THE profound debate over an individual's ``right to die'' is being pushed into more difficult ethical, professional, and - inevitably - political ground.
Both supporters and opponents of assisted suicide see the issue as the equivalent of abortion, in both social and legal importance. A federal court case launched recently in Washington State could well become the next ``Roe vs. Wade'' for judges to decide.
In Oregon, there is a petition campaign for a ballot initiative to allow doctors to provide ``death with dignity'' by prescribing lethal medication for patients diagnosed as terminally ill and specifically requesting such medication.
Proponents of the Oregon measure say it has many safeguards not included in similar measures defeated in Washington State in 1991 and California a year later. Since then, public opinion (including many medical doctors) has moved in favor of physician-assisted suicide.
A national Harris Poll in December showed 73 percent agreeing that ``the law should allow doctors to comply with the wishes of a dying patient in severe distress who asks to have his or her life ended.'' This is a 10-percent increase from eight months earlier.
Meanwhile, the trial of Michigan doctor Jack Kevorkian, charged with violating state law banning assisted suicide, has drawn international attention. (At this writing, the case was in the hands of the jury, which had taken the weekend off.)
Opposition to physician- assisted suicide comes mainly from the medical establishment (including the American Medical Association and state medical groups), the Roman Catholic church, and anti-abortion groups.
``It's a real devaluation of human life,'' says Kay Estes, who works with Oregon Right to Life, which includes a political action committee supporting candidates opposed to abortion and assisted suicide. ``It comes down to people allowing doctors or families deciding whether a person has quality of life.''
``It's a real big issue,'' she adds. ``It may even become larger than abortion.''
At the moment, such opponents have the political edge. Thirty-three states have laws banning assisted suicide. There have been recent attempts in four states to make assisted suicide legal (Connecticut, Rhode Island, Texas, and Wisconsin). But in no state has such a bill passed.
The group ``Compassion in Dying,'' which provides information and counseling on suicide to those diagnosed as terminally ill, is challenging Washington State's ban on assisted suicide on the grounds that it violates the 14th Amendment to the United States Constitution. Both the group and its opponents expect to see the case (brought on behalf of four Seattle physicians and three patients) decided in federal court - perhaps eventually in the United States Supreme Court.
Signature-gathering to challenge the constitutionality of the Michigan law is being led by Dr. Kevorkian and the state Hemlock Society, an organization that supports the legalization of suicide. Three circuit judges declared the law unconstitutional last year; that decision is now before the Michigan Court of Appeals.
There also are efforts to challenge the constitutionality of suicide bans in the state legislatures of Florida and New York, says John Pridonoff, executive director of the Hemlock Society U.S.A., the national organization based in Eugene, Oregon.
The Oregon ``Death With Dignity Act,'' expected to be on this November's ballot, allows a patient diagnosed as terminally ill to request from his or her physician a prescription for a lethal amount of medication to be self-administered. There is a 15-day waiting period, a second medical opinion is required as to the patient's condition (including sound mental state), and the act specifically prohibits ``lethal injection, mercy killing, or active euthanasia.''
The issue is bipartisan in Oregon. A majority of those attending a recent conference of Republican officials approved the idea. State Democrats recently made ``right-to-die'' part of their platform. ``One of the amazing things to me is how many people we have working on the campaign who've never been active in politics before,'' says campaign director Geoff Sugerman.
The issue obviously is a struggle for medical doctors. A key tenet of the Hippocratic Oath sworn to by physicians is that ``I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.''
While President and Mrs. Clinton both have signed ``living wills'' (directing all life support measures be ended if signer is diagnosed as terminally ill), the administration is steering clear of the ``right-to-die'' issue as it pursues its national health care plan.
Opponents of proposals like the one in Oregon say it could lead to patients being coerced into taking their own life in order to avoid the high cost of extended medical care - particularly if some procedures are not covered under health insurance.