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residential candidates’ talking points can seem incredibly pre-rehearsed, but an exchange last night had Hillary Clinton lost for words.

In CNN’s town hall-style Democratic debate in New Hampshire, Jim Kinhan, a Concord resident who is terminally ill with cancer, asked Clinton how she could “advance the respectful conversation that is needed around this personal choice that people may make,” to “help enhance their end of life with dignity.”

Kinhan did not explicitly mention physician-assisted suicide, but the implication was clear. Kinhan is an advocate for physician-assisted suicide in New Hampshire, which is among the 45 states that have not legalized the measure. Last month he authored an op-ed in a local paper in support of assisted suicide, and he recently testified to the state legislature about the issue.

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Clinton’s response could be best summed up this way: Thanks for that important question. I don’t yet know enough about the topic to comment on it.

The exchange revealed an odd disconnect: namely, an issue that sparked one of the biggest health care battles in the nation last year — California’s decision to legalize assisted suicide — has somehow eluded national debate. Kinhan’s question signaled that the days when federal officials could avoid the galvanizing topic may be over.

Some proponents of assisted suicide took to social media to express frustration with Clinton’s (non) answer, but other advocates seemed thrilled to finally register in a national conversation.

Kinhan, 81, who was diagnosed with metastatic colon cancer three years ago, was happy with Clinton’s response.

“I was pleased that she said she didn’t want to be glib and wanted to be honest and could concur with the concept of a respectful conversation,” he told STAT.

“I wasn’t trying to stump her,” he said. “These people hear the same questions a thousand times, and after a while they go ‘click, click’ and give the answer they’d given 25 times before. So I don’t find it troublesome that she didn’t have a prepackaged response.”

Kinhan said he was contacted before the debate by CNN, which had sought recommendations from various opinion leaders across the state about residents who might have informed questions. He said he discussed his question with CNN producers before he asked it.

After the debate, he said, Clinton briefly met with him, asking about his condition, and thanking him for his question.

Barbara Coombs Lee, president of Compassion & Choices, a Denver-based advocacy group for medically-assisted suicide, said she was “gratified” Clinton took the question seriously.

“It did a lot to advance the cause,” she said. “We raised the dialogue to a national level.”

Physician-assisted suicide has been largely a matter of state-based policy, but Coombs Lee said the federal government, and a sympathetic president, could affect the debate. “Perverse incentives” embedded in the Medicare system, for instance, encourage doctors to aggressively test and treat people with end-stage illnesses, she said. “There’s a lot the federal government can do to address this.”

During the 2008 campaign, President Obama also faced questions about end-of-life issues. In an interview with an Oregon publication, Obama declined to articulate a federal policy or express a personal opinion on assisted suicide, instead referring to the “legitimate interests of states to prevent a slide from palliative treatments into euthanasia.”

That was early in the year, when Oregon was still the only state to have legalized physician-assisted suicide. Since then, the procedure has been recognized as legal in Washington, Vermont, Montana, and California.

Buoyed by that victory — and the viral support on social media for California’s death-with-dignity champion, Brittany Maynard — proponents are charting strategies to flip the next states. Maryland, Washington D.C., Hawaii, and Maine appear the most likely targets, advocates said.

Nationwide, death-with-dignity has growing support. In a Pew Research Center poll last year, nearly 70 percent of respondents said that terminally ill people living in severe pain should have the option of physician-assisted suicide.

Kinhan, for his part, said his health is stable and he is not in severe pain. He receives a four-hour chemotherapy treatment every three weeks at a medical facility, with further infusions delivered by a pump that he can take with him even when golfing.

“It slows my backswing; gives you a little better rhythm,” he said with a chuckle.

“But at some point my oncologist said there’ll come a time when chemo can’t keep pace with the cancer cells. That’s the time I may as well say ‘This is my final passage.’”

Kinhan said his brother and his father both faced terminal diagnoses, and in their final weeks chose to hasten death by refusing food. “But that’s painful and arduous, and you eventually go into something like a coma,” he said. “You’re there but you’re really gone.”

If New Hampshire enacts an assisted-suicide law before he dies, he said, he would choose that path instead, so he can be aware and alert, and engage with the people surrounding him.

“I want to have family and friends around me, sharing it with me.”

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  • My elder mother is dying by what I consider death by euthenasia through the Kaiser HMO system. What can we do to stop this before its too late?

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