The passing of Terri Schiavo ends one of the most protracted and high-profile right-to-die cases in American history. But beyond the personal tragedy it represents, the case also adds fuel to an array of unresolved legal and political issues and sets the stage for contentious national debate for years to come.
Already, the case of the brain-damaged Florida woman - who died Thursday after 15 years in what doctors called a persistent vegetative state and almost 13 days after her feeding tube was removed - has spurred some states to accelerate legislation aimed at preventing the kind of intrafamily conflict that kept Mrs. Schiavo in legal limbo for seven years.
The US Congress is also ready to take a fresh look at end-of-life issues, even after polls showed many Americans opposed the intervention of Congress and President Bush into the Schiavo case last month. Members of Congress from both parties, some spurred by right-to-life sentiments, others by advocates for the disabled, say the question of who makes decisions in disputed right-to-die cases is worth another look on Capitol Hill.
On a personal level, the legal tug-of-war over Schiavo has forced Americans to confront the unthinkable by vividly illustrating the importance of a living will.
At heart, the Schiavo case represents the latest skirmish in the nation's culture war, already heated over abortion, gay marriage, and stem-cell research. Social conservatives have long sought to tip the balance on these issues through appointment of conservative judges - and, analysts say, one direct effect of Schiavo could be to inflame passions even more than expected over a US Supreme Court vacancy that could come soon. The high court declined to take up the Schiavo case three times within the past two weeks.
"The most significant aspect of [the Schiavo case] is that it's likely a stage-setter for a huge conflagration over the first Supreme Court nominee," says Marshall Wittmann, a senior fellow at the Democratic Leadership Council and former Christian Coalition official.
But the most surprising aspect of the case, Mr. Wittmann adds, is that it brought to light the simmering tensions within the Republican coalition between the limited-government activists and religious conservatives. High-profile economic conservatives such as Grover Norquist and Stephen Moore, who usually support President Bush and the congressional Republican leadership, criticized their unorthodox move to turn what is normally a state issue over to the federal courts in the Schiavo case.
On the day of Schiavo's death, however, Bush remained undeterred. "The essence of civilization is that the strong have a duty to protect the weak," he said. "In cases where there are serious doubts and questions, the presumption should be in favor of life."
Negative public reaction to Congress's intervention may nevertheless deter similar attempts to federalize a case like this in the future, analysts say.
"A good number of those who cast votes last time are going to be frightened the next time," says Douglas Kmiec, a constitutional law professor at Pepperdine Law School who is critical of the federal intervention in the Schiavo case. "The polling data is telling them that most people are not all on one side or at least not on their side. So they will be gun-shy."
While many Americans are opposed to government intervention in what they view as private medical decisions dealing with end-of-life issues, the Schiavo case has also raised concerns about the power of guardians and judges to end someone's life even when a patient's wishes remain a matter of dispute among family members.
Florida state law requires that evidence of an individual's desire to cut off hydration and nutrition must be "clear and convincing." But some legal analysts say such a standard alone is not enough to head off concerns about spouses and guardians who may have financial or other personal motives to end nutrition or other life-support. In such cases, these analysts say, judges should be required to make specific findings dealing with each issue, including the credibility of guardians and spouses, future treatment prospects, and whether earlier casual statements by an individual who is now in a persistent vegetative state were well-informed and specific enough to justify a decision years later by a spouse and/or judge to end that person's life.
Ultimately the goal of pro-life activists is to establish as a matter of constitutional law that government has an affirmative obligation to protect life. In contrast, death-with-dignity supporters emphasize the existing and well-established constitutional right to decline unwanted medical treatment and be free from government intrusion into the most private aspects of their lives.
Analysts are divided over whether Congress will continue to take actions that favor the pro-life side in this broad debate. While some political observers have criticized the congressional action in the Schiavo case as being politically motivated, others stress that broad support for the measure among both Republicans and Democrats suggests many politicians were acting out of conscience.
In the long run, any political fallout over Schiavo is hard to predict. But it's possible, say Wittmann and others, that the Schiavo case - specifically, the unusual intervention of Congress in a family matter - could contribute to unease among moderate suburbanites who vote Republican on the economy and national security but are less comfortable with religious conservatives' dominance of the party on social issues. And at a time of narrow Republican control in Washington, every vote matters.
For the Democrats, the Schiavo case also presented no clear partisan advantage. "If you look carefully, you see that everyone is divided by the issue one way or another," says Jim Guth, a political scientist at Furman University in Greenville, S.C. "The very fact that the Democrats in both houses had such a hard time reacting to this - some went along with the Republican bill that passed, some opposed, others refrained from voting - suggests this is not an easy issue to discern exactly where long-term or short-term political advantage lies."
Like the embryonic stem-cell issue - on which some strong abortion foes, such as Sen. Orrin Hatch (R) of Utah, favor expanded federal funding for research - positions on end-of-life issues often don't break neatly along the same lines as those on abortion and gay marriage.
"There's a lot of debate on the evangelical side of the religious spectrum on these [end-of-life] issues," says Professor Guth. "I don't think anyone has settled into final positions on these yet. Some leaders on the religious right have, but among their constituency there's a lot more division on this than there is on abortion."