The 1980s have witnessed mounting concern among older adults and policy makers about the ability of people to maintain control over health care decisions in later life. Laws authorizing living wills, durable powers of attorney, and family consent for incompetent patients have proliferated throughout the states. Even the United States Supreme Court finally entered the arena as it pondered the fate of Nancy Cruzan in the face of Missouri's refusal to authorize the withdrawal of the nasogastric tubes which keep her alive. The challenge of translating personal autonomy in health care into legal rights has captured the attention of legislators and courts alike. What began as an isolated decision in the Quinlan case in 1976 has become a torrent of lawmaking action by 1990.

Staying in control of health care arrangements in later life, however, embraces much more than refusing or terminating life-sustaining treatment. Mechanisms for financing health care services often determine the quality of the older person's life and the extent to which the individual retains autonomy over the myriad details of daily life.