During the ensuing decade, the unique law has provided what supporters of the act deem a "safe harbor" from criminal and civil liability. That term means that a competent adult who has fewer than six months to live may self-administer a lethal dose of prescription drugs for the purpose of controlling the timing and circumstances of an imminent death.

Moreover, counselors, physicians or family members who provide aid and comfort, but do not administer the drugs, cannot be prosecuted or sued. Oregon voters approved the law in 1994 by a 51-49 percent ratio. They handily defeated a repeal effort in 1997. But until then, legal challenges blocked Oregonians from using the law.

Citizens who drafted the law were connecting with growing sentiments regarding personal autonomy and medical care when death is near. In an atmosphere of policy efforts as ambitious as the "war against cancer," belief in a technical ability to conquer disease downplayed professional and institutional competence in coping with dying patients and their families. Death was treated as a failure of the hoped-for powers of medicine, and dying became an often-protracted and medicalized event.

In response, increasing numbers of Americans expressed a desire to control decisions about when to decline treatment, refuse resuscitation and withdraw tubes and machines. States followed one another in approving laws to support "do not resuscitate" and withdrawal of treatment decisions. Many Americans expressed the sentiment that they'd rather die at home than in a hospital.

But a line was drawn at what's been labeled "physician assisted suicide." Citizens in Oregon tested that line, campaigning successfully in 1994 for their "death with dignity" reform (and persuading the American Public Health Association later to embrace the term "aid in dying").

Over the past decade, few reformers and lawmakers in other states have sought to model the Oregon regime. Voters in Michigan (1998) and Maine (2000) turned down similar initiatives. Still, two years ago, a bill with provisions similar to Oregon's passed the California Assembly. And this year there are bills pending before legislative committees in Wisconsin and Arizona.

Also, a broad coalition in Washington is collecting signatures for an initiative for November's ballot.

Failure to adopt an Oregon-style death and dying law in other states is not because Americans reject laws promoting further autonomy at the end of life. Public opinion polls assessing government attempts in 2005 to keep Terri Schiavo alive in a persistent vegetative state indicated that Americans largely disapproved of officials' actions, viewing them as an unwelcome government intrusion into the most personal of life decisions. Those responses surprised legislators and pro-life advocates.

Our comments on the Schiavo case in 2005, about changing expectations concerning autonomy and choice in decisions about death and dying, still strike at the heart of the matter: "What the recently intense national discussion demonstrates is that below the radar of politicians, political strategists and analysts, such change has slowly but surely come through the many conversations that have taken place in family kitchens, hospital hallways and church offices over the last 30 years."

In Oregon, meanwhile, just 541 prescriptions for lethal medications were written during the years 1998-2007, and only 341 people died using them (compare that with 85,755 Oregonians who died from the same underlying diseases during the same period). Annual reports, which the law requires the state to publish, show that those numbers don't reflect greater use among demographically disadvantaged groups, as opponents of the law argued would happen. Claims that physicians and families would abuse the law appear to be unfounded.

This is not to suggest, however, that what has succeeded in Oregon will necessarily work easily in other states. One key to Oregon's experience has been a relatively insular and progressive medical practice, deftly engaged by savvy activists with a burning desire to demonstrate that such a law can succeed.

What is clear, regarding the legal treatment of dying, is that U.S. public opinion will undergird deference to personal autonomy in a post-Schiavo world.