AbstractIn the 20 years that have passed since the Karen Quinlan case exposed a simmering clinical issue to the light of day — more precisely, to the press and to judicial process — a consensus has developed in American law about how end-of-life decisionmaking should occur. To be sure, there are dissenting voices from this consensus, but they are often (though not always) about minor issues. By illustrating how this consensus has evolved, this paper explores how law is made in the American legal system and the roles that different legal and extra-legal institutions play in lawmaking.