The Cruzan Decision and Medical Practice

David C. Thomasma, PhD
Arch Intern Med. 1991;151(5):853-854. doi:10.1001/archinte.1991.00400050007001.
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s the authors of "What Does Cruzan Mean to the Practicing Physician?"1 point out, complex court cases have maramifications for clinical practice. This is especially true garding the withholding and withdrawing of fluids and ttrition from incompetent patients. The argument that advance directives ought to be elicited from patients by physicians is essential for the future of clinical practice. Despite reservations some physicians may have regarding such directives, eg, that they might artificially "tie down" their options, patient-directed care not only derives from the law today, but also from good medical ethics and good clinical practice.

The objection of those who argued that fluids and nutrition constituted a "special form of care" somehow immune to the patient's judgment about implementation and withdrawal always struck a negative chord in families who had to live with the enthusiasm of health professionals about prolonging the life of their loved ones. The Cruzan


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