OPINION -- THE BIG PICTURE: To be or not to be: Who picks?

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As this issue went to press, the Supreme Court had just decided not to intervene in the case involving Terri Schiavo. She has spent the past decade and a half in a Florida nursing home. There, she has been "treated" for a condition clinicians refer to as a "persistive vegetative state."

Her story is wrenching for several reasons, not the least of which is that she had become the rope in a tug-of-war between her husband (who wanted her feeding tube removed) and her parents (who didn't).
Reasonable people can disagree about which choice was more humane.
What's not in doubt is this: As chemotherapy respirators, feeding tubes and other medical advances extend our ability to care and comfort those at the end of life, they are also going to make the distinction between life and death more doubtful.
By some estimates, more than 10,000 people in this country are now in persistive vegetative states, mostly due to head injuries. (Schiavo's condition is the result of heart failure that caused brain damage.) Surely, those totals are only going to balloon in the years ahead, particularly among the nation's growing elderly population.
Bill Keane, who is the director of dementia services at the Mather Institute on Aging, holds that it's just a matter of time until the abortion controversy is overtaken by the end-of-life debate. And it's a rare administrator in this field who has not already had to deal with this matter.
Bioethicists have helped us better understand how to address this controversial issue. But even within the bioethicist community, there is considerable disagreement about how to frame the discussion. The referees, it seems, are not fully free of the cultural, religious and other biases that tend to impede objective judgment.
Advance directives and living wills can help operators better understand residents' caregiving preferences, but even these are not foolproof. They do not always accompany residents to hospitals after a setback. Moreover, paramedics in some states are required to treat patients in their care, regardless of condition.
While the events surrounding Terri Schiavo's case are horribly sad, they do present an opportunity. Now is an ideal time to put together a national end-of-life commission.
Commission members should represent various perspectives and disciplines. The panel should be tasked with this critical goal: doing what's best for people in that purgatorial place between life and death.
Perhaps the commission would not be able to reach consensus on definitions or solutions. But it would certainly help improve the dialogue.
Undoubtably, it would give our lawmakers and courts -- those most likely to be the final arbiters in this matter -- a chance to make more informed decisions than are now being made.  John O'Connor is vice president, McKnight's Long-Term Care News. john.oconnor@mltcn.com