On February 3, the Montana Senate passed Senate Bill 136, which would modify Montana state law so physicians cannot use a patient’s consent as a defense to homicide, which would affect physician assisted suicide. Montana does not legally permit or regulate physician assisted suicide, which is sometimes referred to as “aid in dying” or “death with dignity.” However, the current law does allow physicians to use a patient’s consent as a defense against criminal prosecution for homicide. Now, SB 136 is under consideration in the Montana House.
The majority of states prohibit physician assisted suicide. Currently, ten U.S. jurisdictions have laws that permit physician assisted suicide, including California, Colorado, the District of Columbia, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont and Washington. Each state has slightly different procedures, but all states require that patients are over 18, of sound mind, terminally ill with six months or less to live, and can ingest the medication themselves.
Critics of SB 136 assert that this measure would eliminate an important end-of-life option because patients need physician assisted suicide to die peacefully on their own terms. Advocacy groups often portray physician assisted suicide as a “good death,” and suggest it offers a way to avoid needless suffering.
Allowing physician assisted suicide appeals to wanting to give compassion to people experiencing excruciating pain, hopelessness from debilitating symptoms, and anguish that comes with impending death. Some experts say that physical deterioration and dependence on others for caretaking chips away at our dignity. In fact, data suggests that the vast majority of people opt for physician assisted suicide not because of physician pain, but because they fear reduced autonomy, not being unable to do things they enjoy, and worry about losing their dignity.
This depiction paints a false binary: if states don’t allow physician assisted suicide, then ill patients are resigned to suffering and pain, or trying to end their own life alone. But patients already have control to choose different options, such as trying to slow disease progression and manage symptoms; or alternatively forgo unwanted treatments and get support from palliative care. One physician puts it bluntly: physician assisted suicide does not “aid” in the dying process but instead terminates the dying process because it terminates the patient.
Over the past several decades, advocacy groups have developed methodical strategies to change both public opinion and law by marketing euphemistic terminology (e.g., death with dignity, end-of-life choice, aid-in-dying) rather than using the plain term of assisting a suicide. Media campaigns are designed to influence public perception so people believe that intentionally ending one’s life is now normal or desirable for certain classes of people on the basis of age, disability, illness, or proximity to death.
Physician assisted suicide is not just another end-of-life treatment option, nor is it a Constitutional right according to the Supreme Court. For context, state laws classify assisting a suicide by counseling a person to end his life or providing the instrument to cause death as a serious crime. Many people who commit suicide don’t necessarily want to die, but rather they cannot imagine continuing in their current circumstances: enduring physical deterioration, grappling with mental distress, or rebounding from crushing personal loss. Criminal prohibitions against assisting a suicide apply even in cases where a patient is ill, pleading for assistance, or close to death. States that allow physician assisted suicide operate by carving out an exception in the law.
Some physicians suggest there is a better way to respond when patients are frail and at their most vulnerable. Physicians can remind patients who are sick, old, and impaired by illness that they will continue to offer support and accompany them despite their suffering. Human value and dignity do not wane or dissipate based on age or illness – they are an inherent part of being human. While caring for people who are ill may become burdensome, laws should not perpetuate the notion that people can become a burden.
Montana is part of a larger conversation about efforts to allow and expand physician assisted suicide. Currently, advocacy groups have advanced bills in fifteen other states, attempting to expand physician assisted suicide. However, expansion is not inevitable.
Despite assurance the practice would be rarely used with strict guardrails, proponents have recently advocated for changes to allow physicians to administer lethal medication; allow it for patients with dementia and cognitive disabilities; eliminate the terminal illness requirement; and expand it for people with mental illness. A physician in Colorado has already used it for patients suffering from anorexia, which is classified as a treatable psychiatric condition. Montana and other states are at a critical juncture of deciding the appropriate role of physicians when faced with desperate patients who are most in need of care and regard.
Katherine Drabiak, JD is a Professor of health law, public health law, and medical ethics in the College of Public Health at the University of South Florida.