How Montana Is Revolutionizing the Movement For End-of-Life Choice

On New Year's Eve 2009, Montana's Supreme Court handed down the ruling in "Baxter v. Montana" and authorized the practice of aid in dying for mentally-competent, terminally-ill adults. The Court declared that such a patient may request medication that could be ingested to ensure a peaceful death. They ruled that a physician providing such medication does not violate public policy and is safe from prosecution.

It was a remarkable ruling in many ways. With subsequent legislative events, the Court's findings created a watershed between previous assisted-dying advocacy typified by Oregon's Death with Dignity Act and the new era, in which patient choice becomes integral to the scope of medical practice at the end of life.

Early in 2010 the medical practice of aid in dying began to take shape in Montana. Terminally-ill patients began to ask about this option, now openly available. Willing physicians began to evaluate their requests and measure them against the qualifying standards laid out by the Court. Montana physicians sought guidance from doctors with years of experience in Oregon and Washington. The state medical society engaged counsel to explain the Court's ruling, and it received confirmation that aid in dying was a choice Montanans were entitled to make and physicians providing it were not subject to criminal prosecution. Hospices began to consider policies and practices if a patient requested life-ending medication or decided to self-administer it while under hospice care. One year later patients, families, physicians and health care providers across the state already had personal experience -- or knew someone who had personal experience -- with aid in dying.

When legislators convened in Helena in January 2011, they considered two bills related to aid in dying. One would nullify the Court's ruling and repeal the end-of-life freedom people had come to appreciate. The other itemized the steps to evaluate a request and provided civil and regulatory immunity for following them. Neither bill passed a committee or reached the governor's desk.

Montana residents now enjoy the freedom of knowing one of the most important, private, intimate and meaningful decisions in life is safe from blockade or intrusion from prosecutors or authoritarian busybodies.

Here are some aspects of the ruling that will, from now on, direct the flow of liberty at life's end:

• The Montana Supreme Court called the practice "aid in dying" and enshrined that name in a legal context. Professional associations, medical and legal scholars and ethics publications had adopted this term for the medical practice that gives patients peace of mind and control over their dying and distinguish it from "suicide." But never before had the term achieved legal authority.

In 1976, the New Jersey Supreme Court ruled that Karen Ann Quinlan had a right to refuse artificial ventilation, beginning a line of jurisprudence that protects health care decisions, even if they advance the time of death. (In re Quinlan) The Quinlan court imposed no extraordinary governmental policing on the newly-recognized right. So it is with "Baxter v. Montana," and the Baxter ruling is to aid in dying what Quinlan was to withdrawal of mechanical ventilation.

The Montana experience is ongoing, with aid in dying governed by standards of practice and the same regulatory procedures as all medical care. Its impact will likely reach across our nation. As our path leads forward from this point, we draw water from the streams that flow from Montana. "Baxter v. Montana" is the watershed.