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Introduction

Parts of this chapter originally appeared in Journal of Intensive Care Medicine.

This chapter discusses the problem of substituted consent and decisions to terminate life support. (Substituted consent is defined as consent by a person who is neither a guardian appointed by the court nor a surrogate appointed by the patient.) Patients' right to die preoccupies bioethicists. We believe this is a misplaced concern; with the exception of a small number of well-publicized cases such as that of Nancy Cruzan, current reimbursement policies shift the concern from right to die to right to live. The greatest threat is the conflict between substituted consent for incompetent, terminally ill patients and substituted consent for competent patients seeking controversial care, such as abortion and reproductive medicine. Our analysis of recent U.S. Supreme Court decisions leads to the conclusion that if the Court is persuaded to accept substituted consent for terminally ill patients, it also will allow substituted consent in other contexts, such as giving husbands a right to be consulted about their wives' reproductive care.


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