Nancy Niedzielski’s husband, Randy, endured six years of treatment for brain cancer that spread to his nervous system, causing chronic, painful muscle contortions. He died in 2006, incontinent, unable to swallow normally and barely able to speak.

Peyton and Niedzielski are on opposite sides of a fight over a ballot initiative to allow physicians in Washington state to help terminally ill patients end their lives. Peyton opposes the measure; Niedzielski supports it. Oregon, where voters first approved the idea in 1994, is the only state with such a law.

Supporters need to collect about 225,000 valid voter signatures by July 3 to get the “Washington Death with Dignity Initiative” on the November ballot. The campaign has raised more than $1 million, more than enough for a successful signature drive, setting up a fiercely fought and emotional campaign.

Outside Oregon, advocates of the idea haven’t fared well. California, Michigan and Maine voters rejected the idea, and bills have failed in statehouses around the country. In Washington, voters rejected physician-assisted suicide in 1991.

This year’s proposal differs in that it would not allow doctors to administer lethal drugs on behalf of patients who couldn’t do so themselves.

Initiative 1000 mirrors the Oregon law, which took effect in 1997 after a lengthy court fight, and would allow terminally ill people to obtain lethal prescription drugs for ending their own lives.

Any patient requesting the fatal medication would have to make two oral requests, 15 days apart, and submit a written request witnessed by two people, including one person who is not a relative, an heir, an attending doctor, or connected with a health facility where the requester lives.

Two doctors would have to agree on the diagnosis of a terminal disease – giving the patient six months or less to live – and declare that the patient “is competent, is acting voluntarily, and has made an informed decision.”

Popular former Washington Gov. Booth Gardner, a millionaire heir to the Weyerhaeuser fortune, has waged a public campaign in support of the measure.

Gardner suffers from Parkinson’s disease, which is incurable but not fatal, so he would not qualify if the initiative becomes law. But his worsening condition has made him an advocate for those who want control over how they die.

“It’s amazing to me how much this can help people get peace of mind,” Gardner said. “There’s more people who would like to have control over their final days than those who don’t.”

Gardner’s position has caused strain with longtime friends, political allies and his own family.

Gov. Chris Gregoire, a Catholic, has said she personally can’t support the measure, but won’t actively work against it.

Gardner’s 46-year-old son, Doug, said he and his father didn’t talk for a while once it was clear he was opposed to the measure. While their relationship has improved, the younger Gardner said he’ll still “join the chorus” of voices opposed to Initiative 1000.

“I love him, I want the best for him,” Doug Gardner said. “But don’t make it easier for these people who are in a weak state to have an opt-out option.”

Niedzielski, of Lynnwood, said her husband wanted to move to Oregon as his condition worsened, but doctors said he wouldn’t live long enough to establish residency. One of his last wishes was for her to fight for a law in Washington state. Six weeks before he died, the pain was so great that he asked his wife to help him die. She told him she couldn’t.

“To be in this position, where I couldn’t give to him what he wanted … for me it was very frustrating to see that he wanted to end his suffering,” she said. “I saw what my husband went through and it changed me forever.”

Peyton sees it differently. He says he’s made peace with the pain and anxiety he may face as his disease increasingly impairs his breathing, eventually killing him.

Initiative 1000 he argues, makes “suffering and pain such an evil that any means justifies the end of eliminating the suffering or the pain.

“What we’re really doing I believe, is attempting to eliminate the sufferer so we don’t have to deal with them,” he said.

Those in favor of the measure say that it’s not meant to encourage people to prematurely end their lives.

“They are realistically accepting that their death is imminent,” said Barbara Coombs Lee, president of the Portland-based group Compassion and Choices, part of the coalition supporting I-1000. “Knowing that, they want to protect themselves from unnecessary and unbearable suffering.”

Critics, including many doctors and disability rights advocates, say assisted suicide laws could exploit depressed or vulnerable people who worry they’ve become a burden on their families.

“This capitalizes on those fears people have about a disability, about people losing bodily control and function, that people would be better off dead than having to face that,” said Duane French, spokesman for Not Dead Yet, a disability advocacy group that’s part of the coalition against the measure.

Chris Carlson, chairman of the Coalition Against Assisted Suicide, was diagnosed with cancer in 2005 and told he had less than six months to live.

“I’m a living example of what is one of the major flaws in the proposal,” he said.

Forty-nine people died under the terms of the law last year, according to a report by the Oregon Department of Human Services. Since it went into effect, more than 340 patients used the law to end their lives.

Most suffered from cancer, and the most common end-of-life reasons they expressed were loss of autonomy, loss of dignity and a decreasing ability to participate in activities they enjoy.

What Initiative 1000 would do

Similar to Oregon law, under Washington state’s proposed Initiative 1000, to qualify for a lethal prescription:

a patient must

 • Be at least 18, declared competent, and a resident of Washington state.

 • Have been determined by an attending physician and a consulting physician to have a terminal disease from which the person will die within six months. A person does not qualify solely because of age or disability.

 • Make an oral and written request, signed and dated by the patient and witnessed by two other people. One of the witnesses must not be a relative of the patient, entitled to the patient’s estate, anyone tied to a health facility where the patient is being treated or is a resident, or the attending physician.

 • Repeat the oral request to the attending physician at least 15 days after making the initial oral request. The patient can rescind the request at any time. There must be at least two days between when the patient signs the written request, and when the prescription is written.

Once the request is made, the attending physician

 • Determines whether the patient is competent and has made the request voluntarily.

 • Informs the patient of other alternatives, like hospice care and pain control.

 • Refers the patient to another physician for confirmation of the terminal diagnosis and to ensure the patient is competent and acting voluntarily.

 • Recommends the patient for counseling if the person, or the consulting physician, believe the patient is suffering from a psychiatric or psychological disorder, or depression.

 • Recommends that the patient notify next of kin, though the patient is not required to do so in order to receive the prescription.

 • Dispenses medication directly, or, with the patient’s consent, contacts a pharmacist to fill the prescription.

 • Signs the patient’s death certificate, listing the underlying terminal disease as the cause of death.