PORTLAND, Ore.—Stand vigilant and keep morality in the forefront.

That's the call some are making in the aftermath of Oregon's Nov. 4 vote to keep physician-assisted suicide legal. The lopsided balloting— in which Measure 51, the repeal initiative, was defeated 60% vs. 40%— officially gives the state a dark distinction: It is the only place in the country where it is legal to kill yourself—and with your doctor's help.

The law allows doctors to prescribe a lethal dose of oral medication to a terminally ill person who is deemed to have less than six months to live and who requests life-ending drugs. The person must wait 15 days before receiving the drugs.

Now the question becomes where to go from here. The Vatican says the goal is to give the issue of euthanasia “the highest priority,” as those it most directly impacts are the ill and the elderly.

Responding to the Oregon vote in the Nov. 7 edition of the Vatican newspaper L'Osservatore Romano, father Gino Concetti wrote that “even if it's with the benefit of the law, whoever commits suicide is making a homicidal choice that offends the dignity of the person and the honor of the Creator.”

“To legitimize assisted suicide—or better still, auto-homicide—through law is never a victory for civilization, much less so for humanity,” the moral theologian wrote. “Procured death has always been considered a defeat which reason has never accepted. Only the ideology of the culture of death succeeds in mystifying it with the absurd and aberrant [concept of] right to life with dignity.”

Church leaders in Oregon say they were not surprised by the disheartening vote, yet did find clarity of mission during the ambitious campaign. In the lead-up to the election, Catholics launched a door-to-door effort to discuss the law they believe will imperil those on society's fringe.

Election officials said more than 1 million all-mail ballots were received, representing about half of the state's registered voters.

“While Measure 51 did not pass as we had hoped and prayed, we claim a moral victory in that a state with a small percentage of ‘churched,’ and a much smaller percentage of Catholics, can have such a positive impact on the voters of Oregon, and indirectly around the world,” said Bishop Kenneth Steiner, administrator of the Archdiocese of Portland. “Life is sacred and we take comfort in our right to eternal life.”

Bishop Steiner said the Church will “continue to proclaim the Gospel in word and action” through Catholic schools, a health-care system, social-service agencies, and parishes.

Western Oregon's new spiritual leader, Archbishop John Vlazny, of Winona, Minn., who will be installed Dec. 19, said Catholics will continue defending the dignity of human life at all stages of life.

“We know that the terminally ill need our support, our love, and our prayer in their last days,” Archbishop Vlazny said. “We know that our support can provide them with hope for eternal life.”

Cardinal Bernard Law, chairman of the Bishops'Committee for Pro-Life Activities, said the defeat of Oregon's Measure 51 is a “tragedy for all Americans.” Cardinal Law warns that the so-called “right-to-die” may erode into a “duty-to-die.”

“This is a time for Americans of all backgrounds and beliefs to work together to solve the real problems of terminally ill patients,” the cardinal said. “By ensuring relief of pain, compassionate care, and loving support, we can build a society in which physician-assisted suicide is irrelevant as well as illegal.”

Dr. John Haas, president of the Pope John Center for the Study of Ethics and Health Care in Boston, Mass., said this is no time to mourn. “We will have to very closely monitor what's going on out there to prevent physicians from getting away with murder—and that's not just a figure of speech,” Haas said. “Any individual needs the help of society to keep from wrongdoing and Oregon physicians have lost that help.”

Now that practical and spiritual support for life has been stripped away by the Oregon legal system, Catholics and others committed to the equal dignity of all human beings must step forward. That's the message from Richard Doerflinger, associate director for policy development at the Secretariat for Pro-Life Activities, National Conference of Catholic Bishops.

“The Catholic health care system will become an immensely important haven for patients and families who seek to be cared for in ways that respect the inherent dignity of human life,” Doerflinger said. “We must remind our neighbors that the worst misery, and the worst enslavement, is a judgment by others that your life is not worthwhile. In continuing to point out the injustice of socially sanctioned assisted suicide, and in standing with those it places at risk, Catholics will hasten the day when Oregon turns away from this misguided experiment.”

Carrie Gordon, a bioethics analyst for Focus on the Family, a Colorado-based Christian ministry dedicated to the preservation of family, predicts that other states can expect attempts to legalize assisted suicide.

“In this age of skyrocketing health care costs and desperate cost-cutting attempts, an early death may become a reasonable substitute for treatment and care,” Gordon said. “There is no question that physician-assisted suicide activists will interpret this tragic vote as a clarion call to push their death agenda in the 49 other states. Attempts to legalize physician-assisted suicide in other states must be vigorously opposed so we can assure our sick and weak citizens that they will not be killed in the name of ‘compassion.’”

The suicide law could remain in a legal holding pattern for years, says Indiana attorney James Bopp Jr. A lawyer for the National Right to Life Committee, Bopp has presented appeals through federal courts since 1994. In that year, Oregon voters passed the state's first referendum on assisted suicide, Measure 16, known as the “Death with Dignity Act,” by just two percentage points. Measure 16 legalized assisted suicide via a prescription of lethal drugs for those with less than six months to live. Legal challenges previously kept the law from taking effect until just before the recent vote, however.

In 1995 District Judge Michael Hogan of Eugene, the only magistrate actually to review the merits of the case, said Measure 16 was unconstitutional. He found it placed the rights of terminally ill people at risk.

It was February 1997 when U.S. Circuit Court of Appeals wiped out Hogan's ruling, saying plaintiffs lacked legal standing. That decision was upheld in June when the U.S. Supreme Court weighed in without actually discussing Measure 16.

No legal suicides are expected in the next few weeks as a 15-day waiting period is required for receipt of a lethal prescription.

Bopp will likely return to court before that time elapses with new plaintiffs. The challenge is to find people who realistically stand to be harmed by the suicide law, such as families of terminally ill patients or health workers forced to comply with the law against their religious beliefs.

Bob Castagna, executive director of the Oregon Catholic Conference, offered a somber reflection on the ballot outcome: “Today is a tragic day for Oregon, the nation, and the world. A minority of Oregon's registered voters has reaf-firmed its decision to become the first jurisdiction in the world to fully embrace the culture of death. May God have mercy on us.”

Hazel Whitman is based in Portland, Ore