l ethicists warned then that the ruling was the beginning of a trend--the slippery slope--which could lead to decisions to end a person's life being made by third parties not only on the basis of medical condition but also on such considerations as age, economic status, or even ethnicity.6In 1990, the Supreme Court case, Cruzan v. Missouri, recognized the principle that a person has a constitutionally protected right to refuse unwanted medical treatment. In 1983, Nancy Beth Cruzan lapsed into an irreversible coma from an auto accident. Before the accident, she had said several times that if she were faced with life as a "vegetable," she would not want to live. Her parents went to court in 1987 to force the hospital to remove the tube by which she was being given nutrition and water. The Missouri Supreme Court refused to allow the life support to be withdrawn, saying there was no "clear and convincing" evidence Nancy Cruzan wanted that done. The U.S. Supreme Court agreed, but it also held that a person whose wishes were clearly known had a constitutional right to refuse life-sustaining medical treatment. After further proof and witness testimony, a probate court judge in Jasper County, Mo., ruled Dec. 14, 1990, that Cruzan's parents had the right to remove their daughter's feeding tube, which they immediately proceeded to do. Nancy Cruzan died Dec. 26, 1990.7The Cruzan decision sparked a fresh interest in living wills and in 1990 Congress passed the Patient Self-Determination Act. It requires health care facilities that receive Medicare or Medicaid funds (95 percent of such centers) to inform new patients about their legal right to write a living will or choose a proxy to represent their wishes about medical treatment, and what kind of measures will be taken automatically for patients as institutional policy. Where state law permits, these institutions must honor living wills or the appointment of a health care proxy.8On March 6, 1996, f...
