PORTLAND &

Peggy Sutherland grew up in the Northeast and married a doctor.




Neither she nor her husband had ever been west of the Mississippi, but they moved to Oregon &

in large part to get away from the confines and structure of the East




"She really felt liberated out here," said her daughter, Julie McMurchie.




And when Sutherland's lung cancer became terminal, she appreciated Oregon all the more.




On Jan. 25, 2001, Sutherland took a lethal dose of medicine prescribed by her doctor. She ended her life at age 68. Her family was at her side.




"I believe she was able to appreciate every day instead of living in fear of what was coming because she knew she would have control at the end," McMurchie said.




Oregon has the country's first and only assisted suicide law.




It was a difficult decision in the state. The law took effect on Oct. 27, 1997. A decade later, experts say it's unclear if the state will continue to stand alone.




Oregon voters approved the Death with Dignity Act in 1994 and again in 1997. The law allows terminally ill, mentally competent adults to give themselves a life-ending medication prescribed by a physician.




In a decade, fewer than 300 people have died under the terms of the law. Far more people request the lethal prescription than use it.




The majority of those who do use it are older and more educated than the average Oregonian, according to state data. Most suffer from cancer.




Their primary end-of-life concerns are about dignity, autonomy and the ability to participate in activities that made life enjoyable.




It's the matter of autonomy that some say is why Oregon moved on the issue where others have stalled.




Oregon is known for its independent and progressive streak. It passed the nation's first bottle bill, keeps all its coastline public and just set one of the nation's toughest renewable energy standards for itself.




"Oregonians are used to doing courageous things," said Barbara Combs Lee, president of Compassion Choices, a national group that backed the Oregon law.




Even critics concede the state has its own character.




"We are pretty much a maverick state," said Gayle Atteberry, executive director of Oregon Right to Life, which opposed the law.




Its creators say the Oregon law did not rely on earlier models, such as that of the Netherlands.




But even in Oregon, the issue passed narrowly and was challenged repeatedly.




Advocates hoped a 2006 ruling by the U.S. Supreme Court upholding the Oregon law would lead other states to follow, but so far that has not happened.




Proposals to allow assisted suicide were considered this year in states such as California, Vermont and Hawaii. Lawsuits have been taken up in others to demand it. None has succeeded.




Proponents say it has failed to take root elsewhere because of powerful opponents such as the American Medical Association and the Roman Catholic Church, which mounted more aggressive and organized campaigns after Oregon's law passed.




"There is enormous opposition from political behemoths," Combs said. "Until that can be changed or overcome, I think it's going to be very hard for other states to emulate Oregon's experience."




But critics say what stymies laws like Oregon's are questions of ethics.




Groups like Right to Life and Physicians for Compassionate Care Education Foundation say such laws are a means of society condoning suicide. They see abuses of the Oregon law, such as not enough psychiatric evaluations. They also say the idea was sold as a way to relieve pain, but fewer than half the people who use it cite that as their reasoning.




"While the other side will say everything is peachy fine, we have information to say otherwise," Atteberry said.




Politics also has a role &

proponents in many states have tried to get a law through their legislatures rather than putting it before voters.




"It was a constant barrage of fear, and it's always easier to maintain the status quo than to do something new," said Sandy Haas, a Vermont legislator who supported an unsuccessful bill in her state.




Religious opposition continues to be strong.




In California, the head of the nation's largest Roman Catholic archdiocese singled out one of the bill's prominent sponsors, Assembly Speaker Fabian Nunez, D-Los Angeles, criticizing him publicly for being Catholic and supporting an assisted suicide bill.




Opponents are dedicated to stopping the law from spreading but say their role in Oregon is that of a watchdog.




"We say that Oregon is an anomaly, not a harbinger," said Dr. Kenneth Stevens, vice president of Physicians for Compassionate Care, which opposes it.




Despite the controversy over assisted suicide &

which some prefer to call "hastened death" or "aid in dying," both sides say Oregon's experience has raised awareness of end-of-life care.




"Oregonians have really been able to open a lot of eyes around the country on the debate about end-of-life care," said Sen. Ron Wyden, D-Oregon.




Many say the in-depth discussion of the issue helped raise attention to the need for alternatives and better understanding of end-of-life care.




"The whole issue of nature taking its course and having some decision-making about the time of death is the American way of dying," said Dr. Susan Tolle with the Center for Ethics in Health Care. "For the vast majority of Americans there is active decision-making about treatments that result in a slightly different time of death. ... To think that we allow things to happen is just not the American concept anymore."




Oregon now has the largest percentage of in-home hospice deaths in the country. And the majority of people who die in Oregon have a written directive or other end-of-life planning in place, Tolle said.




"Whether other states do it is less important than the fact that Oregon has been a crucible, opening the debate on such an important topic," said John Kitzhaber, a physician who was governor of Oregon when the law was passed.




"Death isn't optional," he said. "As a society it's important to have an open, candid discussion of how we want to handle that."