The ruling by a US federal appeal court declaring a constitutional right to die has sharply divided American doctors and set the scene for a painful national debate over the issue of assisted suicide.
The strongly worded decision was a virtual invitation to the Supreme Court to step into a thorny area of medical ethics that, like abortion, pits the sanctity of life against personal freedom of choice, legal experts said.
The Ninth Circuit Court of Appeals in San Francisco declared on Wednesday that a mentally competent, terminally ill adult "has a strong liberty interest in choosing a dignified and humane death rather than being reduced at the end of his existence to a childlike state of helplessness, diapered, sedated, incompetent".
The ruling in a case involving three terminally ill patients, all of whom have since died, applies to nine western states from California to Alaska.
The court overturned local statutes banning assisted suicide and said doctors, pharmacists and family members who helped a patient to an early death were not to be prosecuted. Its decision came as a jury in Michigan yesterday debated the case of Dr Jack Kevorkian, the controversial figure known as "Dr Death" who has flouted US laws by helping 27 people take their own lives. He faces up to four years in jail.
Though polls suggest a majority of US doctors favour legalising assisted suicide, the American Medical Association attacked the ruling, along with some churches. Right- to-life groups raised the spectre of bungled mercy killings and of people pushed into choosing death by the pressure of medical bills or impatient family members.
The Ninth Circuit has a long-standing reputation as one of the most liberal appeal courts in the country and has often been over-ruled by the Supreme Court. Washington state prosecutors, who brought the case, have 90 days to appeal.