After Terri Schiavo

THE DEATH yesterday of Terri Schiavo concludes a legal battle, but its moral quandaries live on. The Schiavo case gripped the nation because of the lines drawn between life and death, and the middle ground of dementia or coma, agonizingly hard areas to delineate. In addition, because of a mute understanding that this subject is too awful to contemplate, a discussion of Schiavo-like choices has not fully penetrated the public square. It will be a healthy thing if this taboo is permanently shattered. We may not want to discuss death, but it will come to all of us. And, because of medical technology, more people will be empowered, or perhaps some would say condemned, to make judgments about when life is worth living, and when not.

A century ago, death usually came abruptly; the most frequent causes were pneumonia, tuberculosis, diarrhea and injuries, sudden killers all. Today, the average American spends two years disabled enough to need help with the routine activities of living; and growing numbers survive to be 85 and older, at which point they have a 50 percent chance of suffering dementia before they die. In 2000, there were 4.2 million Americans in the 85-plus cohort, but by 2030 there will be nearly 9 million, according to a paper for the Rand institute by Joanne Lynn and David M. Adamson. We speak of people being "snatched from life." Death, for more and more Americans, however, is the final stumble in a slow decline.

We have not adjusted to this transformation, in emotional, moral or economic terms. Death is often portrayed in the movies as gunfights or as heroic battles against diseases. Less discussed are the fading figures in hospices where agonizing questions about the end of life, pain, dementia and, yes, financial costs are confronted. We speak of medicine as "saving lives." But at some point, arguably, medicine isn't so much about saving life as managing the options for parting with it.

Many Americans, and not just social conservatives, feel that life is always worth preserving and that wavering from this principle opens the door to selfish relatives who don't want the burden of caring for the vulnerable. It's an honorable outlook -- also a natural one. Many believe on religious grounds that life is sacrosanct. With the survival instinct hard-wired into human nature, others find it difficult to contemplate the extinction of the self. Yet there has to be space in a free society for others to differ: to draw up living wills that specify limits to life-prolonging medical interventions, and perhaps also to opt for assisted suicide.

It isn't possible for government to withdraw from this sphere altogether. The Terri Schiavo case featured two claims to speak on her behalf; inevitably Florida's legal system had to adjudicate between them and to decide what standard of evidence was necessary to establish that Mrs. Schiavo herself would have chosen to die. Equally, laws permitting assisted suicide, such as the one in Oregon, require government to create and enforce tight limits on its use. But it's clear that, on a matter as imponderable as this one, the federal role should be minimized. Thanks to Terri Schiavo, a national conversation is, we hope, beginning.