US: Oregon is alone in US to allow assisted suicide. Now California seems set to emulate it. Nancy Vogel reports on the Oregon experience.
On a Sunday morning in late January, with cancer consuming his lungs and bones, David Prueitt swallowed a cupful of apple sauce mixed with the bitter powder of 100 barbiturate pills. In six minutes, the once- rugged logger fell asleep. His wife, Lynda, watched his chest rise and fall and waited for him to die.
Prueitt (42) expected to become one of more than 200 critically ill Oregonians who have taken the end of life into their own hands under the state's assisted suicide law, which took effect in 1998.
But he didn't die. He slept for three days, then he woke up. "What happened?" he asked his wife. "Why am I not dead?"
Later, Lynda Prueitt says, he told her that he had been in the presence of God while unconscious. "God told him, 'This is not the way to get into heaven'," she said.
Prueitt, the only person to have survived a full dose of the barbiturates prescribed under the law, succumbed to his cancer two weeks later, but his story has lived on, fuelling debate over the Oregon law.
Now California lawmakers are considering a bill that would essentially copy Oregon's Death With Dignity Act, the only assisted-suicide law in the US.
The bill would free doctors from liability in prescribing lethal doses of drugs to terminally ill people and, as the law has done in Oregon for seven years, allow those with incurable diseases to obtain a lethal prescription after asking for it once in writing and twice orally, then waiting two weeks.
As in Oregon, the California law would require that they ingest the drugs themselves.
Californians on both sides of the issue are looking to Oregon's example for evidence to support their cases.
In Oregon, the worst-case scenarios cited by opponents - that people would move to the state from all over the US to die, that inheritance-hungry children would coerce elderly parents to take the lethal drugs - have not come to pass. But the law has continued to raise thorny issues, such as those in Prueitt's case, which is being investigated by the state Board of Pharmacy.
Between 16 and 42 people have ended their lives each year through legally sanctioned suicide since the law's passage. Eight to 26 others each year have obtained the prescriptions but not used them.
Those who have opted to end their lives with physician assistance are almost evenly split between men and women, with a median age of 69. They are as likely to be Republicans as Democrats. Most have cancer, Lou Gehrig's disease or chronic respiratory illness.
They tend to be better educated and are more likely to be divorced or never married than other Oregonians dying of the same diseases. Residents of the more rural eastern part of Oregon were less than half as likely to use physician-assisted suicide as those in the more urban west, according to state reports. Doctors of those who request help hastening their deaths say that the most frequently mentioned end-of- life concerns are a decreasing ability to do the things that make life enjoyable, loss of autonomy and loss of dignity.
One issue raised by opponents when the Oregon law was first debated was whether the drugs would consistently work without causing other side-effects, like vomiting. Proponents dismissed those concerns but between 1998 and 2004, 10 people have regurgitated the drugs.
Most still died fairly quickly - half of those who took the medication died within 30 minutes - but one person who regurgitated the drugs last year lingered for 31 hours.
Prueitt's case was the most exceptional. Still, his story has become a rallying cry for opponents of assisted suicide.
Physicians for Compassionate Care, a group of doctors and other health professionals opposed to assisted suicide, issued a news release saying that Prueitt "proved the reality that dying by overdose is not easy, comfortable and certainly not dignified".
Lynda Prueitt, who reluctantly agreed to help her husband obtain the lethal prescription, tells his story because he asked her to do so to warn others. But she reflects the majority of Oregonians, who defend the law. "Leave it up to the people," she said. "Whatever happens between them and God, that is between them and God."
Even the most ardent opponents acknowledge that the best chance of overturning the law comes from the Bush administration, which in 2001 interpreted the federal Controlled Substances Act to ban lethal barbiturate prescriptions.
Federal courts have so far ruled against the Bush administration and upheld Oregon's law. Last November, then-Attorney General John Ashcroft appealed to the US Supreme Court, which agreed to hear the appeal in its next term, beginning in October.
Oregon voters first passed the Death With Dignity Act in 1994 by 51 per cent-49 per cent. The National Right to Life Committee immediately went to court and succeeded in delaying its implementation.
In October 1997, the Supreme Court rejected that challenge, saying states had the right to set their own courses on assisted suicide. The divided Oregon legislature put its repeal on the November 1997 ballot. More debate only led to greater support. No other state has followed Oregon.
California weighed the issue in 1992, with an unsuccessful initiative that would have legalised euthanasia by allowing doctors to give fatal injections.
Experts can't say exactly why Oregon forged this path but the state has long stood out on end- of-life care, with high rates of morphine use for the dying and a greater percentage of its residents than the national average receiving hospice care and dying at home instead of hospitals or nursing homes.
Oregonians are also less connected to established churches than the rest of the US.
The original campaign to pass the law was heated, with the opposition financed heavily by the Catholic Church. Adverts warned that if the law passed, people would die in large numbers of horrible deaths or that doctors and pharmacists would refuse to participate.
Former Governor Barbara Roberts, who supported the law, called the ads in 1997 less "ugly" than those of 1994. "Death came out of the closet," she said. "People were used to talking about it and there was a comfort level people had in '97 that was not there in '94."