MILLIONS WATCHED as health care demagogue Betsy McCaughey slammed down a fat binder onto Jon Stewart's desk on The Daily Show last Thursday night, August 20, claiming that the infamous "death panel" policy was right there on pg. 425. Portland's own Representative Earl Blumenauer originally penned the language on that page—one small "advance care planning" clause within the massive health care reform bill.

It makes sense that the national "death panel" hysteria has its roots here in Portland. Oregonians have dealt with tricky end-of-life issues in the political arena for over a decade now, since passing the nation's first law allowing terminally ill patients to request a lethal quantity of painkillers in 1998. The debates about "killing granny" (lies and sound bites included) were first heard here in Oregon.

Blumenauer originally wrote up the now-famous clause six months ago, introducing it as a bill co-sponsored by a Louisiana Republican, Charles Boustany. Policymakers folded that bill into the overall America's Affordable Health Choices Act and it was not controversial until Republican leaders like Sarah Palin, Michele Bachmann, and Chuck Grassley targeted it using McCaughey's "death panel" phrase.

"This is not a matter of it being criticized, this part of the provision has been singled out and used as a scare tactic," says Blumenauer's communications director Erin Allweiss (Blumenauer himself is currently visiting his daughter in the Peace Corps in Africa). "The truth is that this would do a lot to improve quality of life at the end of people's lives."

In the last six months, Blumenauer's office received roughly 6,000 comments from constituents about health care, including a lot of heat in recent weeks as he has defended his end-of-life policy. The controversial clause is still in the House's draft of the health care bill, but Senate leaders are threatening to strike it from their version.

The little piece of legislation that exploded into "death panels" is really a rather simple policy change from the status quo: to reimburse doctors for time spent talking to patients about end-of-life care. It would be up to the patient whether to have that conversation, which could include discussion of nursing homes, living wills, directions on when to pull the plug, or whether to reject artificially life-sustaining tools such as feeding tubes and ventilators.

"People who want end-of-life care counseling have to pay out of pocket," explains Oregon's Compassion & Choices Executive Director George Eighmey, who says that doctors will keep alive any American who does not have written orders to let them die naturally.

The end-of-life counseling included in Blumenauer's clause does not allow doctors to prescribe lethal doses of drugs to terminally ill patients, as Oregon law does, but Death with Dignity Executive Director Peg Sandeen says health care reform foes are using many of the same tactics previously used against her movement.

"They're against the changes in the health care system and they know the American people are afraid of death. They're using fear tactics to derail the debate and they're very effective," she says.

Sandeen lists familiar lies that appeared in ads against death-with-dignity laws that resurfaced in the current debate: the government will kill your grandma, children will be forced to take their own parents' lives, and weaker patients will be killed to save money.

"When President Obama came out and said, 'That's a lie,'" says Sandeen, referring to death panels, "we were nodding our heads yes." In the past 11 years, 401 Oregonians have legally taken an overdose of barbiturates to end their own lives. There has been not a single incidence of coercion, says Sandeen.

The Oregon Health Plan got itself into trouble last summer when it sent a letter to a patient denying coverage of expensive life-prolonging medication but offering to cover the $50 cost of barbiturates that would let her take her own life. Offering lethal drugs to patients is illegal (the patient must bring up the idea with doctors themselves), but the incident still confirmed the worst fears of some death-with-dignity foes.

"It makes us very nervous to have the government involved in that very personal and painful choice in that time of life," says Oregon Republican Party Communications Director Greg Leo. "Oregon has been there, but in other parts of the country, I can see how it would be shocking."