At the end of February, a Montana Senate committee killed a bill that would have set explicit guidelines for ‘aid in dying’ -- the process when a doctor prescribes medication to a terminally ill patient that will allow them to die. Less than two months later, the Senate struck down legislation last week that would have imprisoned doctors for up to 10 years if they helped a terminally ill patient end their life.
As the legislative session winds down -- with both proposals blocked and going nowhere -- Montana finds itself stuck in the middle of a national debate about physician-assisted suicide (a term that its supporters admittedly dislike).
Montana is in a strange predicament regarding end-of-life care because a 2009 Montana Supreme Court ruling declared that physician-assisted suicide was already legal under state law, but the court provided little other guidance. The bill that was killed in February, sponsored by state Sen. Richard Barrett, a Democrat, mirrored policies in Oregon and Washington -- the only two states to legalize aid in dying. Though the bill failed -- partly, Barrett says, because critics warned it could lead to a rationing of health care -- he expects to resurrect it next year as part of broader end-of-life legislation.
“My point of view is that this is a question of providing people with choices regarding end-of-life care,” he says. “But in the future, we have to avoid any confusion or any concern that providing for aid in dying is a ploy for rationed health care, which is to me an outrageous misreading of what we want to do.”
While Barrett’s proposal sought to add structure to the Supreme Court decision, the bill to imprison doctors for helping people end their lives was seen as an effort to reverse the ruling. Supporters warned that allowing physician-assisted suicide could, among other things, lead to sick people being taken advantage of.
“Basically [the bill] is written to target elder abuse,” state Rep. Krayton Kerns, who introduced the legislation in the Montana House, told the Associated Press. “And the fear that comes with that idea.”
The respective bills represent two extremes that have fueled a contentious and emotional debate nationwide about whether states should allow aid in dying. Advocates say modern medicine has allowed us to live longer, but also through more painful conditions, so patients should be allowed to decide when the pain stops. Opponents are often morally opposed to effectively authorizing suicide or worry that allowing the practice could result in it being exploited.
Doctors, for their part, are caught in between. It’s not easy to prescribe medications knowing that the patient will use it to end their life, says Eric Kress, a doctor in Missoula, Mont., who has helped three patients die since the 2009 court ruling and testified against the imprisonment bill. But it’s equally difficult to watch someone suffer through an illness knowing they will eventually die.
“We're dealing with the benefits of our success. People live a long time, and so they're going through incredible suffering at times,” Kress says. “At some point, they know they're not going to beat the disease. That’s what we're really talking about with aid in dying: letting the individual person make these decisions.”
Oregon and Washington have set the early standard for legalizing the practice. In Oregon, doctors must determine that patients have less than six months to live and then get a second opinion. Patients must be assessed to ensure that they have clear mind and fully understand their decision. Lastly, patients have to ask the doctor to prescribe the life-ending medication three times, twice verbally and once in writing, to be sure it’s what they want to do.
Other states, including New Jersey and Vermont, are considering similar policies in their 2013 legislative sessions. While supporters are encouraged by those proposals, the movement has also experienced setbacks in recent years. Most notably, a Massachusetts ballot initiative to legalize physician-assisted suicide was defeated by voters in November.
But there's a sense among advocates that changing public opinion is on their side. A recent poll found 73 percent of Montanans opposed sending doctors to prison for helping patients end their lives. A national NPR poll taken last fall showed 55 percent of Americans supported aid in dying, while 45 percent opposed it.
Part of this growing acceptance could stem from people’s personal encounters with terminal illness and end-of-life choices, says New Jersey Assemblyman John Burzichelli, who introduced the aid in dying bill in his state and is watching his sister-in-law battle with a terminal illness. When you know someone who’s been through these circumstances, you might be more likely to understand why someone would want a choice in ending their life. Montana Sen. Bruce Tutvedt, a Republican, gave an impassioned speech on the Senate floor against the imprisonment bill, partly because his terminally ill mother has said she wants a choice in how she dies.
“People are seeing how other people are dying. We all know someone. I think that's affecting people,” Tutvedt says. “They don't know that they would do it, but they want the comfort of knowing they may have that option.”