As she nears death at age 92, former first lady Barbara Bush's announcement that she is seeking "comfort care" is shining a light -- and stirring debate -- on what it means to stop trying to fight terminal illness.
Bush, the wife of former President George H.W. Bush, has been suffering from congestive heart failure and chronic obstructive pulmonary disease, according to family spokesman Jim McGrath.
In a public statement Sunday, the family announced she has decided "not to seek additional medical treatment and will focus on comfort care."
The announcement comes amid a national effort to define and document patients' wishes, and consider alternatives, before they are placed on what has been described as a "conveyor belt" of costly medical interventions aimed at prolonging life.
Ellen Goodman, co-founder of the Conversation Project, which encourages families to discuss and document their end-of-life preferences, applauded the Bush family announcement.
"It sounds like this forthright, outspoken woman has made her wishes known and the family is standing by her," Goodman said.
"It makes perfectly good sense at her age, with her failing health, that she would say at some point, 'Life's been good, and while you always want more, it's enough,'" said Dr. Joanne Lynn, director of the program to improve elder care at Altarum Institute.
Lynn worked with Barbara Bush years ago, when she was a congressional spouse volunteering at the Washington Home for chronically ill patients. Bush helped with the founding of the hospice program there.
"We have so few examples in visible leadership positions" of public figures promoting palliative care, she said.
"It's a personal decision that she didn't have to share, but hopefully it will encourage others to think about their choices, talk about their choices, document their choices and have those choices honored," said Nathan Kottkamp, founder and chair of National Healthcare Decisions Day.