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Over the past decade, planning for health care decision making through the making of an advance directive has become a routine part of personal counseling. Public interest in the subject has been fueled by well-publicized cases such as Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990). In response to this interest, most states authorize their citizens to make at least one form of advance directive: all states statutorily authorize powers of attorney for health care, and all but Massachusetts, Michigan and New York authorize living wills. State legislation has been a mixed blessing. Although intended to facilitate the making of advance directives, many of the statutes may actually inhibit their use. The execution requirements are often detailed. Restrictions on the types of treatment that may be withheld or withdrawn are common. There is little uniformity. The result is a system of fragmented, incomplete and often inconsistent legislation, both among states and within single states.


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