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November 13, 2013

THEIR OPINION — For Nov. 13

Recent editorials published in Indiana newspapers distributed by The Associated Press

Good roads key to state’s future

After a summer of traffic delays and detours, it may seem Indiana always is working on its highways.

But a new study suggests we need to make even more improvements.

A report by Reason Foundation rates Indiana 22nd of the 50 states in the condition and cost-effectiveness of roads. We’ve been sliding downhill since we ranked 14th in 2005. However, some of the 11 factors in the rankings are based on 4-year-old financial data.

The report ranks states on categories such as pavement condition of interstate highways, traffic congestion, condition of bridges and spending per mile on roads.

Indiana leaders believe traffic congestion hurts our rankings. Our bottlenecks are found around Gary, Indianapolis and suburban Louisville, so local drivers don’t have to deal with them except when traveling.

State leaders say we’re on a path to raising Indiana’s rating with projects such as the extension of I-69 to the Evansville area, new bridges in the Jeffersonville area and improvements to U.S. 31 between Indianapolis and South Bend.

Future needs include widening high-traffic areas of Interstate 65 and Interstate 70, if not their entire routes across the state.

Last winter, the Indiana Legislature added more than $200 million per year for state and local road projects.

In the long run, to keep our roads in shape Indiana will have to find a way to compensate for declining revenue from gasoline taxes. The fact that Indiana government enjoys a much better financial status than many states should help us start climbing in the road rankings.

Indiana can’t afford to settle for middle-of-the-pack highways. We claim to be the “Crossroads of America,” and we’ve staked our future heavily on trucking and warehousing industries. Northeast Indiana’s dominance in manufacturing depends on efficient transportation of our goods to buyers.

Hoosiers need to decide that for our future road rankings, No. 22 won’t do.

— KPC News

Hunter’s end-of-life decision a reminder to us all

Tim Bowers gave his family a final gift this week — peace of mind that the decision to disconnect the machines keeping him alive was his own.

In turn, his family’s decision to share details of the Decatur man’s last hours represents an even greater gift to the rest of us — a reminder of the importance of communicating end-of-life wishes and considering all ethical and cultural implications in such situations.

Bowers, 32, apparently fell 16 feet as he climbed a tree stand while hunting last Saturday in Adams County. When he was found, Bowers’ vertebrae were crushed to the point that he would likely spend the rest of his life in a rehabilitation hospital, connected to a ventilator. His brain was not injured, however, so the family asked doctors to take Bowers out of a drug-induced coma to learn what he wanted them to do. He said he had lived a great life and it was time to go.

Abbey Bowers said her husband understood that he would never be able to hug or hold the baby she is expecting and that he did not want to spend his life in a wheelchair — a point he had made even before his accident.

Tim Bowers’ clear counsel might have eased his family’s minds even as their hearts were breaking, but it also points to the complexity of such cases, according to Abraham Schwab, a medical ethicist and associate professor of philosophy at Indiana-Purdue Fort Wayne. It also underscores the growing emphasis on honoring a patient’s wishes.

“Under the traditional doctrine of medical paternalism, this would have been much harder for the medical professional to do,” he said of the decision to end life support. “But patients have been given more authority to direct the course of their lives.”

Schwab said the role of patient autonomy comes with limits, however. Life-or-death decisions can only be made if the patient is competent to decide.

In Bowers’ case, he had expressed his wishes even before his injury, but such cases aren’t always so clear. Schwab said spinal cord injuries can result in depression, for example.

“It might color the decision,” he said. “Our predictions about how we will feel in the future can be wrong. It’s important to determine if this is a snap judgment or a persistent decision — ‘this is clearly what I want.’ “

Schwab, speaking from a medical and research ethics conference in Boston, said the tragic case emphasizes the care that must be taken to ensure a patient is competent to make the decision.

For the Bowers family, it is surely the realization of a worst nightmare; for the rest of us it is a reminder that the best time to consider tough questions is well before we face them.

— The Journal Gazette, Fort Wayne

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