VERMONT - Emotionally charged advertising and lobbying campaigns are intensifying as the state legislature heads for a showdown on a bill that would permit terminally ill Vermonters to end their lives with the help of their doctors.
The two sides in the increasingly fervent debate can't even agree on how to refer to the focal point of the controversy. Supporters say the legislation will facilitate "death with dignity," while opponents warn that Vermont is on the verge of becoming the second state in the nation to legalize "physician-assisted suicide."
Foes of the measure include the Vermont Medical Society, the Catholic diocese of Burlington and disability-rights activists. Among the bill's backers are prominent - and aging - Vermont political figures such as Madeleine Kunin, Phil Hoff and Barbara Snelling. Gov. James Douglas opposes the initiative, which was recently approved by two Vermont House committees.
The legislation at issue is officially designated H.44 - An Act Relating to Patient Choice and Control at the End of Life. Under its provisions, a mentally competent patient who is independently diagnosed by two physicians as having less than six months to live would be able to ask his or her doctor to prescribe lethal medication. Following a 15-day waiting period, the patient would receive the drug, which would have to be self-administered.
The full Vermont House is expected to vote soon on H.44. And the outcome will likely prove "very tight," predicts Dr. Robert Orr, who heads a group that's fighting the bill through ads critics call misleading and alarmist.
Orr's Vermont Alliance for Ethical Healthcare  (VAEH) has repeatedly run a TV spot that, he says, "poses troubling questions" regarding the 9-year-old Oregon law on which Vermont's bill is modeled.
The ad implies that doctors could be encouraged to take the lives of poor, elderly or disabled patients. The VAEH media campaign further suggests that vulnerable teens might be led to believe it's OK for sick people to kill themselves - a scenario that Douglas has sketched as well.
VAEH is joined on the frontline in the battle to kill H.44 by disability-rights groups and religious organizations. The alliance presents itself as a secular defender of human life against the threat of rampant euthanasia. Almost all of VAEH's 25 officers and advisors are medical professionals, and many of them object to the legislation on ethical grounds not necessarily colored by religious beliefs, Orr says.
But Orr himself, a retired physician and former director of clinical ethics at Fletcher Allen, describes his Lutheran creed as "very important to me." In addition to teaching ethics at UVM's College of Medicine, Orr currently serves as a trustee of the Tennessee-based Christian Medical and Dental Associations . CMDA's mission statement enunciates a set of beliefs that could be viewed as fundamentalist, including the association's dedication to "the divine inspiration and final authority of the Bible as the Word of God."
Orr says he knows of no other alliance leader who is affiliated with CMDA, which bills itself as the nation's largest faith-based organization of doctors. He says the alliance operates independently of the Christian group.
But CMDA's director came to Vermont to offer strategic guidance prior to the launch of VAEH five years ago. He advised local organizers to build an alliance between medical professionals and disability-rights groups. And CMDA's approach matters. The group has played a role in the defeat of doctor-assisted-death legislation in several states.
The Vermont Center for Independent Living , a 28-year-old disability-rights group, works with VAEH in the campaign against H.44. In its own TV ads, the center suggests the legislation would devalue the lives of disabled Vermonters. These spots conclude with the image of a crutch drawing "a line we must not cross."
VAEH also has links to the Vermont Right to Life Committee . The state's anti-abortion group participates in monthly strategy conferences that the alliance helps arrange, notes Orr, who says he was active during the 1970s in the movement to overturn the Roe v. Wade ruling that legalized abortion in the United States.
"Dr. Orr doesn't make all these connections clear," says Dick Walters, head of Death with Dignity Vermont . "But the dots are all there waiting to be connected."
Death with Dignity Vermont has entered the TV ad fray with spots in which former governors Hoff and Kunin speak vaguely about the issue while a screen text suggests that "the time has come" - though for what it does not specify.
Death with Dignity advocates regard the legislation as ethically proper and argue that the opposing camp has no monopoly on morality.
"I respect Bob Orr's religious convictions," Walters says, "but he has no right to impose those beliefs on me and the vast majority of Vermonters."
In a recent interview, however, Orr did not take a dogmatic approach to the issue. "I understand where people are coming from," he says of the bill's supporters. "I understand the dilemmas and difficulties faced at the end of life. I understand the importance of patient autonomy."
But Orr distinguishes between a terminally ill patient's right to refuse treatment, which he terms "unassailable," and active intervention by a medical provider in ending life, which he views as a violation of professional and ethical standards. He adds that prosecuting doctors who help patients end their lives would be "non-productive."
Orr would not indicate how much VAEH is spending for TV and radio ads and for retaining a Montpelier lobbying firm. "We know our opponents have a very large budget, and we'd rather not let them know how small ours is," he says.