Ethical IssuesAutonomy – The ideal of self-determination is the basis of autonomy. It is important that the patient can decide what to do with their own body. In other words, no one else has the right to assert power over others. Likewise, a doctor should be allowed to decide not to perform a procedure if it would be contrary to his or her values. In the Cruzan case, Nancy's autonomy through her parents' substituted judgment was overturned in favor of the State of Missouri's policy of preserving life. Although the Supreme Court did not deny that Nancy had the right to refuse food/hydration, there was not enough clear and convincing evidence to know that this refusal was what Nancy actually wanted. Furthermore, the autonomy of hospital staff was taken into consideration as they did not consider it right to discontinue treatment without the approval of a court. At first glance, it may seem that Nancy's autonomy was not taken into consideration because her parents had to wait a very long time before the courts agreed to take away her nutrition/hydration. However, the courts actually erred on the side of caution because there was no advance directive indicating withholding treatment as an option. Once Nancy's parents found three other witnesses to attest to her wishes, the Supreme Court agreed that Nancy would have wanted to refuse treatment. Benefit/non-maleficence – Doctors strive to do what is good for the patient while avoiding harm to the patient in the process. In the Cruzan case, the definition of good may be questionable. Some may view preserving life as a good thing, while others may argue that relying on life-sustaining interventions that have little or no benefit does more harm than good. Furthermore, the question arises as to who should decide what is considered “good” for a patient when the patient is incompetent. Is it the doctor, the family, the state or the Supreme Court? The doctor has medical knowledge of what will sustain life while the family knows the patient's wishes. The State of Missouri has a policy emphasizing the preservation of life and seeking to protect the citizens of this State, while the Supreme Court has a duty to do what is right under the Constitution in order to protect the rights American citizens. Ultimately, the decision to stop nutrition/hydration could be considered an act in the middle of a paper as to how that same patient would act if competent. The surrogates in the Cruzan case were Nancy's parents. The surrogate, whether she has received written documentation, oral communication, or no communication from the patient, gives or withholds consent to the physician's treatment recommendations. If the patient documented or orally communicated his or her treatment wishes before the onset of incompetence, the surrogate must use substituted judgment. In the Cruzan case, the State of Missouri (like many other states) required clear and convincing evidence regarding Nancy's feelings regarding consent to treatment. The state demanded clear and convincing evidence because it did not want to encroach on Nancy's autonomy; they also thought that considering her autonomy, it was better to make a mistake and keep her alive than to make a mistake and end her life. A surrogate decision maker is necessary in place of an incompetent patient to accept or withhold consent to end-of-life treatment, but it is only effective to use substituted judgment when there is clear and convincing evidence regarding the wishes of..