History of the Gateway End-of-Life Coalition

Since its inception in 1999, the Gateway End-of-Life Coalition has been a leader in providing the St. Louis community with critical information regarding end of life health care.  Its dedicated board of volunteers, professionals, educators and community leaders initiate opportunities for learning and dialogue about end of life decisions by offering workshops for both the general public and those working in the field.


In many ways, Missouri has been at the center of our country’s conversations about end of life care since the landmark 1990 Nancy Cruzan U.S. Supreme Court case. The case—officially known as Cruzan vs. Director, Missouri Department of Health—sparked a national dialogue about the right to end medical treatment.  Cruzan, 25, was driving home from her job at a Carthage, MO cheese factory on January 11, 1983 when she lost control of her car. Thrown from the vehicle, she landed face-down in a ditch, and was unresponsive when paramedics reached her.

Cruzan suffered critical brain injuries during the accident, and never regained higher brain functioning. Doctors inserted a feeding tube for her care, yet she remained in a persistent vegetative state for six years. A legal battle ensued, with the hospital and state steadfastly refusing to remove the feeding tube. Although the high court ruled against the Cruzan family, the family was eventually able to convince a probate judge to hear the case again. During this trial, witnesses provided evidence demonstrating that Cruzan would not have wanted to receive extraordinary care in order to remain alive.  She died on December 26, 1990, weeks after a feeding tube was removed.

“On Our Own Terms”

The Cruzan case embedded the idea of patient directed care, prompting conversations about advanced directives and other end of life decisions.  In 2000, a PBS documentary, “On Our Own Terms,” featured Bill Moyers traveling to different cities to interview end of life care experts.  The national debate again found its way to Missouri when producers filmed an episode in St. Louis. During the filming, a small group of individuals came together to form the Gateway End of Life Coaltion.

Continuing The Mission

Today, the Gateway End-of-Life Coalition fulfills its mission of promoting high-quality end of life care for patients and their families by educating the community, advocating for policies and legislation, and training professionals and health care providers in offering optimal care. The Gateway End-of-Life Coalition provides meaningful resources and compassion to those faced with life’s difficult decisions.

To contact us, email gatewayeol@gmail.com or click here to follow us on Facebook.