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Bruce David White, DO, JD; Mark Siegler, MD; Peter A. Singer, MD, MPH; Kenneth V. Iserson, MD, MBA

Arch Intern Med. 1991;151(5):925-928.

Abstract
The United States Supreme Court's recent decision in the Cruzan case declared that the states have broad powers to formulate their own rules in "right to die" cases. The Court held that competent adults have a constitutionally protected "liberty interest" that allows them to accept or refuse medical treatments. Since liberty interests are subject to rational state regulation, the narrow holding in Cruzan affirmed Missouri's authority to require a "clear and convincing" evidence standard to determine a patient's wishes before life-sustaining treatment could be withdrawn from a formerly competent adult now in a persistent vegetative state. For practicing physicians, some of the implications of Cruzan are as follows: (1) For competent adult patients, physicians should respect patient wishes regarding life-sustaining treatment. (2) Physicians also should discuss with competent patients their wishes for life-sustaining treatment at a future time, when a patient may no longer be able to participate in such decisions. (3) Physicians should record these wishes in a legally acceptable instrument that addresses two aspects of care that may arise in the future if the patient becomes incompetent. What would the patient want done? Who would the patient wish to designate as a surrogate or proxy? (4) For patients who are now incompetent, but for whom decisions must be made about lifesustaining treatment, physicians should focus on the previously expressed wishes of the patient rather than on the patient's current quality of life or on the wishes of the patient's family.

(Arch Intern Med. 1991;151:925-928)

Author Affiliations
From The Center for Clinical Medical Ethics at the University of Chicago (Ill) (Drs White, Siegler, and Iserson) and The Centre for Bioethics at the University of Toronto (Ontario) (Dr Singer).

Footnotes
Accepted for publication November 19, 1990.

The opinions expressed are those of the authors, and they do not necessarily represent those of the Henry J. Kaiser Family Foundation, the Andrew W. Mellon Foundation, the Pew Charitable Trusts, or the Ontario Ministry of Health.

Reprint requests to The Center for Clinical Medical Ethics, The University of Chicago, 5841S Maryland Ave, Box 72, Chicago, IL 60637 (Dr White).

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