What legal principle underpins the provision of SNS according to the Cruzan decision?

• A. The government can determine life-sustaining treatment in all cases.
• B. Competent individuals have the right to refuse life-sustaining treatment; surrogates must honor previously expressed wishes when meeting state evidentiary standards.
• C. SNS may never be withdrawn once started.
• D. Surrogates may decide based on personal beliefs regardless of prior wishes.

Answer: (B)

The central idea is patient autonomy in decisions about life-sustaining care. Cruzan acknowledges that competent individuals have the right to refuse life-sustaining treatment. When someone cannot decide for themselves, a surrogate may authorize withholding or withdrawal only if there is clear and convincing evidence of the patient’s prior wishes. This protects the patient’s autonomy while requiring the surrogate to reflect what the patient would have wanted, rather than the surrogate’s own beliefs. So the correct understanding is that individuals may refuse life-sustaining treatment, and surrogates must honor previously expressed wishes when the evidence meets that high standard.