Natural Death Acts
Natural Death Acts sprang from the belief that medi¬cal technology had made possible the artificial prolon¬gation of patients’ lives beyond their natural limits. Another underlying assumption of the Acts was that adults in the United States have the right to control de¬cisions about how they live their lives as well as how. they die. The California Natural Death Act was one of the first in the country. Originally enacted in 1975 and revised in 1992, it authorized people to sign a decla¬ration directing, that life-sustaining treatment be with¬held or withdrawn should they become terminally ill or permanently unconscious if the administration of life- sustaining procedures would only prolong their dying process or unconscious condition.
Now, every state has a Natural Death Act explicitly allowing patients to refuse excessive medical care at the end of life. In addition, the Natural Death Acts in some states, such as Washington, specifically state that “phy-sicians and nurses should not withhold or unreason¬ably diminish pain medication for patients in a terminal . condition where the primary intent of providing such medication is to alleviate pain and maintain or increase the patient’s comfort” [1992 c 98 § 1; 1979 c 112 § 2.]. Finally, most states also include in their Natural Death Act a provision that a person’s right to control his or her healthcare may be exercised by an authorized represen-tative who validly holds the person’s durable power of attorney for healthcare.
However, as shown by the SUPPORT study (SUP-PORT Principle Investigators, 1995), the presence of Natural Death Acts did not ensure that patients and their families were able to obtain the end-of-life care they desired. Guido (2006) states that the case of Nancy Cruzan, a young woman who remained in a persistent vegetative state following an automobile accident and whose family maintained that she would never have desired such technologically driven care, motivated Congress to enact federal legislation that would re¬quire states to make patients aware of their rights , to have advance directives and to decide about their own care (Cruzan v. Director, Missouri Department of Public Health, 1990).