In 1997, the last time Clatsop County voters were asked about it, 61 percent favored keeping Oregon’s law allowing terminally ill adults to obtain a lethal prescription. When Washington state authorized the same law in 2008, 64 percent of Pacific County voters supported it.

Despite these strong endorsements for the concept that rational adults deserve to control their own fates when it comes to end-of-life decisions, it remains stubbornly difficult for terminally ill residents of the Columbia estuary counties to obtain physicians’ help in ending their suffering. In fact, this gap between the law and pragmatic reality is an issue throughout the rural Pacific Northwest.

Many of the Northwest’s hospital systems are affiliated with the Catholic Church, which has strong doctrinal objections to suicide in any form. This takes Providence Seaside Hospital out of the equation. Columbia Memorial Hospital is Lutheran-affiliated and also opts out of participation. In other cases, many pharmacies, publicly owned hospitals and their medical staffs have chosen not to participate in “aid in dying.”

This means, as a practical matter, that the ability to conveniently obtain this form of help is limited to patients in urban areas with abundant healthcare choices.

As EO Media Group journalist Natalie St. John reported last week, a recent report found that in Washington state few minority, lower-income and rural residents have taken advantage of the law. According to the report, 92 percent of participants were white, 93 percent had some form of insurance, and 76 percent had at least some college education. More than half were married, and 95 percent lived west of the Cascades. In Oregon, participation trends have been very similar to those in Washington — white, well-educated, insured, west side. But only 7 percent were from Oregon’s coastal counties in 2014.

A common challenge is that people who don’t live in major cities may have to travel out of their area to have the two required consultations and pick up the medication. That can be a serious hardship for people who are low-income, don’t have transportation or are too sick to travel.

It’s time for rural healthcare providers to reassess their positions by expanding access to aid in dying. Measures supported by strong majorities of local voters deserve deference.

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