NANCY Cruzan died this week, but it would be nearly as accurate to say that she died on Jan. 11, 1983.
On that date, she was found face down in a ditch after an automobile accident. Paramedics restarted her heart, but because she had stopped breathing for about 15 minutes, her brain was badly damaged.
She continued in what medical people call a persistent vegetative state, lying rigidly comatose in a Missouri hospital bed, sustained by a nutritious chemical mixture fed through a tube to her stomach.
Sometimes her fingernails dug into her wrists and sometimes her eyes opened without recognition, but doctors said she was in a coma with no prospects of recovery -- ever.
About 10,000 other Americans are also in long-term comas, but Ms. Cruzan gained public attention because of the tenacious efforts of her parents to obtain legal clearance for their daughter's dignified and peaceful death through removal of the feeding tube.
Her case found its way earlier this year to the U.S. Supreme Court, which coldly ruled that Missouri and other states have the right to require a high standard of "clear and convincing evidence" of the patient's wishes before life supports are removed from people who cannot speak for themselves.
It was the high court's first case in the tricky right-to-die category. Sadly, the court, in the words of a dissenting justice, allowed Missouri's abstract interest in preserving life to overwhelm the best interests of Ms. Cruzan. While the court acknowledged a right to die, she was compelled to "live" on.
Missing from the court's ruling were measures of human compassion and simple good sense. Can there be any question that Ms. Cruzan would choose to finally die -- if miraculously given a lucid moment to understand her state?
But the case had its beneficial side, a side that is Ms. Cruzan's unwitting legacy to us all. It spurred great public interest in living wills, in which healthy people can say what sort of treatment they would wish if they lose competence, and health-care proxies, in which people can designate others to make treatment decisions for them if they cannot.
Lagging lawmaking bodies were inspired to act so their constituents could better meet the high court's exacting standards. The New York State Legislature even caught the drift, passing a good health proxy law that takes effect Jan. 18. The form contained in the law includes a place where the signer can state "instructions, wishes and limits," giving it the effect of a living will.
Congress responded by passing legislation requiring health-care institutions to tell patients of their right-to-die options under their states' laws.
Ms. Cruzan's tortuous trip through the legal maze also began to make sense. Missouri withdrew from the case. A judge heard three of her friends testify that she had made comments about not wanting to live as a vegetable. The judge ruled that to be "clear and convincing" evidence and permitted the feeding tube's removal. Twelve days later she died without distress.
The right-to-die issue is not simple. Not every case is as clear-cut as the Cruzan case. And then, medical science keeps finding new ways to keep people alive. The feeding system that kept Ms. Cruzan going did not exist 20 years ago.
There has to be a place for compassion in the equation. There has to be a place for recognition that the rights of the hopelessly comatose override neat legalities.
For the last legal proceeding, Ms. Cruzan's court appointed guardian, Thad C. McCanse, wrote that there comes a time when "reason should triumph over ritual."