Twenty years ago this month, the entire country was watching Oregon decide how to die.
On Nov. 4, 1997, Oregon voters upheld America's first doctor-assisted suicide law. The wildly controversial Death With Dignity Act allowed terminally ill patients with less than six months to live to ingest a lethal dose of drugs.
The bill sparked death threats, legal battles and a massive freak-out in the Roman Catholic Church, which spent millions of dollars campaigning against it.
In the past two decades, the law has rocked the medical profession, served as a political pawn and comforted the hopelessly sick. At least 1,127 people have used the law to die in Oregon (see chart below). One of them, Brittany Maynard—a beautiful 29-year-old with brain cancer—tugged the world's heartstrings when she ended her life three years ago. But many of them made the choice without public notice—and, as proponents note, painlessly.
Death With Dignity is widely considered a success in Oregon. It's part of how the state defines itself: as pioneering, stubbornly independent and deeply compassionate. Since then, five states and Washington, D.C. have followed Oregon's lead and adopted physician-assisted suicide.
At the time, the outcome wasn't such a no-brainer. The fight was politically risky and emotionally wrenching. And the people leading the way had to be brave.
How did they find the courage?
WW spoke to more than a dozen current and former lawmakers, activists and families about the bill, its impact and how it has blazed a legislative trail across the nation.
Interviews have been edited and condensed for clarity and brevity.
PART 1: BEFORE
Barbara Roberts, former Oregon governor: In September 1992, my husband, [Oregon state Sen.] Frank Roberts, was in for a routine check. The doctor told him he had lung cancer and it was terminal. We made the decision not to tell anyone. He didn't want people to look at him with pity.
Ann Jackson, former director of Oregon Hospice and Death With Dignity advocate: I met my fiancé, John, at the Bohemian Club in San Francisco in 1991. I planned to move in with him. But when I arrived on his doorstep, just before the 4th of July in 1996, his eyes and skin were yellow. He was diagnosed with pancreatic cancer and given a life expectancy of three months.
Roberts: Eventually, we had to quit sleeping together because he was in so much pain. For a while, I kept a baby monitor in his room. I was governor at the time, and I was getting up several times a night and trying to work the next day. As he got worse, I got less sleep.
Jackson: John lost lots of weight. He began stockpiling medication to kill himself. They were mostly opiates with Tylenol, which are hard on the gut and liver. It would not have been a good death. He also had guns hidden everyplace. I was worried he would use them on himself.
Roberts: He lost track of reality. In the last weeks he was alive, he was asleep more and more and was in a great deal of pain. He stopped eating and lost control of his bodily functions. The last thing he ate were my sister's home-canned peaches.
Jackson: I got John into hospice before he could take the pills [he'd collected to kill himself]. But we had to sedate him to the point of unconsciousness. He was 59 when he died.
Roberts: Frank died on Halloween 1993. There's no question in my mind that, if the Death With Dignity law had been in place, he would have done it before there was no end to the pain, before all of the pleasure in his life was gone.
Jackson: I have no doubt that John—as much as he loved life—would have used physician aid to die on his own terms.
PART 2: THE BALLOT
Roberts: Frank was the first major advocate of the law in Oregon. He'd say, "We would put an animal down. We wouldn't let it suffer. So why would we let a human suffer?" In 1987, he introduced the first Death With Dignity bill. But legislators just didn't think it was realistic.
Barbara Coombs Lee, A chief petitioner of the Death With Dignity Act: Frank was revered. They called him "The Conscience of the Senate." But for all of that stature and credibility, he still couldn't get a fair hearing on his bill.
Roberts: The third time he introduced it, in 1991, he started pushing. That's when discussion about taking it to the ballot started.
Oregon passes most of its laws in the Legislature. But it also was one of the first states with a ballot-initiative process—allowing the state's voters to decide directly on issues.
Lee: I was aware of how impossible it would be to get this through the Legislature. But when people vote, they vote from their hearts. They don't have to be concerned about what their minister or priest might say—what kind of shunning might come down on them.
In early 1993, backers of doctor-assisted suicide decided to take the issue to the ballot.
Geoff Sugerman, campaign manager for Measure 16: We knew it was going to be a brutal campaign. But we also knew that Oregon was one of the least churched states, with an independent spirit. Oregon voters had been willing to do things through the ballot box no other state had ever done. We had the first bottle bill in the country. We had the first open public access to beaches bill.
Lee: We met and pored over this bill for months.
Sugerman: We knew opponents were going to talk about doctors killing patients and family members wanting inheritances.
Lee: One of the keys to winning was to make it perfectly clear that the control would reside with the patient from beginning to end.
The law requires patients to self-administer the drugs after a 15-day waiting period and two doctors sign off on a terminal diagnosis.
Roberts: While we were dealing with Frank's illness, he would ask me, every so often, "How's our petition doing?" And he would say, "If they get this on the ballot, Oregonians will pass it."
PART 3: THE WAR
Roberts: When it got to the ballot in 1994, it was a huge issue. People were talking about it in schools, at the barber shop, at the dinner table. Families were talking about dying for the first time.
Sugerman: The Oregonian was violently opposed to it. They started editorializing against it before we even filed it as an initiative.
Lee: The archbishop of Portland, William Levada, called us "murderers in the name of mercy."
Todd Cooper, director of the Oregon Catholic Conference, which opposed the measure: There was a fear that it would influence society's attitudes towards suicide in general. We believe life is a gift and it's precious. To suggest suicide is dignified was hard to understand.
Rodney Page, former executive director of Ecumenical Ministries of Oregon, which was also opposed: We put together the largest religious coalition in the history of the state—with Buddhists and Hindus and Jews and Roman Catholics all coming together to oppose the bill. I had to draft a statement that all the religious groups could agree on. It was like herding cats.
Sugerman: People said we would try to use it on disabled people. We got death threats. We were called Nazis. Somebody threw a brick through the window of my house.
Ron Wyden, former Oregon congressman and U.S. senator since 1996: Initially, I [voted against] the measure because I was involved with senior citizens. My concern was—and there were a fair number of progressives who felt this way—that it could be used against vulnerable, low-income persons. That somehow if you had those folks, and they had big medical expenses, that the law could be used to push them into using this option and saving people money on Medicaid costs.
Jackson: In the public debates, "pills don't work" was one of the big arguments: that people were going to vomit up their pills and be left as vegetables.
Sugerman: The week before the election was tense. Our lead had gone down 3 points. I remember having a conversation and saying, "Shit. We lost."
The night of the election [Nov. 8, 1994], it was a complete feeling of euphoria. We threw our hands up and cheered.
Lee: On election night, I remember a journalist saying to me, "Do you expect this law be challenged?"
PART 4: THE BLOWBACK
Less than two months later, opponents challenged the law in federal court. U.S. District Judge Michael Hogan placed a "temporary" hold on the law—preventing Oregonians from using it for three more years.
Lee: The lawsuit was brought by the [anti-abortion group] National Right to Life. Their argument was essentially: A person making a decision to hasten his death is never rational; it's always a sign of mental illness.
They were basically saying a dying person who is writhing in pain—and ready to end it—should be removed from his home and locked in a psychiatric hospital so he won't injure himself.
The case was dismissed in February 1997 after a federal judge found it did not deny people's constitutional right to equal protection under the law.
Roberts: The Legislature referred it back to the ballot in 1997. But this time, 60 percent of Oregon voters said they supported it. There was a lot of resentment on the part of Oregonians. They thought, if they had passed it the first time, who had the right to take it away?
This time, Measure 51 asked Oregon voters to repeal the Death with Dignity Act that had passed in 1994. On Nov. 4, 1997—days after Measure 16 went into effect—the attempted repeal failed.
Sugerman: It pissed people off that they had to vote on it again.
Wyden: In 1999, a bill passed in the [U.S.] House to basically throw the law in the trash can. It came to the Senate, and it was widely assumed it would pass lickety-split. And I said, "Not so fast."
Not only did I change my views, but I filibustered in the Senate to protect it. I consider it one of the most important things I've done in my time in public service.
Roberts: In 2001, U.S. Attorney General John Ashcroft really thought he could stop it. But every time anyone tried, they failed.
Ashcroft declined comment through a spokesman.
Lee: We used to call this law "The Little Engine that Could." It's a miracle it kept on chugging.
Here are the demographics of the people who have used Oregon's Death With Dignity law.
PART 5: THE CHOICES
Dr. Peter Reagan, retired family medicine doctor: I wrote the first [assisted-dying] prescription in March 1998. My patient, Helen, had terminal breast cancer. She was 84 and an immigrant from Central Europe. She lived alone in Portland.
By the time she got to me, she was pretty tired of doctors saying, "I get it, but I don't want to do it for you." I believed she had the right, and I sympathized with her. There was no way I was going to chicken out.
I called Barbara Coombs Lee and said, "What pharmacy do you guys use?" And she said, "Really? You have a prescription?" That's when I realized it was the first one. It was frightening to be the first.
Dr. Charles Bentz, physician and Death With Dignity opponent: I saw firsthand a depressed patient who, instead of addressing his depression, was given the means to kill himself. In 2003, he was diagnosed with melanoma and I sent him to a cancer doctor.
Instead of treating his depression—he was suicidally depressed—the doctor gave him the means to end his life. I was quite taken aback. I actually lost my job over it. I resigned.
Reagan: On the day [Helen] died, her son, daughter and I were at her home. Her attitude was as if she was getting ready to go on vacation, like she was thinking ahead—and pretty soon she got to get out of there. She was just ready.
She looked at me and asked me to kiss her on the cheek goodbye. She drank the phenobarbital with red juice. Then she looked up and the emotion on her face was pride. Like, "See, I did it." She went to sleep and then just faded away.
It came with an emotional weight. Asking someone to help you die initiates a very intense relationship. There's no way you could get paid enough to do it. It's a labor of love.
Bentz: Advocates believe this is the best thing since sliced bread. But, I gotta tell you, this is one of the worst things to happen to the profession of medicine since the Middle Ages. It's a stain on the honor of medicine. We should do no harm.
Deborah Ziegler, mother of Brittany Maynard: In January 2014, we found out she had a lesion on her brain. She asked, "Can I be transferred to a hospital in Oregon?" That's when I knew that she was going to try to find a different way to die.
Lee: Brittany's impact was huge. Her story broke in People magazine on Oct. 6, 2014, and by the end of the day, it was the most viewed online story in the history of any Time Warner property. It beat out the Angelina and Brad twins, which had previously been the most viewed.
Nora Miller, whose husband used the law in 1999: I was 18 when I met Rick. He was the first person I had any relationship with. We grew up together. So it was terrifying when, in 1999, he was diagnosed with lung cancer and given just months to live. I remember having this sensation that the curtains that block the future were opening. I could see to the end—and I knew it wasn't going to be good.
Dan Diaz, Maynard's husband: Brittany was frustrated that it took her—a 29-year-old, well-spoken woman—to have an impact. She said, "Why is it OK for 90-year-olds to face the prospect of dying painfully? Nobody paid attention to that."
Ziegler: We were afraid people would find out where we were living. We had already been bombarded with hate mail at our home address. We got letters saying we were going to hell.
Sometimes there were people reaching out with what they thought was a cure. Somebody would write, "Drink this carrot juice I made, it will cure you." But the message would still be the same: Don't take the medicine.
Miller: The hardest part was that there was nothing I could do about it. I'm a fixer, a doer. I worked in computers, and it was my job to fix everybody's problems. But this was a problem I could do absolutely nothing about. The cancer had spread. We talked about it, and Rick said, "I'm going to use the Death With Dignity law."
Ziegler: The day she died, [Brittany] wanted to go for a walk in the woods. Later, we formed a circle with chairs around her big four-poster bed. She took the medicine down in one drink. She said she wanted it mixed with water and [to chase] it with a little bite of ice cream.
She wanted somebody to read poetry, so I read poetry to her. Her friend, who was a doctor, tapped me on the arm and said, "She's gone." I ran out of the room and into the woods.
The law—and knowing the medicine was there—calmed her fear. When she got panicky, she could say to herself, "No, no, no. I will not die in a horrible way."
Miller: The night I went to pick up his medication was tough. It was dark and rainy, near the end of October  and I had to drive all the way to a pharmacy in Tualatin. It made it concrete and real in a way that nothing else had.
On the day he died, he was still able to communicate and say goodbye. It would have been so much more traumatic to see him waste away. Rick wasn't afraid of pain or being a burden to us. He just wanted to be in control.
PART 6: AFTER
Roberts: There isn't any question that the law has changed end-of-life treatment. Patients don't have to do the next step on a treadmill of treatment with no hope. Patients can say, "No."
Lee: We have a learned that a third of the people who get the prescription either never fill it or never ingest it.
Roberts: Many of them simply want to know that, if it gets so bad that they can't tolerate it, the choice is there for them. There is a comfort in knowing it's there.
Jackson: We know now that the pills do work. Out of more than 1,000 people who have used physician aid in dying, only five people have awakened after taking it. They did not suffer brain damage.
Bentz: I still feel the law is a coarsening of culture. It requires doctors to lie on death certificates. Doctors are forced to put down that the patient died of their underlying condition instead of assisted suicide.
Cooper: I think 200 years from now we'll look at doctor-assisted suicide like slavery: It will be abhorrent to us.
Page: If the bill was on the ballot this November, I still would not vote for it. My view of suicide has not changed. But in terms of the law working well in Oregon—I feel it has.
Doctor-assisted suicide is now legal in six states and Washington D.C..
Roberts: Last year, 22 states introduced the bill. There's a chance it will pass in New Jersey and New York. I think, 50 years from now, this will be pretty common practice across the United States.
Wyden: There's a lesson in all of this. It's the wisdom of Oregon voters.
Jackson: If you are diagnosed with ALS, you are going to choke on your own saliva. With pulmonary hypertension you are going to suffocate and not be able to breathe. And these are quite reasonable things to be afraid of. Now, you can have a plan in case you are facing one of these awful deaths. You can have a conversation with your doctor about it now.
Ziegler: Today, people can say, "This is my life and my death—and I won't be told what I have to do." People aren't afraid to talk about death anymore. Its time has come.
Here's how many people each year ordered prescriptions for lethal drugs using Oregon's Death With Dignity law—and how many took the dose.