In the end, peace of mind

OREGON IS A good place to live, especially if you’re dying. It’s the only state in the nation that gives you a choice about how and when to die. Physicians in Oregon are allowed to give terminally ill patients a lethal prescription -- a hefty dose of barbiturates, in liquid form to make swallowing easier.

There are safeguards: The patient must be an Oregon resident, ascertained to be of sound mind by two physicians, put his or her wish to die in writing and observe a waiting period; the physician may be present during the death but may not assist directly.

I would have been grateful for such a law 22 years ago when I helped my mother die. She was in the last stages of ovarian cancer and dying slowly and horribly. She had had, by her own estimation, a wonderful life, “but now it’s over,” she said in her hard-headed, straight-shooting way. “Get me out of this.” So with great difficulty and fear -- both of being found out and not doing it right -- I did. We were lucky. She got out. She died peacefully, painlessly, gratefully -- like others in Oregon do today.

But Oregon residents will lose their unique right to die if the U.S. government has its way.

On Oct. 5, the Supreme Court is scheduled to hear arguments that could result in the end of the state’s Death With Dignity law, even though the residents voted in favor of it twice. The case, begun by then-Atty. Gen. John Ashcroft, argues that dispensing drugs for a suicide does not serve a “legitimate medical purpose” under the federal Controlled Substances Act.

Should the Death With Dignity law be struck down, not only would physicians no longer be able to openly help desperate patients die, they would also risk prosecution if they treated a patient for extreme pain and the patient accidentally died. It would mean giving unprecedented power to the federal Drug Enforcement Administration to inject itself into the practice of medicine. An inevitable result of that, say physicians who support the law, would be under-medication for pain -- a persistent and cruel problem in American medicine as it is. And whatever improvements there have been in pain management would be set back, the doctors say, interfering with private medical decisions made between them and their patients.

The Oregon law has been in place for about a decade, and probably the biggest surprise to supporters and opponents alike is how few people have taken advantage of it -- between 16 and 42 a year. That number makes some people wonder: Why bother trying to keep Oregon’s law in place, and encouraging other states to enact similar laws?

A fair question, but anyone who has seen how patients react when, at last, they hold in their hands a potion that will end their suffering, knows the answer. When my mother learned she had a way out of life, she became herself again. I know this because she began bossing me around. Sitting straight up in bed, she pointed at her closet. “There’s an awful hat I bought in Bloomingdale’s on the top shelf. Don’t forget to return it.” When I rolled my eyes, she looked at me sternly. “I mean it,” she said.

A couple of years ago, I went to Oregon and met with some people who had qualified under the law and had received the means to die. They were more cheerful than a lot of healthy people I know. One of them, a crusty old guy in Portland with a girly magazine on his coffee table and a framed photo of his hospice nurse on the mantle, let me know that the vial was in his basement, where, he told me with a half grin, “it’s nice and cool.”

He was not among those who took a lethal dose. He died on his own -- but he didn’t have to, and he knew it. He knew he had only to make a short trip to his basement to be rescued from life if he wanted to be.

Peace of mind. That is the point. And control. For some people, like my mother, they are one and the same. Study after study shows that what very sick people fear most is not death but pain, misery and the loss of control.

It’s hard to measure fear, but you know it when you feel it and when you see it. And when fear dies, you know that too. That’s why the Oregon law is important. A lot of fear has died in Oregon. And it’s not only among people who are sick. I would guess that, for every person who takes advantage of the law, there are thousands of others who are comforted knowing the law is on the books -- just in case.

Many of us in the other states want that comfort too. An April Harris Poll showed 70% of respondents answered “yes” when asked if terminally ill people should be allowed to die with a physician’s help. If Oregon loses the battle to preserve its law, the comfort Oregonians now have will be lost to them -- and most likely to all of us.