When 85-year-old Kate Cheney was diagnosed with terminal cancer, she sought to end her life, as allowed under Oregon's assisted-suicide laws. A problem, however, arose because she suffered from dementia, raising questions of mental competence to make such a decision. Rather than prescribe lethal drugs, her doctor referred her to a psychiatrist, as required by law.

Cheney was accompanied to the consultation by her daughter, Erika Goldstein. The psychiatrist found that Cheney had a loss of short-term memory. It also appeared that Ms. Goldstein was more interested in her mother's assisted suicide than Ms. Cheney herself. The psychiatrist concluded that while the assisted suicide seemed consistent with Ms. Cheney's values, "she does not seem to be explicitly pushing for this." Accordingly, he nixed the assisted suicide, as part of a safeguard included in the law.

While Cheney seemed to accept the psychiatrist's verdict, Ms. Goldstein viewed it as an obstacle to her mother's right to die. Goldstein petitioned Kaiser Permanente, her mother's HMO, for a second opinion, and they acceded.

The psychologist who examined Ms. Cheney also found that she had memory problems—an inability to remember when she had been diagnosed with cancer, for example. The psychologist also worried that Cheney's decision to die "may be influenced by her family's wishes." But despite these reservations, the psychologist determined that Cheney was competent to kill herself and approved the writing of the lethal prescription.

Before killing herself, Cheney had to be interviewed by an ethicist/administrator at Kaiser, a group that stood to save thousands of dollars in health care costs. Cheney told Dr. Robert Richardson that she wanted the pills not so much because she was in terrible pain, but because she feared not being able to attend to her personal hygiene. Dr. Richardson okayed prescribing the suicide pills.

Ms. Cheney did not take the pills right away. At one point, she asked to die after her daughter had to help her shower following an accident with her colostomy bag, but she quickly changed her mind. Then Cheney went into a nursing home for a week so that her family could have some respite from care giving.

As soon as Ms. Cheney returned from the nursing home, she declared her desire to take the pills immediately. After grandchildren were called to say goodbye, Cheney took the poison and died with her daughter at her side.

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