Amy Van Meter’s death four years ago brought passionate testimonials about the 43-year-old mediator, social activist and writer and her handling of an agonizing battle with multiple sclerosis. “We have learned the meaning of fortitude in unrelenting pain, courage in uncommon trials, generosity of spirit, and faithfulness to a fully present life,” her obituary in The Des Moines Register said.

What it did not say was that Van Meter, who was raised in Iowa City and lived in Santa Barbara, Calif., had intentionally ended her life the only way that is legal in most American states: She starved herself to death.

Diagnosed at 25, Amy was in what her mother, describes as “chronic, unremitting, neuropathic pain” caused by a particularly severe case of MS. So for all of the mother’s grief at losing her daughter, Lea Halterman of Des Moines supported Amy’s choice.

But she is indignant that it had to be achieved in such an awful, drawn-out way. She said opiates were not an option because Amy had been on them for so long, she couldn’t predict the outcome. “She said, that April, ‘Mom, I can’t do this any more,'” Halterman wrote me in a letter.

Amy starved herself to death that next October. Halterman described the pain of watching someone you love “die by degrees,” and the helplessness of being unable to “alter the inevitable.”

So Halterman has taken her daughter’s quest forward. She wants Iowa to pass a law, as Oregon, Washington state and Vermont have done, that would allow someone who is terminally ill, mentally competent and of legal age to choose death with a doctor’s help. “I promised my baby girl that I would work in Iowa, her home state, to bring death with dignity here,” she said.

Physician-assisted suicide has received renewed attention since 29-year-old Brittany Maynard, who suffered from painful brain cancer, ended her life this month after publicly announcing her decision. The difference was that Maynard could do it with medicine prescribed by her doctor. She and her husband had moved deliberately to Oregon, where doctors can help patients end their lives legally as long as two doctors confirm a patient is terminally ill and has six months or fewer left. Courts in Montana and New Mexico have ruled there is a constitutional right to aid in dying in those states.

Working with the Iowa chapter of Compassion and Choices, Halterman met with nine state legislators last session. Some said they were too busy to read her materials, and others said they haven’t given death — including their own — any thought.

“When people haven’t thought about their own deaths, they’re a long way from this bill,” Halterman sighed. In May, she presided over a meeting where a Vermont state representative talked about that state’s experience getting the nation’s first Death with Dignity law passed last year. Proponent Linda Waite-Simpson said it took a lot of political negotiating and was propelled by vocal public support.

Though Vermont’s governor had made a campaign promise to get the law passed, the Senate was divided and the Senate leader didn’t support it. But he didn’t stand in the way.

The bill was opposed by the Catholic Church. The Vatican opposes suicide and recently condemned Maynard’s. But Waite-Simpson said groups from other congregations supported it, and Vermont’s strong libertarian streak helped.

At the Des Moines gathering, she advised proponents to ensure a bill has the votes to pass both chambers before being introduced.

“You have to dig deep inside yourself and be courageous,” she said. Ironically, Waite-Simpson’s courage advocating for background checks for gun buyers is blamed for the loss of her re-election bid last week.

Compassion and Choices has identified Iowa as a “near next state” for an aid-in-dying bill. Several prominent Iowans already have paved the way. In 2002, at age 94, Des Moines philanthropist and social activist Louise Noun publicized her struggle to obtain the means to end her life, which she eventually did. That same month, 80-year-old Ruth Nash of Dubuque, also an Iowa Women’s Hall of Fame member, drowned herself after two previous attempts ended in unwanted rescues and even one confinement in a mental-health facility. Both women were facing declining health.

This is about the right to make choices for one’s self, in consultation with a doctor, under narrow and difficult circumstances. Lawmakers in most states may not be eager to tackle the issue, but we’ve heard enough compelling stories from suffering people that it’s time for a public conversation about end-of-life options.

Rekha Basu is a columnist for the Des Moines Register. Email at rbasu@dmreg.com. This column was distributed by MCT Information Services.