ObjectiveThis article analyzes, from a legal perspective, a recent phenomenon involving a clash between the values of attending medical personnel and the instructions of surrogate decision-makers acting on behalf of incompetent patients. Some hospitals have gone to court to challenge decisions by surrogates to continue life support for permanently unconscious or other gravely debilitated patients. Their claim has been that continuation of life support would be medically inappropriate and that the surrogates' decisions ought to be overridden. These petitions have thus far been rejected. The objective here is to explain those decisions and to predict the outcome of future, similar litigation.Data SourcesThe primary data are the judicial decisions and legislation accumulated since the Quinlan case in 1976, regarding the medical handling of dying medical patients.ConclusionsJudicial rejection of healthcare providers' claims in the decided cases is explainable under traditional guardianship principles. The explanation lies in surrogates' authority to make decisions in the best interests of incompetent patients, and in judicial reluctance to brand life preservation of nonsuffering patients as abusive or contrary to patient interests.At the same time, the author anticipates a change in judicial posture, as courts acknowledge the widespread antipathy of people toward being indefinitely preserved in a noncognitive status. Because the judicial approach to the handling of dying persons often seeks to replicate what the patient would have wanted, there is room to consider consensus preferences where the particular patient has never indicated any deviation from those preferences. Courts will eventually override surrogate decisions that do not conform to widely shared preferences for avoiding the indignity of permanent unconsciousness or other gravely debilitated states.(Crit Care Med 1996; 24:883-887)