Every day, the United States Congress and the president make decisions profoundly affecting Americans and their families. Sending US troops or diplomats into harm's way, for example, or setting policy regarding capital punishment or abortion.
But what is the federal government's legitimate role in deciding how and when people may choose to continue - or to end - their lives?
This is the essence of the national debate over physician-assisted suicide, which now is being argued in state legislatures, federal courts, and Congress.
The House Judiciary Committee last week approved a bill that could overturn the state of Oregon's landmark law allowing doctors to provide patients the means to commit suicide. A companion to this bill - which is strongly backed by the National Right to Life Committee and the Roman Catholic Church - is proceeding in the Senate as well.
"I am worried about the culture of death that seems to have overtaken this country," says Rep. Henry Hyde (R) of Illinois, chairman of the House Judiciary Committee and sponsor of the Lethal Drug Abuse and Prevention Act. The measure would prohibit doctors and pharmacists from dispensing any federally regulated drug for the purpose of suicide.
Supporters of Oregon's law - approved by voters in a 1994 ballot measure and reaffirmed by another initiative in 1997 - note that since the measure passed legal muster last October, only five people here have ended their lives in accordance with the law's regulations. (It applies to mentally competent adults who declare their intentions in writing, are diagnosed as terminally ill, and take the drug themselves orally after a waiting period.)
Lower-level courts across the country have given conflicting signals regarding the procedure. The US Supreme Court ruled a year ago in a New York case that there is no constitutional right to commit suicide, but the high court also indicated that it is up to the states to decide the issue.
Still, lawmakers opposed to assisted suicide are trying to quell any movement by states to follow Oregon's lead. "It is essential that Congress does not remain silent," says Sen. Don Nickles, (R) of Oklahoma, assistant majority leader and author of the Senate bill.
At the moment, it does not appear that Senator Nickles need worry about a mass movement among states to approve assisted suicide. It is outlawed in 36 states and criminalized in seven more states under common law. Yet there are efforts in many states to legalize the procedure, including several ballot measures. The question will be put to voters in Michigan this fall, and supporters in Maine are gathering signatures for next year's election.
Public opinion, at least according to the polls, generally supports the right to ask for and receive the means to end one's own life under certain circumstances. A national survey last month sponsored by the group that wrote and promoted Oregon's successful initiative showed that 69 percent favored Oregon's approach. An even higher figure (75 percent) oppose congressional efforts to overturn Oregon's law, according to the poll. Other national polls have brought similar results.
But opponents argue that such polls seldom use the words "suicide" or "assisted suicide." And how a person feels about the issue when confronted with it personally or for a loved one is harder to gauge than it is in the abstract.
As with abortion, the issue becomes one of "the right to choose" for many people, but states' rights are involved as well. "Does this Congress ... believe it is better equipped than the citizens of my state to make moral decisions about acceptable medical practice in Oregon?" asks Sen. Ron Wyden (R) of Oregon, who personally opposes doctor-assisted suicide but argues against the bills now being discussed on Capitol Hill.
The current congressional debate has made for an odd grouping of interest groups.
The American Medical Association (AMA) and professional hospice providers both oppose physician-assisted suicide. But they also oppose congressional attempts to prevent the practice under federal drug-control laws.
"We agree with the sponsors that physician-assisted suicide is ethically incompatible with the physician's role as healer," Thomas Reardon, head of the AMA, told a House hearing last month. But expanding the Drug Enforcement Administration's power to cover doctors "would be an unacceptable federal intrusion over matters of state law regarding the practice of medicine," Dr. Reardon said.
Those who care for patients diagnosed as being at a stage approaching the end of life say more strictly regulating drugs that the medical profession uses to relieve extreme discomfort could have unintended harmful results - especially if doctors believe they could be prosecuted under federal law.
"We believe that this bill, while intended to curtail physician-assisted suicide, will actually increase suffering," Joanne Lynn, head of a nonprofit organization of hospice physicians, told the Senate Judiciary Committee recently. "Paradoxically, that increased suffering, and the fear of suffering, will increase the demand for physician-assisted suicide."