I worked as chaplain in a large medical center in Knoxville, Tenn., for several years.  I had affirmed many times my belief that there are things worse than death. As chair of the hospital medical ethics committee, I experienced with the families and physicians the agonies of making these difficult end-of-life decisions. The committee repeated often the words, "Not every thing that medical science can do should be done."

One behavior in particular happened so frequently we named it "the California syndrome." So often, it seemed, the family member who lived the greatest distance and had visited least was the one who insisted that everything be done no matter how painful and distressing to the other family members and sometimes the patient.  Guilt seemed to be the motivating factor. God has given us life and wants us to live it to the fullest.  When we indulge ourselves by playing God, we diminish the gift.

My family has had to make the "tough decision" more than once for family members, including for my 35-year-old sister after a botched suicide attempt, as well as my 78-year-old father and three of four grandparents.  Fortunately, before any of those situations emerged, we had discussed the issue -- and all concurred that "no heroic means" was a "faith issue expressed in love" -- and so, when the tough time came, we were ready and capable of supporting one another.

Clearly it is easier not to begin a feeding tube, ventilator, etc., than to have to remove it. But it is not always possible to intervene at that moment.  That's where clear consensus, including a written document, makes the difference.

How tiresome it must be to God, listening so long to the pleas of bereaved people seeking a miracle. If God has taken away the sting of death through Jesus' sacrifice, why should we impede the welcome of souls into heaven?

There is some Christian logic in this debate over the prolongation of life. Unfortunately, in many instances, the threat of loss and grief overshadows the good sense God has given us. We can't help it though, because we love so hard and so much. To give up what small remnant might remain of that love is like suffering our own death; and so, we go to unbelievable extremes and pray unrealistic prayers and prolong beyond blessing God's gift of everlasting life.

What pains me is the willingness to even drag God's name into this whole thing.  The politicization of God is painful and divisive. The spectre of Father Frank  Pavone calling Terri Schiavo’s husband “heartless and cruel” denotes an anger, in fact an absence of God, in his  understanding. Where there is God, there is love. The parents who couldn't let go.  Where there is God, there is love. 

The husband who kicked her grieving family from her bedside.  Where there is God there is love. The mourners outside who held signs against Michael Schiavo.  Where there is God there is love. It's something everyone seems to have lost sight of.

One need not be a Bible-thumping conservative nor an ACLU supporter to perceive the possible dangers to individual rights entailed by the courts' decisions.  Terri Schiavo’s recovery might have been highly unlikely, but it was not impossible; at the very least, the judges might have decided upon a lethal injection, instead of letting her die of thirst and starvation.

Rulings that allow the state to terminate a patient's life in absence of written instructions or a "living will" could certainly lead to frightening scenarios, such as those common to, say, the Netherlands, where euthanasia of dying, old and poor patients is fairly routine.

I had to make the decision to terminate the lives of both my mother and my husband. My mother was put on a respirator after fracturing her skull in a fall in 1981. Because she was brain dead, my request to have the respirator removed was immediately honored. My husband, suffering from incurable cancer in 1989, also was put on a respirator. It could not ethically be removed, but the doctors were not obliged to continue medication to raise his blood pressure. When that was discontinued, he died a few days later, with me at his side.

In both cases, I had no hesitation about making the life-and-death decision because, although neither my mother nor husband had a living will, they had many times expressed the wish never to be kept alive on machinery. I felt I was doing the most loving thing possible for them by letting them die a natural death. When the rector of my church saw my husband right after his death, he said that in all his years of ministry he had never seen anyone look so at peace. His words were a source of great comfort to me, validating my decision.

As to desires and arrangements, we have each executed a medical power of attorney.  This is a comprehensive document that includes living-will provisions.  The key paragraph, written by our attorney, Episcopalian Kathleen Stephenson, is: "In acting hereunder my Agent shall consider my firm and settled commitment to refuse life-sustaining treatment and my request that life-sustaining treatment be withheld or withdrawn if such treatment serves only to prolong the process of my dying. 

In such event, I request that treatment be limited to measures to keep me comfortable and to relieve pain, including any pain that might occur by withholding or withdrawing life sustaining treatment.  I encourage my Agent to seek counsel and support from my pastor in the execution of the powers and responsibilities conferred in this document."

As to the above-mentioned “Agent," we are each other's agents.  In the case of our agent's inability to serve, we have appointed our children (in birth order) as "successor Agent."

Because of the Schiavo case and the pope's death, I am now writing out my Rite II funeral plan and will give a copy to my rector.  I also keep all necessary documents and keys in a special box known to my adult children and executor.

Planning my trust was a result of my experiences with the elderly, the funerals and, most of all, my time spent with an elderly woman with dementia, as she began her end of life with people fighting over her estate, her health care and her death.  I vowed I'd not put my children through the same thing.

I also hope that I will continue to live as to not keep death in a dark closet.  We need to talk more to our families and parishes about the quality-of-life issues, our plans, and not leave the scary parts out. Does the Episcopal Church have a booklet that is like a checklist for planning one's end of life?  It should be readily available.

My name is William H. Hasskamp, RN, BSN, CPTC. I am an organ procurement coordinator for LifeShare of the Carolinas and junior warden of St. James Episcopal Church, Black Mountain, N.C. We cannot stress enough the importance of making end-of-life decisions and having substantive conversations with our loved ones well in advance of the need for them. I work daily with families in crisis. Because they have never had a conversation about end-of-life issues, they now must guess what a severely brain-damaged or brain-dead loved one would want them to do.

End-of-life decisions include living wills, medical directives, health-care power of attorney, organ donation and funeral arrangements.  I approach families to offer the option of organ and/or tissue donation to a grieving family in hopes that their gift may save another. The worst thing that I hear as I ask if they have ever discussed donation with their loved one is not, "My husband/ wife said they didn't want to be a donor." These families have had the discussions and made their wishes known. The worst thing that I hear is, "We've never talked about it."

In western North Carolina, LifeShare has been working closely with hospice, churches and hospitals to conduct end-of-life workshops to help people begin the decisions and conversations with their families. End-of-life decisions relieve the remaining family members from the fear that they are making a decision that would violate their loved one's wishes. They know, because they have been told, exactly what is desired.

Who is to judge "quality of life?"  Is an Alzheimer's patient terminal or merely disabled?  Unless the basic systems are not functioning, then the patient is disabled, even if he/she cannot recognize anybody due to advanced dementia.  I have heard in these circumstances that families of such patients deny treatment for pneumonia and let them die of that disease because of "quality of life" and because they believe it is for their own good.  This is dangerous. 

Far be it from me to get into somebody's head, but having been faced with invoking the terms of a living will for my father, I ask myself, whose quality of life are we talking about?  Is it the quality of life for the patient or the quality of life of burned-out caregivers who want the burden lifted?

Underneath all the fancy talk of ethics, which generates more smoke than clarity, this boils down to dumping Grandma overboard because she is of no use and also a heavy burden.  Let's call the hypocrisy what it is and have the courage to come out from behind these pseudo-academic smokescreens invoking the guise of "complexity."

The Anglican bishops need to go back to the drawing board and do some serious thinking.  They are not only way off the mark, they are completely wrong.  I hope none of them are my pastors should I be in a vegetative, disabled state.

My 74-year-old spouse, Glen, died March 14, having lived 10 years with prostate cancer.  Our primary concerns for his last 10 weeks of life were:  controlling his pain to keep him comfortable, discerning how to know when to summon our two adult children to spend some quality time with their father and knowing when hospice care should be instituted.  Glen's last 12 days were spent in a lovely hospice facility with the children, our family cat and myself.  Many friends and relatives came from near and far to visit and to say goodbye.

Through the federal family-leave legislation, the children were able to arrange time off work.  They  were able to come from their homes in other states to spend about five weeks with us, time which deepened our relationships and allowed all of us to come to grips with Glen's (and our) mortality.  Hospice allowed us to be family rather than to bear the responsibility for caregiving.  We responded by learning how to be helpful to the staff, coming to accept that it was time to let our husband/father go with gratitude for his life with us and observing his readiness for birth into his next life.

How did we reach this point?  In 1997, we had set up revocable trusts, executed wills and health-care advance directives (including DNR/DNI), all of which we discussed thoroughly with our children.  It played out over the past year with ongoing conversations between Glen and our vicar, a planning session with the vicar in November, a family discussion at Christmas and later weekly and finally daily visits from our vicar.  We were blessed to be surrounded and supported by the love of our congregation.

NOEL, the life-affirming ministry in the worldwide Anglican Communion, believes that, as beings created by God, we must live lives according to God’s purpose for us. When we die, with God’s grace at judgment, we hope to return to God. NOEL views the Terri Schiavo case in the context of its official position against euthanasia, which can be viewed at http://www.noel.forlife.org/.

America’s increasingly secular culture has forgotten the basic Christian principle on the sanctity of life. As we are created by God, we do not have the authority to end life. The culture has become overly focused on quality of life as defined by social mores. If a person cannot participate in a perceived minimum condition for living, decision-makers are concluding that such people do not really wish to live. For the seriously disabled, this thinking leads decision-makers to believe that it is more merciful to allow them to die or to force death upon them by withholding food and waster, as in Terri Schiavo’s case.