By Kevin Anderson
BBC News, Washington
The death of Terri Schiavo is unlikely to be the end of the debate over end-of-life issues in the United States.
State legislatures across the country are debating new laws to govern end of life decisions, with some responding directly to the issues raised in the Schiavo case.
Terri Schiavo's case has brought together right-to-life advocates in the US
The fight over her final days has also brought together conservative Catholics and Evangelical Christians with disability-rights advocates into an energised coalition that is fighting to change state laws and elect conservative judges.
But whatever the political impact, the case has raised the Americans' awareness of the importance of making their wishes clear to spare themselves and their families the agonising political and legal battles if they were in a similar situation as Mrs Schiavo.
New laws proposed
Ethicists and legal experts in the US say that it is rare for cases like Mrs Schiavo's to receive the publicity it did.
Families across the country quietly and privately make decisions to withdraw care from beloved relatives every day, they say.
And Dr James Hoefler said that a broad consensus exists in end-of-life cases that individuals have the right to make decisions for themselves.
"And incapacitated patients don't lose the right of self-determination," he said.
At least 10 states are considering new laws to address end-of-life issues, some in direct response to issues raised in the Schiavo case.
Some of the laws work to make living wills more available, while others try to address what to do when patients have not drawn up an advance directive for withdrawal of care.
But Kenneth W Goodman, an ethics professor at the University of Miami, says religious conservatives are pushing laws that would make it difficult to withdraw care even when a patient's wishes are clear.
- The Kansas state House of Representatives overwhelmingly approved a measure that would require a guardian to obtain court approval for the withdrawal of care. The law was championed by abortion opponents and disability advocates.
- The Alabama state legislature has drawn up the Starvation and Dehydration Prevention Act, which prevents the removal of a feeding tube without written instructions from the patient.
- A Michigan state legislator has proposed a law that would bar adulterers from acting as a guardian for an incapacitated patient.
And in addition to proposed changes in state law, legal experts say that the intervention by both the Florida legislature and the United States Congress could set a precedent for cases in the future.
New political alliance
But politically, the case energised the right-to-life movement and brought it new allies, Dr Hoefler said.
"Catholics and Evangelicals never worked together, but now they have a common theme, common ground," he said.
"They can marshal their forces and their arguments and be a much bigger force in the debate," he added.
Mr Goodman is concerned that religious conservatives will "take a number of articles of faith and give them the force of law".
Some of the laws being proposed would impose insurmountable barriers to the withdrawal of care and lead to "unwanted treatment of thousands of people", he said.
Justice William Rehnquist might step down, opening the way for a battle
And conservative activists decrying the role of the courts in the case have promised a drive to elect and nominate more conservative judges.
And President Bush is almost certain to have at least one opportunity to nominate a justice to the Supreme Court with the failing health of Chief Justice William Rehnquist.
Both conservatives and liberals are predicting a major battle over the nomination, saying that the Schiavo case will embolden right-to-life conservatives who want a strong abortion opponent elevated to the nation's highest court.
But Americans have showed strong reluctance to get the government involved in cases like Terri Schiavo's.
A poll taken after her feeding tube was removed showed that a majority of Americans would not want to continue care if they were in her position.
And a FoxNews poll taken near the time of her death found that 54% of Americans thought the removal of the feeding tube was an act of mercy, while 29% thought it was murder.
Dr Hoefler said that this case has raised the awareness of the necessity of living wills and advance directives.
He said that legislatures are unlikely to overturn a patient's right to self-determination.
"For all the hand wringing, we are not going to solve these problems with the legislative process," he said.
And no matter what legislatures do, people can solve this problem themselves by just talking with their parents, spouse and friends about their wishes.
A verbal advance directive carries the weight of law and might be easier to interpret than a written directive, Dr Hoefler said.
"I can solve the policy problem for myself, by telling people what I want, and there is not a damn thing they can do about it," he said.