January 13, 2010
By Pat McCaughan

The Montana Supreme Court may have ruled Montanans have a right to die with dignity, but questions remain about the future of the new law and its implementation.

The court ruled that neither state law or public policy preclude doctors from prescribing lethal drugs to mentally competent, terminally-ill patients who want to end their lives.

Some supporters, like Helena personal injury attorney James Hunt, a former chancellor of the Episcopal Diocese of Montana, described the court's Dec. 31 decision as affirming an "option for aid in dying and as compassionate Christian care-giving," not suicide.

"I had a brother who died of pancreatic cancer and I watched him die, and I've watched others die," said Hunt, who filed a brief for religious leaders in support of Baxter v. Montana. The lawsuit was filed by Compassion and Choices, a right-to-die advocacy group, on behalf of 75-year-old retired Billings truck driver Robert Baxter. He had terminal cancer and sought the right to obtain medication from his doctor to end his life. He has since died.

Joining Hunt's brief were several Episcopal clergy, including the Rev. Steve Oreskovich, rector of Holy Spirit Church in Missoula. After counseling dozens of dying people during 27 years of ordained ministry Oreskovich concluded, "when we can control suffering … the suffering has redemptive value. But when it's destroying the self, when it's terminal, it seems to me we aren't taking the life, we're aiding the process. It seems the compassionate thing to do as a Christian."

On his first Christmas Eve as associate rector at the Missoula parish he was called to the home of a dying cancer patient. "The only words out of his mouth to me were, ‘there's a shotgun in the closet, would you get it for me?'" Oreskovich recalled.

In another instance, a parishioner with terminal cancer ended his own life very violently, affecting his spouse for the rest of her life, which might have been averted had the law been in effect, he said.

"Our tradition has always been so strong about people making their own decisions, it seems to me there's a lot of room to think about dealing with death," he added.

The other Episcopal Church clergy who joined the friend-of-the-court brief were the Rev. Jean Collins, the Rev. John C. Board and the Rev. Canon Gary Waddingham. Also included in the brief were United Church of Christ and Disciples of Christ ministers, a hospital chaplain and a Montana State University English and philosophy professor.

Trudy James, who conducts "Let's Talk About It" classes through her Heartwork consultant service, said suicide is violent, unlike dying with dignity. Preparing for such deaths can be a transformational time for families, as well as the patient, she added. "People always say they want a natural death, but it's not natural to be hooked up to all kinds of tubes in intensive care," added James, who serves as a chaplain at the Seattle Cancer Care Center.

The ruling makes Montana the nation's third state to allow the procedure. Oregon was first to adopt a death with dignity law in 1997; in November 2008 Washington state followed suit.

Opposing the ruling were the state attorney general's office, which argued that intentionally taking a life is illegal and that the issue is the responsibility of the state legislature, not the courts.

Opponents include the Montana Family Foundation and Roman Catholic Bishop Michael W. Warfel of the Diocese of Great Falls-Billings, who has vowed to take the fight to the state legislature.

"As Catholics, we are committed to the protection of life, from conception to natural death," he said in a press release on the diocesan website. "We will work tirelessly to protect the life and dignity of all."

Dr. Margaret Stockwell, who helps runs hospice care for dying patients at St. Peter's Hospital in Helena, told the Associated Press that she isn't sure how she'd react if asked to aid in a patient's death.

"If someone comes to me and says I need help ending my life because my situation is untenable, then as a physician you feel you have failed in helping them in whatever they need help dealing with," she said. "I would do everything I could, and I have, at least that's my goal, to try to provide a setting and the tools a person needs to carry on their life as best they can."

Hunt agreed that it's unclear how the new law will be implemented and that the criteria for aided deaths must be fine-tuned.

"It's very important that the person meet the criteria … (that they are) imminently terminally ill, mentally competent, and able to administer the medications themselves, so it's their own free will."

But, he added that until "the Legislature steps in and sends forth some more specific criteria" it is likely physicians will be reluctant to aid in a patient's death.

"They've got to have more specific criteria, about how physicians are involved, how they determine if the person is competent" especially given concerns voiced by opponents that the law could be misused, by those who were depressed or could even target lower-functioning people or those who felt their illness a burden to their loved ones.

Patients in hospice care are already given medications that shorten life, but the goal is to manage their pain, according to Stockwell. She said she has seen colleagues prolong imminent death by putting patients on ventilators and feeding tubes far too long. But she added that she is not sure prescribing the drugs to kill immediately is the solution.

The American Civil Liberties Union of Montana is organizing an April 10 conference in Helena, and inviting representatives from legal, medical, religious and patient communities to discuss the issue.

"The court's ruling reinforces how important community understanding and discussion of death with dignity will be in the coming years," said ACLU of Montana Public Policy Director Niki Zupanic in a press release. "The ACLU is committed to facilitating that process and ensuring that individuals' right to determine their own medical decisions is protected."

Episcopal News Service
The Rev. Pat McCaughan is Episcopal Life Media correspondent for Provinces V, VI, VII and VIII and the House of Bishops. She is based in Los Angeles.