Nursing faculty, nursing students, and practicing nurses address ethical and legal issues including end- of-life care with patients and family members daily in clinical practice. With increased medical technology and competing interests of dying patients, their families, and significant others, the wish of many to die with dignity is a concern for healthcare professionals. Nurses are in a key position to address the escalation of bioethical dilemmas that result in wrenching situations for patients, families, providers, and the courts. Since the landmark cases of Karen Ann Quinlan(In re Quin lan, 1976) and Nancy Beth Cruzan (cruzan v. Director Missouri Department of Health, 1990), nurses, physicians other professionals have shaped public policy regarding patient and surrogate participation in end-of-life decision making even when the patient is incapacitated and unable to make decisions.