s "clear and convincing evidence' standard, and refused the parents. Public sympathy for Cruzan's parents was enormous and they took the case back to a local judge, and three of Nancy's former friends testified that 10 years previously, she had made statements indicating she would not have wanted to live this way. The feeding tube was ordered removed, and she died 12 days later.
In reaction to the Cruzan case, the US Congress enabled the Patient Self-determination Act (PSDA) to be enacted in 1991, which had been proposed by Missouri Senator John Danforth and New York Senator Daniel Patrick Moynihan (Valko, 2004). The PSDA mandated that patients be offered information and documents on their right to refuse treatment. Right to die advocates were disappointed that more people did not sign living wills or advance directives, but they applauded the media attention and public acceptance of the right to die which made withdrawal of treatment decisions common, even if living wills were not signed.
The right to die advocates used the Nancy Cruzan case to
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