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Baxter v. Montana

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Citation. Baxter v. State, 224 P.3d 1211, 2009 MT 449, 354 Mont. 234, 2009 Mont. LEXIS 695 (Mont. Dec. 31, 2009)

Brief Fact Summary. Robert Baxter (Plaintiff) was terminally ill and seeking a lethal dose of medication prescribed by his doctor to assist in his own suicide.  Baxter (Plaintiff), and his doctors (Plaintiff), filed suit seeking to prevent prosecution for physician-assisted suicide.

Synopsis of Rule of Law. Under the privacy and dignity provisions of the Montana Constitution, a right to die with dignity exists, including a physician’s assistance in dying.

Facts. Robert Baxter (Plaintiff) was a retired truck driver who was diagnosed as terminally ill with lymphocytic leukemia.  Baxter (Plaintiff) sought to end his life by self-administering and ingesting a legal dose of medication his doctor would prescribe.  Baxter (Plaintiff) and his doctors (Plaintiff) brought suit against the State (Defendant) to protect the doctors from criminal prosecution for assisting in the proposed suicide.  The district court held that under the Montana Constitution, a competent, terminally ill patient has a right to die with dignity and that includes protecting the patient’s doctor from prosecution under the state’s homicide statutes.  The district court concluded that state’s homicide laws were unconstitutional as applied to a doctor who provides assistance to a competent, terminally ill patient in dying.  Defendant appealed.

Issue. Under the privacy and dignity provisions of the Montana Constitution, does a right to die with dignity exist, including a physician’s assistance in dying?

Held. (Leaphart, J.)  Yes.  Under the privacy and dignity provisions of the Montana Constitution, a right to die with dignity exists, including a physician’s assistance in dying.  This court begins with the proposition that suicide is not a crime under state law.  In the aid-in-dying situation, the only person who might possibly be prosecuted for criminal behavior is the doctor who prescribes a lethal dose of medication.  Because the claims of the Plaintiff’s doctors (Plaintiff) are premised largely upon concerns that they could be prosecuted for assisting in dying, the court deems it appropriate to analyze their possible culpability for homicide by examining whether the consent of the patient to his doctor’s assistance in dying could constitute a statutory defense to a homicide charge against the doctor.
  The consent statute would protect doctors from homicide liability if, with the consent of the patient, the doctors provide aid in dying to terminally ill patients who are mentally competent adults.  The court must first determine whether a statutory consent defense applies to doctors who provide aid in dying and, second, whether patient consent is rendered ineffective by state law because permitting the conduct or resulting harm “is against public policy.”  The law states that a person commits the offense of deliberate homicide, if “the person purposely or knowingly causes the death of another human being…,” and establishes consent as a defense, stating that the “consent of the victim to conduct charged to constitute an offense or to the result thereof is a defense.”  Therefore, if the State (Defendant) prosecutes a doctor for providing assistance in dying to a mentally competent, terminally ill adult patient who consented to such assistance, the physician may be protected from liability pursuant to the consent statute.  However, this consent defense is only effective if none of the statutory exceptions to consent applies.
  The State codified the exceptions, which include that consent is ineffective if: (d) it is against public policy to allow the conduct or the harm that results, even though consented to.  The court finds no indication in the law that physician assistance in dying provided to terminally ill, mentally competent adult patients is against public policy.  This “against-public-policy” exception to consent applies to conduct that is disruptive to public peace and physically endangers others.  Clearly unruly, physical and public aggression between people falls within the parameters of the “against-public-policy” exception.  A doctor who aids a terminally ill patient in dying is not directly involved in the final decision or the final act.  The doctor only provides a way for the terminally ill patient himself to achieve the result of his life-ending decision, or not, as the case may be.  Each stage of the physician-patient interaction is private, civil, and compassionate.  The doctor and the terminally ill patient work together to create a way for the patient to control his own mortality.  The patient’s subsequent private decision whether to take the medication does not endanger others or breach public peace.
  The act by the terminally ill patient of ingesting medication is not criminal.  There is no language in the homicide statute to indicate that killing “oneself,” as opposed to “another,” is a punishable offense, and there is no separate statute that criminalizes suicide.  There is therefore no indication in the homicide statutes that physician assistance in dying—in which a terminally ill patient chooses and consents to taking possession of a quantity of medication from a doctor that, if he chooses to take it, will cause his own death—is against public policy.
  Similarly, there is no indication in the state’s Terminally Ill Act that physician assistance in dying is against public policy.  The Rights of the Terminally Ill Act very clearly provides that terminally ill patients are entitled to autonomous, end-of-life decisions, even if enforcing those decisions involves direct acts by a doctor.  The Terminally Ill Act confers on terminally ill patients a right to have their end-of-life wishes followed, even if it requires that a doctor participate by withdrawing or withholding treatment.  There is nothing in the statute to indicate it is against public policy to honor those same wishes when the patient is conscious and able to vocalize the decision and carry it out himself with self-administered medication and with no immediate or direct assistance from a physician.
  Even if this court were to extend consideration to the state’s Terminally Ill Act, as a generalized reflection of the legislature’s views on the involvement of third parties in suicides, there is still no indication that the statute was ever intended to be applied to the very narrow set of circumstances in which a terminally ill patient himself seeks out a doctor and asks the doctor to provide him the means to end his own life.
  In conclusion, the court finds nothing in state statutes or in Montana Supreme Court precedent to indicate that physician aid in dying is against public policy.  The “against-public-policy” exception to consent has been interpreted by this court as applicable to violent breaches of the public peace.  Physician assistance in dying does not satisfy that definition.  Also, the court finds nothing in the plain language of the state’s statutes to indicate that physician assistance in dying is against public policy.  In physician assistance in dying, the patient—not the physician—commits the final act to cause death by self-administering a lethal dose of medication.

Dissent. (Rice, J.)  The prohibition against homicide—intentionally causing the death of another—protects and preserves human life, is the ultimate recognition of human dignity, and is a foundation for modern society, as it has been for thousands of years.  Based on this foundation, Anglo-American law, encompassing the law of the State, has prohibited the enabling of suicide for over 700 years.  However, in contradiction to these fundamental principles, the court concludes that physician-assisted suicide is not in violation of state public policy.  In doing so, the court has badly misinterpreted our public policy.
  An underlying flaw of the court’s analysis is its failure to distinguish between the doctor’s basic intention in the assisted-suicide case from the doctor’s intention while providing treatment in other cases.  As developed further, herein, the intentions in these two cases are diametrically opposed, and create the very difference between a criminal and non-criminal act.  Physician-assisted suicide occurs when a doctor provides a lethal drug with the intent to cause the patient’s death, when the patient takes the drug.  With palliative care, the doctor does not intend that his or her actions cause the patient’s death, but rather intends to brief relief to the pain and suffering of the patient.  For this reason, when a doctor provides palliative care, even in cases where the treatment arguably contributes to the death of the patient, the required mental state to be charged under homicide statutes is absent.  There is a similar distinction in the withholding or withdrawal of medical treatment that only prolongs the dying process, pursuant to the Montana Rights of the Terminally Ill Act.  Under the Act, a patient may refuse treatment and allow death to occur naturally, and doctors are not liable as there was no administered treatment to cause death.
  Under state law, physicians who assist in suicide are subject to criminal prosecution regardless of whether the patient survives or dies.  If the patient survives, the doctor may be prosecuted under aiding or soliciting suicide.  If the patient dies, the doctor may be prosecuted under the homicide statutes.  It is important to note that it is also very clear that a patient’s consent to the efforts of the doctor is meaningless under these statutes.  I would reverse.

Concurrence. (Nelson, J.)  I concur in the court’s analysis and further conclude that physician assistance in dying is protected by the Montana Constitution as a matter of privacy and a matter of individual dignity.  The Montana Constitution also firmly protects physician assistance in dying.  This case is not about the “right to die.”  Indeed, the notion that there is such a “right” is patently absurd, if not downright silly.  No constitution, statute, legislature, or court can grant a person the “right to die.”  Nor can this right be taken away.  “Death is the destiny of everything that lives.  Nothing ever escapes it.”  Within the context of this case, the only control that a person has over death is that if he expects its coming within a relatively short period of time because of an incurable disease, he can simply accept his fate and seek drug-induced comfort; or he can seek additional treatment and right to prolong the advance of death; or at some point in his illness, and with the assistance of his doctor, he can embrace the destiny at a time and place of his choosing.  The only “right” guaranteed to him in any of these decisions is the right to preserve his personal autonomy and his individual dignity, as he sees fit, in the face of an ultimate destiny that no power on earth can prevent.
  In my view, the first clause of Article II, Section 4 (the Dignity Clause) is a stand-alone, fundamental constitutional right.  Human dignity is, perhaps, the most fundamental right in the Declaration of Rights.  This right is “inviolable,” meaning that it is safe from violation; incapable of being violated.  Significantly, the only right in Montana’s Constitution that is “inviolable” is the right of human dignity.
  But what is “dignity” exactly?  It would not be practical to attempt providing an exhaustive definition here.  The right of dignity under Article II, Section 4 is absolute.  Indeed, human dignity transcends the Constitution and the law.  Each retains the right to demand of the state that his dignity as a human being be respected in spite of the government’s interference in his life as is sometimes necessary.
  This case is about individuals who are mentally competent, who are incurably ill, and who expect death within a relatively short period of time.  The State (Defendant) has failed to explain what interest the government has in forcing a competent person who is incurably ill and going through prolonged suffering and slow, excruciating physical deterioration to hang on to the last possible moment.  In addition, the State (Defendant) has not come close to showing that it has an interest, much less a “compelling” interest, in taking over the decision of a competent person who is incurably ill and making an autonomous decision to obtain the assistance of a licensed physician in dying so that she might die with the same human dignity with which she was born.  This right to physician assisted suicide typically involves the inviolable right to human dignity—our most fragile fundamental right.  The state’s Dignity Clause does not permit a person or entity to force an agonizing, dehumanizing, demeaning, and often protracted death upon a person who is mentally competent and incurably ill for the sake of political ideology, religious belief, or a paternalistic sense of ethics.

Discussion. Baxter (Plaintiff) and his doctors (Plaintiff) brought suit against the State (Defendant) to prevent prosecution for assisting in his decision to end his life.  The lower court’s decision confirming his right to physician-assisted suicide came on the same day as Plaintiff’s death.  The appeal concluded when the state’s highest court affirmed Baxter’s (Plaintiff) right and the protection of his doctors (Plaintiff) from criminal prosecution.  At odds were the competing religious, moral, and ethical concerns about seemingly legalizing suicide.  The majority determined that suicide itself was not a crime, and distinguished the right to die by physician-assisted suicide from criminal liability under the state’s homicide statutes.  The significance of the decision was to permit terminally ill patients the right to seek their doctor’s assistance.  The concurring and dissenting decisions reveal that there are still unresolved issues as to whether or not the legislature intended the majority’s holding, by providing an exception to a homicide prosecution that was otherwise successful.


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