The Quest to Reform End of Life Care: Rethinking Assumptions and Setting New Directions‪.‬

The United States Supreme Court decision in the case of Nancy Beth Cruzan, Cruzan v. Director, Missouri Department of Health, was a landmark in law concerning decision-making near the end of life, but it was not the end of social controversy. The Court established the constitutional right to refuse medical treatment--even life-prolonging medical treatment--but it did not settle the moral question of how and when this legal right should be exercised, nor did it lessen the gap between the theory of how end of life decisions should be made and the practice of how such decisions actually are made at the bedside. Twenty-five years after Cruzan, end of life care is a nexus of cultural and political conflict. The mass media's aggressive pursuit of discord, coupled with various interest groups' use of the Internet to amplify divergent points of view, fuel the polarization of the issue. Sifting out accurate, responsible medical information and opinion from unfounded or exaggerated claims has become exceedingly difficult. Although conflict and rhetoric ran high in the 1980s as the Cruzan case moved through the courts, that episode seems almost calm compared to the spectacle unleashed in 2005 by the sad case of Terri Schiavo.