LONDON, Ont. — State by state, supporters of assisted suicide are ramping up their efforts to seek friendly legislators or sympathetic judges to enable the terminally ill to get help ending their lives if they are incapacitated.

Hawaii, Montana, New Hampshire and Vermont are among half a dozen states where legislators have recently faced bills to either legalize or outlaw assisted suicide. Opponents have hastily assembled to fight the measures, aided by national or international groups like the Euthanasia Prevention Coalition, Not Dead Yet and the Patients Rights Council.

Outside the U.S., since the beginning of 2010 five countries have defeated efforts to pass more radical laws enabling not just assisted suicide but Netherlands-style euthanasia, which allows medical professionals to kill very ill or depressed patients.

“There have been three significant victories lately,” said Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, based in London, Ontario. “France, Hawaii and Montana.”

A string of pro-life victories internationally began in January of last year, when the Canadian parliament defeated Bill C-384, which would have legalized both euthanasia and assisted suicide. The vote was 228-59. In September, the Western Australia legislative council defeated a euthanasia bill, and in November, South Australia did the same. That same month the Scottish parliament decisively rejected an End of Life Assistance Bill, and in January of this year both the Israeli House of Representatives and the French Senate defeated similar measures.

On March 7, the Indian Supreme Court rejected a petition for active euthanasia.

In the United States, Hawaii presents the most decisive defeat for assisted suicide and euthanasia to date. According to Schadenberg, opponents from the Christian and disabled communities testified so convincingly before the legislature’s Health Committee that it defeated the measure unanimously. Even the bill’s most ardent backer, Senate Health Committee chairman Josh Green, a medical doctor, voted against it, saying, “Community sentiment here today has been overwhelmingly opposed to moving this measure forward.” While Green claimed the views in the community outside the committee room were more evenly divided, he said he believed it would be wrong to proceed before a consensus emerged.

Murkiness in Montana

Montana’s situation has all parties worried. Last year the state Supreme Court produced an ambiguous ruling that overturned a lower court decision recognizing a constitutional right to “die with dignity.” But the court also declared that physician-assisted suicide was “not contrary to public policy.”

Both sides claimed victory. Pro-life analysts said the decision left anyone assisting another in committing suicide open to a murder charge, but they admitted it provided a potential defense for doctors who were charged, if the victim could be shown to have requested assistance in dying.

But euthanasia advocates said doctors were now permitted to provide drugs in lethal dosages for those desiring death to take on their own.

Both sides were unhappy enough with the outcome that they found legislative sponsors for contrary bills this year to clear things up, one clearly permitting assisted suicide, the other just as clearly prohibiting it. And last month, both bills were defeated in committee.

New Hampshire lawmakers now are considering a bill legalizing assisted suicide, a virtual duplicate, says Schadenberg, of one they defeated by a 2-1 margin last year. But instead of going to the judiciary committee, this time it is being considered by the Health, Human Services and Elderly Affairs Committee. Said Schadenberg, “The suicide lobby believes politicians will be more comfortable with assisted suicide in the medical model, where the legislation always has doctors well placed to give approvals, than with the legal model.”

Schadenberg, whose organization has helped to found anti-assisted suicide groups in several U.S. states, thinks they might be right about this. He never uses the term “physician-assisted suicide,” saying it plays into the public’s trust of doctors and the politicians’ willingness to pass the moral buck to the medical profession.

In March 2010, Idaho lawmakers overrode Gov. C.L. “Butch” Otter’s refusal to sign the Health Freedom of Conscience Bill, going on to pass into law a bill aimed chiefly at protecting health workers who refuse to participate in abortions. However, the new law also defends health workers who want no part of an institutional order to administer or withdraw treatment if either action would end a patient’s life.

In February, Idaho’s Legislature defeated a bill that would have forced those same health workers to comply with patients’ advance directives regardless of whether it conflicted with their consciences, even if these directives were to discontinue life-sustaining measures. On March 11 Idaho’s Senate passed a biill that would explicitly ban assisted suicide. The Idaho Medical Association (the state’s doctors) supports the bill, which would specifically protect health workers who provide appropriate end-of-life palliative care. The bill is now before the state’s House of Representatives.

Palliative Care

Maryland is considering another type of legislation that gives legal force to advance directives or living wills. Proponents of the Health Care Decisions Act insist it does not legalize assisted suicide but, like California’s palliative-care law, merely ensures the terminally ill are fully informed about their right to insist on what level of care will and will not be provided.

Palliative-care proposals are stealth maneuvers, warned Schadenberg, intended to “prepare the ground for assisted suicide legislation down the road.” Measures already enacted in California and New York require medical staff to offer patients a discussion on their “end-of-life options,” which will be the occasion, said Schadenberg, to broach the subject of assisted suicide. New York doctors opposed the measure on the grounds it would discourage doctors from trying their best to preserve their patients’ lives. But Compassion & Choices claims the evidence is that, where such discussions take place, patients live longer.

Similarly, Schadenberg argues, assisted suicide has prepared the way for euthanasia, which in the Netherlands has degenerated to the point where a third of those who are euthanized have not requested it, according to a 2010 Canadian study.

Barbara Coombs Lee, the president of Compassion & Choices, one of the leading proponents of assisted suicide and palliative-care laws, or patient-controlled health-care decision-making, says her group is opposed to euthanasia, as she is personally. “Euthanasia requires someone doing something to you,” she said, whereas her group wants chiefly to put people in charge of their own end-of-life decision-making.

As for the Netherlands demonstrating the slippery slope, Lee says, “the Dutch are not Americans.” The Dutch were practicing euthanasia for some time before it became legal, while Americans are generally uninterested.

Lee said her group and those who oppose assisted suicide have “common ground” in their resistance to the current medical model’s reliance on technology and even in a preference for dying at home. “But a person can die at home more comfortably if they know that if it becomes intolerably painful they won’t have to return to hospital, that they can take their prescription.”

She sees the fight for the right to “aid in dying” as “an uphill battle” in the short term, but in the long term expects success as Americans observe that “the sky hasn’t fallen” in states such as Oregon and Washington, where assisted suicide is legal. In states where the politicians are adamantly opposed, she puts her hope in legal actions that declare prohibitive legislation unconstitutional — as in Washington. This will give people proof that allowing assisted suicide or living wills does not open the door to euthanasia.

But Schadenberg said that groups such as Compassion & Choices are concealing their real goal, which he said is, indeed, euthanasia. As for the slippery slope, he sees it already happening in Oregon, where the number of assisted suicides has climbed from 24 in the first year allowed, 1998, to 65 last year. “It’s growing,” he said.

Moreover, it is very poorly monitored, he claims, since the reporting is done by the doctors who prescribe the fatal doses for applicants. “If they’ve done something improper, are they likely to report on themselves?”

But Lee countered that assisted suicide accounts for only .15% of Oregon’s deaths, and that a quarter of those who obtain prescriptions do not use them. For them, she said, having the prescription merely provides a comfort.

Schadenberg warned that, as much as he is personally opposed to suicide, an important moral line is crossed if society says it’s okay for other people to help, or for other people to actually do the deed. “That is why disabled people are so concerned about this. They already depend on others and so are vulnerable to others.” Disabled people above all want it to be very clear when the line is crossed and others want to help them “to death.”

Father Tad Pacholczyk of the National Catholic Bioethics Center agreed with Lee that people have a tendency to “pretend that medicine can always save us.”

“Some families grasp at any and every possible treatment offered, even when it is extremely unlikely to be beneficial,” he said.

But living wills containing blanket directives saying I don’t want any tubes aren’t helpful, “because sometimes tubes will make perfect

sense for a particular patient,” he said; “other times they may not.”

Father Pacholczyk advised everyone in care to designate a “health-care proxy, someone who loves us and whom we trust” to make decisions for those who become incapacitated.

He supports palliative care but also expressed concern lest “end-of-life planning sessions” provided in palliative-care laws be used as “pressure points to coerce individuals towards unethical treatment options such as euthanasia or assisted suicide.”

“Dying well always involves dying in the time that God appoints, rather than in the time that we establish,” Father Pacholczyk said. “Acknowledging the impending arrival of death, and seeking to pass from this life at home surrounded by loved ones, can be a great grace.”

Steve Weatherbe writes from Victoria, British Columbia.