time of death. The political process, while not perfect, helps ensure that in questions of "life" or "death," more physicians will choose life rather than death when at the margins. While this does lead to some individual hardships, the processes of law are complex and can lead to surprising results. Even under the Missouri statute, alleged as a barrier to Nancy Cruzan's death, it remained the framework which her parents used to convince a judge to eventually remove the artificial food and hydration sustaining her life. On the other hand, the Karen Ann Quinlan case, which started the modern "right to die" movement, was horrific in some ways. We should recall that it took ten years for Ms. Quinlan to die after the supposed life-sustaining respirator was removed.
In all the concern about individuals' control over their own future deaths, the past and current problems of access to any health care are almost forgotten. For some groups, passing legislation to ensure that one can say "no" to health care becomes a primary social concern. Federal law, for instance, now requires any hospital receiving Medicare and Medicaid funding to give all admitted patients notice of their rights under state law to refuse treatment or to sign advanced directives about treatment. 55 At the same time, more than forty million Americans worry about their ability to obtain any form of health care at all. It is time to ponder the ways in which money defines the nature of the institutions that shape our lives and our deaths. Will physician-assisted suicide become a factor that is used to balance the resources/access equation?