By Vincent Dowd
BBC News, Montana
Oregon and Washington State already allow assisted suicide
The Supreme Court in the US state of Montana is due to begin hearing arguments to decide if severely ill people there have the constitutional right to ask their doctor to help them die.
A lower court judgement last December decided that they did, but now the state of Montana is trying to have that ruling overturned.
By and large, the rest of the US does not focus on legal proceedings in the small city of Helena.
It might be a state capital but the "Queen City of the Rockies" has a population of less than 30,000. Yet a hearing at Montana's Supreme Court in Helena may influence how other Americans live and die.
Last December, Montana became the third US state to permit what supporters call "assisted dying" or "death with dignity".
District Judge Dorothy McCarter had ruled in the case of Robert Baxter, a terminally ill former truck driver who wanted to establish a right in law to ask his doctor to help him die.
Mr Baxter died just hours after Judge McCarter decided
the Montana constitution
did indeed allow such a right.
But the change has, in effect, been on hold pending this week's hearing. The initial ruling was significant because the two states which already permit assisted suicide did so after ballots and prolonged public debate - Oregon in 1998 and then last year Washington.
Campaigners for assisted dying believe that if the McCarter ruling stands, arguments based on state constitutions could now hold sway elsewhere.
They hope New Hampshire and Massachusetts could be among the next to change their laws.
That both Washington and Montana moved towards assisted suicide at almost the same time was no coincidence.
The organisation Compassion and Choices has been lobbying for years to permit assisted dying state by state.
It believes that momentum is building in its favour. The group pursues whichever route will work best - legislative change, ballot initiatives or an appeal to a state constitution.
The group identified the Montana constitution, dating from 1972, as placing a useful emphasis on the privacy of the individual.
Though it might take weeks for a ruling to emerge, those who oppose assisted suicide fear Montana's historic emphasis on individual responsibility could well see the ruling survive.
Moe Wosepka speaks for the Catholic Church in Montana. He acknowledges polls tend to show opinion moving slowly in favour of assisted suicide.
He believes the lobbyists have been skilled in employing emotive arguments. He says assisted dying may seem merciful but he believes it is just an easy cop-out for society.
"In palliative care, if medications are given to the point where they may hasten death that's a different issue. But if what we're doing is just utilising death to solve the issue of pain then we're not really dealing with the issue - we're just getting around it," he says.
Mr Wosepka points to the active involvement of the Catholic Church in the hospice movement in Montana.
"That's what all of us need to concentrate on - not on ending patients' lives prematurely."
The national chair of Compassion and Choices, Cindi Gibbs, believes the appeal will be rejected.
"Montana has a particularly strong provision for individual dignity and privacy. It has a strong history of being very supportive of individual choices and rights," she says.
"So particularly if the Supreme Court in Helena rules it's a key component of individual privacy, to make this decision with your family and your doctor, then their decision may be more broadly applicable."
This week's review is on a point of law: does Montana's constitution allow assisted suicide?
It is not up to the seven justices hearing the argument to decide if it should do so.
But Bill, 85, and Betty Lovelady, 82, are Helena residents who are sure the answer to that question ought to be yes.
They've been married for 60 years and when they lived in in Oregon in the 1990s they both voted in favour of assisted dying there.
Since then, Mrs Lovelady has survived breast cancer while her husband has had cancer and heart surgery.
They say they want assisted dying to be available to them in Montana too if their problems recur. They have discussed the decision with their four children who support them.
"I think it's cruelty to keep someone alive who's no longer functioning at all. What I really dread is being paralysed and not being able to tell the doctor to pull the plug," says Mr Lovelady.
Like her husband, Mrs Lovelady wears a "Comfort One" bracelet to show doctors she does not wish to be resuscitated after any serious medical incident.
And they have arranged a code so that if either is robbed of speech they can indicate to the other if they wish to die.
"It's human intervention that can keep people alive when they're in misery, " says Mrs Lovelady. "I don't think it's God's will that we suffer and suffer. It's the doctor's will or the state's will. It's not my will. I don't want a life that has no quality."
The couple's concern now is that that death should come with dignity. Mr Lovelady has no patience with the pretence that death is not an inevitable part of things.
"I'm going to die. Betty's going to die. Time always wins."
Until a year ago, only one US state allowed assisted suicide. Whatever happens in Montana after this week's hearing it seems likely that number will grow.
With more people living into their 80s and 90s, it is a debate that will not be limited to any one state or to any one nation.