Washington State Voters May Grant the Right to Die : Medicine: Pioneering ballot measure could make doctor-assisted suicide a legal option for terminally ill.

Venturing off the map into waters deep and uncharted, Washington state may soon become the first jurisdiction in America, the first in the Western World, where citizens can hasten their own impending deaths with the assistance of their doctors, legally.

“Death with Dignity” is what Initiative 119’s grass-roots sponsors call their November ballot proposition. They might also describe it as a boiling mutiny against the health care Establishment--against the traditions of physicians, the covenants of hospitals, the protocols of nursing homes and also against the dogma of important elements of the clergy. It is a mutiny stirred by fear that humanity is becoming a slave to advancing medical technology.

Opponents see Initiative 119 as a fearsome, profound change in American values--a leap into a future where life is cheapened, where the weak are stripped of their slender hopes, where doctors become licensed killers, where death becomes a treatment option and where disposing of the dying becomes a means of cutting medical costs.

In other words, voters of Washington state go to the polls Nov. 5 to carve a mark in history: They can, for better or worse, usher in the modern age of euthanasia. Or they can significantly set back America’s expanding right-to-die movement.

If successful here, the initiative is certain to inspire ballot measures in other states. In California, backers of the movement already are preparing just such a campaign.

Placed on the ballot after a citizen petition drive, the Washington initiative seeks to legalize doctor-assisted suicide in cases where patients have been found by at least two doctors to be terminally ill, with six months or less to live. The means of assisted death is not specified, but advocates expect that it would be by a lethal dose of drugs, given orally or by injection.

Additionally, the initiative seeks to end ambiguity in the state’s natural death law to make absolutely clear that individuals can specify in advance that they wish to be given no forced feeding or water. This provision has become commonplace in the laws of many states, including California.

But no state and no Western government has given legal sanction to physician-assisted death for the terminally ill.

In the most celebrated U.S. case of modern times, a judge last year dismissed murder charges against a Pontiac, Mich., pathologist who built an intravenous apparatus that allowed a deteriorating Alzheimer’s patient to end her life with a lethal solution.

The doctor was later barred by a judge from using the device again.

In the proposed Washington state law, such an Alzheimer’s sufferer probably would not be able to receive physician assistance in dying because such patients typically are not found to have six months or less to live.

The case for the initiative is advanced poignantly through the testimonials of patients and families who have endured suffering in what they believe are deaths prolonged.

Harold Fogelquist of Redmond, Wash., came forward recently on behalf of the ballot measure to tell about the death of his mother, Freda.

Under a threat of legal action by the hospital if he did not acquiesce, he said he allowed his mother to be connected to feeding tubes against her will. She was kept alive for months after a stroke even though she resisted and pulled the tubes from her body several times. Finally, a feeding tube was sewn into her stomach, and her one good arm was strapped down.

“We essentially tortured her to death,” he told a news conference.

Through a long battle with bone cancer, Goldie Nickson was a moving advocate for the measure. She expressed a simple belief that someone who lived life fully should not have to face the agony of unbearable pain that accompanies the final weeks of a disease such as hers.

“I value life. But life to me is living. Not a living death,” she said.

On Sept. 3, she died. Her son, Douglas, said her worst fears came true--toward the end she lay immobilized, deformed by her collapsed skeleton, each breath bringing bolts of pain that 4,000 milligrams of morphine could not quell.

“Twenty-four hours a day for 3 1/2 weeks she was locked in a pain cellar, a pain hell,” said Douglas, who has taken up the campaign on her behalf. “It’s time people have an option. . . . We’re talking about life at the end of the trail, when the only question is how much pain do you have to endure before it’s over.”

The campaign over Initiative 119, however, is also debated with plenty of punch in the realm of the philosophical and theological. If death is made easy, what then?

Sister Sharon Park of the state Catholic Conference, a leading opponent of the ballot measure, describes the final days of former Republican National Chairman Lee Atwater as a reason people should not fear the end of life and not hurry to embrace it.

Atwater was the young political strategist who managed George Bush’s presidential campaign and built himself a colorful, tough-guy image. When he was found to have brain cancer, he fought gamely and lived to share his regrets about some of the people he hurt in his galloping quest to win elections. When he died in March at the age of 40, he had many new admirers.

“Only in dying did he see what life was about,” Park said. “Dying is part of the human experience, a constitutive element of our own humanity. In death, people do things and teach us things (that) they never did in their lives. They focus on the important things, they forgive and they prove to us what are the mundane things in life and what are the essentials.”

Leon R. Kass, a physician and professor of social thought at the University of Chicago, argues passionately that doctors should never be asked or allowed to cross the line and kill.

“Once physicians get it into their minds that death is an acceptable ‘treatment option,’ their ability and willingness to be wholehearted defenders of the patient’s best interests will be profoundly compromised,” he said.

The back-and-forth debate also asks voters to think about a broad range of social assumptions.

On the pro side:

Initiative 119 is a matter of personal choice, pure and simple. No one is forcing this on the unwilling. Doctors can refuse if they wish. Yes, there may be some dangers of abuse, but all freedoms carry such risk--and this law carries less risk of harm than such freedoms as granting driving privileges to 16-year-olds or allowing gun ownership for virtually everyone. No one should have to endure relentless pain in the modern age, and there is no way to control pain in the final stages of some illnesses. True enough, this may seem like a huge step in the 4,000-year history of Western Civilization, but is it really any bigger step than granting universal suffrage or racial equality?

On the con side:

What starts out as a right is sure to become a duty. Grandma is sick and is draining family resources, is it not time for her to check out? Wanting to end one’s own life and avoid pain is much different than demanding that health care professionals end it for you. If you do not trust doctors and hospitals now, why trust them with more life-or-death power? There are ways to control pain so that the overwhelming majority of the dying can escape anguish.

Public opinion polls have shown that two-thirds of Washington voters favor the concept of physician assistance in dying. But the history of voter initiatives shows that support for a general concept does not always give rise to passage of a proposition.

Opposed to Initiative 119 are Washington state’s medical and hospital associations along with organizations of nursing homes and hospices. The state’s leading anti-abortion group, Human Life of Washington, has emerged as a major contributor to the opposition campaign. Fundamentalist religious leaders have joined the Catholic Conference in opposition and in voter registration drives.

So far, the vote-no campaign says it has raised about $200,000 and has been first to launch a television campaign.

Supporting Initiative 119 are the Hemlock Society, the Gray Panthers and other groups of elderly activists, a range of organizations concerned with acquired immune deficiency syndrome, the Unitarian Church, the United Methodist Churches of the Pacific Northwest and liberal and libertarian political organizations.

Supporters say they expect to raise and spend $1 million or more, probably setting a state record for a citizen-sponsored initiative.

Researcher Doug Conner assisted with this story.