For the last 18 months, Dan Crews has been waging a battle to die, one that he is losing.
For the last 24 years -- since he was paralyzed at age 3 in a car accident -- Crews has been a quadriplegic, able to speak and eat, but not breathe on his own.
"Just imagine having your arms and legs strapped down 24 hours a day, seven days a week and not being able to do anything about it and not going anywhere," said the 27-year-old, who lives with his mother in Antioch, Ill.
"I have no education," said Crews. "No education prospects. No job prospects. I have no love prospects. All I want is to no longer live like this."
The Supreme Court ruled a decade ago that a person can refuse medical treatment -- provided they are competent. And that is the biggest hurdle for Crews.
The head psychiatrist at Froedtert Hospital in Wauwatosa, where Crews has received most of his treatment since he was airlifted from the accident, says he is depressed and that overrides his ability to make a life or death decision.
The hospital did not return calls for comment, but medical records obtained by the Milwaukee Journal-Sentinel revealed that psychiatrists and mental health professionals have ruled Crews is depressed and must be treated before they will agree to such an irrevocable step.
Crews said he is not depressed -- "no more than the average person in my position."
Crews is now on antidepressants, but has refused psychiatric care. When he tried to starve himself, doctors threatened to use a feeding tube and he relented. But he hasn't changed his mind about dying.
Because his diaphragm is paralyzed, he is hooked up to a mechanical ventilator connected to his throat that breathes for him.
He can use the telephone and type on the computer with a mouth stick and has no problem eating, if family members or nurses put the food in his mouth. But Crews is physically unable to kill himself.
Lately, he spends most of the day in his dark bedroom sleeping, in between medical checks for vital signs. In the evening he watches movies and television.
His father, Gerald Crews, objects to his son's wishes. "He does not understand what I am going through," said Crews. "He thinks I'll get better."
His mother, Cheryl Crews, 60, is willing to stand by her son. "In the end, if this is what he wants, I have promised to support him," she said.
An estimated 5 to 10 percent of spinal cord injury patients contemplate suicide, six times higher than in the general population, according to the Kessler Institute in New Jersey, one of the nation's top rehabilitation centers, the one that treated the late actor Christopher Reeve, who was paralyzed in a riding accident.
Suicide Rate Higher Among Spinal Cord Injury Patients
"Quality of life is determined more by support and reintegration into the community rather than level of severity or injury," said Loran C. Vocaturo, Kessler's director of neuropsychology. "Paraplegics don't do better than quads. It's more about the perception of their health status and level of care giving."
Many in the disabled community are uncomfortable with Crews' decision, but says Crews, "Most quadriplegics had a life before they were paralyzed. They had wives before the accident, but I had nothing."
No one expected Crews to live as long as he did, according to his mother. She was driving the car 24 years ago that swerved off a slick country road into a ditch.
Cheryl Crews punctured a lung and broke her neck, but Dan, strapped in to his car seat, "came out looking like he hadn't even broken a bone."
"But he was all blue and they had to breathe life back into him," she said. He has needed a ventilator ever since.
After the accident, the family won a lawsuit and received a $4 million trust to take care of their son's medical expenses.
"We were told to bring him home and make his life count and to make him happy, because he wasn't going to live very long," said his mother.
The trust settlement gave the family enough money to hire good nurses. "My ex-husband and I watched over him carefully," she said. "He didn't get bed sores. Who knew this would turn around and bite him."
Nursing care -- two a day working 92 hours a week – has cost the family $300,000 to $500,000 year.
With the medical expenses and the economic downturn, the trust fund ran out, dashing any hopes for further education, seeking the second opinion of new psychiatrists or even a legal fight against the hospital.
Crews has applied for Medicaid and will likely end up in a ward of the state and in a nursing home. "Who wants to die there?" said his mother.
Though he would like to continue to live at home, Illinois Medicaid often denies requests for the 24-hour care, according to the Journal-Sentinel report.
"I would be lying if I said money was not a part of it, but that's never been the only reason," said Dan Crews. "I am just tired of living like this."
He said he even considered moving to Oregon or Washington, states where doctor-assisted suicide is legal, and establishing the required 12-month residency. But no one could promise that a psychiatrist would rule him capable of making the decision and he couldn't afford the move.
Crews said he life had been "pretty good" until the age of about 19. He was an honors student, earned a two-year degree at College of Lake County and aspired to be a criminal prosecutor.
But soon, he began to feel he had no control over his future. Crews couldn't find a college close by to continue his education and missed the social interaction. All but one friend dropped away.
In May of 2009, Crews asked his doctor for permission to start drinking alcohol. "I wanted to drink myself into oblivion," he said.
The doctor suggested that he might consider removing the ventilator.
"It was his idea," Crews said. "No one ever gave me that option."
It was also the best moment he'd had in years. "I was happy, sleeping better, smiling more and feeling better," he said.
His family was devastated. "I made people sob," said Crews. "My dad broke down in front of me. My friend sobbed for 10 minutes."
But after a series of consultations with palliative care experts and psychiatrists, one of whom ruled him competent, doctors changed their minds. Crews was asked to take antidepressants and wait three months.
By June 2010, Crews was so desperate he had an outburst threatening to kill himself. Then he staged an unsuccessful four-day hunger strike.
He was told he needed two psychiatrists to override the hospital decision -- one they might reconsider in several months or a year.
"You can look at it legally and ethically, and this case lines up the same way," said Dr. Stuart Youngner chair of the bioethics committee at Case Western Reserve University in Ohio. "If he is a competent adult, he has the right to refuse treatment. The complicating issue is if they complain he is depressed and not competent."
But, said Youngner, "there is a difference between being depressed and unhappy. Clinical depression is an ethical diagnosis and a checklist of symptoms. If people are taking the position he is depressed, he has no chance."
And that is precisely the case with Crews, who prays every day that he will die.
He doubts the hospital will reverse its decision -- ever.
"That's as likely as being hit by lightning on a submarine," he said. "It's now been months and my bladder is no longer working properly and my body is shot."
"They have been screwing with me and destroying my life," he said. "Unless someone breaks into my house and kills me or there's a drive-by shooting where I live, I can't win this fight."