The Supreme Court last week overturned former Attorney General John Ashcroft’s finding that dispensing opiates and barbiturates for the purpose of assisted suicide violates federal drug regulations. Oregon’s “Death with Dignity” law stands.

The high court decision mostly revolved around technical issues involving state and federal jurisdiction. But some have speculated it may also lead to a renewed flurry of interest in other states in mimicking the Oregon law. Under that law, if two physicians agree that a patient is of sound mind and likely to die of a terminal illness within six months, they may fulfill a request for a lethal dose of narcotics after a 15-day waiting period.

Official Oregon statistics show that there have been 208 such assisted suicides since the law was enacted in 1997. In California and Vermont, assisted suicide laws have been introduced in the legislature in recent years. And in the abstract, assisted suicide is popular with the American public, according to polls.

But in the end such proposals seem to be a tough sell. Oregon’s law was approved by a narrow 51 percent of the voters. An assisted suicide measure went down to defeat by a 51-49 margin in Maine in 2000. The Hawaii legislature initially approved and then killed a legalization bill despite all-out support from then-Gov. Ben Cayetano. And in Michigan, for a time the ground zero of the assisted suicide movement, a 1998 referendum initially polled 72 percent approval but was defeated by an astonishing 3-1 margin.

True, the situation in Michigan was doubtless colored by the, er, terminal weirdness of Jack Kevorkian, a pathologist who had never actually practiced medicine. He talked often and openly of his crusade to use assisted suicide as a means of harvesting organs and conducting research on the dying process. There were pictures of him making house calls to local motels in his rusty Volkswagen with his death-dispensing apparatus. And the vast majority of his 170 or so “patients” were women; many were disabled or suffering from depression.

Ultimately Kevorkian was sentenced to a lengthy prison sentence for his self-videotaped offing of a man with Lou Gehrig’s disease, shown on “60 Minutes.” He was denied parole late last year by Democratic Gov. Jennifer Granholm despite reports that he himself is now terminally ill.

But it’s also possible that the more the public generally thinks about the issue, the less attractive physician-assisted suicide comes to seem. High-toned chatter about “death with dignity” and “individual autonomy” notwithstanding, assisted suicide can be far messier than it seems from afar.

For one thing there is that slippery phrase, “terminally ill.” Medical studies show that predictions of imminent death are highly unreliable even when made by experienced physicians. Then there is the example of the Netherlands, the world capital of assisted suicide and euthanasia, where physicians have been prosecuted for helping kill people who were merely “tired of life.” And in Oregon there have been reports of cancer specialists making terminal diagnoses of people with neurological problems.

A far safer middle ground is to focus on improvements in pain control. Model guidelines were promulgated in 1998, but many physicians may not be aware of them or reluctant to prescribe high doses of narcotics for fear of inducing addiction. As the New York Times’s Jane Brody wrote recently, they may also worry about getting busted by the Drug Enforcement Administration if the medicine falls into the wrong hands.

The high court may be right to leave the matter of assisted suicide to the states. But out in the states, most voters are smart enough to sense the legal and moral thickets surrounding assisted suicide. When it takes 12,000 words to explain a ballot proposal, as the Michigan assisted suicide referendum did in 1998, you tend not to be reassured – much less think the state has any business authorizing mere men and women to exercise the God-like powers of life and death.

Mr. Bray is a Detroit News columnist.