Abstract
The United States Supreme Court's recent ruling in Cruzan and Congress' passage of the Patient Self-Determination Act of 1990 are part of the expanding legal and ethical concerns affecting medicine. These changes force us to examine not only issues in termination of treatment and advanced directives, but questions of medical futility and the quandary of how to pay for beneficial but costly new technologies. These problems indicate the need for more vigorous intensive care unit admission and discharge criteria and for policies on appropriate care of patients. We review these developments and propose approaches to such issues as do not resuscitate orders, requests for “futile” treatments, brain death, organ retrieval, advanced directives, and decision making for competent and incompetent patients.
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