The following correction was printed in the Observer's For the record column, Sunday December 19 2004
The article below claims the Royal College of Nursing has changed its position of opposition to euthanasia to one of neutrality. This, however, is not the case: the RCN continues to oppose euthanasia and assisted dying.
When Karen Yanoch was ready, 18 of her closest friends and relatives came to sit around her bedside at her home in Eugene, Oregon. Each of them had received a formal invitation to be with her in her final moments.
Yanoch, who was terminally ill with liver cancer, had decided to end her life by drinking a bitter solution of a lethal barbiturate. She took several small sips and then a final big gulp.
Three minutes later, lying in her bed wearing her favourite striped socks, she told those around her: 'I think I'm going to sleep now,' as she lapsed into a coma before dying shortly afterwards.
Yanoch's death last April was hard for her friends to take but they understood why she had opted to depart in her own way at a time of her choosing. She could do so only because the state where she lived had a law, the Death with Dignity Act, which allows what is known as physician-assisted suicide.
This week, an influential committee of the House of Lords will fly to Oregon to study how this law is working. At present, the committee is scrutinising a private members' bill which would legalise assisted deaths for the terminally ill.
The crossbench peer Joel Joffe, a retired human rights lawyer, is hoping to steer the bill through the Lords. If he succeeds it will be debated by MPs who are far less convinced of the case for voluntary euthanasia. It has already sparked off fierce debate about how society can best help the dying.
Joffe's proposals centre around the concept that voluntary euthanasia would be made available to patients in 'unbearable pain' who have less than six months to live.
They would have to undergo psychiatric and medical examinations and there would be a cooling-off period to allow them to change their minds. Tory peers vehemently oppose the bill which attracted 100,000 submissions of evidence during its consultation process, which ended earlier this year.
The bill is completely at odds with the present British law, which makes it a criminal offence, punishable by imprisonment, to assist anyone who tries to kill themselves.
But the peers have chosen to go to Oregon to look at how doctors there administer the scheme, and the kind of ethical dilemmas it raises.
On Friday they will meet Dr Nick Gideonse, a family doctor in Oregon's largest city, Portland. The softly-spoken Gideonse has helped five patients die using the Death with Dignity Act.
'Every case has its own complexities, and there are always mixed feelings about the process,' he said. 'But what I'm increasingly aware of is that the law, as it's designed, works well. It gives people an open avenue of communication about the things they care about, such as the ideas they have about what dying might be like as well as for the much smaller numbers who use the law.'
The figures on this back him up. Since the Act was introduced six years ago, nearly 180 people have been helped to commit suicide, but that is only around 1 per cent of the number who have requested information about it.
The latest figures show that most of the patients, like Yanoch, were terminally ill with cancer. Around 20 per cent had motor neurone disease.
Their median age at the time of death was 70, much older than some critics of the act had predicted. They have tended to be college graduates, better educated than the majority of the population.
The doctor says the people who use the law tend to have a long history of independence and self-reliance. 'It takes courage and quite a lot of strong will to do this, particularly when these people are really quite ill and have low reserves of energy,' Gideonse said.
The Oregon law is framed to allow adults with terminal diseases who are likely to die within six months to obtain lethal doses of drugs from their doctors.
They have to talk through the process with the doctor, and agree to have a full interview with a second physician to make sure that they are mentally competent. There is then a 15-day cooling off period when they can think about their decision. If they decide to go ahead after that, they have to see another doctor before approval is given.
But the Oregon law has provoked controversy in others parts of the United States. It has been fiercely opposed by President George Bush, whose stance has the backing of conservative Christian groups.
The American Appeal Court recently upheld Oregon's Act, ruling that the Attorney General, John Ashcroft, had overstepped his authority by trying to punish doctors in the state who had prescribed suicide drugs.
And while there is still strong opposition around the country to laws such as Oregon's, support within the state has grown over the years. Its voters have approved the Act in two separate referendums, and even some former opponents say the widespread abuses forecast initially have not taken place.
Yet there remain many across the States who detest it. Physicians For Compassionate Care, a group which is campaigning for repeal of the law, argues there have been cases of depressed and mentally ill patients being helped to die - a claim strongly denied by state officials. The group also says, more persuasively, that good palliative care can do an enormous amount to alleviate pain but that often this avenue isn't open to patients.
In Britain the arguments about euthanasia were brought into the open last week. A High Court judge cleared the way for a husband to help his wife, referred to only as Mrs Z as her anonymity is protected by a court ruling, travel to Switzerland so she could be helped to die. The couple had been stopped from going to Zurich by the local authority which provides care for her.
Mrs Z could not go by herself as she suffers from an incurable brain disease, but her husband had agreed to help her to get to Dignitas, an organisation which helps people to commit suicide. Last Wednesday, immediately after the court ruling, the woman flew to Zurich where she took a lethal dose of barbiturates in a flat accompanied by a doctor, nurses and a lawyer .
The British court had ruled that the law should not interfere with 'the rights' of the wife to die. The case appears to weaken the barriers that prevent assisted suicide in English law, under which it is a criminal offence punishable by up to 14 years in jail.
Whether more British people will now travel to Switzerland to end their lives remains to be seen, but euthanasia has again started to become a real public concern.
Health staff have shifted their positions on this issue. The Royal College of Nursing has moved from being steadfastly against assisted dying to a stance of neutrality. In 1996, 54 per cent of 1,000 doctors polled favoured legalising it in some circumstances. Three per cent of GPs had helped terminally ill patients to die.
But one of the big surprises of the Oregon law is that the patients who choose their own time to die are not so much depressed as determined. Linda Ganzini, a psychiatry professor at Oregon Health Sciences University, led a survey of 35 doctors who had been asked for suicide drugs, and found them describing the patients as feisty and unwavering.
When patients gave their reasons for seeking assisted suicide, their greatest concern appeared not to be fear of pain but fear of losing their autonomy.
This was cited by 87 per cent of those who went on to take their lives with the drugs. Only 22 per cent gave their reason as fear of inadequate pain control.
'The standard version of care says, in effect, "We're going to take care of you",' said Ganzini. 'But for these people, the real problem is just that - other people taking care of you.'
Related links
The UK Voluntary Euthanasia Society - the leading UK lobby for the right to die.
An Oregan-based site for the movement that led the succesful campaign for a legal right to physician-assisted death.
A site rich with links to other voluntary euthanasia resources. The site says it is 'committed to the fundamental belief that the intentional killing of another person is wrong,' but has 'deep sympathy for those people who are suffering'.
The mainly anti-abortion party also takes a robust line against voluntary euthanasia.
