A 2003 Gallup poll found that 80 percent of respondents believe that a spouse should be permitted by law to decide to allow a partner in a permanent vegetative state to die a natural death. The poll showed no meaningful difference based on religion, ideology or political affiliation.

While there can be no question that treatment decisions for a loved one raise wrenching emotional issues, there is wide agreement among legal, clinical and ethical experts and the public that self-determination in these cases should remain the basis for sound policymaking.

The 1976 New Jersey Supreme Court decision made in the Karen Ann Quinlan case made clear that an individual's right to privacy grows in strength against the state's interest in preserving life, as treatments become more invasive and the prognosis for death more certain.

The right to self-determination is an important social benefit that comes with the responsibility of making one's wishes known in a signed document and, perhaps more important, legally designating someone who can represent you and your wishes should you become unable to speak for yourself. The End-of-Life Care Partnership in Utah makes these legal documents available on their Web site http://www.carefor dying.org .

The Terri Schiavo case is the tip of the iceberg that is the silent epidemic of growing brain injury problems in this country. A task force in 1994 estimated the number of adult patients in persistent vegetative states to be as high as 35,000 with medical care for these patients costing up to $7 billion annually.

While I would not presume to make choices for other individuals or families, I personally believe that a majority of costly medical interventions are not supporting life as much as they are prolonging death. This prolonging of death is a side effect of both medical progress and of ignorance about the process of dying itself.

The most emotionally charged aspect of the Schiavo tragedy is around the argument that to discontinue a feeding tube is to starve an individual to death. When an individual is allowed a natural death, a disinterest in food and water and an inability to take them in is seen as a sign of dying and not as the cause of death.

Hospice chaplain Hank Dunn, author of Hard Choices for Loving People, maintains that the permanent inability to take in food and water is itself a terminal condition. Natural death in humans, as in other mammals, is virtually always accompanied by cessation of eating and drinking. Medical evidence is clear that dehydration in the end stage of a terminal illness is both a natural and a compassionate way to die.

Among the benefits of a natural death accompanied by dehydration is a reduction in fluids that makes breathing easier; less pressure around tumors results in less pain; there is less urination and therefore less need to change the bed and less risk of bedsores.

One of the most fascinating aspects of a natural death is a natural release of pain-relieving chemicals as the body dehydrates. Some have described these chemicals as the body's natural morphine and the state that they induce as a mild euphoria.

Not that long ago the normal behavior of a dying individual was to become disinterested in eating and drinking. The individual likely went into a coma followed by death from the underlying terminal condition.

Both making your wishes known and determining to align those wishes with the naturalness of dying can bring peace, comfort and dignity to individuals and families at the end of life.

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Julien Puzey is director of the End-of-Life Care Partnership, a coalition of nearly 300 individuals representing more than 100 organizations throughout Utah who improve care for people near the end of life and their families. It is sponsored by HealthInsight, a private nonprofit organization dedicated to improving the health-care systems of Utah and Nevada.