A year ago, voters in Washington state defeated a measure that would have legalized physician-assisted suicide. This campaign season the right-to-die spotlight is focused on California, where voters are being asked to approve a proposition similar to the Washington state proposal.
Once again, the arguments are raising heated passions on each side. Supporters argue that people with terminal conditions should be able to control the timing of their death, and that good medical care should include allowing physicians to help them do so.
Opponents maintain that doctors should preserve lives, not end them, and that passing such legislation would create unintended opportunities for abusing the process.
However you describe the issue -- aid in dying, physician-assisted suicide, mercy killing, death with dignity, legalized euthanasia -- it's one that is likely to be with us for years to come, regardless of the outcome of the California proposition.
Given the difficulty this country has in coming to terms with life-and-death issues like abortion or physician-assisted suicide, political campaigns with their charges and countercharges may not be the best setting for this kind of debate. But the exercise in democracy represented by a referendum may be the closest thing we can get to a thoughtful examination of the issue.
As in Washington last year, public-opinion polls in California show that a majority of voters support the concept of physician-assisted suicide, but that doesn't mean the measure will pass. This is a close-to-the-bone issue, and polls don't necessarily hold true. In Washington state, the measure was defeated by a margin of 54 percent to 46 percent despite polls that showed strong support several weeks before Election Day.
Some observers blamed the defeat in part on Jack "Dr. Death" Kevorkian, the retired Michigan pathologist who has used various suicide devices to help several women die. Only days before voters went to the polls last November, Dr. Kevorkian struck again, assisting in the death of two women in a Michigan park.
Those women would not have qualified for aid-in-dying under either the Washington or the California proposal, since they were not terminally ill. Their conditions were chronic, but would not cause death within six months.
The California proposal is considered somewhat narrower than the one defeated in Washington last year. Even so, many groups are opposing the measure on the grounds that it does not contain enough safeguards against abuse.
The bogyman many opponents raise is the maverick physician who seems to get a thrill from helping people die. But the greater dangers are the more subtle ones. At a time when access to health care as well as the cost of treatment are critical national issues, many people worry that the availability of physician-assisted suicide will allow financial considerations to influence decisions about life and death. They have a point.
There are times when giving a patient control over the final days of life can free him up to live more fully in the days he has left. Dr. Timothy Quill found that to be the case when he prescribed an overdose of barbiturates for a woman dying of leukemia. He later wrote about the case in the New England Journal of Medicine.
No doubt there are many Dr. Quills, physicians who care passionately about their patients' best interests. And there is no doubt that physician involvement in a patient's death happens more than we admit.
But there are also plenty of people -- including many physicians -- who don't want to legalize physician-assisted suicide.
One alternative is the method used in the Netherlands, in which physician involvement in the suicide of a terminally ill person is not legal, but is not prosecuted as long as certain conditions are fulfilled.
Could Americans accept that kind of ambiguity? Judging from our record on life-and-death issues, probably not. That's why we're likely to see right-to-die campaigns in many states, regardless of the outcome in California.