Although proponents of a bill to legalize medically-assisted suicide in California are currently silent after several consecutive setbacks in previous years, opponents remain alert and are closely watching for the approval or introduction of similar bills in other states.

Proponents might in fact be waiting for results at a half a dozen states where pro-assisted suicide bills have been introduced, said Carol Hogan, California Catholic Conference's pastoral projects and communications director.

"There is no bill, but that doesn't mean we are free," Hogan said. Assisted suicide proponents, she said, "might even try to introduce a proposal in a health care bill, probably with a different title."

Opponents say the legalization of such a measure will affect the socially and economically disadvantaged segments of society that have less access to the health-care system.

Physician-assisted suicide is defined as the suicide of a terminally ill patient by a self-administered lethal drug prescribed by a medical doctor who has previously judged the patient as mentally competent to make the request. It is different than euthanasia, where a physician performs the act with or without the patient's knowledge and/or consent.

On March 5, Washington became the second state in the country to allow physicians to prescribe lethal drugs for terminally ill patients. The "Death with Dignity" law was modeled after Oregon's measure, which was reaffirmed by referendum in 1997. The Washington measure was made possible by last November's ballot initiative (Initiative 1000).

In Montana, a doctor-assisted suicide law approved in December 2008 by Montana District Court Judge Dorothy McCarter was appealed in February to the Supreme Court.

According to opponents, the law made it very easy for terminally ill patients to end their lives. "They can phone in their requests, and then a prescription for a lethal overdose could be mailed to them," said Rita Marker, executive director of the Ohio-based nonprofit International Task Force on Euthanasia and Assisted Suicide, as quoted on the Web site onenewsnow.com. Montana has the highest suicide rate nationwide.

Similar bills have been banned in Hawaii, New Hampshire, Pennsylvania, Massachusetts, Arizona and Maryland.

In California, efforts to pass a bill to legalize assisted suicide have consistently failed, largely due to opposition by Californians Against Assisted Suicide (CAAS), a coalition of disability rights, health care, civil rights and religious organizations including the CCC.

In 2008 the End-of-Life-Care bill, AB2747, sponsored by Compassion and Choices (a group representing different religious faiths, including a Jesuit scholar), was passed by the Legislature and signed into law by the governor. It requires physicians to inform terminally ill patients about their end-of-life options.

Months later the bill was amended due to heavy opposition, removing parts mentioning the voluntary stopping of eating and drinking and palliative sedation.

Activists say the whole process of writing and introducing a ballot initiative is very costly, which might be another reason why proponents remain cautious.

"But we know that the issue is not gone forever," said Marilyn Golden, policy analyst and leader of the Disability Rights Education and Defense Fund, a member of CAAS.

"The matter picks up momentum because people want to avoid difficult deaths for their relatives," she said. "They are pushing it for their loved ones and don't see its negative consequences for society."

Other factors that have surfaced are worries for the future and financial considerations.

A study released March 9 by Oregon Health & Science University found that patients who request physician-assisted suicide often make their requests based on their worries for their future, not because of physical symptoms or their current quality of life.

"People are usually fearful about suffering extreme pain in the future, or of losing physical abilities that will affect their future quality of life," said Golden, who is disabled herself.

In the current "profit-driven broken health-care system," decisions are often made based on financial considerations rather than medical, she said.

"Assisted suicide is cheaper than treatment for financially burdened patients or for burdening caretakers," she said. "Some patients are misdiagnosed and in their depression they want to take a shortcut --- and ending their lives is the first thought that comes to mind."

Like, Golden noted, a friend of hers who wanted to end his life after being diagnosed with a terminal illness. "But he had been misdiagnosed and now he is so glad that he is still alive," she said.

Most at risk, said Golden, are the disabled, the terminally-ill and low-income patients. That means education is crucial --- "education on the bills and on the health-care system," she said.

For more information about the California Against Assisted Suicide, go to www.ca-aas.com.