Baxter v. State
354 Mont. 234, 224 P.3d 1211, 2009 MT 449 (2009)
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Rule of Law:
Under Montana law, a competent, terminally ill patient's consent to physician aid in dying constitutes a statutory defense to a charge of homicide against the aiding physician, provided no other consent exceptions apply, because such aid is not against public policy.
Facts:
- Robert Baxter was a retired truck driver from Billings who suffered from terminal lymphocytic leukemia with diffuse lymphadenopathy.
- Baxter's disease caused debilitating symptoms, including infections, chronic fatigue, anemia, night sweats, nausea, swollen glands, digestive problems, and generalized pain, which were expected to worsen.
- There was no cure for Baxter’s disease, and his chemotherapy treatments were expected to become less effective over time.
- Baxter desired the option of obtaining a lethal dose of medication prescribed by his physician, which he would self-administer at a time of his choosing.
- Four physicians and Compassion & Choices joined Baxter in challenging the application of Montana's homicide statutes to physicians who provide aid in dying to mentally competent, terminally ill patients.
Procedural Posture:
- Robert Baxter, four physicians (Stephen Speckart, M.D., C. Paul Loehnen, M.D., Lar Autio, M.D., George Risi, Jr., M.D.), and Compassion & Choices brought an action in the First Judicial District Court (state trial court) challenging the constitutionality of applying Montana's homicide statutes to physicians providing aid in dying.
- The complaint alleged that patients have a right to die with dignity under Article II, Sections 4 and 10 of the Montana Constitution (individual dignity and privacy).
- In December 2008, the District Court issued an Order and Decision, holding that the Montana constitutional rights of individual privacy and human dignity encompass the right of a competent, terminally ill patient to die with dignity.
- The District Court further held that this right includes protection for the patient’s physician from prosecution under state homicide statutes for providing aid in dying, and awarded Mr. Baxter attorney fees.
- The State of Montana appealed the District Court's order granting summary judgment to the Montana Supreme Court.
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Issue:
Does a competent, terminally ill patient's consent to physician aid in dying, where the patient self-administers the lethal medication, constitute a statutory defense to a homicide charge against the aiding physician under Montana law?
Opinions:
Majority - Justice Leaphart
Yes, a competent, terminally ill patient's consent to physician aid in dying constitutes a statutory defense to a charge of homicide against the aiding physician when no other consent exceptions apply. The Court declined to rule on the constitutional questions, instead focusing on whether the issue could be resolved statutorily. Montana law's consent defense (§ 45-2-211(1), MCA) allows a victim's consent to be a defense unless it falls under an exception, particularly if the conduct is 'against public policy' (§ 45-2-211(2)(d), MCA). The Court found no indication in Montana case law or statutes that physician aid in dying for terminally ill, mentally competent adults is against public policy. It distinguished physician aid in dying from violent, peace-breaching conduct previously deemed against public policy (e.g., State v. Mackrill). The Montana Rights of the Terminally Ill Act (MRTIA) was seen to reflect legislative respect for end-of-life autonomy, immunizing physicians for withholding or withdrawing life-sustaining treatment, which involves direct physician action. Physician aid in dying, where the patient self-administers, involves lesser physician involvement and is consistent with this legislative ethos. The Court also rejected the dissent's reliance on the aiding suicide statute (§ 45-5-105, MCA), noting its plain language applies only when suicide does not occur, and dismissed legislative commission comments as non-binding in interpreting public policy. Finally, the Court reversed the award of attorney fees, finding the private attorney general doctrine inapplicable as the decision was statutory, not constitutional.
Dissenting - Justice Rice
No, physician aid in dying is against Montana's public policy, and a patient's consent should not be a defense to a homicide charge for a physician providing such aid. The dissent argues that Montana's prohibition on aiding or soliciting suicide has been in place for over a century and is part of the state's public policy to protect human life. It asserts that if a patient dies, the act should be prosecuted as a homicide, and the Criminal Code Commission Comments to § 45-5-105, MCA, explicitly state that consent or solicitation is not a defense if the offender is the 'agent of the death.' The dissent criticizes the majority for disregarding these comments and for creating an artificial distinction between aiding suicide (if the patient survives) and homicide (if the patient dies). It further contends that the Montana Rights of the Terminally Ill Act (MRTIA) only permits withholding or withdrawing life-sustaining treatment, which allows death to occur naturally, and does not support the deliberate action of a physician causing a premature death. The dissent also highlights that the 1972 Montana Constitutional Convention explicitly rejected proposals for a 'right to die,' indicating no constitutional basis for such a right under the dignity or privacy clauses.
Concurring - Justice Warner
Yes, a physician may assert the defense of consent if charged with a crime for assisting a suicide, as the Legislature has not plainly stated that assisting suicide is against public policy. Justice Warner concurred with the majority, emphasizing the principle of judicial restraint, which dictates that courts should avoid deciding constitutional questions if a case can be resolved on statutory grounds. He agreed with the majority that the Montana Legislature has not explicitly declared physician aid in dying to be against public policy, thus preventing the Court from adding such a provision through judicial interpretation. He stated that the citizens of Montana, through their legislature, should squarely face and decide the policy on this issue.
Concurring - Justice Nelson
Yes, a patient's consent to physician aid in dying should constitute a statutory defense to homicide, and further, physician aid in dying is protected by the Montana Constitution's rights of privacy and individual dignity. Justice Nelson joined the majority's statutory analysis, agreeing that there is no indication in Montana law or caselaw that physician aid in dying is against public policy, especially given the legislative intent of end-of-life autonomy reflected in the Montana Rights of the Terminally Ill Act. He explicitly rejected the dissent's reliance on non-binding commission comments. Additionally, Justice Nelson strongly asserted that physician aid in dying is constitutionally protected under Article II, Section 4 (individual dignity) and Section 10 (privacy) of the Montana Constitution. He viewed the Dignity Clause as a stand-alone, fundamental, and 'inviolable' right that broadly prohibits any law or act infringing upon human dignity, which includes a competent, incurably ill individual's autonomous decision to choose a dignified death rather than prolonged suffering and degradation. He defined 'dignity' as inherent worth and the capacity for autonomous action, which is violated by forcing a person to suffer an agonizing death against their will.
Analysis:
This case significantly clarifies the legal landscape surrounding physician aid in dying in Montana, establishing a statutory defense for physicians under the consent statute rather than a constitutional right. By avoiding the constitutional question, the Court set a precedent for judicial restraint while still providing a legal pathway for terminally ill patients seeking end-of-life options. This decision will likely influence future legislative debates and potentially future cases seeking to establish a broader constitutional right. It also highlights the tension between statutory interpretation, legislative intent, and evolving societal values concerning end-of-life care.
