California was the first state to enact a “natural death law.” The laws are also known as Death with Dignity Acts or Living Will Acts. The state passed its law in 1976, and it took effect in 1977. Legal principles in these laws acknowledged the rights of the terminally ill to refuse medical treatments and interventions. And because of the likelihood of impaired judgment at some point in the illness, individuals were allowed to make their wishes known through advance directives regarding care and through “living wills.” Other states quickly followed California's lead in the late 1970s and '80s. All states now have such laws on the books. And a federal law also exists providing for the same protections. Congress enacted the Patient Self-Determination Act in 1990, which took effect in late 1991.