The cause of assisted suicide made a significant breakthrough this week when voters in the northwest state of Washington approved Initiative 1000. This measure authorises doctors to prescribe lethal medications for the terminally ill. The measure is patterned on the "Death with Dignity" law in neighbouring Oregon. The margin was convincing – about 58% of voters supported it and only 42% opposed it.

A similar proposal failed in 1991, but subtle changes in the proposal, massive spending and high-profile supporters seem to have made the difference. The leader of the campaign was a former governor, Booth Gardner. He has Parkinson’s disease and says that I-1000 provides a compassionate way for people to die.

The difference between the successful measure and the 1991 version is that it does not allow doctors to administer lethal drugs on behalf of patients who can't do so themselves. Any patient requesting the fatal medication must be at least 18, declared competent and a resident of Washington state.

The patient 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, heir, attending doctor, or connected with a health facility where the requester lives. Two doctors also would have to certify that the patient has a terminal condition and six months or less to live.

Bioethicist and anti-euthanasia activist Wesley J. Smith says that euthanasia now has the wind in its sails. "There are many reasons for the loss having to do with the overwhelming financial backing from all around the world in favor of assisted suicide, to a popular former governor as spokesperson, an in-the-tank media that were full cheerleaders for the pro side, to a local campaign in opposition that was, to put it politely, very disappointing in its vision, imagination, and execution."

He believes that the euthanasia "juggernaut" will use clever marketing to press for legislative change in other states. "Anyone who still says ‘it can't happen here,’ isn't paying attention." Progressive bioethicist Arthur Caplan agrees: "I suspect it will become a political hot potato in a number of states in the next few years. An aging population, the increasing cost of medical care and a lack of high-quality palliative and nursing-home care almost guarantee it."

As the popular economics blog Freakonomics points out, a good business case can be made for euthanasia. It cites a 1998 paper in the New England Journal of Medicine which estimated that legal euthanasia for terminally ill patients could cut American health-care costs by US$627 million per year (in 1995 dollars).