Ethical and Professional ImplicationsThe autonomy of a competent patient is an issue not often discussed in medical ethics. Refusal of unwanted treatment is a fundamental right, comparable to the common law of assault and battery, accessible to anyone capable of making a competent choice. These fundamental rules of medical ethics entered an entirely new forum as medical technology developed highly effective life-sustaining care during the 20th century. Several landmark cases elucidated these emerging issues in the 1960s and 1970s, none more effective than that of Karen Ann Quinlan. Crucially, this case established that a formerly competent patient with no possibility of cure could have their autonomy exercised by a surrogate mother with respect to withholding life-sustaining treatment. This decision had profound implications for medical ethics, including the treatment of incompetent patients at the end of life, the creation of advance directives, physician-assisted suicide (PAS), and active euthanasia. In ruling in favor of Mr. Quinlan, the New Jersey Supreme Court permitted an incompetent patient's exercise of patient autonomy. Although the legal implications of this decision vary from state to state, medical ethics now had to accommodate the possible refusal of a formerly competent patient who was incapable of giving that refusal. This concept is not entirely unexpected by the medical community. By developing mechanisms capable of maintaining life even in cases of serious deficit, it is entirely natural that medical ethics must adapt and develop to accommodate this new area of ​​consideration. Just as a competent person has the right to decide "how much to fight, how much to suffer, how much bodily invasion to tolerate, and...... middle of paper ...... perfectly protected right, but patients and doctors must be much more willing to discuss difficult issues because of the possibility of cases like Quinlan's arising. Journal of Law, Medicine and Ethics 29 (2001): 1073-1105. Garrett, Thomas, Baillie, Harold and Garrett, Rosellen. Health care ethics; Principles and problems. 4th ed. Upper Saddle River, New Jersey. Prentice Hall, 2001. Meisel, Alan. “Quality of life and decision making at the end of life”. Quality of Life Research 12 (2003): 91-94. Supreme Court of New Jersey. The Quinlan affair. Washington: GPO, 1976. Sulmasy, Daniel. “The accuracy of surrogate judgments in patients with terminal diagnoses.” Annals of Internal Medicine 128 (1998): 621-629.