The protracted and public dying of the late Pope John Paul II, the tube-feeding cases of Terry Schiavo in Florida, Mrs BWV (in the case of that name) and Maria Korp in Victoria, are all examples of a rumbling dialectic in modern Western societies about the limits of medical treatment and causing death. In The Tablet last year, Paul Keeley, a palliative care physician in Glasgow, challenged those responsible for the prolongation of the late pope’s dying process. He wondered why the pope was not allowed to die peacefully, ‘rather than an ugly medicalised death’, being subjected to futile and intrusive treatment, such as a tracheostomy, when afflicted by terminal pneumonia. One can also only be amazed at the incredible death-denying spin put out by the Vatican medical spokesman throughout the saga. Why were devout Catholics praying for their Holy Father to be further delayed in his reunion with his creator? Keeley rightly points out the spiritual importance and history of the ‘good death’. Causal assertions are never far away when the media considers these issues. When talking of the decision by the Public Advocate of Victoria to withdraw tube feeding from Maria Korp, who was dying with severe irreversible brain damage after prolonged asphyxia, a Melbourne newspaper unhelpfully ran a headline stating that she was being ‘starved to death’. In an attempt to improve decision-making at the end of life, specifically for situations where the patient is incompetent, there has been growing interest in the development of advance directive programs in Australia. Programs such as Respecting Patient Choices and Planning My Future Medical Care (the latter currently under consideration by the Australian Catholic Bishops Conference and Catholic Health Australia) attempt to get people to appoint agents and leave written instructions recording their wishes for future care when they are unable to speak for themselves. Similar moves are under way in Britain, and there are long-established legal instruments of this sort in the United States, Canada and several Australian states. So far, however, all such policy-based legalistic approaches have had negligible impacts on care and decision-making at the end of life, despite high hopes. The problem is that the issue of causing or not causing death, the moral line in the sand, has become virtually the only aspect of care and decision-making at the end of life that gets societal or media attention. In fact, much of the thinking about