NANCY CRUZAN'S SISTER DISCUSSES LONG COURT BATTLE

It didn't look like the same person.

On the left side of the screen was a vibrant, beautiful woman with wide eyes and a big smile. On the right, her eyes were closed, her face swollen, her expression blank.

Christy Cruzan White used the photos to illustrate the change in her sister, Nancy Cruzan, after a 1983 car accident.

Cruzan spent nearly eight years in what doctors term a "persistent vegetative state," with a feeding tube surgically implanted in her stomach to keep her alive.

Cruzan White spoke about the experience to a group of about 75 Monday at the Drury Lodge, explaining what those years with her sister, and the accompanying court battles, were like. Her presentation was sponsored by Southeast Missouri Hospital.

The Cruzan family wanted the feeding tube removed, but the state of Missouri and doctors at Missouri Rehabilitation Center, the Mount Vernon medical facility where Cruzan was treated, said no.

Cruzan hadn't filled out an advance directive -- a living will or durable power of attorney for health care -- so the state said her ideas about life support couldn't be known.

The case went to the U.S. Supreme Court, which ruled in 1990 that the tube shouldn't be removed.

But during the appeals process, witnesses revealed Cruzan had talked to them about the Karen Ann Quinlan case, another right-to-die court battle. Cruzan also allegedly said she wouldn't want to live like a disabled girl she knew who had to be force-fed to stay alive. However, the evidence couldn't be admitted during the appeals.

"During the years in court, it seemed like only the medical profession was listened to," said Cruzan White. "What we as Nancy's family felt didn't seem to matter to most of the justices."

After the U.S. Supreme Court ruling, the case went back to a circuit court in Missouri and the state withdrew from the proceedings. The witnesses were allowed to testify, along with Cruzan's doctor.

He detailed her bouts with diarrhea, constipation, bleeding gums, choking and other problems. The more he spoke, the more uncomfortable the courtroom became.

"If people became uncomfortable hearing about Nancy's life for 45 minutes, imagine living like that for eight years and being forced to live like that for another 30," said Cruzan White.

The court ruled the feeding tube could be removed, and Cruzan died eight days later on Dec. 26, 1990. She was 33.

Cruzan White said she hoped listeners learned the importance of filling out advance directives. People should communicate with their loved ones and physicians about whether or not they want life support used should they become incapacitated.

Dr. Michael Jessup, chairman of Southeast Missouri Hospital's Ethics Committee, admitted it is a difficult topic to discuss.

Literature about living wills and durable powers of attorney is available at both Cape Girardeau Hospitals. While they may be contested, specific wording and a personal values statement -- a presentation of one's idea of what a life worth living is -- makes them more effective.