To the Editor: I agree with the articles by Annas and others (Sept. 6 issue)1,2 on the problems in the Cruzan opinion, but I would like to suggest another way in which this decision is out of touch with medical reality. The Supreme Court in Cruzan found that the standards of best interest and substituted judgment for medical decision making are distinct and that the states may set the level of evidence needed to meet the standard of substituted judgment. In contrast, physicians do not treat these standards as entirely distinct, especially when risks are high. The more physicians believe.
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