American families grapple with decisions on death

The legal battle over whether to remove the feeding tube that keeps a severely brain-damaged Florida woman alive has overshadowed a quiet truth about death in America: More often than not, it follows a deliberate decision to end or withhold life-prolonging treatment.

A judge ordered that a feeding tube be removed last Friday from Florida's Terri Schiavo, possibly marking the end of a long legal fight between her parents and her husband.

In most cases, there is no such drama because family members are able to agree whether to pursue further treatment.

For an estimated 85 percent of the roughly 1.76 million people who die in America's hospitals, hospices and nursing homes every year, death follows explicit decisions by their families to either stop or not start treatment.

"America is a place where death is thought of as being optional," said Alan Meisel, a University of Pittsburgh law professor who specializes in bioethics and drafted a study for President Ronald Reagan on informed consent and end-of-life decision making.

The medical advances of the last three decades have made it frequently possible to delay death, for a while.

"Once you medicalize the process of dying, then the moment of death and the style of death is simply bound up in the whole set of medical decisions," said Steven Miles, a Center for Bioethics professor at the University of Minnesota. "You instantly put on the table the question of when do you stop."

Schiavo has depended on tube feeding since she suffered a Heart attack in 1990 that starved her brain of oxygen and left her in what the courts have ruled is an irreversible and unconscious state.

A study done under the Reagan administration estimated there could be about 10,000 people in the United States in "persistent vegetative states" similar to Schiavo's in which they could live for decades if they are fed and cared for.

In 1990, the year Schiavo suffered her Heart attack, the U.S. Supreme Court said in a landmark ruling that food and water could be withheld from a comatose Missouri woman named Nancy Cruzan if there was clear evidence she would not have wanted to live.

According to 1996 congressional testimony, there are about 2.2 million annual deaths in the United States and 80 percent occur in health-care facilities. Of those, roughly 1.5 million deaths, or about 85 percent of the deaths in health facilities, are preceded by an explicit decision to stop or not start medical treatment, according to testimony Dr. Leon Kass, who is now chairman of President Bush's Council of Bioethics. The 1990 Supreme Court decision gave similar data.

Medical experts said a decision to stop or not start treatment most commonly involves whether to perform cardiac resuscitation or use ventilators, feeding tubes, kidney dialysis or antibiotics.