Randy Niedzielski, a real estate property manager in Lynnwood, Wash., died of brain cancer two years ago. During the last few months of his illness, he was in severe pain. He suffered muscle contortions, couldn’t control his arms and legs, developed double vision, was incontinent and couldn’t stop drooling. He also suffered great anxiety, says his wife, Nancy, because he knew it would only get worse. Niedzielski wanted to move to neighboring Oregon, the only state in the country where he could legally get a prescription to end his own life. But he couldn’t establish residency in time.

Now, Washington voters will decide whether to give terminally ill patients like Niedzielski the legal right to obtain lethal doses of barbiturates and hasten their own death. The state’s Death with Dignity ballot initiative, I-1000, received more than the required 225,000 petition signatures, qualifying it for the November ballot.

If Washington voters approve the controversial measure on the second try—the first effort lost, 54 to 46 percent, in 1991—it could lead to similar proposals in other states. Supporters say the first targets would be states where such measures have been narrowly rejected: California, Vermont, Maine and Hawaii. Polls show, however, that the American public remains narrowly divided on the issue of physician-assisted dying.

Washington’s proposed legislation, modeled closely on Oregon’s voter-approved Death With Dignity Act, would allow mentally competent adult patients who have a prognosis of six months or less to live to get a prescription for a lethal drug from their physician. In Oregon, oral secobarbital or pentobarbital are primarily used. Only the patient, who would have to ask for the drug twice, at least 15 days apart, could administer the drug. Independent confirmation by two doctors of the patient’s prognosis, mental competence and the voluntary nature of the request would be required. Physicians and pharmacists would report all prescriptions to state health authorities.

Proponents of the initiative point out that in Oregon, where the law was enacted in 1997, doctor-assisted suicide has been problem-free and remains popular—and rare. From 1998 to 2007, 341 Oregonians took advantage of the law, accounting for 0.1 percent of all deaths. A 2000 study in the New England Journal of Medicine (NEJM) found that Oregon physicians granted about one in six requests for lethal prescriptions, and that one in 10 requests resulted in suicide.

“People choose it to regain some level of autonomy and control over their uncontrolled descent into illness and death,” said Nicholas Gideonse, M.D., medical director of the Oregon Health  & Science University’s Richmond Clinic in Portland. He’s been involved in about a dozen Death With Dignity cases. “I find many patients take comfort that these options are available and can be openly discussed with their doctor, without fear.”

But critics, particularly members of religious organizations and disability groups as well as some physicians, warn of dire consequences if the Washington initiative passes, similar to the warnings to Oregonians 10 years ago. Besides arguing against the morality of suicide, opponents contend that older, disabled and depressed patients are vulnerable to being pressured to kill themselves. “Does a person who is feeling a burden on [his or] her family think, ‘Maybe assisted suicide is something I should do?’ ” says Sister Sharon Park, a nurse and executive director of the Washington State Catholic Conference. “This is very dangerous. It creates groups that won’t be protected.”

She adds, “The truth is, people are never burdensome, though situations sometimes are. The solution is not to prematurely end the life of the person” but to have adequate care for the person so family members don’t feel stressed.

Marilyn Golden, a policy analyst with the Disability Rights Education and Defense Fund in Berkeley, Calif., points out that “the disability community is full of people who were told they had six months to live, and are still around.”

Supporters of the law argue that 10 years of data from Oregon, along with the experience of advocacy groups for older people and the disabled, don’t support these fears. Most of the patients who ended their lives under the law were well-educated people with health insurance who were dying of cancer, according to data collected by the Oregon Department of Health. More than 80 percent were receiving palliative care in hospice programs. The NEJM study found that while 20 percent of patients had symptoms of depression, none of those were given lethal prescriptions.

Physician reports in Oregon and interviews with researchers and families of terminally ill patients indicate that the desire for autonomy, rather than pain relief, is paramount. More than 80 percent of the patients who have taken their own lives under the Oregon law did so due to the loss of autonomy, dignity and ability to enjoy life, according to their doctors. Less than 40 percent mentioned being a burden on their family and friends, and less than 30 percent cited inadequate pain control.

“These were pretty independent people,” said Helene Starks, an assistant professor of bioethics and humanities at the University of Washington. Starks’ team studied 35 cases of terminally ill people who sought aid in dying. “Many of them valued life, but they were looking at tradeoffs in terms of the loss of function and sense of self. They were used to being in charge, and they wanted to manage this last thing.”

The legal advocacy group for disabled people, Disability Rights Oregon in Portland, said it has received no complaints about abuse of the law since it was enacted. Similarly, a study in the Journal of Medical Ethics in 2007 found no statistical evidence that people in vulnerable groups—such as older people, minorities, the disabled or the poor—were likely to kill themselves in disproportionate numbers in Oregon. Only people with AIDS were more likely to use the law, but according to the study’s lead author, breakthroughs in AIDS treatment may have changed these statistics.

The 75-member Seattle chapter of the Older Women’s League has endorsed the Washington initiative because its members want choice in dying and see no risk that older people like themselves would be pressured into taking their own lives, says chapter spokeswoman Midge Levy. “I’ve had friends and family members who wished the Oregon law were in effect here,” says Levy, a retired hospice social worker. “They would have died more peaceful, dignified deaths if it had been.”

But even supporters of Oregon’s Death With Dignity law and the Washington state proposals would like to see them strengthened to guarantee that patients with impaired judgment or depression are screened out. That’s why the measure requires two physicians to independently determine whether a patient who requests the drugs is mentally competent. If either doctor feels the patient may not be competent, a psychological evaluation of the patient is required; if the patient’s judgment is found to be impaired, a prescription cannot be written.

“My experience is that most people who want assisted suicide do not have depression or another mental health condition that would affect their decision,” says Linda Ganzini, M.D., a psychiatrist at Oregon Health & Science University who has consulted on about 30 Death With Dignity cases. “But that doesn’t mean depressed people aren’t getting through.” A study led by Ganzini and reported in the Oct. 8 British Medical Journal found that of 58 participants who had requested aid in dying, three had depression.

Supportive critics of assisted dying want doctors to make more referrals for psychological evaluations. They note that Oregon doctors referred none of the 49 patients who killed themselves in 2007 for psychological evaluations, while nearly 11 percent were referred in the previous decade.

The entire debate over doctor-assisted dying should be moot, says Park of the Washington State Catholic Conference, given the widespread availability of quality hospice and palliative care. “If we could teach people more about a good death, how it can bring families together, and the services we have to live and die naturally, we wouldn’t be looking toward assisted suicide,” she says.

Randy Niedzielski’s widow, Nancy, disagrees; she is carrying out her husband’s wishes that she work for a Death With Dignity law—she has gathered more than 1,700 signatures to get the initiative on the Nov. 4 ballot. “It’s easy to be healthy and say [assisted death] isn’t right,” she says. “But until you’re in that situation, you really don’t know how you’ll feel. It should be no one else’s business but the person who is suffering.”

Harris Meyer, winner of the Gerald Loeb Award for business writing, covers health care, business and politics. He lives in Yakima, Wash.