MAAS Will Appeal

On December 13, 2013, District Court Judge Mike Menehan dismissed MAAS's appeal with the Montana Medical Examiners Board. The order ruled that the appeal was moot due to the Board's having recently rescinded "Position Statement No. 20."  (Order, pp. 5-8).  The order also refers to Montana's assisted suicide case, Baxter v. State, as providing a defense to a homicide charge, as follows:

On December 31, 2009, the Montana Supreme Court issued its opinion in Baxter v. State, 2009 MT 449, 354 Mont. 234, 224 P.3d 1211, in which it held that under section 45-2-211 MCA, a terminally ill patient's consent to physician aid in dying constitutes a statutory defense to a physician charged with the criminal offense of homicide.  (Order, page 2, lines 17-21).

This part of the order is consistent with Greg Jackson's and Matt Bowman's article, Baxter Case Analysis, Spring 2010 ("the Court's narrow decision didn't even "legalize" assisted suicide"). Available at http://www.choiceillusionmontana.org/p/baxter-case-analysis.html

Since Baxter, there have been two bills proposed in the Montana Legislature to legalize assisted suicide.  Both bills, SB 167 and SB 220, have failed.  Assisted suicide is not legal in Montana.

MAAS is disappointed with the dismissal, but pleased with that the order addresses Baxter, over which there is ongoing controversy as to its meaning..  MAAS will appeal.

* * *

For information about problems with assisted suicide and how it puts people at risk, see http://www.choiceillusionmontana.org/p/quick-facts-about-assisted-suicide.html 

Montana has not legalized assisted suicide

http://billingsgazette.com/news/opinion/mailbag/montana-has-not-legalized-assisted-suicide/article_758a6b1d-dc3d-5488-9750-a13b37d7d1ef.html

December 02, 2012 12:00 am

 

A recent AP article which appeared Nov. 16 in most major newspapers in our state incorrectly stated that Montana is the third state to allow assisted suicide, along with Washington and Oregon. Attorneys Greg Jackson and Matt Bowman did an extensive analysis of the case and concluded it "did not legalize assisted suicide and it continues to carry both criminal and civil liability for any doctor, institution, or lay person involved." The Montana Lawyer, the official publication of the Montana State Bar concluded the issue is open to argument, confirming that the Legislature needs to clarify the issue this coming session.

Your readership needs to know that there are problems inherent in passing a law that would allow a physician to kill their patient. People need to understand that we are talking about a physician writing a prescription for the express purpose of one taking their own life. The very oath that physicians take in stepping into this profession states that they "shall do no harm." Their purpose is to cure, to heal, to provide comfort and care at the end of life, but not to aid in facilitating the end of that life through active means. Physicians are fallible human beings and often are wrong in their prognosis concerning how long a patient will survive their illness. Often, it is depression that prompts one to think that life is not worth living or perhaps the feeling that because of their illness they are a burden to their family. The whole matter is a recipe for elder abuse.

I appreciate the opportunity to set the record straight and hope that The Gazette will continue to report on this vital topic.

David W Hafer, DDS, MS
Dayton

Assisted Suicide not legal in state, needs clarification

http://mtstandard.com/news/opinion/mailbag/our-readers-speak-assisted-suicide-not-legal-in-state-needs/article_6d1ca724-337f-11e2-9eee-001a4bcf887a.html

November 21, 2012 12:15 am  •  by David W. Hafer

A recent Associated Press article, which appeared last Friday in most major newspapers in our state, incorrectly stated that Montana is the third state to allow assisted suicide, along with Washington and Oregon.

Attorneys Greg Jackson and Matt Bowman did an extensive analysis of the case and concluded it “did not legalize assisted suicide and it continues to carry both criminal and civil liability for any doctor, institution, or lay person involved.”  [Click here to see Jackson/Bowman article]

The Montana Lawyer, the official publication of the Montana State Bar concluded the issue is open to argument, confirming that the Legislature needs to clarify the issue this coming session. [Click here for link to Montana Lawyer article, with this headline:  "The aid-in-dying debate: Can a physician legally help a patient die in Montana? Court ruling still leaves the issue open to argument"]

Assisted Suicide is Not Legal in Montana

This letter, by attorney Craig Charlton, responds to a prior letter claiming that assisted suicide is legal.  Mr. Charlton, attorney for Montanans Against Assisted Suicide, states:

Dear Physician . . . 

You may have received a letter from Compassion & Choices, formerly known as the Hemlock Society, dated June 5, 2012. The letter claims that assisted suicide, referred to as "aid in dying," is legal under the Baxter decision issued by the Montana Supreme Court on December 31, 2009. This is untrue. I urge you to read the materials below or contact your own counsel for advice regarding the court's decision in Baxter.

The letter states: "Physicians can provide prescriptions to such patients without fear that doing so could give rise to criminal or disciplinary sanction." This statement is contrary to Baxter, which merely gives doctors a defense to prosecution. Baxter states:

"We therefore hold that under § 45-2-211, MCA, a 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."[1]

You may also be interested in this analysis of Baxter by attorneys Greg Jackson and Matt Bowman:

"[T]he Court's narrow decision didn't even ‘legalize’ assisted suicide. . . . After Baxter, assisted suicide continues to carry both criminal and civil liability risks for any doctor, institution, or lay person involved."[2]

Please note that [Compassion & Choices'] "aid in dying" letter omits any discussion of a doctor’s potential civil liability for wrongful death and/or malpractice.  Baxter did not overrule Montana case law imposing civil liability on doctors who cause or fail to prevent a suicide. See Krieg v. Massey, 239 Mont. 469, 472-3 (1989) and Nelson v. Driscoll, 295 Mont. 363, Para 32-33 (1999).  Other cases include  Edwards v. Tardif, 240 Conn. 610, 692 A.2d 1266 (1997)(affirming a civil judgment against a physician who had prescribed an "excessively large dosage" of barbiturates to a suicidal patient who then killed herself with the barbiturates).

For another example, see William Dotinga, "Grim Complaint Against Kaiser Hospital," at http ://www.courthousenews.com/2012/02/06/43641.htm  This case is relevant to Baxter given that patient consent is the linchpin to Baxter's defense to prosecution. Moreover, even if a doctor avoids prosecution, there is civil liability. . . .

Letter from Craig Charlton to Montana Physicians, dated June 20, 2012.  To see a print copy of the entire letter, click here.   

* * * 

[1]  Baxter v. Montana, 354 Mont. 234, para. 50, 224 P.3d 1211 (2009).

[2]  To see the entire Jackson/Bowman analysis, go here: http://www.montanansagainstassistedsuicide.org/p/baxter-case-analysis.html

Laws Against Assisted Suicide are Constitutional

By Margaret Dore

This article describes why laws against physician-assisted suicide are constitutional in Montana.  See below.

A.  Physician-Assisted Suicide

The American Medical Association defines "physician-assisted suicide" as follows: "[A] physician facilitates a patient’s death "by providing the necessary means and/or information to enable the patient to perform the life-ending act (e.g., the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide)."[1]

Physician-assisted suicide is also called assisted suicide and "aid in dying," a term which also means euthanasia.[2] 

B. Assisted Suicide is Not Legal in Montana

In Montana, the law on assisted suicide is governed by statutes and case law.[3]  The most recent case law is Baxter v. State, 354 Mont. 234, 224 P.3d 1211 (2009), which gives doctors who assist a patient's suicide a defense to a homicide charge.  Baxter states:

"We therefore hold that under § 45-2-211, MCA, a 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."[4]

Under Baxter, this defense fails if the patient's consent cannot be shown.[5]  In that case, prosecution for homicide can go forward.[6]

Baxter did not overrule Montana case law imposing civil liability on persons who cause or fail to prevent another person's suicide.  See Krieg v. Massey, 239 Mont. 469, 472-3 (1989) and Nelson v. Driscoll, 295 Mont. 363, ¶¶ 32-33 (1999).  Other relevant case law includes Edwards v. Tardif, 240 Conn. 610, 692 A.2d 1266 (1997) (affirming a civil judgment against a doctor who had prescribed an ”excessively large dosage” of barbiturates to a suicidal patient who then killed herself with the barbiturates).  

Attorneys Greg Jackson and Matt Bowman state: "After Baxter, assisted suicide continues to carry both criminal and civil liability risks for any doctor, institution, or lay person involved."[7]  In short, Baxter did not legalize assisted suicide."

C.  Clarifying Legislation Would be Constitutional

Some assisted suicide proponents, nonetheless, claim that assisted suicide is legal under Baxter.[8]  With this situation, clarifying legislation is needed.  Some proponents, however, counter that any such legislation would be unconstitutional.  This is untrue.  See below.

Senator Hinkle Corrects the New England Journal of Medicine

"Assisted Suicide is Not Legal in Montana"

Dear Editor:

I am a Montana State Senator.  I disagree with your article, "Redefining Physicians' Role in Assisted Dying," claiming that assisted suicide is legal in Montana.  At the very least, Montana law is unclear.

Last year, Senate Bill 167, which would have legalized assisted suicide in Montana, failed.  This leaves assisted suicide governed by a Montana Supreme Court case, Baxter v. Montana.  An analysis by attorneys Greg Jackson and Matt Bowman describes Baxter as follows:

"The Montana Supreme Court s assisted-suicide decision . . . didn't even 'legalize' assisted-suicide. . . . After Baxter, assisted-suicide continues to carry both criminal and civil liability risks for any doctor, institution, or lay person involved."[1]

Since then, competing articles have appeared in the official Montana State Bar publication disputing whether Baxter legalized assisted suicide.[2]  The editor's headline states: "Court ruling still leaves the issue open to argument." [3]

Correct reporting would be that assisted suicide is not legal in Montana and/or hotly disputed.  Thank you for your attention to this matter.

False & Misleading "Aid in Dying" Letter

To view a copy of Mr. Charlton's letter, dated June 20 2012, as sent, click here.


Dear Physician:

I represent Montanans Against Assisted Suicide & For Living with Dignity.  You may have received a letter from Compassion & Choices, formerly known as the Hemlock Society, dated June 5, 2012.  The letter claims that assisted suicide, referred to as "aid in dying," is legal under the Baxter decision issued by the Montana Supreme Court on December 31, 2009.  This is untrue.  I urge you to read the materials below or contact your own counsel for advice regarding the court's decision in Baxter.


The letter states: “Physicians [under Baxter] can provide prescriptions to such patients without fear that doing so could give rise to criminal or disciplinary sanction."  This statement is contrary to Baxter, which merely gives doctors a defense to prosecution.  Baxter states:

Request to Retract Solicitation Letter

On April 6, 2012, attorney Craig Charlton wrote Dr. George Risi and Dr. Stephen Speckart requesting a retraction of their solicitation letter encouraging other doctors to engage in assisted suicide contrary to state law.

The letter was sent via Certified Mail Return Receipt Requested and Regular U.S. Mail.  To date, neither Dr. Risi nor Dr. Speckart have responded.  A web version of the letter is set forth below.  For the original print version, click here. 

Dear Dr. Risi and Dr. Speckart:

I represent Montanans Against Assisted Suicide & For Living with Dignity.  We are in receipt of the enclosed letter signed by you, which was mailed to doctors in Montana.  I am putting you on notice that the letter exists, that it has been widely distributed, and that the letter has false and misleading information.   

Senator Jim Shockley Published in the Montana Lawyer

"No, physician-assisted suicide is not legal in Montana:

 It's a recipe for elder abuse and more".[1] 

By State Senator Jim Shockley and Margaret Dore
Published in The Montana Lawyer
The State Bar of Montana

There are two states where physician-assisted suicide is legal: Oregon and Washington.  These states have statutes that  give doctors and others who participate in a qualified patient’s suicide immunity from criminal and civil liability.  (ORS 127.800-995 and RCW 70.245). 

In Montana, by contrast, the law on assisted suicide is governed by the Montana Supreme Court decision, Baxter v. State, 354 Mont. 234 (2009).  Baxter gives doctors who assist a patient’s suicide a potential defense to criminal prosecution.  Baxter does not legalize assisted suicide by giving doctors or anyone else immunity from criminal and civil liability.  Under Baxter, a doctor cannot be assured that a suicide will qualify for the defense.  Some assisted suicide proponents nonetheless claim that Baxter has legalized assisted suicide in Montana.

Legalizing assisted suicide in Montana would be a recipe for elder abuse.  The practice has multiple other problems.

What is physician-assisted suicide?

The American Medical Association (AMA) states: “Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act.”  (Code of Medical Ethics Opinion 2.211).  For example, a “physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide.”  (Id.)

The Baxter decision

Baxter found that there was no indication in Montana law that physician-assisted suicide, which the Court termed “aid in dying,” is against public policy.  (354 Mont. at 240, ¶¶ 13, 49-50).  Based on this finding, the Court held that a patient’s consent to aid in dying “constitutes a statutory defense to a charge of homicide against the aiding physician.”  (Id. at 251, ¶ 50).

Baxter, however, overlooked elder abuse.  The Court stated that the only person “who might conceivably be prosecuted for criminal behavior is the physician who prescribes a lethal dose of medication.”  (354 Mont. at 239, ¶ 11).  The Court thereby overlooked criminal behavior by family members and others who benefit from a patient’s death, for example, due to an inheritance.

Baxter also overlooked caselaw imposing civil liability on persons who cause or fail to prevent a suicide.  See Krieg v. Massey, 239 Mont. 469, 472-3 (1989) and Nelson v. Driscoll, 295 Mont. 363, ¶¶ 32-33 (1999).  Baxter is, regardless, a narrow decision in which doctors cannot be assured that a suicide will qualify for the defense.  Attorneys Greg Jackson and Matt Bowman provide this analysis:

If the idea of suicide itself is suggested to the patient first by the doctor or even by the family, instead of being on the patient's sole initiative, the situation exceeds "aid in dying" as conceived by the Court.  If a particular suicide decision process is anything but "private, civil, and compassionate," . . . , the Court's decision wouldn't guarantee a consent defense.  If the patient is less than "conscious," is unable to "vocalize" his decision, or gets help because he is unable to "self-administer," or the drug fails and someone helps complete the killing, Baxter would not apply. . . .

No doctor can prevent these human contingencies from occurring in a given case . . . in order to make sure that he can later use the consent defense if he is charged with murder.

“Analysis of Implications of the Baxter Case on Potential Criminal Liability,” Spring 2010, at  http://www.montanansagainstassistedsuicide.org/p/baxter-case-analysis.html


The 2011 Legislative Session

The 2011 legislative session featured two bills in response to Baxter, both of which failed: SB 116, which would have eliminated Baxter’s potential defense; and SB 167, which would have legalized assisted suicide by providing doctors and others with immunity from criminal and civil liability.

During a hearing on SB 167, the bill's sponsor, Senator Anders Blewett, said:  “[U]nder current law, ... there’s nothing to protect the doctor from prosecution.”  ( http://maasdocuments.files.wordpress.com/2011/07/blewett_speckhart_trans_001.pdf ).  Dr. Stephen Speckart made a similar statement: "[M]ost physicians feel significant dis-ease with the limited safeguards and possible risk of criminal prosecution after the Baxter decision."  (Id. at p.2)

Legalization would create new paths of abuse

In Montana, there has been a rapid growth of elder abuse.  Elders' vulnerabilities and larger net worth make them a target for financial abuse.  The perpetrators are often family members motivated by an inheritance.  See e.g.  www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf .

Preventing elder abuse is official Montana state policy.  See e.g., 52-3-801, MCA.  If Montana would legalize physician-assisted suicide, a new path of abuse would be created against the elderly, which would be contrary to that policy.  Alex Schadenberg, Chair of the Euthanasia Prevention Coalition, International, states:

With assisted suicide laws in Washington and Oregon, perpetrators can . . . take a 'legal' route, by getting an elder to sign a lethal dose request.  Once the prescription is filled, there is no supervision over the administration. . . . [E]ven if a patient struggled, “who would know?

http://www.isb.idaho.gov/pdf/advocate/issues/adv10oct.pdf, p. 14.

“Terminally Ill” Does Not Mean Dying

Baxter’s potential defense applies when patients are "terminally ill," which Baxter does not define.  In Oregon, “terminal” patients are defined as those having less than six months to live.  Such persons are not necessarily dying.  Doctors can be wrong.  Moreover, treatment can lead to recovery.  Oregon resident, Jeanette Hall, who was diagnosed with cancer and told that she had six months to a year to live, said:

I wanted to do our [assisted suicide] law and I wanted my doctor to help me.  Instead, he encouraged me to not give up . . .  I had both chemotherapy and radiation. . . .

It is now 10 years later.  If my doctor had believed in assisted suicide, I would be dead. 

http://mtstandard.com/news/opinion/mailbag/article_aeef3982-9a98-11df-8db2-001cc4c002e0.html 

Legal physician-assisted suicide empowered the Oregon Health Plan, not individual patients 

Once a patient is labeled “terminal,” an easy argument can be made that his or her treatment should be denied.  This has happened in Oregon where patients labeled “terminal” have not only been denied coverage for treatment, they have been offered assisted-suicide instead.

The most well known cases involve Barbara Wagner and Randy Stroup.  (KATU TV, at http://www.katu.com/news/26119539.html , ABC News, at http://www.abcnews.go.com/Health/Story?id=5517492  Ken Stevens, MD, at pp. 16-17, at http://choiceillusionoregon.blogspot.com/p/oregons-mistake-costs-lives.html).  The Oregon Health Plan refused to pay for their desired treatments and offered to pay for their suicides instead.  Neither Wagner nor Stroup saw this as a celebration of their “choice.”  Wagner said: “I’m not ready to die.”  Stroup said: “This is my life they’re playing with.”
            
Stroup and Wagner were steered to suicide and it was the Oregon Health Plan doing the steering.  Oregon’s law empowered the Oregon Health Plan, not individual patients.

Oregon’s studies are invalid

Oregon’s statute does not require a doctor to be present when the lethal dose is administered.  (ORS 127.800-995).  During a hearing on SB 167, Senator Jeff Essmann made a related point, as follows:

[A]ll the protections [in Oregon’s law] end after the prescription is written.  [The proponents] admitted that the provisions in the Oregon law would permit one person to be alone in that room with the patient.  And in that situation, there is no guarantee that that medication is self-administered.

So frankly, any of the studies that come out of the state of Oregon’s experience are invalid because no one who administers that drug . . . to that patient is going to be turning themselves in for the commission of a homicide.

Senate Judiciary Hearing Transcript, February 10, 2011, p.15, at http://www.margaretdore.com/pdf/senator_essmann_sb_167_001.pdf

Public confusion

In Montana, the moving force behind legalizing assisted suicide is Denver-based Compassion & Choices.  On September 15, 2011, that organization’s president published an article on Huffington Post claiming that under Baxter physicians in Montana are “safe from prosecution.”  ( http://www.huffingtonpost.com/barbara-coombs-lee/aid-in-dying-montana_b_960555.html )  This is clearly not the case and  propaganda.  A physician relying on her advice could be charged with homicide.

Conclusion  

Baxter is a flawed decision that overlooked elder abuse.  Baxter has created confusion in the law, which has put Montana citizens at risk.  Neither the legal profession nor the medical profession has the necessary guidance to know what is lawful. 


Legalizing assisted suicide is bad public policy.  Doctors’ diagnoses can be wrong and legalization is a recipe for abuse.  Legalization would also allow the state government to encourage citizens to kill themselves.  This is an area where the government does not belong.  Montana consistently has one of the highest suicide rates in the nation.   Montana doesn’t need the “Oregon Experience.”


Legislation should be enacted to overrule Baxter and clearly declare that assisted suicide is not legal in Montana.  
      

* * *

Senator Jim Shockley, of Victor, is a Republican State Senator, probate lawyer, and an adjunct instructor at the University of Montana School of Law. 

Margaret Dore is an attorney in Washington State where assisted suicide is legal.  She is also President of Choice is an Illusion, a nonprofit corporation opposed to assisted-suicide.  (www.choiceillusion.org)  She is a Democrat.  

* * *

[1] To read this article as published in The Montana Lawyer and the opposing article by Senator Anders Blewett, go here:

http://www.montanabar.org/associations/7121/November%202011%20mt%20lawyer.pdf                                                                                                  

Propaganda About Montana: Baxter & Assisted Suicide

By Margaret Dore, Esq.

Barbara Coombs Lee, President of Compassion & Choices, has posted a propaganda piece on Huffington Post falsely claiming that a physician who assists a suicide in Montana is "safe" from prosecution.  My request for equal time to correct the record on Huffington Post has been ignored.  A discussion of the actual law of Montana is set forth below. 

A.  Assisted Suicide

There are just two states where physician-assisted suicide is legal: Oregon and Washington.  These states have statutes that give doctors and others who participate in a qualified patient’s suicide, immunity from criminal and civil liability.  (ORS 127.800-995 and RCW 70.245). 

In Montana, by contrast, the law on assisted suicide is governed by the Montana Supreme Court decision, Baxter v. State, 354 Mont. 234 (2009).  Baxter gives doctors who assist a suicide a potential defense to criminal prosecution.  Baxter does not legalize assisted suicide by giving doctors or anyone else immunity from criminal and civil liability.  Under Baxter, a doctor cannot be assured that a particular suicide will qualify for the defense. 

B.  The Baxter Decision is Wrong

Baxter found that there was no indication in Montana law that physician-assisted suicide, which the Court termed “aid in dying,” is against public policy.  (354 Mont. at 240, ¶¶ 13, 49-50).  Based on this finding, the Court held that a patient’s consent to assisted suicide “constitutes a statutory defense to a charge of homicide against the aiding physician.”  (Id. at 251, ¶ 50).

Baxter, however, overlooked caselaw imposing civil liability on persons who cause or fail to prevent a suicide.  See e.g., Krieg v. Massey, 239 Mont. 469, 472-3 (1989) and Nelson v. Driscoll, 295 Mont. 363, ¶¶ 32-33 (1999).  Baxter also overlooked elder abuse.  The Court stated that the only person “who might conceivably be prosecuted for criminal behavior is the physician who prescribes a lethal dose of medication.”  (354 Mont. at 239, ¶ 11).  The Court thereby overlooked criminal behavior by family members and others who benefit from a patient’s death, for example, due to an inheritance.

The Baxter decision is fundamentally flawed and wrong.

C.  Doctors are not "Safe" Under Baxter

Baxter is a narrow decision via which doctors cannot be assured that a particular suicide will qualify for the defense. Attorneys Greg Jackson and Matt Bowman provide this analysis:

"If the patient is less than 'conscious,' is unable to 'vocalize' his decision, or gets help because he is unable to 'self-administer,' or the drug fails and someone helps complete the killing, Baxter would not apply. . . .

http://www.montanansagainstassistedsuicide.org/p/baxter-case-analysis.html

Even if a doctor "beats the rap" on prosecution, there is the issue of civil liability.  See Krieg and Nelson, supra.  Like O.J. Simpson, a doctor who escapes criminal liability could find himself sued by a family member upset that he "killed mom."  The doctor could be held liable for civil damages.

* * *

Margaret Dore is President of Choice is an Illusion, a nonprofit corporation opposed to assisted-suicide. (www.choiceillusion.org)  She is also an attorney in Washington State where assisted suicide is legal.

* * *

[1] http://www.huffingtonpost.com/barbara-coombs-lee/aid-in-dying-montana_b_960555.html