A year after Oregon's "Death with Dignity" law made it legal for physicians to help certain patients take their own lives, this profound and controversial measure has begun to have significant impact across the United States.
It has prompted a congressional attempt to restrict the use of certain federally controlled drugs that could expedite death. It has accelerated the use of hospice and palliative care for patients diagnosed as terminally ill. Above all, it has become a major issue for religious and other groups commonly associated with the fight to prevent abortion.
Gary Bauer, head of the conservative Family Research Council and a possible candidate for the presidency, recently called the fight to prevent physician-assisted suicide "the front line of the battle to protect the sanctity of human life."
Other anti-abortion organizations have weighed in as well.
Burke Balch, medical ethics director for the National Right to Life Committee, says doctors who provide drugs designed to take a patient's life and pharmacists who prescribe such drugs "should have their licenses revoked."
Religious groups weigh in
Meeting in Washington this week, Roman Catholic bishops are working on a proposal to make assisted suicide - along with abortion - one of the church's top political priorities.
The Church of Jesus Christ of Latter-day Saints actively opposes the practice as well. Mormon Church officials have declared that hastening the end of one's life undermines the "measures designed to maintain and strengthen the family as the fundamental unit of society."
Church spokesman Don LeFevre recently told the Deseret News in Salt Lake City that taking part in suicide or euthanasia "violates the commandments of God."
Following Oregon's groundbreaking move, critics warned there would be a spurt of secretive Kevorkian-type demises, that out-of-staters would rush here to commit suicide, that safety measures built into the law would fail and strictly controlled suicide would become involuntary euthanasia.
None of that has happened. Only about a dozen individuals have ended their lives under the law, which requires a 15-day waiting period and a second opinion as to the patient's mental condition, and which specifically prohibits "lethal injection, mercy killing, or active euthanasia." Caution seems to have been the byword as medical professionals and their patients move into this controversial new world touching on the most profound of questions.
"This law is well-crafted, it is safe, workable, and provides both doctors and patients a clear path to follow in the final days of life," says Barbara Coombs Lee, a nurse-turned-lawyer who helped draft the law and is now executive director of the Portland, Ore., group Compassion in Dying.
Nor has Oregon's closely-watched experiment spread to other parts of the country. Earlier this month, voters in Michigan (where retired pathologist Jack Kevorkian has assisted in some 120 suicides that officials say were illegal) overwhelmingly rejected a ballot measure similar to the one Oregon voters approved in 1994 and again in 1997. The biggest donors to the successful effort to defeat the measure were the National Right to Life Committee and the Catholic Church.
Religious and anti-abortion groups are pushing proposed legislation that would outlaw the use of any federally controlled drug to assist patients' suicides. Among congressional leaders behind the measure are Rep. Henry Hyde (R) of Illinois, a longtime abortion foe.
"I am concerned about old people who don't want to be a burden on their families," says Mr. Hyde, who adds that he is motivated by his "reverence for life ... in the womb or in the hospital bed."
Hospice care as alternative
Meanwhile, both sides in the debate are cheered by the increasing use of hospice care (which provides physical, emotional, and spiritual comfort in a home-like setting) and the use of palliative drugs to alleviate discomfort in patients whose cases are diagnosed as terminal - both seen as alternatives to taking one's own life. According to the federal Drug Enforcement Administration, the use of morphine has approximately doubled in the United States since the debate over officially sanction suicide began about six years ago.
The American Medical Association (which opposes physician-assisted suicide) fears that legislation like Hyde's would inhibit doctors from trying to relieve their patients' discomfort. But some medical professionals are concerned widespread use of such drugs could become a way to hasten death without going through the kind of formal procedures now in place in Oregon.
"Physicians are increasingly being pushed into a role of hastening death," says Patrick Pullicino, a neurologist in Buffalo, N.Y., and spokesman for the group Physicians against Euthanasia, Assisted Suicide, and Withdrawal of Nutrition. "This is contrary to many physicians' concept of their healing role."