This week, the Bush administration went to the Supreme Court to challenge Oregon’s physician-assisted suicide law, which was passed twice by voters in the state.

If the government wins the case, it could move to shut down a law that supporters say has been helping hundreds of Oregonians die with dignity since 1998. Oregon is the only state in the nation with a physician-assisted suicide law.

Like last year’s medical marijuana suit, this week’s case will prove to be a key test in how far states can go in setting their own medical policies when those laws violate federal statutes. It could also prove to be a decisive moment for doctors operating under a controversial law that continues to enjoy the support of most Oregonians.

More than 200 terminally ill patients have ended their own lives under the state’s Death with Dignity Act in the nearly eight years since it was enacted. Thirty-seven of them -- mostly cancer patients -- died in 2004, accounting for about one in every 800 Oregon deaths, according to the state.

Who Chooses Physician-Assisted Suicide?

How the Law Works

Oregon allows terminally ill adult patients who are expected to die within six months to seek a doctor’s prescription for a lethal dose of medication. Patients must be at least 18 years old and a resident of the state. Under the law, patients must make verbal requests for assistance on two separate occasions at least 15 days apart.

The patient must also submit a written request -- signed by witnesses -- to his attending physician. The physician then has to consult with a second doctor to confirm the terminal diagnosis and determine that the patient is mentally competent and is not suffering from a psychiatric disorder that could impair decision making. The attending physician must request that the patient notify next of kin regarding the prescription. At any time, the patient may change his or her mind.

Doctors also have to inform patients about alternatives to suicide, including hospice care. After that, they are authorized to write a prescription for a lethal dose of medication, in most cases barbiturates -- tranquilizing drugs that can stop the heart. Prescribing physicians must be MDs or DOs who are licensed to practice medicine by the Oregon Board of Medical Examiners. It is important to note that the patients take the prescribed medication on their own.

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Who Are the Typical Patients?

According to state statistics, the average patient requesting assisted suicide is a 69-year-old cancer patient, though people as young as 25 have used the law to end their own lives.

Still, close to half of the prescriptions written under the law are never used, the state says. Instead, the orders are used as “an insurance policy” against debilitating pain by many patients facing predictable decline and death, says Barbara Coombs Lee, president of Compassion and Choices, a group that lobbied for Oregon’s law.

According to Lee, terminally ill patients often face months of relatively normal living followed by a steep drop in mental and bodily functioning about two weeks before natural death.

“They are waiting to see if that decline includes unbearable suffering. If it doesn’t, the medication goes unused. If it does, they have the medications in possession and they can use them,” Coombs Lee says.

That does little to assuage opponents, who see assisted suicide as devaluing life and a potentially dangerous shortcut to providing the best end-of-life care possible.

In a report last week, the President’s Council on Bioethics strongly condemned assisted suicide, along with euthanasia, and warned that the practices could become more commonplace as the nation’s elderly population doubles in the next 50 years.

“This is going to be an increasing temptation, we have to guard against it,” Leon Kass, MD, the council’s chairman, told reporters.

The Supreme Court ruled in 1997 that dying patients have no constitutional right to assisted suicide. That decision cleared states to pass their own laws, as Oregon voters soon did. An April Harris Interactive poll this year concluded that two-thirds of U.S. adults now support Oregon’s effort.

If the Bush administration wins the case, the federal government will gain the authority to use the Controlled Substances Act to prosecute doctors who prescribe drugs for assisted suicide. Such a ruling would not bar other states from passing assisted suicide laws of their own, however.

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By Todd Zwillich, reviewed by Louise Chang, MD

SOURCES: Seventh Annual Report on Oregon’s Death with Dignity Act, Oregon Department of Human Services, March 10, 2005. Barbara Coombs Lee, president, Compassion and Choices. Leon Kass, MD, PhD, chair, President’s Council on Bioethics. Harris Interactive Poll, April 27, 2005.