Question: My mother and father both passed away in the past eight months. Each had terminal illnesses, and each died in the hospital under excruciating, painful circumstances despite being on hospice care. While I was mostly pleased with the hospice program, the final days were nothing less than barbaric. My father had to be tethered to the bed; my mother could not breathe, causing her also to be tethered to the bed to keep her from pulling out her IV lines.

Each had a living will stating that neither wanted life support if they were terminally ill, but they got it anyway. After they died, their contorted faces showed the agony each suffered. Neither had eaten for days, so they were fed despite their living wills.

While I certainly know the difference between the two situations, when my 14-year-old family dog got to the point he could no longer walk or eat, I took him to the vet, who put him down in a fast, humane manner without our pet suffering.

Why are we so barbaric with terminally ill family members while beloved pets get the easy way out?

Answer: While the space we have here is insufficient to provide a full response, we will do what we can with the space we have and follow up with subsequent columns based on reader demand.

It's no secret that the greatest medical cost is associated with the dying process. With the current budget debate, the significant cost of end-of-life care will come to the forefront yet again.

On November 5, 1990, Congress passed the Patient Self Determination Act as an amendment to the Omnibus Budget Reconciliation Act of 1990. This act required certain health care providers to give information about signing end-of-life documents called "advance directives." Despite a mandate for a government educational program on advance directives, however, Congress never funded its own mandate, so the program never got off the ground. Nevertheless, a move toward palliative care for end-of-life patients has been implemented where patients have frank discussions with their doctors about what they want for comfort, care, etc., at the end of life.

Then there is the issue of assisted suicide, which has waxed and waned since before Dr. Kevorkian publicly promoted and participated in a terminally ill patient's right to die by physician-assisted suicide. Kevorkian served eight years of a 10-to-25-year sentence for second-degree murder in a Michigan prison; he was paroled in June 2007.

Physician-assisted suicide is available to Oregon residents under a state law that has been tested in the United States Supreme Court. Washington State has recently passed a similar law. And the Montana Supreme Court has declared that a competent person's decisions about end-of-life care are constitutional rights. We predict that this controversial issue will be tested in more state Supreme Courts, and will be with us for a long, long time.

Taking the NextStep: If you are interested in reading more about end-of-life issues, please e-mail us with your questions and comments. Our upcoming book will deal with these and many other important issues for elders, disabled individuals and their families.