Advocates say the option gives patients more control over their fate, and relieves some of their anxiety over death. Opponents say giving people the ability to end their own lives is immoral, undercuts doctors and risks abuse.

In the middle are people like Gallegos. He embraced the option but spent his final weeks agonizing over it. Roughly a third of people who get prescriptions for end-of-life medications do not take them, according to states that track their use. As more states offer the option to terminally ill patients, thousands of Americans each year, along with their loved ones, are confronting this harrowing dilemma.

Gallegos did not want to suffer unnecessarily, but he wasn’t sure where to draw the line. Was it when he could no longer breathe, or eat, on his own? Or when he felt he’d become too much of a burden to his family? The drugs offered an escape, but he worried that ending his life was cowardly and unnatural.

Family members, friends, doctors and counselors told Gallegos he would know when the time was right, but he wasn’t so sure.

“Day to day, I just fight with the symptoms and hope I can still make the decision as to when my last day will be,” Gallegos said in one of many conversations with NBC News as he moved toward death.

“I know I’m close,” he said.

‘There’s no way I’m going to die’

The disease came with dates.

The neurologist who diagnosed Gallegos with ALS in November 2015 cited research on average survival rates: Most patients lived from two-and-a-half to five years.

“Within that window is likely to be the time you have remaining,” the doctor told him.

George Gallegos with his dog Yaleb in 2009. Sandra Martinez

The news — following symptoms that began with difficulty writing certain numbers — felt like an ambush. Gallegos, an avid waterskier and fly fisherman, considered himself “relatively bulletproof” as he entered his late 60s. Now he was promised an early, agonizing death from a progressive neurodegenerative disease that attacks nerve cells in the brain and spinal cord, leaving them unable to communicate with the body’s muscles, which then waste away. Those afflicted gradually lose the ability to speak, swallow, control their bladder and bowels, and breathe.

It seemed impossible that could happen to him.

“There’s no way I’m going to die,” he remembered thinking. “I’m feeling OK. I can’t write so well. Yes, I have a limp. But I’m OK. I’m healthy. They’re telling me something that’s not going to happen to me.”

George Gallegos visits Yellowstone National Park in 2015. Courtesy of Sandra Martinez

When his denial subsided, he saw that he could use his remaining time to say goodbye to the people he loved, leave things in proper order for Karen Miller, his partner of two decades, and live the rest of his days in as dignified a way as possible. At a basic level, that meant being able to maintain connections with family without becoming completely dependent on others and to die at home.

He joined an ALS support group. He retired from the nursing facility where he was known by the elderly residents as Dr. George. Many of them contributed to a GoFundMe campaign that sent Gallegos to the 2016 Super Bowl in San Francisco, which his beloved Denver Broncos won.

Gallegos also watched with interest a campaign to make medical aid in dying legal in Colorado. In November 2016, he and Miller joined 65 percent of Colorado voters who approved a law based on Oregon’s that legalized the option. By then, Gallegos was getting around in an electric wheelchair.

“Why wouldn’t you allow a person who is sure to die the opportunity to die with dignity, taking medications and perhaps avoid all the long worse kind of suffering that the condition brings to them?” Gallegos recalled thinking during the campaign.

But he didn’t pursue it himself.

“I was thinking: ‘That’s way far away. I’m not close to that yet. I can do it whenever,’” Gallegos said in a November 2018 interview. “Which was technically true. But I was closer than I would know.”

‘There are times when we'll just cry together’

ALS’s assault on Gallegos’ central nervous system continued.

He relied more on voice-to-text software for emails and text messages. His lung capacity diminished, requiring more time on a ventilator. It grew harder to swallow and cough. His speech slurred more often. Cleaning himself and going to the bathroom became arduous. He rarely left his house.

With each new complication, Gallegos added to an array of medications that helped him get through each day. He took pills for pain, swelling, chronic itchiness, bladder spasms, constipation, infections, lung congestion, sleeplessness, heartburn and high blood pressure. He kept track of them in a pill box and washed them down with water sucked from a cup fitted with a wide straw.

He depended on others for routine tasks. Nurses stopped by daily. He hired an Army veteran who lived nearby to help when Miller, a secretary at a nearby middle school, was at work. Medicare and long-term care insurance covered much of the cost, but still the out-of-pocket bills mounted. That included $5,000 for the wheelchair, more than $20,000 for a used wheelchair-accessible van and more than $20,000 to make their bathroom accessible.