Ask any woman. The back alley is an inherently unsafe and degrading place to go for medical treatment.

At one time the epicenter of the back alley for end-of-life choice was a Volkswagen bus in Michigan. Today's epicenter is a veterinary pharmacy in Tijuana, Mexico.

A recent New York Times article, ("In Tijuana, A Market for Death in a Bottle," July 21, 2008) explains it all and has quickly become one of the most visited and emailed pieces on the Times website. The zebra-striped burro featured in the accompanying photo gives the whole scene a surreal, Fellini-like tone.

Yet desperate, determined people from around the globe regularly visit this scene to obtain the short-acting barbiturates they know could deliver to them or their loved one the same rapid mercy they have seen delivered to their beloved pets. They come with no Spanish language skills. They carry pictures of the bottle they seek as they labor to decipher confusing instructions on dosage.

If it weren't so sad it would be comical, in addition to surreal, to watch the couple on a linked video lamely explain to a quizzical shopkeeper how the reason they need a really big dose is they have a "really big" dog (150 pounds). The shopkeeper doesn't seem to be buying that story.

Tragically, after bickering about which one of them is right on the dose, this couple returns to Australia empty-handed. The woman, with advancing Alzheimer's Disease, resigns herself to her fall-back plan, obtaining a pistol and shooting herself when she no longer recognizes her husband.

Now this is where I get angry. What kind of barbaric, merciless society would consign a loving, conscientious, thoughtful and considerate woman to such a cruel ending to her fruitful and meaningful life? Shame on this callous, cruel world.

Only a few places in the world have made it legal for dying patients to receive life-ending medication from their physician and self-administer it: Belgium, Luxembourg, Netherlands, Switzerland and Oregon.

In Oregon the practice has been closely watched and voluminously reported for 10 years. Most Oregonians are comforted to have a death with dignity option; few use it (about one in 1000 deaths) and hospice and pain care have grown and flourished with the law in place. Just last month an esteemed panel of pain care experts awarded Oregon an "A" grade for pain care, joining only four other states so honored.

Here's the irony. Solid medical research, over long periods of time and across many geographic regions, shows underground, back alley assistance happens FOUR TIMES as often (one in 250 deaths) as legal death with dignity in Oregon. Meticulous studies show the underground practice in Oregon has completely ceased, having been replaced with an open, transparent, regulated, safe medical practice one-fourth the size of covert, illegal assisted deaths in the other 49 states.

So you'd think, rationally, death with dignity opponents would promote legalization, to keep the incidence down at least. You'd be wrong! Apparently right-to-lifers prefer to drive the dying to a rampant, dangerous back alley of degradation than to a rare, safe medical practice of dignity. Go figure.

Yes, underground practice goes on unfettered in 49 states. But just because you're venturing in the underground, is no reason to stay in the dark.

Promise me this. If you or someone you love needs to talk with a non-judgmental, knowledgeable and compassionate expert in peaceful dying, please, please, call Compassion & Choices. Our consultation program applies over 20 years' experience walking people through the labyrinth of end-of-life choices. Our network of medical professionals and trained volunteers covers over the nation.

We understand each person, situation and family is different and regardless of the situation, we can always identify a peaceful, humane escape from unbearable suffering. Different situations call for different options. There's no need to break the law. Often the answer is right there, waiting to be discovered through a careful, frank conversation. Effective medication is almost always available without traveling to Mexico or any other country.

Compassion & Choices never abandons a client to their suffering and never charges a fee for consultation. Our counselors and volunteers will stay with you through the tough times— ongoing consultation lasts an average of five months until the time of death.

Assurance of a peaceful death brings great comfort to people facing terminal illness. We often say that assurance "enhances the celebration of life." It's just that the assurance and the celebration are usually available without the risks of foreign travel.

- Barbara Coombs Lee is President of Compassion & Choices, a nonprofit organization dedicated to improving care and expanding choice at the end of life.

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