The news came in October: Willi Moelzer had six months to live.
But he and his wife, Janet Moelzer, weren't alarmed. In fact, the Eugene couple had been waiting for such news.
The diagnosis, confirmed by a second doctor, was one more step on the arduous road to obtaining a life-ending prescription for Willi Moelzer, 74, who suffered from Fahr's Syndrome -- a rare and often fatal genetic disorder that was causing his body to deposit calcium in his brain, leading to physical and mental decline.
For the past few years, they had watched his health wane, and in August, he began having seizures. A few months later, he started experiencing breathing problems and decided he was ready to utilize Oregon's Death with Dignity Act, which allows terminally ill but mentally competent individuals to hasten their death with a doctor-prescribed, self-administered dose of barbituates.
"He was tired," Janet Moelzer, 68, said of her husband, who was a retired high school teacher and Vietnam veteran. "It seemed to be a relief for him when we set the date."
Oregon in 1997 became the first state to enact a Death with Dignity Act, which provides legal protection for physicians, a patient's loved ones and the patient who requests the lethal prescription. In the years since, more than 1,100 Oregonians have had such a prescription written for them, and more than 750 have died from ingesting the medications prescribed under the law.
Variations of Oregon's law are slowly catching on in a handful of other states that have passed similar legislation, including Montana, Washington and, most recently, Vermont. Hawaii doesn't have official legislation for a death with dignity process, but it does provide legal protection for doctors who prescribe the lethal dose. Campaigns for similar laws are ongoing in California, Connecticut, Massachussetts, New Jersey and New Mexico.
Local advocates, meanwhile, continue their efforts at public education, such as a "Personalizing End-of-Life Choices" program to be held at a Eugene church this weekend.
Oregon's law is designed to keep patients from hastening their death out of desperation or at the urging of family members, advocates say. To qualify, Oregon residents 18 or older with a terminal diagnosis of six months or less to live must have the capacity to understand their illness and their options, as well as the ability to swallow the medication, which comes in capsules and is typically served in liquid form.
The process of obtaining the prescription takes at least 15 days -- often longer if the pharmacy needs to order it.
"That was the stressor for us," Janet Moelzer said. In their case, the process took one day longer than expected -- they had to push Willi's "hastening" -- the scheduled date for his death -- back a single day to Nov. 23.
She said she also worried throughout the process that she may unwittingly be "hastening the hastening" of her husband, who she had met and married in Hawaii in 1972.
"I was the active person who would make phone calls, who would take him places" in his final months, she said, and she sometimes wondered, "I'm not pushing it, am I?"
But the conversations that she and her husband had long before his condition took hold, as well as their discussions as his health worsened, confirmed that they were making the right choice for him, she said.
"He had always believed that life, when one is incapacitated, is not worth living," she said.
"Hastening" the inevitable
At least 122 Oregonians received a Death with Dignity Act prescription last year, and 71 of those patients -- just slightly over half -- actually used the medicine to accelerate their death. Nearly all of them died at home and were under hospice care.
Of those individuals, 64 percent had terminal cancer, nearly 10 percent had chronic lower respiratory disease and 7 percent had amyotrophic lateral sclerosis, commonly known as Lou Gehrig's disease, according to state health officials. The individuals' median age was 71.
Sixty-two different physicians wrote the 122 prescriptions, but physicians were present at the time of death for only eight of the 71 who took the medicine.
Susan Smith is a Eugene-based volunteer and advocate for Compassion & Choices -- part of a national nonprofit organization that first formed in Oregon in 1998 to help residents navigate the Death with Dignity Act. The agency's institutional predecessor was the Hemlock Society, which was founded in 1980 -- by Junction City resident Derek Humphry -- and dedicated to "fighting for voluntary euthanasia and physician-assisted suicide."
Not surprisingly, terminology is important to both advocates and detractors of the state's law.
Compassion & Choices, for example, intentionally calls the act of taking a life-ending prescription a "hastening" because "it's hastening the inevitable," Smith said. "We're all terminal."
The terminology is important to the progression of the "death with dignity" movement, she said. In a May 2013 Gallup survey, 70 percent of Americans said they support allowing doctors to "end the (terminally ill) patient's life by some painless means," in contrast to only 51 percent who said they support doctors helping a terminally ill patient "commit suicide."
Efforts to expand the "death with dignity" movement across the country is "a matter of shifting belief systems to allow people to choose what's legal," said Smith, 69.
Opposition and support
But there are others who are far from sold on Oregon's death with dignity law, or with the terminology preferred by advocates. Those critics include Dr. William Toffler, a professor of family medicine at Oregon Health & Science University in Portland and a founder of Physicians for Compassionate Care Education Foundation, a nonprofit organization opposed to assisted suicide.
Proponents may like to speak of aid in dying, "but what we're talking about here is assisted suicide," Toffler said. The law "empowers doctors to give massive overdoses of sleeping pills so that people can kill themselves."
Toffler calls Oregon's law "well-intentioned but horribly misguided." The law's "myriad" problems, he said, include the failure to acknowledge that some individuals considering the prescription suffer from clinical depression; that physicians are rarely present when someone takes the prescription, meaning that reports of what happens at the moment of death is second- or third-hand; and that terminal diagnoses of six months or less to live are often wrong.
"Doctors are lousy at predicting the future," he said.
Toffler also notes that while proponents speak of supposed gains in cultural acceptance of "death with dignity" laws, the fact remains that -- 17 years after Oregon's law was passed -- the vast majority of states have not embraced the idea.
Other critics, including many Roman Catholics and members of other Christian denominations, object to the law on religious grounds. At PeaceHealth, a Catholicbased agency and the largest healthcare provider in Lane County, doctors aren't allowed to prescribe life-ending medication because "we view end of life -- we view all life -- as a gift," said John Holmes, PeaceHealth's regional director of ethics.
PeaceHealth doctors, when asked about the aid-in-dying option, direct patients to online resources such as the national Death with Dignity website, Holmes said. The medical group specializes in high-quality hospice care rather than life-ending prescriptions, and continues to provide hospice care for patients who choose to use the Death with Dignity Act, he said.
"We certainly want people to have access to the kind of care that they think is right for them, and we don't want to be a player in the community that tells people what's right for them," Holmes said.
The medical group's stance also protects doctors from participating in a process that they may find personally or professionally objectionable, Holmes said. "Physicians need to feel comfortable doing something for their patients," he said.
For its part, Compassion & Choices helps patients find doctors and pharmacists who are comfortable dealing with a lethal prescription. Smith said utilizing such a prescription is not patients' only option for aiding in their own dying.
They also can opt for hospice care and heavy pain medication or sedation, discontinue treatments, or voluntarily stop eating and drinking.
In her work with Compassion & Choices, Smith has been a part of many "hastenings," which volunteers attend in pairs to assist a family with the prescription and process.
She said she's seen broken family relationships healed just before the planned death, as well as ceremonies that incorporate everything from religious rituals to Beatles montages.
Often, she said, the volunteers will mix the prescription for the patient. But when her husband, who suffered from lung cancer, chose death with dignity in 2005, Smith said she had no qualms about taking charge of the process.
"Some people are uncomfortable handing that glass to their loved one," she said. "For me, it was my last gift to my husband."
On the day of Willi Moelzer's death, Janet Moelzer said she didn't wake with grim feelings but rather with a sense of everything that needed to be done -- she had a hastening to prepare.
She had previously notified her husband's former students, many of whom had traveled with him on school trips to Europe, and she posted their warm responses to her husband's upcoming death (sample: "Best teacher EVER") on the walls of their living room for people to read as they gathered to say goodbye.
About a dozen close friends arrived, she said, though only a couple of them felt comfortable enough to follow Willi Moelzer into the bedroom where he would take the prescription.
Janet Moelzer and a friend helped hold her husband up in bed as he drank a solution containing the prescription -- three months' worth of sleeping pills.
Janet then gave her husband a fruit juice chaser to counter the bitter taste.
Within 10 minutes, she said, her husband was in "sleep mode," and soon after, he died in his sleep.
For Janet Moelzer, who had grieved her husband's death long before his actual departure, the process was peaceful -- joyful, even.
"The spark that really drove him through his life, that made him such a compelling person to be around, had died down to an ember," she said.
The way he chose to die, she said, "gives me a sense of completion. We brought him to the place that he wanted."
Team Editor Jeff Wright contributed to this report. Follow Kelsey Thalhofer on Twitter @kelseythalhofer. Email firstname.lastname@example.org.