After a long political battle over the right to physician-assisted suicide, people in Oregon have begun to take their own lives with the help of doctors. But will this ethically and morally wrenching practice - still outlawed everywhere else in the world - spread to other states?
Given the rush to pass laws banning the practice elsewhere, that seems unlikely. And despite the warnings of opponents who continue to challenge the law in federal courts and in Congress, most experts doubt that Oregon will become for suicide what Nevada once was to quickie marriages and easy divorces - a magnet to out-of-staters.
In the five months since voters here overwhelmingly approved the "Death With Dignity" ballot measure, just two Oregonians are known to have used drugs prescribed under the law to commit suicide. Supporters say this is because of safeguards built into the statute.
Referring to a recent Oregon case, Faye Girsh, executive director of the right-to-die organization Hemlock Society USA said, "The woman was able to die gently, peacefully, quickly, and with certainty in the presence of her family, aided by a compassionate doctor who will not lose his license or go to jail."
Not everyone agrees with this assessment. Burke Balch, director of medical ethics for the National Right to Life Committee, called it the first step down a "slippery slope" from allowing patients the means to end their lives, to euthanasia - cases in which others make that decision for them.
In addition, there are other things that raise warning flags for medical ethicists and the public watching Oregon's unique experiment: the hospital worker in California who says he euthanized 40 to 50 patients whom he, and perhaps others on the medical staff, believed would soon die anyway. And Jack Kevorkian, who continues to defy authorities in Michigan by helping people kill themselves there - 100 so far, he claims.
Opponents of Oregon's groundbreaking law, including groups representing the disabled, raise the specter of Dr. Kevorkian and his "suicide machine" to argue their case. Mr. Balch warns that, should Oregon's model be followed, there will be "nonvoluntary euthanasia for those who cannot speak for themselves."
But in an echo of earlier debates about "back-alley abortions," supporters also cite the controversial Michigan pathologist to warn of "clandestine or violent methods when legal help is not available."
"Do we want more Oregons or more Kevorkians?" asks Ms. Girsh.
Under Oregon's law, a patient diagnosed as likely to die within six months may request a prescription for a lethal amount of medication to be self-administered orally. There is a 15-day waiting period, a second medical opinion is required as to the patient's physical and mental condition, and the act specifically prohibits "lethal injection, mercy killing, or active euthanasia."
Under the law, physicians and pharmacists may refuse to take any role in suicide. While this allows medical professionals to act on conscience, it also raises the possibility of having someone who may not know the patient well prescribe the drug. In one of the recent Oregon cases, two physicians refused the request, and the one who agreed had known the patient a short time.
And while the mental state of those opting for suicide is to be taken into account in applying the law, some medical experts worry that people may want to take their own lives primarily because of "clinical depression."
"Depression in the face of advanced illness is as treatable as it is in those who are otherwise healthy," says Eric Chevlen, medical consultant to the International Anti-Euthanasia Task Force, which advocates pain medication and hospice care for those diagnosed as terminally ill. "The treatment might include medicine, counseling, or prayer, but it surely does not include a lethal injection."
Polls indicate that most Americans do not object to the taking of one's life with a doctor's help under certain circumstances. But as theory becomes reality, the percentage of those approving the procedure has fallen in recent years from more than 70 percent to less than 60 percent.
THE US Supreme Court last year left it up to states to decide the legality of physician-assisted suicide, but it also ruled that there is no constitutional right to the practice. Chief Justice William Rehnquist warned that if legalized "it will prove extremely difficult to police and contain."
Reflecting this concern, a group of Oregon medical professionals recently visited the Netherlands. There, physician-assisted suicide is technically illegal but rarely prosecuted. Dutch officials estimate that some 4,500 cases of voluntary and involuntary euthanasia occur in that country each year - far more than the 500 annual cases of suicide using a doctor's help.
Most states explicitly outlaw assisted suicide or prosecute it under common law. Congress has forbidden the use of federal funds to carry out physician-assisted suicide.
In response to a query from Republican lawmakers, the head of the US Drug Enforcement Agency said it was his opinion that prescribing a drug for the purposes of suicide would violate the federal Controlled Substances Act. Attorney General Janet Reno is expected to announce soon whether she agrees with her subordinate's reading of the law.