PHILOMATH, Ore. — Months after he was diagnosed with stage-four lung cancer, his body wasting away and his voice reduced to a whisper, Ben Wald woke up his wife in the middle of the night and told her he was dying.
"I've had a good life. I love you," Pam Wald remembers him saying. "I just don't want to continue living like this. I want to explore Oregon's death with dignity law."
She didn't want to listen at first. After 43 years of marriage, she couldn't fathom the idea that her husband was dying. But the next night, he brought it up again.
"He looked me in the eye, and he said, 'I need your help.' I knew then I had to listen."
Wald is one of the 991 people who have used Oregon's Death with Dignity Act since it was passed in 1997. The law allows terminally ill residents with less than six months to live to request lethal medication to end their lives.
As Canada debates its own assisted-death legislation, families say Oregon's law gave their loved one a sense of control and the chance to die surrounded by friends and family. But critics say the law robs families of precious final moments, with one expert saying the safeguards aren't strong enough to stop depressed people from getting the drugs.
Wald had to overcome a number of barriers while seeking a prescription in 2012 in Philomath, a rural community about 140 kilometres from Portland. His oncologist was reluctant to use Oregon's law, so he turned to advocacy group Compassion and Choices, which referred him to Dr. David Grube.
"Ben was so sick he couldn't even get out of bed," Grube recalled. "He was having trouble even completing sentences. He usually weighed around 190. He weighed about 100 pounds. He looked horrible. But he was witty, and very alert."
Grube and a second doctor confirmed that Wald had less than six months to live, his judgment was not impaired and his decision was voluntary, all criteria of Oregon's law. But Wald couldn't find a local pharmacist to fill the prescription, forcing his friends to drive to a pharmacy near Portland.
"Once he got the prescription, I had my husband back," Pam Wald said. "He was weak as hell, but he had a twinkle in his eye because he knew he was going to have his choice."
On May 4, 2012, a group of the couple's close friends came over. They sang and read poetry, and spoke with Wald privately in his bedroom. Pam Wald shared with the group her husband's final advice to her, which was, "Make people earn your trust," and "Live simply, act nobly and obey your heart."
After two Compassion and Choices volunteers prepared the medication, Pam Wald gave it to her husband. He consumed it quickly, falling asleep in five minutes and dying in two hours.
"Before he closed his eyes, he looked at me and he said, 'Thank you.' Those were his last words."
Sitting in her tiny living room surrounded by photos of her husband, Pam Wald said everyone who was there that day says their lives have been changed forever.
"What death with dignity does ... it shows individuals we're all going to die. It shows individuals how to have a dignified death on their terms."
In Oregon, the language people use to describe using the law remains political, 19 years after legalization. Critics deliberately call the practice "assisted suicide," to the disdain of advocates who prefer "aid in dying" or the euphemistic "death with dignity."
Grube said deaths under the law have an entirely different emotional impact on families than suicides. About five years before the law was enacted, his neighbour, a cancer patient, killed himself with a shotgun. Grube had to go over to his house to find his body.
"It was horrible for his family and horrible for me," he said. "Everybody wonders. I wondered: 'How come I didn't recognize he was feeling this way?' And there's the physical mess of it. It's so awful. Nobody grieves normally.
"Aid in dying is a planned thing, which is gentle and kind and the family usually is all there. So when the person dies, the family grieves appropriately. They're sad because they lost their family member, but it was a beautiful death."
Still, critics argue the final weeks and days of one's life before a natural death can be beautiful and that a hastened death isn't the answer. After Dr. William Toffler's wife was diagnosed with cancer and given months to live, she survived for five years.
"I wouldn't wish cancer on anyone. But the reality is that we were married 40 years and among the best years of my life and her life were the last five," he said. "If you know you only have a limited amount of time to live, you don't take days for granted."
Oregonians who seek aid in dying are often described as well educated, accomplished people with a lifelong focus on independence and control. In a 2003 survey by psychiatrist Linda Ganzini, doctors described their patients not as depressed but as "determined" and "decisive."
The law requires patients be referred for a psychological exam if a doctor suspects they have depression or a mental illness, but these examinations are surprisingly rare. Just five of the 218 people who received prescriptions last year were referred to a psychiatrist.
In a 2008 study of 58 terminally ill residents, Ganzini found that of the 18 people who used lethal medication to end their lives, three were depressed when they obtained a prescription.
"The current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug," she concluded.
Susan Smith, who became a Compassion and Choices volunteer after her husband Joe Smith used the law in 2005, said suicide is a decision made by someone who has a choice to live or die. Her husband had terminal lung cancer and could only choose when, where and how to die, she said.
"He was an independent thinker and wanted quality of life instead of quantity," she said. "He wanted to be able to be conscious and say goodbye when his body was ready to go."
Smith recalled standing with her stepdaughter in her kitchen and pulling apart 100 bright pink capsules of Seconal to mix into applesauce. As a former nurse, she had a moment where she wondered, "Is this the right thing to do?"
But she thought of his suffering and what he would endure if she didn't help him. He had grown skeletal, his chest was filled with mucous and he was suffering tumour fevers. Refusing to give him the medication would have been selfish, she concluded.
He told his family and friends he loved them before Smith gave him the applesauce, her "last gift."
"I've always wondered about the mystery and now I get to go find out," she recalled him saying.
He died within 45 minutes of eating the mixture, and only a few minutes after a friend opened a door. He was part Cherokee, a culture that believes the soul needs a portal to exit.
"I felt very relieved and joyful — sad, but it had happened and it happened well," his wife said. "He was where he needed to be."
