to accomplish its goals in that confined period? Such procedural questions are inevitable if the above-mentioned perceptions are accepted.

The main thesis of this paper, to which the bulk of it is devoted, is that these perceptions are incorrect, both about the President's Commission and about the New York State Task Force. The report of the President's Commission was a success in summarizing a consensus that had emerged, and in beginning the process of moving beyond it, not in shaping that consensus. The reports of the New York State Task Force were a success in producing legislation that incorporated this consensus, and the controversy was nothing more than the expected accompaniment of any important legislative initiative. The nature of their successes differed because they were operating in different contexts and had different roles. A second thesis, to which we shall return briefly in the conclusion, is that the structural and procedural differences mentioned above are reflections of these different contexts and roles, and that the proper conclusion to be drawn is that structure and process should be a function of context and roles.

The strategy for my analysis is as follows: In the rest of this introduction, I will present a statement of the current consensus about limiting life prolonging treatment. For the sake of this analysis, I will take its validity for granted. In the next two sections, I will discuss the relation of the work of the two groups to the current consensus, to the context in which they operated, and to their roles. It is in those two sections that I will defend my claims about the nature of their successes. Finally, in the conclusion, I will briefly return to some of the structural and procedural issues.

I offer the following, which is a modification of an analysis recently presented by Meisel,3 as my statement of the current consensus:

  1. The mere fact that some treatment exists that would prolong the life of some patient does not by itself suffice to justify providing that therapy to that patient, because extending life by providing the treatment in question may not be beneficial to the patient in light of the patient's values and patients have a right to refuse therapy whose provision they judge to be against their interests.

  2. Both competent and incompetent patients have that right to refuse life-prolonging therapy; of necessity, the way in which that right is exercised is different in the two cases.

  3. Despite the differences, decision making for both types of patients should usually occur in the clinical setting without recourse to the courts.

  4. The main role of legislatures is to see that these rights are adequately recognized in law, and the main role of health care institutions is to insure that there are proper policies and mechanisms in their institutions for facilitating proper processes for such decision making and for insuring that they are appropriately documented.

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