For many Americans the quest for a good life now includes "a good death." For most that means death on one's own terms -- in a hospital or at home, without pain or chaos, with or without feeding tubes, ventilators and other tools of modern medicine.

It sounds simple, but it is not yet a right that's easy to claim.

Despite nearly 30 years of legal, ethical and legislative effort, "good" deaths remain elusive. Death in America often still means miscommunication, missed opportunities, unwanted or unneeded medical intervention and pain.

Powell 'Preacher' Forbes begged his son Dan not to let doctors insert a feeding tube after his kidneys shut down and he was rushed to the hospital.

--Powell Forbes' story

Many of us are left to fear dying more than death.

Today there's a diverse and mounting national effort to understand why American medicine sometimes goes so terribly wrong at life's end. It's a grass-roots movement fueled partly by alarm over efforts to help people end their suffering by killing themselves.

At least 50 initiatives are under way to improve end-of-life care. Marilyn Webb, author of "The Good Death -- The New American Search to Reshape the End of Life," envisions a movement in which people reclaim death much as the natural childbirth movement helped women reclaim birth.

In 1991, federal lawmakers crafted a measure to get things rolling.

Hospitals, nursing homes and other institutions were required to tell Medicare and Medicaid patients about the option of preparing legal documents to guide medical care if one day they're unable to speak for themselves. Patients can designate someone to act in their behalf, detail what treatments are acceptable when, and outline when death would be welcome.

Despite the legal opportunity to map their own roads to death, few do so. A 1997 study found fewer than one in five nursing home residents taking advantage of the opportunity.

Why?

Do you have a living will?
	Yes
	No

Blame patients who don't want to contemplate their own demise. Add doctors who are pressed for time and sometimes as reluctant as patients to introduce the subject. Take note of hospitals, nursing homes and other institutions at which advance directives are sometimes just another question to be asked on the admission checklist.

Complicating human reluctance to plan for the end is the fact that states sometimes limit the legal power of patients with a terminal illness, filtering out those battling progressive dementia or other chronic problems. Rules vary from state to state.

Even when completed, experts say, advance directives are often either too vague or too specific.

From 1991 through 1993, New York researchers reviewed hospital care of 114 elderly patients. All had advance directives, but only 26 percent of the documents were consulted or recognized during the hospital stay.

What's needed, advocates argue, are honest discussions about the medical dilemmas a particular person will likely face.

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