PERSPECTIVE ON SUICIDE : Death Emerges as a Civil Liberty : The battle for the right of the terminally ill to choose how and when to die takes a major step forward in Oregon.

Choice over whether to live longer while suffering or to die sooner with dignity has finally arrived. For some, this signals the beginning of the end of a 1,600-year-old Judeo-Christian tradition against voluntary death; for others, it is the ultimate civil liberty.

Two recent, but very different, events heralded this new era:

First, Oregon voters passed a law permitting limited physician-assisted suicide for the terminally ill.

And then in Massachusetts, Billy Best, a 16-year-old with cancer, declined medical treatment that might save his life.

The breakthrough on choice in dying has been 20 years in gestation. High-tech medicine became widely available in the 1970s, spawning the significant Karen Ann Quinlan case in New Jersey in 1976. Through her ordeal--and that of her parents--the public learned that people previously considered as good as dead could be kept alive in a twilight world almost indefinitely by machines.

In the immediate wake of that case, California passed the world’s first living-will legislation, which has been copied and improved upon throughout America and elsewhere in the world.

Billy Best’s story brought attention to a little discussed aspect of the double-edged sword that is modern medicine: Do some treatments aimed at curing or slowing a disease have such unbearable side effects that a patient is right to refuse them, even if death is thereby hastened?

This was Billy’s case. After he began chemotherapy last August to treat Hodgkin’s disease, a form of lymphatic cancer, his hair fell out, his jaw ached and he was often left with a metallic taste in his mouth. He complained of severe nausea, aches and pains. When he protested against the chemotherapy, his parents insisted that he stay with it because there is a high cure rate when this disease is caught early and treated promptly.

So Billy packed his things and ran away from home. “I felt like the medicine was killing me instead of helping me,” he said upon his return home weeks later. His chastened parents then promised that there would be no more pressure.

Although only 16, Billy seems intelligent enough to make his own decisions. Probably there was poor communication between him, his health professionals and his parents. I hope he changes his mind and tries again for a cure, perhaps a different one.

Almost simultaneously, on the other side of the nation, Oregon voters initiated a world first by passing a ballot measure that, as of Dec. 8, permits doctors to fill terminally ill patients’ requests for prescriptions for lethal overdoses of drugs. There is a thicket of safeguards, such as two waiting periods, second opinions, documentation, family notification and mandatory counseling by the doctor on pain control, depression and hospice alternatives, that must be gotten through before the cup of hemlock is dispensed. Injections are forbidden.

This law does not oblige anybody to do anything. Health professionals, hospitals, patients with different ethical values can ignore it. But those who want to escape their suffering by an accelerated death now have a choice.

All that has happened is that a procedure that was illegal and covert is decriminalized in Oregon. It will bring great comfort to thousands of dying people just to know this escape route is there.

But a firestorm of controversy is building over the new Oregon law. The religious right and hospice community have already vowed to repeal it, either through the courts, the Legislature or another initiative. The National Right to Life Committee has filed a lawsuit trying to block implementation. Staggered that the measure passed, the medical profession is nursing feelings hurt by the voters’ implicit criticism of their care of the dying. From now on, the dying in Oregon will receive the best terminal care known to world medicine because no doctor wants to be labeled as “the first” to assist a suicide.

The Oregon public believes life to be sacred, but we deny its sacral quality when it degenerates to the point of being unbearable and meaningless to the individual. Organized religion is offended by this attitude.

The bruising, 25-year battle over the rights of the unborn is about to be replaced by a much bigger nationwide struggle for the right to choose to die.