CORVALLIS, Ore. - While there is much we don't know about why some 30 people each year in Oregon choose physician-assisted suicide, the most common reason given for the decision is fear of losing autonomy and control, said Patricia Moran, an Oregon State University expert in end-of-life issues.

"Improving end-of-life care so that patients are well-supported throughout the process is critically important to all Oregonians, regardless of their desire to utilize Oregon's unique law," Moran said.

Moran, an associate professor in the Department of Human Development and Family Sciences in OSU's College of Health and Human Sciences, is the author of "Perfectly Still: A Journey Through the Heart of Loss to Love." The book is about the transformational power of death, based on close relationships with a graduate student who died of leukemia and her mother, who died of a brain tumor.

She has also made numerous presentations across the nation on death and dying and has served as chair of a Lane County community coalition subcommittee in Oregon called "Spiritual Issues Facing the Dying and Their Families."

The U.S. Supreme Court cleared the way for Oregon's doctor-assisted suicide law this month, rejecting federal attempts to stop physicians from prescribing life-ending drugs to terminally ill patients.

Discussions spurred by the case are a big step in the right direction for a society that typically keeps death at arms length, said Moran.

"We are so afraid of death in the United States," Moran said. "To improve end-of-life (situations) everyone involved - patients, family members and the medical community - need to talk more openly about our feelings and desires around end-of-life care."

It's difficult for any healthy person, even for a researcher such as Moran who has sat at the bedsides of dozens of dying patients, to place themselves in the mindset of the terminally ill. But Moran said she expects the number of people seeking physician-assisted suicide to remain low.

"Only a fraction of 1 percent of the thousands of people who have died in the state during the years the option has been available have selected physician-assisted suicide," Moran said. "And while there is a lot of work that needs to be done in terms of support and end-of-life care, there is some really great work happening - especially here in Oregon, where we are leading many states."

Oregon, she says, is a pioneer in assuring that patient wishes to have or limit life-sustaining treatment are noted and followed.

The state also has taken a leadership role in hospice care for the terminally ill. And Oregon doctors have stepped up palliative care in a number of ways, including aggressive treatment of chronic pain.

There are still many questions concerning physician-assisted suicide that have yet to be answered, Moran said.

"For example, we know that there are often issues of stigma, anger, and guilt for family members of persons who commit suicide but we do not know the extent that these issues relate to physician-assisted suicide."

Another question is whether people begin to think about suicide as a fairly natural part of the process of coming to terms with one's impending death.

"It may be that the few who follow through with these thoughts have simply not gone all the way through this part of the overall 'work' of dying," she said.

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Patricia Moran, 541-737-1074