Advance Medical Directives (cont.)

The landmark Quinlan and Cruzan cases emerged out of similar situations and similar needs. Both cases dealt with the medical care of young, physically strong people in a persistent vegetative state. While similar in these regards, the two judicial decisions dealt with different types of advance directives. The case of Karen Ann Quinlan dealt with the ability of the individual to appoint a health care proxy. The case of Nancy Cruzan addressed the right of a healthy individual to establish a binding living will.


In the United States, four out of every five adults has no advance directive, a situation that some have likened to taking your car to the mechanic and saying, "I think it needs a tune-up, but if you find something really wrong with it, just go ahead and fix it, even if it won't run afterwards? And by the way, please charge me for the work and if I can't pay for it, I'm sure my estate will!"

When asked what would provide a good death, the majority of Americans answer, in essence; "Quick, painless, at home and surrounded by family."

In 1950, about half of Americans who died did so at home. Now, about 85% of Americans die in a health care setting: a hospital, a nursing home or a rehabilitation center. At least 12% die in an intensive care unit.


Over the past three decades, the United States -- all fifty states and the District of Columbia -- have passed laws to legalize the use of living wills, health care proxies and/or the durable power of attorney. The U.S. federal government has validated state laws on advance directives through the 1991 Patient Self- Determination Act. And the U.S. Supreme Court has handed down an opinion acknowledging the congruence of the Constitution of the United States with state laws on the right to designate future medical treatment.

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