After the Cruzan case: the primary care physician and the use of advance directives.

In the case of Nancy Cruzan, involving an incompetent patient's right to have artificial feeding withdrawn, the Supreme Court of the United States upheld the State of Missouri's right to set evidenciary standards prior to the discontinuation of care. The "clear and convincing" standard of the Cruzan ruling highlights the primary care physician's importance in proactively addressing advance directives with patients in the outpatient setting. Primary care physicians need to familiarize themselves with and discuss with patients such advance directives as the living will and the durable power of attorney. Physicians also need to understand the legal requirements of advance directives, as well as the implications of the clear and convincing standard in their own state.