The law is clear on what should happen to Terri Schiavo, a noted bioethicist said Thursday: Her feeding tube should be removed.
Arthur Caplan, a bioethicist and author, predicted the tube that has kept Schiavo alive for 14 years will be taken out by the end of the year.
"That is what the courts ultimately will go to," Caplan said. "I know what they're going to decide."
Caplan said he sympathizes with the family, and that both Schiavo's parents, Bob and Mary Schindler, and her husband, Michael Schiavo, seem to be acting with "loving motives."
"This is a bad case in the sense that you have a family torn apart," Caplan said.
Still, Caplan said, courts have consistently ruled loved ones can act as surrogates in such cases, and say what a person who can't respond would have wanted.
Those decisions also have spelled out an order in which family members are called upon: spouse, parents, siblings, other relatives.
In other words, Terri Schiavo's husband, Michael Schiavo, who says she would want the tube removed, takes precedence over her parents, who want it to stay.
The case shows the importance for everyone, young and old, to put their wishes in writing, Caplan said. People should say what treatment they would want, or who they would want to make such decisions if they no longer were able.
"If you don't like your spouse, parents, siblings or other relatives," he said jokingly, "you better write that down."
Caplan is director of the Center for Bioethics at the University of Pennsylvania, author of several books and a regular commentator on questions involving medical ethics.
In Thursday's presentation, sponsored by the University of South Florida Health Sciences Center and Tampa General Hospital, Caplan also predicted that the debate over how Americans die will shift ground over the next few years.
Before long, Caplan said, people will find themselves fighting doctors and hospitals not for the right to refuse costly medical interventions and die quietly, but for the right to receive them even when doctors think it would do little to prolong their lives.
"The next round of court cases is going to be hospitals coming in and saying, "She's 87 (and gravely ill) and you can't order us to treat.' I think we're going to see them flip to the other side."
Fears that hospitals and health insurers may prefer not to treat is part of the reason that the Schiavo case has become so controversial, Caplan said.
Past cases drew controversy because people feared hospitals' refusal to stop treatment, but he believes people's views have shifted.
"There's a tremendous fear of undertreatment," he said. "The cultural attitudes have changed."
Caplan laid out a history of the laws governing the right to die. As recently as the 1950s, doctors' decisions were absolute: they treated patients.
Among the first to challenge such treatment were Jehovah's Witnesses, who do not believe in blood transfusions.
Gradually, that right to refuse treatment expanded until people could refuse any treatment for any reason. A series of court cases, however, limited parents' ability to refuse treatment for their children.
In 1976, Karen Ann Quinlan became the center of a right-to-life fight after her parents asked the hospital to remove her ventilator. The hospital refused.
Eventually, courts ruled in favor of the parents, although Quinlan lived for several years after the ventilator was removed.