Montana House considers bill to put more sideboards on medical assistance in dying

Yahoo

27-02-2025

Montana Lt. Gov. Kristen Juras testifies against House Bill 637 on Feb. 26, using her finger to point to her head when discussing the difference between dying by a gunshot and dying by a medical prescription of toxic drugs (Screenshot via Montana Public Affairs Network).
Robert Baxter, the man who originally waged a lawsuit in Montana for his right to choose death as he wasted away from cancer, didn't know that the day he died, a district court judge ruled in his favor.
But his daughter told lawmakers he would have been comforted to know years later, his grandson, suffering from incurable pancreatic cancer, would use the provisions he helped champion as he was dying.
'My father would have never dreamed that his grandson would have needed and benefitted from this decision,' said Roberta King of Missoula.
On Wednesday, in a hearing of the House Judiciary Committee that was full of as much testimony as tears, opponents and supporters of medical aid in dying, sometimes called 'physician-assisted suicide,' discussed House Bill 637, which would codify requirements for physicians to use the process.
Currently, the state's official legal position is that suicide — including those who aid or assist others to end their life — is illegal. However, the 'Baxter decision,' as it has been called, made one of the defenses to homicide patient consent. In other words, if taken to court, a medical provider could argue the patient consented to drugs that led to their death as a defense.
But, as both opponents and supporters of HB 637, brought by Rep. Julie Darling, R-Helena, said, that leaves physicians and terminally ill patients in a legal gray area that doesn't offer any guidance or 'sideboards' on the process.
HB 637 offers a range of steps and requirements that would codify when people could use medical assistance in dying (see sidebar below). Testimony included lengthy testimony from Lt. Gov. Kristen Juras, who spoke of the Gianforte administration's opposition to the bill, offering her own personal story of having grandchildren with the life-shortening disease, cystic fibrosis.
Juras said the issue of medical assistance in dying is a public policy that should be discussed by lawmakers, as the Baxter decision said, but she said that suicide is already an epidemic in the Treasure State, and the state's policy should be consistent. Montana, as Juras pointed out, has been in the top five states in suicide per capita for decades.
'I think we'd all agree: Inconsistent policy is bad policy,' Juras said. 'You cannot say that suicide is not appropriate in these situations but allowable in other situations. That is doublespeak. It's confusing. It sends the message that life matters in some instances but not others. Life matters no matter the condition.'
Demonstrating the often complex political issue that can't be broken down by party lines, Rep. Ed Stafman, D-Bozeman, who is also a lawyer and rabbi, said he was truly conflicted on the bill, and wondered how Juras, also an attorney, viewed the proposed legislation in light of the state constitution's right to dignity.
'The thing I'd ask is does human dignity also include the right to ask your friend or your neighbor to pull the trigger when the gun is at their head to assist them in dying,' Juras responded.
Testimony from medical professionals ranged from strong support to opposition, representing the way the issue doesn't break down along political party lines. The sponsor of the bill, Darling, admitted that it was probably surprising that a Republican would bring the bill, but after seeing the process first-hand with the death of her younger sister, who died in 2024 due to metastatic breast cancer, she said the issue wasn't partisan, rather a personal 'freedom of choice.'
Other Republicans seemed supportive of the measure, wondering if mixing the perennial problem of suicide and medical assistance in dying wasn't a case of an 'apples to oranges' comparison.
Require residents who want 'Medical Assistance In Dying' to have a certified condition with a terminal diagnosis.
Be within six months of death.
Patients must initiate the request themselves.
There would be a 48-hour period between meeting with a physician and a prescription for the drugs that would induce death.
The patient must have the ability to self-administer.
The patient must be 18 years old.
Must be concurrently enrolled in hospice.
The decision to request medical aid in dying must be witnessed, repeated and recorded.
Any witness must not be related to the person.
Any witness must not be entitled to any portion of the person's estate.
The witness may not be the doctor.
The witness may not be affiliated with the facility where the patient resides.
The witness may not be a resident of the facility.
Dr. Carley Robertson, a physician who works mainly in nursing homes in the northern part of the state, worried that the law would mandate her to write prescriptions that she didn't agree with.
Derek Oestreicher, legal counsel for the Montana Family Foundation, said his group opposed the idea because of the role of doctors and the value of human life.
'Doctors should not be killers. Doctors should be healers,' he said.
Matt Brower, representing the Montana Catholic Conference, said the two diocese in the state opposed the bill.
'What incentive is there for the state to put resources into hospice or palliative care?' he asked.
However, others, including those with a terminal disease, spoke in support. Dan Steffensen has Stage IV lung cancer — giving him six months to live, with a possibility of 18 months with treatment.
'I am seeking treatment,' he said. 'But I know the day will come when I will suffocate. I do not care to do that, nor should I have to. I will make the decision for myself. I do not want lose my options. That's what I need — my options.'
David Cooper of Jefferson City who was married for 53 years testified in support of the bill, after watching his wife die of amyotrophic lateral sclerosis, known as 'Lou Gehrig's Disease.' He said that despite the palliative care offered to her, the medication didn't alleviate her pain and suffering, a theme that medical providers continued to emphasize.
Doris Fischer of Sheridan said that her husband died of ALS eight months before the Baxter decision.
'He was not afraid of death, he was scared of the complications,' she said, which includes gradually being unable to breath and suffocating to death.
Dr. Colette Kirchhoff, who has been practicing care for terminal patients, said that medical literature is clear: Palliative care, which seeks to comfort and ease the pain and symptoms of some diseases, is only effective in 93% of the cases, leaving some to suffer during the dying process.
'We cannot soothe every symptom,' she said. 'People have terminal suffering because we are lengthening the death process instead of increasing the life process.'
Toward the end of the testimony, as lawmakers were asking questions, Kirchhoff addressed the question of patients who chose medical assistance in dying, and how it differed from suicide.
'I think sometimes it's hard to remember how much suffering comes along with chemotherapy, how much suffering comes along with stem cell therapy, how much suffering happens with immunotherapy,' Kirchhoff said. 'They don't want to take any more pills, and they don't want the side effects. They want to live. They're not suicidal, and they would take offense to the idea. They've done everything they can to live and to extend their lives.'
Some medical professionals also argued that giving clarification would help ease uncertainty about the practice, which maintains a gray area in law.
'Without guardrails, it's harder, not easier,' said Marika Moore, a certified death midwife.
Some proponents, including Darling, who went through the process with her dying younger sister, said that many times, the patients who select medical aid in dying never use the prescribed drugs, rather they want freedom and options.
'In the end, she did not make it to her chosen date of death,' Darling said, noting that her sister died the day before she had selected with family and healthcare providers. 'But I firmly believe Jackie let go that week because of the plan she had set in motion that week. She needed to be in charge at the end. Jackie did not want to die. She would have taken any medication she could have to live. She had two sons and a grandson. Medical assistance in dying isn't a partisan issue, it's a freedom of choice.'
Others, like Rep. Zooey Zephyr, D-Missoula, asked about whether advanced life directives often used by hospitals and elderly patients to communicate their wishes at the end of life, including 'do not resuscitate' orders, weren't a similar example of medical practice shaping whether a patient lives or dies.
'That's a great question and there is a huge difference,' Juras said.
The hearing often put the lieutenant governor in the defensive position as other lawmakers, some Republican, noted that suicide is often completed by terminal patients with no other means of recovering.
'In those directives, you're prolonging a death that would otherwise end a life, and allowing a death that was imminent so as not to artificially prolong life. That's a lot different than hastening death,' Juras said.
The committee took no action on the bill on Wednesday morning.