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Beyond the Cruzan Case: The U.S. Supreme Court and Medical Practice

1991; American College of Physicians; Volume: 114; Issue: 10 Linguagem: Inglês

10.7326/0003-4819-114-10-895

1539-3704

Bernard Lo, Robert Steinbrook,

Healthcare Decision-Making and Restraints

Medicine and Public Issues15 May 1991Beyond the Cruzan Case: The U.S. Supreme Court and Medical PracticeBernard Lo, MD, Robert Steinbrook, MDBernard Lo, MD, Robert Steinbrook, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-114-10-895 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn a landmark decision, the U.S. Supreme Court affirmed a Missouri ruling that sharply limited family decisions about life-sustaining treatment for incompetent patients. The Court held that the Constitution protects the refusal of life-sustaining treatment by competent patients. For incompetent patients, states may require "clear and convincing" evidence of refusal, specifically for the withdrawal of tube feedings, if such a person were in a persistent vegetative state. The ruling left many clinical questions unanswered, such as whether life-sustaining treatment must be given to terminally ill incompetent patients, whether patients may refuse artificial feedings, and what constitutes clear and convincing evidence of refusal. The decision also has potentially harmful consequences. It may undermine family decision making, encourage cynicism and disregard of the law, and promote defensive medicine. Physicians can minimize such consequences by encouraging patients to provide advance directives, such as the durable power of attorney for health care, by urging legislative action, and by setting national practice standards for decisions regarding incompetent patients....References1. Cruzan v. Missouri Department of Health. 497 U.S. —,111 L.Ed.2d 224,110 S.Ct. 2841 (1990). Google Scholar2. LoRouseDornbrand BFL. Family decision making on trial. Who decides for incompetent patients? N Engl J Med. 1990;322:1228-32. CrossrefMedlineGoogle Scholar3. Angell M. 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Preferences of homosexual men with AIDS for life-sustaining treatment. N Engl J Med. 1986;314:457-60. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From the University of California at San Francisco, San Francisco; and the Los Angeles Times, Los Angeles, California. For current author addresses, see end of text. 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Barnett, JDAllied to MadnessMichael W. Wooley, MDImpact of the Cruzan Case on Medical Practice 15 May 1991Volume 114, Issue 10Page: 895-901KeywordsDecision makingDrug abuseHealth careMedical ethicsPatientsPersistent vegetative statePsychiatry and mental health Issue Published: 15 May 1991 Copyright© 1991 American College of PhysiciansPDF DownloadLoading ...