faced two heartbreaking options: keep their daughter in a facility on life support for the rest of her life, or remove the feeding tube that was her lifeline. Like most parents of a 25-year-old, Joe and Joyce Cruzan never had thought to discuss a situation such as this with daughter. This was the start of a lengthy legal battle focused on the right to refuse care that ultimately was decided by the Supreme Court.

The Cruzans believed their daughter would have wanted to be taken off life support and allowed to die -- rather than be kept alive by the feeding tube and medication, immobilized in a hospital bed. However, the state of Missouri fought the Cruzans, maintaining the couple had no clear and convincing evidence from Nancy herself that the couple was following their daughter’s wishes. This was the start of a lengthy legal battle focused on the right to refuse care.

Although conversations about how people want to die if they’re incapacitated can be uncomfortable and upsetting, Bill Colby, the Cruzans’ attorney, says it is never too early to start talking.

“You know, we hope that these conversations are needed later rather than sooner,” Colby said. “But, we never know.”

Book discussion

Nicole Apprill, an LMH Health advance practice registered nurse specializing in palliative care, will lead a discussion on William Colby’s book, "Long Goodbye: The Deaths of Nancy Cruzan." If you would like to participate in this event on April 11, please read the book so you can join the discussion. Lawrence Public Library has copies available if you need one. Visit lplks.org for more information.

During Colby’s time as the Cruzans’ attorney, he saw their pain and their confusion. Their daughter was not capable of having this conversation with them. They couldn’t know exactly what she wanted.

“The accident took away any good options,” Colby said. “The more information you can gather from your family, friends and loved ones now, the better.”

On April 16 -- National Healthcare Decisions Day -- Lawrence Public Library will host "Nancy Cruzan and the Right to Die: 30 Years Later". The event is part of the library's Before You Check Out program and will feature Colby as the guest speaker. Colby will discuss the importance of advance directives, durable powers of attorney and living wills. Most importantly, he encouraged people to start a conversation with loved ones and friends about their healthcare wishes far in advance of serious illness, a discussion that can prove to be a gift for all involved.

“This sounds like a sad and depressing topic to discuss,” said Colby, who now is general counsel at Truman Medical Center in Kansas City, Mo. said. “However, I believe the event will lead to a good discussion and will be worthwhile for those involved.”

Kim Crisp, a registered nurse with LMH Health Palliative Support Services, said advance care documents are not just for people whose health is failing. In fact, many young, healthy people have advance directives so their wishes are followed in case of an unfortunate event such as an accident.”

“We want people to have the conversation,” Crisp said. “Having that conversation and having advance directives are what you can do to ensure the care you want is the care you receive, even if you cannot speak for yourself.”

After the event, members of the Palliative Support Services staff at LMH Health will have advance care documents available for attendees to complete and be notarized.

Cathy Hamilton, legacy coordinator for Lawrence Public Library, said this event will be a great opportunity for people to learn about advance directives and the importance of telling people what you want your healthcare to be.

“Having LMH Health Palliative Support Services there with the documents will be a great way to get that accomplished, and the trained staff will be nearby to answer questions,” Hamilton said. “Ultimately, the conversation needs to happen. It is a hard conversation to have with a spouse, child or loved one, but everyone needs to be on the same page to avoid additional heartache.”


Jessica Brewer is an intern in the Marketing and Communications Department at LMH Health. 

Key dates
Here are some key dates in the Nancy Cruzan right-to-die case.


Jan. 11, 1983

Nancy Cruzan, 25, has a one-car accident at night in the Ozarks of southwest Missouri. She is thrown from the vehicle and stops breathing. Within 15 minutes, emergency responders restart her heart, but she has suffered severe brain damage. She is permanently unconscious but not terminally ill – a condition known as a persistent vegetative state. One month later, when hope for recovery remains, physicians insert a feeding tube.

1987
Joe and Joyce Cruzan go to court to ask that their daughter’s feeding tube be removed. But the state of Missouri fights the request.

June 25, 1990
U.S. Supreme Court, in a 5-4 decision, rules Nancy Cruzan has a right to die – as long as there’s clear and convincing evidence she would have wanted to die. Five months later, a judge allows removal of the feeding tube after three of Nancy Cruzan’s co-workers testify she told them she wouldn’t want to live “like a vegetable.”

Dec. 26, 1990
Cruzan dies in Mount Vernon, Mo.

December 1991
Patient Self-Determination Act goes into effect. It requires that patients be given information about legal rights regarding living wills and durable powers of attorney for health care (also known as “advance directives”).

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Difficult conversations: Event at Lawrence Public Library to offer help with advance directives