In 1990, the U. S. Supreme Court decided one of the most important cases of the century, with far-reaching consequences for all citizens, when it ruled that every person had a fundamental right of self determination with regard to refusing life-sustaining medical treatment. In the case of Cruzan v. Commissioner, Missouri Department of Health, 497 U.S. 261 (1990), the issue centered around who had the right to decide to remove a permanently brain-damaged and comatose patient from life-support systems, in the absence of the patient’s own ability to express that determination. (The case included family testimony expressing what they felt the patient’s wishes would have been.)

In Cruzan, the family of comatose Nancy Cruzan, an automobile accident victim, requested that she be removed from life support systems and be allowed to die naturally. The hospital refused to withdraw the life support equipment. Cruzan remained on life support in an irreversible coma for the next nine years, while the case went through several appeals. Follow ing the Supreme Court’s decision, Cruzan’s life support equipment was discontinued and she died naturally thirteen days later.

The horror of that scenario, combined with the high court’s recognition of a constitutional right of self determination, led to a flurry of state enactments of various laws permitting living wills or advance directives for health care. However, state laws vary considerably, and it is imperative that individuals first research the laws of their state or consult an attorney before attempting to create any of these legal documents. That said, many state offices or private organizations provide pre-printed forms that comply with state laws, so it is not always necessary to consult legal counsel.