Oregon is voting - again - on whether doctor-aided death will be a legal choice.
In a vote that is stirring unprecedented debate about issues of life and death, the only place in the United States that has legalized physician-assisted suicide is reconsidering its stand.
In the past, most Americans have said they favor patient "choice" in the matter. But Oregon's mail-in vote, which ends tomorrow, comes at a time when public opinion may be shifting.
And as the issue moves from the theoretical to the legally possible, there's no question that it is raising profound medical, religious, and ethical questions. Among these:
How should respect for the sanctity of human life be weighed against a choice involving "death with dignity?"
For those diagnosed as terminally ill, does hospice care allow for an emotional or religious experience - for family members as well as for patients - that suicide or euthanasia would eliminate?
How does all of this fit into current discussions about medical "cost containment" and universal health care?
Americans may be wavering in their support for assisted suicide because it really means allowing for another form of killing, says Courtney Campbell, a medical ethicist and philosophy professor at Oregon State University in Corvalis. "Whenever we've legalized the taking of another human life, whether it be cases of self-defense, capital punishment, or warfare, we've never been able to regulate it very effectively," she says. "We'd be setting ourselves up for that with the taking of life in medicine."
Others who track the issue disagree.
Margaret Battin, a bioethicist and professor of philosophy at the University of Utah in Salt Lake City, believes that safeguards can be built in so that individuals are not coerced into committing suicide simply to avoid medical costs that might burden their families.
Legally providing "an easy and gentle way of dying" to people who believe they have no other option can be a comfort to the family as it "says its final goodbyes and then begins the grieving process," adds Dr. Battin, who has written extensively on the subject.
And just as it is now common practice to sign "living wills" directing doctors and family members not to use extraordinary life-prolonging measures, she says, people can also sign "living won'ts" explicitly rejecting physician-assisted suicide or euthanasia.