Patrick Matheny of Coos Bay, Ore., received an in-person express delivery in November 1998. He waited more than four months before ingesting the lethal drugs that the package contained. The prescribed drugs were legal due to the state’s then-recently passed Death with Dignity Act, which still allows a person to end his or her life with deadly capsules.

Matheny, who was 43 at the time of his death, was nearly paralyzed from ALS and unable to self-administer the barbiturates mixed into a chocolate drink. He received assistance from his brother-in-law, Joe Hayes, who reportedly held the glass while Matheny drank through a straw. Authorities found that there was no breach in the law with Matheny’s death, but questions remained as to how much assistance one person could give to another in taking the prescribed drugs.

Welcome to the world of physician-assisted suicide and its murky realities. In 1997, Oregon became the first state to legalize the practice. Its neighboring state, Washington, became the second in 2008. Assisted suicide was then made legal in Montana through a court ruling the following year. Now, Massachusetts voters can expect to see a similar petition on the November ballot.

Matheny’s situation and death has become fairly well known, as it was documented in the newspaper The Oregonian and later cited by a number of groups. Some two months before his death, reporter Erin Barnett’s feature article showcased Matheny’s progression of thoughts about the fatal choice as his physical abilities deteriorated.

“I really believe I can still accomplish some things and have a purpose in life,” Matheny said in the story. “So it’s not time, and I think I’ll just wait until I get the inner calling — or don’t get it.”

But Matheny also said at another time, “The idea of waiting too long scares me the most.” He understood there would probably be a point when he could not physically take the drugs, even if his mind was set on doing so.

SO-CALLED DEATH WITH DIGNITY

Similar to the legislation in the Pacific Northwest, the Massachusetts Death With Dignity Act seeks to allow those 18 years of age and older the choice to self-administer lethal drugs. This is after an attending or consulting physician determines that the individual has a terminal disease that “will, within reasonable medical judgment, produce death within six months.”

The measure requires that the process be “entirely voluntary on the part of all participants” and that the adult have “the capacity to make health-care decisions.”

Careful to avoid the term “suicide,” the ballot petition states that a patient’s death certificate would list the terminal disease as the cause of death. Instead of the term “assisted suicide,” the phrase “to end a patient’s life in a humane and dignified manner” is used. The initiative even states directly that actions of the proposal “shall not constitute suicide, assisted suicide, mercy killing or homicide under any criminal law of the commonwealth.”

Opponents to the measure have found plenty to take issue with.

In a videotaped homily distributed to parishes in the Archdiocese of Boston, Cardinal Seán O’Malley said, “The bill also requires two witnesses to attest to the patient’s competence. But one of the witnesses can be a total stranger, and another can be the sick person’s heir. Alfred Hitchcock would make movies about this stuff.”

The ballot initiative was spearheaded by a group of 15 Massachusetts citizens that includes current or previous members of the Harvard Medical School faculty, the American Civil Liberties Union of Massachusetts and the organization Compassion and Choices. In 2003, Compassion and Choices became the new name of two merged groups, including one previously known as the Hemlock Society USA, which was founded in 1980.

The idea that the current ballot initiative in Massachusetts is a grassroots effort does not sit well with M.C. Sullivan, a nurse, bioethicist and attorney who works for Covenant Health Systems, a Catholic health provider based in Tewksbury, Mass.

“It is an initiative that was brought to bear by a group of people who have had this agenda for quite some time,” said Sullivan. “The people who are behind ‘Death with Dignity’ are part of a national network that has been trying to legalize assisted suicide for decades.”

Sullivan is among those who take issue with the collection of approximately 80,000 citizen signatures to get the measure considered by the state legislature. Complaints have been made that collection propaganda used misleading and ambiguous phrases like “compassion for the terminally ill.”

“Some of the people who signed those petitions claimed that they never understood that it was about assisted suicide. They really did think that it was about compassion and choices in dying. Well, that’s a very different thing than suicide,” said Sullivan who gives talks about physician-assisted suicide and related issues.

HOPE FOR THE DYING

In contrast with a worldview that favors total autonomy over one’s own life and death stands the Catholic teaching on the sanctity of life. Responding to physician-assisted suicide, the U.S. Conference of Catholic Bishops issued a statement in June 2011 titled “To Live Each Day with Dignity.”

In six pages, the document addresses the continued threat to human dignity resulting from false notions of freedom and of compassion for the sick and dying.

“People who request death are vulnerable. They need care and protection. To offer them lethal drugs is a victory not for freedom, but for the worst form of neglect. Such abandonment is especially irresponsible when society is increasingly aware of elder abuse and other forms of mistreatment and exploitation of vulnerable persons,” the statement argues. “The idea that assisting a suicide shows compassion and eliminates suffering is equally misguided. It eliminates the person and results in suffering for those left behind — grieving families and friends, and other vulnerable people who may be influenced by this event to see death as an escape.”

But the bishops’ statement does not stop at listing a litany of problems with physician-assisted suicide as it is practiced, such as neglect in evaluating mental illness and a lack of scrutiny in the circumstances surrounding one’s choice to die legally. Rather, the bishops go on to provide a message of practical hope and illustrate that respect for life does not require extending life with treatments that do not work or are “unduly burdensome.”

The statement notes that suffering patients should not be refused pain medications even if there is fear that possible side effects could shorten life. “In fact, severe pain can shorten life, while effective palliative care can enhance the length as well as the quality of a person’s life,” the statement says. “Effective palliative care also allows patients to devote their attention to the unfinished business of their lives, to arrive at a sense of peace with God, with loved ones and with themselves. No one should dismiss this time as useless or meaningless.”

Father Roger Landry, pastor of St. Bernadette Parish and chaplain of Msgr. Jean A. Prevost Council 12380 in Fall River, Mass., said Catholics can help by starting with prayer and attending to those who suffer at the end of their lives. Palliative care and “typical human accompaniment for which everyone longs” is a much better course than trying “to kill a suffering patient in order to end the suffering,” he said.

Father Landry said that Catholics, and especially Knights, need “to be at those bedsides, so that people who are in pain are not suffering alone.” He also stressed that the suffering should not believe that their dying is the best way to release their loved ones of caring for them.

“We need to be there with them and say, ‘We’re here with you until God comes,’” said Father Landry.

NATIONAL IMPLICATIONS

Many believe that Massachusetts has been targeted as a pivotal state for the spread of physician-assisted suicide. With its renowned medical facilities and professionals, along with its academic institutions, Massachusetts wields influence over the Northeast and beyond. If the state goes the way of legalized assisted suicide, it could be much easier for other states to follow.

John M. Haas, president of the National Catholic Bioethics Center, remembered when physician-assisted suicide legislation passed in Oregon and one of the campaign leaders declared Massachusetts as a goal for the suicide practice.

Haas explained that if the initiative passes in Massachusetts, it will be harder to dismiss earlier legislative actions in Oregon as a fringe movement. “That’s the most unchurched part of the United States (Oregon), and now here’s Massachusetts with a huge Catholic population finally becoming ‘enlightened’ about these matters,” said Haas, a member of Mater Dei Council 4129 in Newtown Square, Pa. “So when they think about these things strategically, they take all these considerations into account.”

Cardinal O’Malley first addressed the issue publicly at a Red Mass for the legal community in September 2011. “We hope that the citizens of the commonwealth will not be seduced by the language, ‘dignity, mercy, compassion,’ which are used to disguise the sheer brutality of helping someone to kill themselves,” the cardinal said.

Since then, the archdiocese of Boston has launched a website devoted to the issue, including the video homily from the archbishop that was played in nearly 300 parishes in mid-February. More outreach is planned leading up to the vote.

Janet Benestad, who directs the Boston archdiocese’s educational campaign against the initiative, is quick to point out that the situation should not be looked at as only a Catholic issue. Many others in the community, including citizens’ groups and advocates for persons with disabilities, are opposed to physician-assisted suicide, as are medical organizations such as the American Medical Association and the Massachusetts Medical Society.

“It’s also important to consider that 25 states have rejected this in the course of the last several years, and there are good reasons for that,” said Benestad. “They didn’t want it in their states, and it’s important for people to Massachusetts to ask why.”

Three separate coalition groups have been working against the push for legalized suicide in Massachusetts. In one group, which is supported by the Supreme Council, is the Massachusetts Catholic Conference, the public-policy arm of the state’s bishops, representing the state’s four dioceses. A fundamental goal of the MCC is to clear up the language of the petition.

“It’s just getting the terms down to what this actually means — that ‘Death with Dignity’ is a prescription for a legal dose of medication to end one’s life,” explained Peter McNulty, associate director of policy and research for the MCC and a member of Dedham Council 234.

Father Landry suggested a three-point plan for how the local Knights of Columbus can help: prayer, being informed in the issues and mobilization. He added that Knights across the country can pray for Massachusetts and do proactive work in their states to build a culture “that supports life at its most vulnerable extremes.”

“The Knights of Columbus have already distinguished themselves as champions of life and the protection of our unborn brothers and sisters,” said Father Landry. “But now they’re called to become defenders of our older brothers and sisters whose lives are being devalued and threatened by the push for doctor-prescribed death.”

For educational resources from the Archdiocese of Boston and the USCCB, visit suicideisalwaysatragedy.org and USCCB.org/toliveeachday.

JUSTIN BELL, a member of Denver (Colo.) Council 539, has reported for the Boston archdiocese’s newspaper The Pilot and is a correspondent for the National Catholic Register. He currently lives and writes from the Boston area.