euthanasia. in 2020, a legal challenge to the law was launched by ana estrada, aimed at decriminalizing the practice. united states main articles: euthanasia in the united states and assisted suicide in the united states the term right to die has been interpreted in many ways, including issues of suicide, passive euthanasia, active euthanasia, assisted suicide, and physician-assisted suicide. in the united states, public support for the right to die by physician-assisted suicide has increased over time. in a 2005 survey, the pew research center found that 70% of participants say that there are circumstances in which a patient should be allowed to die; however, only 46% of participants approved of laws permitting doctors to assist patients in ending their lives. in may 2018, a gallup poll report announced that 72% of responders said that doctors should legally be allowed to help terminally ill patients die. however, framing effects of using language such as "suicide" rather than "ending one's life" have the potential to lower approval rates by 10-15%. a 2014 survey of physicians revealed that 54% of respondents agreed that physician-assisted suicide should be allowed. in a rigorous survey of physicians in 1996, less than 20% of physicians reported that they received requests from patients to be euthanized, and less than 5% complied. in 2020, the oregon death with dignity act data summary revealed that the number of prescriptions for lethal doses of medications increased by 25% since 2019, and have been steadily increasing since 1998. of patients who received these prescriptions, 66% eventually died from ingesting the medications. karen quinlan the right to die movement in the united states began with the case of karen quinlan in 1975 and continues to raise bioethical questions about one's quality of life and the legal process of death. quinlan, 21, lost consciousness after consuming alcohol and tranquilizers at a party. she soon began to experience respiratory problems, which then prevented oxygen from flowing to her brain. that led her to slip into a comatose state in which a respirator and a feeding tube were used to keep her alive and breathing. quinlan did not have a proxy or living will and had not expressed her wishes if something ever happened to her to those around her, which made it difficult to decide what the next step should be. quinlan's parents understood that their daughter would never wake up and that prolonging her life may be more damaging and it would not be of quality life. her father sought out the right to be quinlan's legal guardian and petitioned for the removal of the respirator that was keeping her alive. the court, however, argued that the removal of the ventilator, which would lead to quinlan's death, would be considered unlawful, unnatural, and unethical. quinlan's lawyer made the counterargument that the removal of the respirator would allow quinlan to have a natural death, which is natural and ethical. the quinlans won the court case and were appointed as the legal guardians of their daughter. the respirator was removed in 1976, but quinlan continued to live without the ventilator until 1985. the case continues to raise bioethical questions of one's quality of life and the legal process of death. it also brings up many important issues that are still being addressed to this day. one of the critical points that the quinlan case brings up is the patient's right to deny or withdraw treatment. cases in which the patient rejected or withdrew treatment were then unheard of and went against medical ethics in preserving one's life. debates on allowing patients the right to self-determination were controversial, and they would be evaluated for the next couple of decades from state to state. the case also brought up whether family members and those who are close to the patient are allowed in the decision-making process. since quinlan had no written documentation, voiced no decision, and appointed no proxy, a lengthy legal battle was caused between the quinlan family and the state in determining quinlan's best interest and determining if she would want to live or die. that had a significant influence on the use and establishment of advance directives, oral directives, proxies, and living wills. nancy cruzan cruzan's gravestone another major case that further propagated the right to die movement and the use of living wills, advance directives and use of a proxy was cruzan v. director, missouri department of health. in 1983, cruzan had a car accident, which left her permanently in a vegetative state. her status as an adult and lack of an advance directive, living will, or proxy led to a long legal battle for cruzan's family in petitioning for the removal of her feeding tube, which was keeping her alive since the accident. cruzan had mentioned to a friend that under no circumstances would she want to continue to live if she were ever in a vegetative state, but this was not a strong enough statement to remove the feeding tube. eventually, the cruzan family won the case and had their daughter's tube removed. the case brought great debate if the right to die should be approved from state to state or as a whole nation. terri schiavo the terri schiavo case occurred between 1990 and 2005. this case was controversial due to a disagreement between schiavo's immediate family members and her husband. in the quinlan and cruzan cases, the family was able to make a unanimous decision on the state of their daughters. schiavo suffered from a cardiac arrest which led to her collapse and soon after began to have trouble breathing. the lack of oxygen to her brain caused irreversible brain damage, leaving her in a vegetative state and required a feeding tube and ventilator to keep her alive. schiavo left no advance directive or had a discussion with her parents or husband about what she may have wanted if something were to happen to her. soon after, her husband was appointed as her legal guardian. years later, her husband decided to remove schiavo's feeding tube since the chances of her waking up were slim to none. schiavo's family, however, argued against this decision and brought this case to court. the case was very turbulent and occurred over some years and involved the state and its legislators before a decision was made. this brought up bioethical debates on the discontinuation of schiavo's life vs. allowing her to continue living in a permanent vegetative state. those who were for preserving schiavo's life stated that removing the tube would be ethically immoral since they do not know what she would have wanted. they challenged her physical and mental state and stated that she might have some consciousness; thus she deserved to continue living. those for removing the tube argued for self-determination and that her quality of life was diminished. the schiavo case is the most recent and significant right to die case that propagates the thought of having an advance directive or living will. it also further looks into other complications that can arise, such as family disagreements, which should have been accounted for when dealing with a right to die case.