Patients' Rights - Limitation of therapy

Prior to the explosion in medical technologies and advances in critical care medicine which occurred after 1965, little could be done to keep critically ill patients alive. And from 1965 through the mid 1980's, public sentiment and fee-for-service insurance encouraged a "do all you can to preserve life AND prolong death" attitude among physicians, payors and patients. Increasing concern over resource allocation and the financing of health care, however, combined with an increased interest by patients in self-determination, has relatively recently stimulated a reexamination of end of life issues. 


The courts have been asked on many occasions to help in decisions about withholding, withdrawing and terminating life sustaining care for patients who, usually, are unable to state their opinion, and often did not make their wishes known prior to falling critically ill. In Cruzan v. Harmon (1988), Chief Justice William Rehnquist's majority opinion established that Nancy Cruzan did not make her wishes viz. life support known prior to falling critically ill, nor did she establish a mechanism for decision making (such as a durable power of attorney), and therefore the State of Missouri was within legal bounds in refusing to allow Nancy Cruzan's parents to remove her feeding tube and let her die.

This decision by Justice Rehnquist helped stress the importance of living wills and durable powers of attorney. It may be said that the decision also helped stimulate the passing of The Federal Patient Self-Determination Act of 1990.