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Public policies on freedom of choice for the dying have changed so much so fast that some older people are growing afraid of euthanasia, a Roman Catholic policymaker says.

"In a few short years, the burden of proof has shifted when patients feel they have to inform their physicians they do not want to have their lives terminated," said Richard Doerflinger of the U.S. Catholic Conference.The associate director of public policy development for American bishops spoke about death decisionmaking at the recent National Council on the Aging convention.

Life-sustaining medical technology has grown so mechanically proficient that questions about the quality of life dominate discussions of death.

The right-to-die debate pits those who believe life should be supported at all costs against those who would give the dying authority to decide when to die.

The issue gets more complicated when the subject changes from the terminally ill facing imminent death to comatose patients who can be kept alive indefinitely and people diagnosed with terminal or degenerative illnesses such as cancer, AIDS or Alzheimer's disease.

And there are financial implications for the 37 million Americans without health insurance.

"Somebody who needs kidney dialysis and their insurance won't pay might say, `I'll just end it tomorrow,' " said Nancy Coleman, director of the American Bar Association's Commission on Legal Problems of the Elderly.

The Missouri case of Nancy Cruzan, a comatose auto accident victim who died last December after the U.S. Supreme Court allowed her parents to disconnect her life support, and Michigan cases of physician-assisted suicides are the latest legal disputes to put death issues in the spotlight.

"All the boundaries between physician-assisted suicide and more egregious forms of death dealing are less fundamental than the basic boundary between healing and killing," Doerflinger said.