Case Name: KATHERINE MORRIS, M.D., AROOP MANGALIK, M.D., and AJA RIGGS, Plaintiffs-Appellees, v. KARI BRANDENBURG, in her official capacity as District Attorney for Bernalillo County, New Mexico, and GARY KING, in his official capacity as Attorney General of the State of New Mexico, Defendants-Appellants
Court: Court of Appeals of New Mexico
Jurisdiction: New Mexico
Decision Date: 2015-08-31
Citations: 2015-NMCA-100
Docket Number: No. 35,478; Docket No. 33,630
Parties: KATHERINE MORRIS, M.D., AROOP MANGALIK, M.D., and AJA RIGGS, Plaintiffs-Appellees, v. KARI BRANDENBURG, in her official capacity as District Attorney for Bernalillo County, New Mexico, and GARY KING, in his official capacity as Attorney General of the State of New Mexico, Defendants-Appellants.
Judges: TIMOTHY L. GARCIA, Judge
Reporter: New Mexico Appellate Reports
Volume: 8
Pages: 559–616

Head Matter:
Certiorari Granted, August 31, 2015,
No. 35,478
IN THE COURT OF APPEALS OF THE STATE OF NEW MEXICO
Opinion Number: 2015-NMCA-100
Filing Date: August 11, 2015
Docket No. 33,630
KATHERINE MORRIS, M.D., AROOP MANGALIK, M.D., and AJA RIGGS, Plaintiffs-Appellees, v. KARI BRANDENBURG, in her official capacity as District Attorney for Bernalillo County, New Mexico, and GARY KING, in his official capacity as Attorney General of the State of New Mexico, Defendants-Appellants.
Kennedy Kennedy & Ives, LLC
Laura Schauer Ives
Albuquerque, NM
ACLU of New Mexico Foundation
Alexandra Freedman Smith
Albuquerque, NM
Kathryn L. Tucker
Ojai, CA
for Appellees
Hector H. Balderas, Attorney General
Scott Fuqua, Assistant Attorney General
Santa Fe, NM
for Appellants
Rothstein, Donatelli, Hughes
Dahlstrom, Schoenburg & Bienvenu, LLP
Kristina Martinez
Carolyn M. “Cammie” Nichols
Santa Fe, NM
for Amicus Curiae The ALS Association New Mexico Chapter
Montgomery & Andrews, P.A.
Lara Katz
Santa Fe, NM
for Amicus Curiae Disability Rights Amici: Not Dead Yet, Adapt, American Association of People With Disabilities, Autistic Self Advocacy Network, Disability Rights Education and Defense Fund, National Council on Independent Living, and the United Spinal Association
Garcia Ives Nowara, LLC
Molly Schmidt Nowara
Albuquerque, NM
Covington & Burling, LLP
Christina G. Kuhn
Washington, DC
for Amicus Curiae American Medical Women’s Association, American Medical Student Association, and New Mexico Public Health Association
Robert Schwartz
Albuquerque, NM
for Amicus Curiae New Mexico Psychological Association
Alliance Defending Freedom
Catherine Glenn Foster
Washington, DC
Modrall, Sperling, Roehl, Harris & Sisk, P.A.
Emil J. Kiehne
Albuquerque, NM
for Amicus Curiae State of New Mexico Senators William F. Burt, Mark Moores, Steven P. Neville, William E. Sharer, and Pat Woods; State of New Mexico Representatives Paul C. Bandy, Sharon Clahchischilliage, David M. Gallegos, Jason C. Harper, Yvette Herrell, and James R.J. Stickler; and Christian Medical and Dental Associations
Stelzner, Winter, Warburton, Flores, Sanchez & Dawes, P.A.
Juan L. Flores
Jaime L. Dawes
Albuquerque, NM
for Amicus Curiae Michael J. Sheehan of the Archdiocese of Santa Fe, Bishop Oscar Cantú of the Diocese of Las Cruces, and Bishop James A. Wall of the Diocese of Gallup

Opinion:
OPINION
GARCIA, Judge.
{1} A New Mexico statute makes "assisting suicide" a fourth degree felony and defines the proscribed conduct as "deliberately aiding another in the taking of his own life." NMSA 1978, § 30-2-4 (1963). The question presented is whether this statute may constitutionally be applied to criminalize a willing physician's act of providing a lethal dose of a prescribed medication at the request of a mentally competent, terminally ill patient who wishes a peaceful end of life (aid in dying) as an alternative to one potentially marked by suffering, pain, and/or the loss of autonomy and dignity. The district court concluded that Section 30-2-4 is invalid under two provisions of the New Mexico Constitution as applied to any physician who provides aid in dying to a patient. In reaching its conclusion, the district court determined that aid in dying is a fundamental liberty interest and that the State did not meet its burden to prove that Section 30-2-4 met a strict scrutiny standard of review. We conclude that aid in dying is not a fundamental liberty interest under the New Mexico Constitution. Accordingly, we reverse the district court's order permanently enjoining the State from enforcing Section 30-2-4. In addition, we affirm the district court's determination that, for statutory construction purposes, Section 30-2-4 prohibits aid in dying. Finally, I would also remand to the district court for further proceedings regarding the remaining aid in dying claims raised by Plaintiffs, including the entry of findings and conclusions concerning whether Section 30-2-4 meets the intermediate standard of review required for important individual liberty interests under the New Mexico Constitution and/or whether it passes a rational basis standard of review as applied to aid in dying.
BACKGROUND
{2} Plaintiffs are Dr. Katherine Morris, a surgical oncologist at the University of New Mexico (UNM); Dr. Aroop Mangalik, aUNM physician; and Aja Riggs, a patient who has been diagnosed with uterine cancer. In the course of their practices, Drs. Morris and Mangalik provide medical care to mentally competent, terminally ill adults who have expressed interest in what Plaintiffs call "aid in dying," which the parties define as the "practice of a physician providing a mentally competent^] terminally ill patient with a prescription for [a lethal dose of] medication which the patient may choose to ingest to achieve a peaceful death and thereby avoid further suffering."
{3} Aid in dying has been legal in Oregon for nearly two decades. Or. Rev. Stat. Ann. § 127.800 to .897 (1997, as amended through 2013). Dr. Morris, who previously practiced in Oregon, administered aid in dying at the request of two patients in that state. The practice is also legal in Vermont, see Vt. Stat. Ann. tit. 18, § 5281 to 5292 (2013), and Washington, see Wash. Rev. Code Ann. § 70.245.10 to 70.245.904 (2009), and has been judicially recognized as a valid statutory defense to homicide in Montana, see Baxter v. Montana, 2009 MT 449, ¶ 1, 354 Mont. 234, 224 P.3d 1211. The practice is statutorily stated to be illegal in five other states, see Ark. Code Ann. § 5-10-106 (2007) (expressly prohibiting "physician-assisted suicide"); Ga. Code Ann. § 16-5-5(b), (d) (2012) (indicating application to physicians by requiring healthcare providers to notify the licensing board upon conviction); Idaho Code Ann. § 18-4017 (2011) (same); N.D. Cent. Code Ann. § 12.1-16-04 (1991) (prohibiting the issuance of prescriptions for the purpose of assisting suicide); R.I. Gen. Laws § 11-60-3 (1996) (prohibiting licensed healthcare practitioners from providing another the physical means to commit suicide), and is potentially prohibited in the majority of remaining jurisdictions by blanket manslaughter statutes similar to Section 30-2-4. See, e.g., Cal. Penal Code § 401 (1905).
{4} Uncertain about the legality of aid in dying in New Mexico, Drs. Morris and Mangalik filed suit seeking a declaration that they cannot be prosecutedunder Section 30-2-4. They alleged that the statute does not apply to aid in dying, and if it does, such application offends provisions of our state constitution, including Article II, Section 4's guarantee of inherent rights and Article II, Section 18's Due Process Clause. The district court held a trial on the merits at which several witnesses testified for Plaintiffs. That testimony was uncontroverted and formed the basis for the district court's findings. The testimony and findings, which remain undisputed, establish the following facts.
{5} Quality of life for terminally ill patients varies depending on the specific illness, its manifestations in the patient, and the patient's physical and psychological reserves. But progressive terminal illness, by definition, interferes with vital functions, such as eating and drinking, breathing, blood flow, and the basic functions of the brain. At any given moment, there are terminally ill patients in New Mexico "who find the suffering from their illness to be unbearable, despite efforts to relieve pain and other distressing symptoms." Some of those patients find the current options in end-of-life care to be inadequate to relieve their suffering and want the option of aid in dying. The dying process is often extremely difficult for patients with terminal illnesses. As a surgical oncologist, Dr. Morris has treated cancer patients with a variety of end-of-life symptoms, such as irremovable "obstruction^]" that cause the inability to swallow, fluid accumulation that leads to rapid and repeated distention of the abdomen, and swelling of the skin such that it splits open. In some instances, a patient's suffering is such that doctors induce unconsciousness — the so-called "barbiturate coma" — and then withhold hydration and nutrition until death arrives. As one example, Dr. Morris recalled treating a "really strong" firefighter who was approximately six foot, five inches tall and weighed 280 pounds. His skin cancer led to metastasis of the spine, which left him "sobbing in pain." All doctors could do to ease his pain "was make him unconscious" by administering "huge doses" of narcotics, muscle relaxants, and sedatives.
{6} Dr. Morris testified that sedating people to this level "suppresses their breathing and sometimes ends their li[ves]." The removal of life-sustaining nutrition and hydration also hastens the death of the sedated patient. Experts at trial described the "double-effect" of this practice of terminal (or palliative) sedation, as it is called: Although the physician's "primary intent" — or more accurately, motive — is to eliminate pain, the physician "inevitably know[s]" that administering such high doses of consciousness-lowering medications — at times, tens or even hundreds of times the normal dosage — will lead, in close proximity, to the patient's death. Palliative sedation is an accepted medical practice and is allowed in New Mexico. See generally NMSA 1978, § 24-2D-1 to -6 (1999, as amended through 2012). The same is true for withdrawal of life-sustaining treatment measures. See generally NMSA 1978, § 24-7A-1 to -18 (1995, as amended through 2009). But these legal options for ending life arise only after the patient potentially endures a period of degeneration.
{7} Apart from pain, there are other reasons why a terminally ill patient may choose aid in dying. In Oregon and Washington, where data on aid in dying are required to be kept by statute, see Or. Rev. Stat. Ann. § 127.865; Wash. Rev. Code Ann. § 70.245.150, the most commonly cited end-of-life concern among patients who choose to ingest the lethal dose of medication is "loss of autonomy." Patients in both states also frequently report that their illnesses cause a loss of dignity and a loss of the ability to engage in the activities that make life enjoyable. Oregon's Death With Dignity Act Rep., supra, at 5; Wash. Death With Dignity Act Rep., supra, at 7. Dr. David Pollack, a psychiatrist practicing in Oregon for over forty years, testified at trial that patients choose to ingest the lethal dose of medication "to alleviate symptoms, to spare others from the burden of watching them dwindle away or be a shell of their former sel[ves] or to feel like they are in control, [to] have some autonomy and some control over the way that they die."
{8} Plaintiff Aja Riggs, who has been diagnosed with life-threatening uterine cancer, testified that she did not know if she "wantfed] to go all the way to the end" and naturally die if the consequences of her cancer reached the terminal stages:
I think one of the images that I had that I didn't and I don't want to have happen is that I'm lying in bed in pain, or struggling not to be in pain, or mostly unconscious with everybody that cares about me around me and all of us just waiting for me to die.
Ms. Riggs further testified that the legal availability of aid in dying would bring her peace of mind and help her feel that she can make controlled personal choices about her experience with cancer. This sentiment was echoed by Dr. Nicholas Gideonse who specializes in end-of-life care in Oregon:
I've had patients who've had breast cancer for [twenty years], been through rounds of fighting and succeeding and remission and then not. They know these illnesses well. And . if they get the chance to write that final chapter, to at least describe how the story will end on their own terms, it's a great relief to patients and their families.
{9} The trial testimony identified the existence and substance of a standard of care for determining terminality and eligibility for aid in dying in other states, derived from the experience with the practice in Oregon, where it has been legal since 1997. In addition, it described a standard of care for determining mental competence, that physicians are trained to apply. The testimony further showed similarities among aid in dying, terminal sedation, and the removal or refusal of life-sustaining treatment, as well as the differences between aid in dying and suicide, including the distinct reasons for these acts.
{10} The experience in Oregon has been that a number of patients who have been prescribed aid-in-dying medication never ingest it. According to the trial testimony, the availability of the medication nonetheless provides patients the comfort of knowing that there is a peaceful alternative to being forced to endure unbearable suffering. Still more patients do not request the medication after discussing the option with their physicians.
The District Court's Judgment
{11} After trial, the district court found that physicians have provided and continue to provide aid in dying to qualified patients in Oregon, Washington, and Vermont (pursuant to statutory authorization); Montana (pursuant to an opinion of the Montana Supreme Court); and Hawaii (where there is no criminal prohibition). The court also found that, when aid in dying is available, "end[-]of[-]life care for all terminally ill patients improves through better pain treatment, earlier and increased referrals to hospice[,] and better dialogues between physicians and their terminally ill patients about end[-]of[-]life care and wishes."
{12} Ultimately, the district court concluded that Section 30-2-4 prohibits aid in dying but that its application to aid in dying violates the inherent-rights guarantee and substantive due process protections afforded by Article II, Section 4 and Article II, Section 18 of the New Mexico Constitution. Citing Washington v. Glucksberg, 521 U.S. 702, 725 (1997), the district court acknowledged that the United States Supreme Court "declined to find the right to aid in dying to be . . . protected by the federal Constitution." The court nevertheless departed from federal precedent established in Glucksberg, noting that New Mexico has inherent power as a separate sovereign in our federalist system to provide more liberty under the New Mexico Constitution than that afforded by the federal Constitution. It then applied the interstitial approach to constitutional analysis mandated by our Supreme Court in such circumstances. See State v. Gomez, 1997-NMSC-006, ¶ 19, 122 N.M. 777, 932 P.2d 1. The district court concluded that the inherent rights clause of Article II, Section 4 provides "distinct additions" to the fundamental rights afforded under the federal Constitution and a basis to diverge from federal precedent.
{13} The district court specifically held that "[a] terminally ill, mentally competent patient has a fundamental right to choose aid in dying pursuant to the New Mexico Constitution's [Article II, Section 4] guarantee to protect life, liberty, and seeking and obtaining happiness . . . and its substantive due process protections [under Article II, Section 18]." Applying strict scrutiny, the court held that the State had failed to prove that by criminalizing the actions of physicians who provide aid in dying Section 30-2-4 furthers a compelling interest. The district court also ordered that the State be permanently enjoined from prosecuting any physician who provides aid in dying to mentally competent, terminally ill patients who choose to utilize aid in dying. The State timely appealed.
ISSUES AND ARGUMENTS ON APPEAL
{14} On appeal, the parties have stipulated to the factual record developed in the district court. The State argues that (1) there is no fundamental right to the deliberate assistance of a third-party in ending one's own life through aid in dying, and (2) the district court's ruling violates the doctrine of separation of powers by legalizing conduct that is designated to be a crime by the Legislature. In addition to disputing the State's contentions, Plaintiffs argue that Section 30-2-4 does not prohibit aid in dying.
DISCUSSION
I. Statutory Construction: Section 30-2-4
{15} We begin with the text of the statute, which provides, "[Assisting suicide consists of deliberately aiding another in the taking of his own life. Whoever commits assisting suicide is guilty of a fourth degree felony." Section 30-2-4. "Our principal goal in interpreting statutes is to give effect to the Legislature's intent." Griego v. Oliver, 2014-NMSC-003, ¶ 20, 316 P.3d 865. To do so, we first look to the language used and the plain meaning of that language. State v. Moya, 2007-NMSC-027, ¶ 6, 141 N.M. 817, 161 P.3d 862. "We refrain from further interpretation where the language is clear and unambiguous." State v. Martinez, 2006-NMCA-068, ¶ 5, 139 N.M. 741, 137 P.3d 1195 (internal quotation marks and citation omitted).
{16} Plaintiffs contend that the statute does not prohibit aid in dying. Citing Rule 12-201(C) NMRA, the State protests that this argument is not properly before us because the district court ruled against Plaintiffs on this point and Plaintiffs did not file a cross appeal. It argues that the doctrine that permits affirmance for any reason supported by the record,see Meiboom v. Watson, 2000-NMSC-004, ¶ 20, 128 N.M. 536, 994 P.2d 1154, cannot be applied because acceptance of Plaintiffs' statutory argument would require reversing, not affirming, the district court's conclusion that Section 30-2-4 prohibits physicians from providing aid in dying. We have held that "an appellee need not cross-appeal to raise an issue that would preserve the judgment below." Cockrell v. Mitchell, 2003-NMCA-094, ¶ 12, 134 N.M. 180, 75 P.3d 396 (alteration, internal quotation marks, and citation omitted). In any event, we cannot address the question presented — whether Section 30-2-4 may constitutionally be applied in the circumstances presented here — without first determining what the statute proscribes. We also must interpret statutes in a manner that avoids, to the extent possible, raising constitutional concerns. Griego, 2014-NMSC-003, ¶ 19. Accordingly, we determine the meaning of Section 30-2-4.
{17} The central point of Plaintiffs' statutory argument is that the Legislature's use of the term "suicide" in Section 30-2-4 suggests that the statute "clearly contemplates individuals who are not already dying, and nothing suggests it reaches a competent, dying patient's decision to achieve a peaceful death." The factual basis for this argument is the uncontested expert testimony of Dr. Pollack, which establishes that "suicide is a distinctly different act than requesting aid in dying[.]" According to Dr. Pollack, suicide is a "despairing, lonely experience." He stated that it is an impulsive act — typically in reaction to psychological isolation, shame, guilt, or misunderstanding by others, and its effect on survivors is devastating. Family members tend to experience shock and disbelief or anger. In contrast, Dr. Pollack noted that those who request aid in dying do so to alleviate symptoms and to maintain relationships, connections, and a sense of self, and recognize that the problem confronting them arises from an irreversible physical calamity. They are already dying, and "[they are] focused on maintaining the quality of life that is something that they cherish." Dr. Pollack also testified that since the 1990s, increasing numbers of mental health and medical professionals have recognized that the two acts are fundamentally different, and treating physicians reject the idea that patients who have chosen aid in dying were committing suicide. He explained that if these patients could have survived their illnesses, they would have chosen to do so. The State concedes that distinctions between suicide and aid in dying identified in the fields of medicine and psychology are "compelling" but contends that they are "irrelevant from a legal standpoint."
{18} As a textual matter, the State is correct. In defining the proscribed conduct — "[ajssisting suicide" — as "deliberately aiding another in the taking of his own life[,]" the statute necessarily also defines "suicide" as "the taking of [one's] own life." Section 30-2-4. This statutory definition of "suicide" binds us. See Cadena v. Bernalillo Cnty. Bd. of Cnty. Comm 'rs, 2006-NMCA-036, ¶ 15, 139 N.M. 300, 131 P.3d 687 ("As a rule[,] a statutory definition which declares what a term means is binding on the court." (alteration, internal quotation marks, and citation omitted)). As noted, the parties define "aid in dying" as "the practice of a physician providing a mentally competent[,] terminally ill patient with a prescription for [a lethal dose of an authorized] medication which the patient may choose to ingest to achieve a peaceful death[.]" While not recognized as "suicide" in a growing body of medical and psychological literature, a patient's choice to "achieve a peaceful death" is still "the taking of [one's] own life" under the statute's plain terms. See § 30-2-4. "[A]iding," in the context of "determining whether one is criminally liable for [his or her] involvement in the suicide of another," means "providing the means to commit suicide[.]" State v. Sexson, 1994-NMCA-004, ¶ 15, 117 N.M. 113, 869 P.2d 301. Dr. Morris testified at trial that a prescription for aid in dying is typically for the barbiturate Seconal, written for a uniform dose calculated to have lethal effect. This conduct, by design, provides a patient the means to take his or her own life and is prohibited by the text of Section 30-2-4.
{19} Citing the Uniform Health-Care D ecisions Act, § § 24-7 A-1 to -18, as evidence of "New Mexico's long, proud tradition of public policy promoting autonomy in end-of-life decision making," Plaintiffs assert that we may consider the "clear policy implications of various constructions" if a statute is ambigrrous. They also cite the Supreme Court of Montana's decision in Baxter, 2009 MT 449, ¶ 26-28, for the proposition that a state's public policy valuing autonomy in medical decision making can guide courts in determining whether assisted suicide includes aid in dying. But "[statutory language that is clear and unambiguous must be given effect." V.P. Clarence Co. v. Colgate, 1993-NMSC-022, ¶ 8, 115 N.M. 471, 853 P.2d 722. And, where the language is plain, the court's task of statutory interpretation ends. Martinez, 2006-NMCA-068, ¶ 5.
{20} Plaintiffs' arguments are unavailing in any event. Since enacting Section 30-2-4 in 1963, the Legislature has twice considered "assisted suicide" in the healthcare context. In both the Uniform Health-Care Decisions Act, § 24-7A-1 to -18, and the Mental Health Care Treatment Decisions Act, NMSA 1978, § 24-7B-1 to -16 (2006, as amended through 2009), the Legislature expressly refused to "authorize . . . assisted suicide . to the extent prohibited by other statutes of this state." Sections 24-7A-13(C); 24-7B-15(C). W e note that the "other statute[ ] of this state" must be a reference to Section 30-2-4. Furthermore, Baxter's exploration of statutes and precedents for evidence of state policy on medical decision making was expressly called for by the language of a statutory affirmative defense that invalidates the consent defense when "it is against public policy to permit the conduct or the resulting harm, even though consented to." 2009 MT 449, ¶ 11-13 (internal quotation marks and citation omitted). Plaintiffs' statutory argument fails, and we must address the district court's ruling that aid in dying is a fundamental liberty interest that is entitled to due process protection under the New Mexico Constitution.
II. The New Mexico Constitution
{21} Plaintiffs argue that Section 3 0-2-4's criminalization of aid in dying violates two provisions of the New Mexico Constitution: the Due Process Clause of Article II, Section 18, which has an analogous provision in the Fourteenth Amendment of the United States Constitution, and the inherent-rights guarantee of Article II, Section 4, which has no enumerated federal constitutional analogue. Although Plaintiffs do not assert a right to aid in dying under federal law, the State's argument is that there is no such right, and the inquiry continues to be identical to and controlled by the United States Supreme Court's analysis in Glucksberg, 521 U.S. at 728, where it held that "the asserted 'right' to assistance in committing suicide is not a fundamental liberty interest protected by the [federal] Due Process Clause" and that "Washington's assisted-suicide ban [is] rationally related to legitimate government interests." Accordingly, we take cognizance of the necessity for an interstitial approach to constitutional analysis adopted by our Supreme Court in Gomez, 1997-NMSC-006, ¶ 19. Our review of the district court's interstitial approach is de novo. See Bank of N.Y. v. Romero, 2014-NMSC-007, ¶ 52, 320 P.3d 1 (stating that constitutional interpretation issues are reviewed de novo).
A. The Interstitial Approach to Interpreting the New Mexico Constitution
{22} Gomez made clear that "states have inherent power as separate sovereigns in our federalist system to provide more liberty than is mandated by the United States Constitution" and that "[w]e are not bound to give the same meaning to the New Mexico Constitution as the United States Supreme Court places upon the United States Constitution, even in construing provisions having wording that is identical, or substantially so, unless such interpretations purport to restrict the liberties guaranteed the entire citizenry under the federal charter." 1997-NMSC-006, ¶ 17 (internal quotation marks and citation omitted). While recognizing that "[federal precedent in areas addressed by similar provisions in our state constitutions can be meaningful and instructive[,]" id. ¶ 21 (internal quotation marks and citation omitted), our Supreme Court explained that it had abandoned a "lock-step" approach to interpretation of the New Mexico Constitution and applied an "interstitial [approach], providing broader protection where we have found the federal analysis unpersuasive either because we deemed it flawed . or because of undeveloped federal analogs[.]" Id. ¶ 20 (citations omitted).
Under the interstitial approach, the court asks first whether the right being asserted is protected under the federal [Constitution. If it is, then the state constitutional claim is not reached. If it is not, then the state constitution is examined. A state court adopting this approach may diverge from federal precedent for three reasons: a flawed federal analysis, structural differences between state and federal government, or distinctive state characteristics.
Id. ¶ 19 (citation omitted); see State v. Garcia, 2009-NMSC-046, ¶ 34, 147 N.M. 134, 217 P.3d 1032 (rejecting widely criticized United States Supreme Court decision weakening a right "beyond a point which may be countenanced under our state constitution"); State v. Rowell, 2008-NMSC-041, ¶ 20-23, 144 N.M. 371, 188 P.3d 95 (declining to follow United States Supreme Court decisions criticized in legal literature as "devoid of a reasoned basis in constitutional doctrine"); N.M. Right to Choose/NARAL v. Johnson, 1999-NMSC-005, ¶ 28-43, 126 N.M. 788, 975 P.2d 841 (concluding that distinctive characteristics of the New Mexico Constitution mandated rejection of federal constitutional analysis affording less protection); State v. Gutierrez, 1993-NMSC-062, ¶ 32, 50-56, 116 N.M. 431, 863 P.2d 1052 (discussing "a willingness to undertake independent analysis of our state constitutional guarantees when federal law begins to encroach on the sanctity of those guarantees" and rejecting a federal constitutional rule as incompatible with the guarantees of the New Mexico Constitution); State v. Ochoa, 2009-NMCA-002, ¶ 12-13, 146 N.M. 32, 206 P.3d 143 (rejecting a widely criticized United States Supreme Court decision, finding the federal analysis unpersuasive and incompatible with state constitutional standards).
{23} Thus, our analysis of rights afforded by the New Mexico Constitution is not "inextricably tied" to federal constitutional analysis. NARAL, 1999-NMSC-005, ¶ 37; see Gutierrez, 1993-NMSC-062, ¶ 16 (stating that, in interpreting state constitutional guarantees, New Mexico courts may seek guidance from decisions of federal courts without being bound by those decisions). In seeking departure from federal due process precedent, Plaintiffs carried the initial burden to establish that greater due process protections should be recognized under Article II, Section 18 of our New Mexico Constitution. See Gomez, 1997-NMSC-006, ¶ 22-23; Rule 12-216(A) NMRA. The basis for interpreting greater protections under Article II, Section 18 of the New Mexico Constitution must first be addressed and found to exist by the district court. Gomez, 1997-NMSC-006, ¶ 23. In its findings of fact and conclusions of law, the district court identified the following reasons for greater protection under Article II, Section 18, which we summarize numerically:
1. Our Supreme Court has already recognized greater protections under the New Mexico Constitution in "many instances},]" citing Montoya v. Ulibarri, 2007-NMSC-035, ¶ 22, 142 N.M. 89, 163 P.3d 476 (recognizing that the New Mexico Constitution provides greater rights than those provided in the federal constitution in the areas of double jeopardy, search and seizure, and equal protection).
2. Our Supreme Court has recognized that some rights of a "personal nature" are entitled to constitutional protection, such as "the right of parents in the care, custody, and control of their children"; "the freedom of personal choice in matters of family life"; and "the right to family integrity," citing In re Pamela A.G., 2006-NMSC-019, ¶ 11, 139 N.M. 459, 134 P.3d 746 (recognizing the interest of parents in the care, custody, and control of their children as a fundamental liberty interest); Oldfield v. Benavidez, 1994-NMSC-006, ¶ 14, 116 N.M. 785, 867 P.2d 1167 (recognizing the general right to familial integrity as a clearly established constitutional right but noting its parameters are not absolute, unqualified, or clearly established); and Jaramillo v. Jaramillo, 1991-NMSC-101, ¶ 15-21, 113 N.M. 57, 823 P.2d 299 (addressing the constitutional right to travel in the context of assigning the burden of proof between a relocating custodial parent and the noncustodial parent).
3. The protected liberty interest of a terminal patient dealing with imminent death that was identified in Cruzan ex rel. Cruzan v. Director, Missouri Department of Health, 497 U.S. 261, 278-79 (1990), is more closely aligned with the liberty interest in this case and is entitled to protection under Article II, Section 18, despite not being protected under the Due Process Clause of the Fourteenth Amendment in Glucksberg.
{24} We note that as part of their interstitial argument, Plaintiffs also asserted that New Mexico has made an enhanced commitment to patient autonomy at the end of life, and Article II, Section 18 should recognize greater protections through the equal protection test articulated in Breen v. Carlsbad Municipal Schools, 2005-NMSC-028, ¶ 8, 138 N.M. 331, 120 P.3d 413. This equal protection assertion was not recognized by the district court and was not included in its findings.
{25} Prior to any hearings held by the district court, the State moved to dismiss Plaintiffs' complaint based upon substantially the same governmental interests determined to exist by the United States Supreme Court in Glucksberg. See 521 U.S. at 703-04. While the State does not fully concede application of the interstitial approach suggested by Plaintiffs, the district court's findings nonetheless identified a basis for establishing greater protections in New Mexico by application of the interstitial approach. First, it held that the distinctive individual interests embodied under Article II, Section 4 are not enumerated as protections within the federal Constitution and these enumerated New Mexico interests have been recognized to support the existence of other inherent rights by our Supreme Court. See Griego, 2014-NMSC-003, ¶ 1 (relying upon Article II, Section 4 to identify the inherent rights "enjoyed by all New Mexicans" that must then be legally measured because "it is the responsibility of the courts to interpret and apply the protections of the Constitution"). Second, its findings concerning the experiences in other states where aid in dying is legal support the notion that the federal analysis in Glucksberg may be flawed and thus may not constitute an authoritative bar to protection under Article II, Section 18 of the New Mexico Constitution. As a result, current due process analysis could result in a different factual and legal outcome than that of Glucksberg. Having identified Article II, Section 18 as the basis for application of the interstitial approach under the New Mexico Constitution, the district court rejected Glucksberg's analysis and concluded that greater constitutional protections are provided under the New Mexico Constitution. We review the interstitial analysis employed by the district court as to both constitutional provisions to address whether aid in dying constitutes a liberty interest under either of these two sections of the New Mexico Constitution.
B. Aid in Dying as Defined and Applied by the Parties
{26} Plaintiffs contend that aid in dying is "fundamental or, at the very least, important under the New Mexico Constitution." On appeal, Plaintiffs identify the fundamental rights implicated in aid in dying as (1) the "right to autonomous medical decision making" and (2) the right to "a dignified, peaceful death." The district court agreed that aid in dying is a fundamental liberty interest protected by the New Mexico Constitution. Constitutional interpretation is an issue of law we review de novo. State v. Boyse, 2013-NMSC-024, ¶ 8, 303 P.3d 830. In doing so, we must consider the claimed constitutional interest in the context in which the allegedly protected conduct takes place. Additionally, we emphasize at the outset that the interest asserted here applies only to a narrowly defined class of New Mexico citizens.
{27} Plaintiffs do not argue that there is a broad, categorical constitutional right to commit suicide that includes a right to third-party assistance in doing so. Rather, Plaintiffs precisely and narrowly define their claimed liberty interest as one that does not apply to any large classification of citizens. We understand Plaintiffs' assertion to be that this narrowly defined interest is only fundamental where: (1) a mentally competent patient is capable of giving consent, (2) the patient is diagnosed as terminally ill, (3) the patient requests a prescription for medication that may be ingested to bring about an immediate end to his/her life, and (4) a willing physician applying the proper standard of care determines that it would be appropriate to provide and prescribes the terminal dose of medication for the patient to ingest and end the patient's life.
{28} The State concedes that citizens have a right to make their own end-of-life decisions and to bring about their own deaths without the aid or assistance of another person. There is also no dispute that a physician may lawfully act pursuant to statute to support a patient's desire to shorten the dying process by removing life-sustaining nutrition, hydration, or mechanical life support, and by administering palliative sedation (high doses of consciousness-lowering medications). See generally § 24-2D-1 to -6; 24-7A-1 to -18. At oral argument, the State even suggested that patients may bring about the end of their own lives by stockpiling morphine lawfully prescribed by a physician and ultimately ingesting a lethal dosage. According to the State, this act does not involve the statutorily defined aid or assistance of another person under Section 30-2-4, even though it involves a physician's act of prescribing the medication used by the patient to cause his/her own death. The State also "readily concede[d]" that, except for the acts of aiding or assisting a person in taking his or her own life, it had no interest in causing mentally competent, terminally ill patients to suffer during the final days of their lives.
C. Aid in Dying Is Not a Fundamental Liberty Interest Protected by the Due Process Clause of the New Mexico Constitution
{29} The Due Process Clause of the New Mexico Constitution provides that "[n]o person shall be deprived of life, liberty or property without due process of law[.]" N.M. Const, art. II, § 18. The federal Due Process Clause similarly provides that no state "shall . . . deprive any person of life, liberty, or property, without due process of law[.]" U.S. Const, amend. XIV, § 1. Because the State's due process argument relies primarily on Glucksberg, the principal federal case interpreting the liberty interest described here as aid in dying, we shall address its application to our decision even though it does not bind our interpretation under Article II, Section 18, or curtail the potential for broader protections under the New Mexico Constitution. See Gomez, 1997-NMSC-006, ¶ 19. We also address the narrow scope of Plaintiffs' proposed liberty interest and its relationship to the interests of life, liberty, and happiness that are enumerated protections within Article II, Section 4.
1. The Federal Analysis of Due Process and Glucksberg
{30} In Glucksberg, the United States Supreme Court confirmed that the substantive component of the Due Process Clause under the Fourteenth Amendment protects certain aspects of personal autonomy as fundamental rights notwithstanding that they are not mentioned in the text of the Bill of Rights. Glucksberg, 521 U.S. at 720-21; see Planned Parenthood of Se. Pa. v. Casey, 505 U.S. 833, 847 (1992) (explaining that the United States Supreme Court has never accepted the view that "liberty encompasses no more than those rights already guaranteed to the individual against [governmental] interference by the express provisions of the first eight [a]mendments to the Constitution"). The Court stated that the government may not interfere with certain liberty interests unless the government meets its burden under a strict scrutiny standard — proving that the infringing statute is narrowly tailored to serve a compelling governmental interest. Glucksberg, 521 U.S. at 721. In Glucksberg, four physicians, three terminally ill patients, and one nonprofit organization filed suit against the State of Washington, seeking a declaration that the state's ban on assisting suicide was unconstitutional. 521 U.S. at 707-08. Under the Due Process Clause of the Fourteenth Amendment, the plaintiffs asserted a liberty interest to allow a mentally competent, terminally ill adult the right to choose physician-assisted suicide as a method to end life. Id. The United States Supreme Court unanimously determined that "the asserted 'right' " to physician-assisted suicide is not a liberty interest entitled to any type of protection under the Due Process Clause of the Fourteenth Amendment. Id. at 728, 735 (precluding its recognition as a constitutionally protected due process liberty interest because of society's nearly universal efforts to prevent suicide and assisted suicide and due to the importance of the state's interest in regulating both the real and potentially adverse consequences of assisted suicide).
{31} Fundamental constitutional rights are enumerated and "specific freedoms protected by the Bill of Rights," id. at 720, or those later identified by process of the United States Supreme Court's enforcement of equality and liberty guaranteed by the Fifth and Fourteenth Amendments. See Lawrence v. Texas, 539 U.S. 558, 575 (2003) ("Equality of treatment and the due process right to demand respect for conduct protected by the substantive guarantee of liberty are linked in important respects}.]"). While constitutional interpretation must address "new dimensions of freedom" over time, see Obergefell v. Hodges, _ U.S. 135 S. Ct. 2584, 2596 (2015), the sum of such rights remains principally static because, in the words of the fourth Chief Justice of the United States Supreme Court, John Marshall, "we must never forget, that it is a constitution we are expounding."M'Culloch v. Maryland, 17 U.S. 316, 407 (1819). Constitutions, including our New Mexico Constitution, are sacred because they were written to apply in perpetuity. See Republican Party of N.M. v. N.M. Taxation & Revenue Dep't, 2012-NMSC-026, ¶ 52, 283 P.3d 853 ("The constitution is the heart, the soul, the genius of our system of government, and its' safeguarding is [our New Mexico Supreme] Court's highest duty and most sacred function." (internal quotation marks and citation omitted)). "The doctrine of judicial self-restraint requires us to exercise the utmost care whenever we are asked to breaknew ground in [the] field [of substantive due process.]" Collins v. Harker Heights, 503 U.S. 115, 125 (1992); see also Log Cabin Republicans v. United States, 658 F.3d 1162, 1170 (9th Cir. 2011) ("[W]hen confronted with assertions of new fundamental rights, rather than invite innovation the [c]ourt has counseled caution."). Plaintiffs' assertion of a new form of constitutional right, one that protects a terminally ill patient's interest in death and the process of dying, is the type of new dimension that warrants such a careful exercise of judicial caution.
{32} The constitutional question here — whether aid in dying is a constitutional right, fundamental or otherwise — has only been directly answered by one case, Glucksberg. Nearly twenty years have passed since Glucksberg concluded that aphysician's "assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause" of the Fourteenth Amendment. 521 U.S. at 728. Despite its share of criticism over the years, see Dissenting Op. ¶ 98-99, no court, federal or state, has held that the concept of death, including a method of a more dignified premature death with the assistance of another person, is rooted within the protections of bodily integrity under the constitution.
{33} Glucksberg both recognized and relied upon "over 700 years [of] Anglo-American common-law tradition [that] has punished or otherwise disapproved of both suicide and assisting suicide." 521 U.S. at 711. Glucksberg's determination that there exists no precipitate constitutional alleyway to the permanent nationwide legality of physician-assisted suicide also stated its awareness of "serious, thoughtful examinations" regarding aid in dying in various states. Id. at 719. It concluded by permitting "earnest and profound debate about the morality, legality, and practicality of [aid in dying] . to continue, as it should in a democratic society." Id. at 735; see id. at 737 (O'Connor, J. concurring) ("There is no reason to think the democratic process will not strike the proper balance between the interests of terminally ill, mentally competent individuals . . . and the [s]tate's interests in protecting those who might seek to end life mistakenly or under pressure."); id. at 789 (Souter, J., concurring) (cautioning against "displace[ment of] the legislative ordering of things"). Confirming that it meant what it held in Glucksberg, eight years later, the Supreme Court rejected executive action undertaken by the United States Department of Justice to apply the Controlled Substances Act to disallow physicians from prescribing fatal narcotics as authorized by Oregon's Death With Dignity Act. See Gonzales v. Oregon, 546 U.S. 243 (2006). Obergefell also recently mentioned the Glucksberg decision that has allowed the states to undertake nearly twenty years of independent experimentation to properly balance the varying interests of the terminally ill. Obergefell,_U.S. at_, 135 S. Ct. at 2596.
{34} Before addressing Plaintiffs' due process claim under Article II, Section 18, we are compelled to address the methodologies applied when litigants pursue due process interests they believe to be implied by the words chosen by the founders of our nation and its states. Prior opinions have expressed the legally analytic, yet structurally ideologic, tug-of-war that exists within courthouses across the nation, including the United States Supreme Court itself. Compare Glucksberg, 521 U.S. at 720-21 (weighing the constitutional stature of an asserted right by direct review of "this Nation's history and tradition" (internal quotation marks and citation omitted)), with Lawrence, 539 U.S. at 572 ("History and tradition are the starting point but not in all cases the ending point of the substantive due process inquiry." (alteration, internal quotation marks, and citation omitted)), and Obergefell,_U.S. at _, 135 S. Ct. at 2598 ("History and tradition guide and discipline this inquiry but do not set its outer boundaries. That method respects our history and learns from it without allowing the past alone to rule the present."(citation omitted)). Yet in this instance, any philosophical attempt to resolve that bigger constitutional picture serves only to distract our focus from the real issues to be considered. The fact that Glucksberg's analytic methodology has been questioned by some legal scholars does not mean the opposite of its holding must be true. More critically for our purposes, Glucksberg provided a substantive due process answer to a factually identical scenario that has never been rejected by any state appellate court. The issue before us is not whether Glucksberg is one of several available constitutionally interpretive "guideposts for responsible decision[]making," Collins, 503 U.S. at 125; rather, it remains the only existing precedent regarding the nearly identical constitutional question that is posed in this case. In order to justify a departure from Glucksberg, Plaintiffs must have shown precisely why greater fundamental due process protections exist under Article II, Section 4.
{35} Obergefell suggests that the assisted suicide analysis in Glucksberg remains unchanged. See Obergefell,_U.S. at_, 135 S. Ct. at 2602. The Obergefell majority briefly addressed aid in dying and distinguished that asserted right of physician assisted suicide from the asserted interest in marriage that was before it. Id. In Obergefell, every member of the United States Supreme Court, including those justices that the Dissenting Opinion identifies to embrace a more evolving due process concept of constitutional analysis and the developed interests in autonomy of self, passed upon an opportunity to question the majority's reference to the outcome in Glucksberg or cast aspersion upon the analysis of aid in dying that was utilized in Glucksberg. Obergefell,__U.S. at__, 135 S. Ct. at 2602. See Dissenting Op. at ¶ 96 & 100. Specifically, while Obergefell recognized the re-ordering of evaluative constitutional criteria in similar due process cases, it provided a specific reference of approval and a brief defense of Glucksberg by stating that the "central reference to historical . . . practices . . . may have been appropriate for . . . (physician-assisted suicide), [yet not for] other fundamental rights, including marriage and intimacy." Obergefell,__U.S. at_p, 135 S. Ct. at 2602. Although the United States Supreme Court appears engaged in an effort to integrate its constitutional jurisprudence, including Glucksberg, see Obergefell,_U.S. at_, 135 S. Ct. at 2602, it is our view that we should continue to be very careful when considering new constitutional interests and remain reluctant to deviate from United States Supreme Court determinations of what are, and what are not, fundamental constitutional rights.
{36} Irrespective of the new interpretive dimensions applied by the United States Supreme Court to address differing applications of due process, the substantive fundamental rights that are recognized to exist under the Due Process Clause of the Fourteenth Amendment have always originated from classic personal interactions or embedded principles in our democratic society. These protections include the longstanding interests in marriage, see Loving v. Virginia, 388 U.S. 1 (1967); sexual relationships, see Lawrence, 539 U.S. 558; family integrity, see Skinner v. Oklahoma ex rel. Williamson, 316 U.S. 535 (1942); child rearing, see Pierce v. Soc'y of Sisters, 268 U.S. 510 (1925); education of one's children, see Meyers v. Nebraska, 262 U.S. 390 (1923); and bodily integrity, see Rochin v. California, 342 U.S. 165 (1952). Plaintiffs have failed to provide any authority to support the position that "death" or "aid in dying" in New Mexico have either been recognized as embedded principles within our democratic society or as a modern interpretation of certain fundamental interests that have been applied to some members of society but historically denied to others. See In re Adoption of Doe, 1984-NMSC-024, ¶ 2, 100 N.M. 764, 676 P.2d 1329 ("We assume where arguments in briefs are unsupported by cited authority, counsel after diligent search, was unable to find any supporting authority."); see also John B. Mitchell, My Father, John Locke, &Assisted Suicide: The Real Constitutional Right, 3 Ind. Health L. Rev. 45, 59 (2006) (evaluating the various attempts at articulating the fundamental right at issue in Glucksberg and illustrating the difficulty in identifying the right's contours, while further suggesting that "it would probably be fairer to the proponents of [physician-assisted suicide] in the Glucksberg [c]ourt to equate the phrase dying with dignity with a [substitute phrase,] rejection of bad death"). For example, Cruzan has been offered by Plaintiffs to identify an equivalent liberty interest to aid in dying. 497 U.S. 261. But the constitutionally protected right assumed to exist in Cruzan, 497 U.S. at 279 — the right to refuse medical treatment, including lifesaving hydration and nutrition — was clearly distinguished and specifically rejected as an equivalent interest to aid in dying. Glucksberg, 521 U.S. at 722-23, 730-31. In addition, the modem concerns associated with aid in dying — regarding issues of pain, suffering, dignity, and autonomy during the final days of a person's life — are medical circumstances that have only garnered growing consideration in modern society due to the longevity, pain management, and life-sustaining advancements that have been made more recently by the medical profession. See Cruzan, 491 U.S. at 270. As discussed in more detail below, we are also troubled that Plaintiffs and their witnesses have narrowed the focus of an autonomous and dignified death to one that favors only a very narrow segment of the population — only those New Mexicans who are competent, terminally ill, and under the care of a physician.
{37} Aid in dying, the medical concept of dying with autonomy and dignity, is a relatively recent human phenomena and deserves appropriate public evaluation and consideration. However, as a new legal consideration, it must also be carefully weighed against longstanding societal principles such as preventing a person from taking the life of another; preventing suicide; preventing assisted suicide; promoting the integrity, healing, and life preserving principles of the medical profession; protecting vulnerable groups from unwanted pressure to considering aid in dying as the best alternative to other medical options; and promoting human life where aid in dying is not the appropriate medical option despite a patient's request for its use. See Glucksberg, 521 U.S. at 703-04;,see also Cruzan, 497 U.S. at 270-71. The recent advances in life-prolonging medical care and the public acceptance of aid in dying in some states has not diminished the other longstanding societal principles and concerns regarding intentional killing, the dying process, the preservation of life, and the basic life saving principles embedded in the medical profession. Cruzan, 497 U.S. at 280 ("As a general matter, the [s]tates — indeed, all civilized nations — demonstrate their commitment to life by treating homicide as a serious crime. Moreover, the majority of [s]tates in this country have laws imposing criminal penalties on one who assists another to commit suicide."). Plaintiffs' witnesses established that certain benefits have been clinically shown to exist and that several of society's concerns have not materialized when careful regulations and safeguards are imposed upon aid in dying by the medical profession and state legislatures. Yet, even where statutory approval has been achieved, improper application of the statutory protections that allow aid in dying will still expose an offending physician or other responsible parties to criminal liability if they fail to comply with the statutes' narrow parameters. See Or. Rev. Stat. Ann. § 127.890; Vt. Stat. Ann. tit. 18, § 5283(b); Wash. Rev. Code Ann. § 70.254.200. As a result, aid in dying is still in the process of being tested by society and the various states where it has been sanctioned. Presently, aid in dying is best described as a legal and societal work in progress. To assert that it has now risen to the level of a fundamental due process right, requiring strict constitutional protection from society's longstanding interest in the protection of life through its final stages, has not been established by this record or by other jurisprudence.
{38} Lastly, regarding the constitutional stature of aid in dying, the ultimate arbiter of the meaning of the New Mexico Constitution is our New Mexico Supreme Court. See State v. ex rel. Serna v. Hodges, 89 N.M. 351, 356, 552 P.2d 787, 792 (1976), overruled on other grounds by State v. Rondeau, 89 N.M. 408, 412, 553 P.2d 688, 692 (1976) (recognizing that "as the ultimate arbiters of the law of N ew Mexico[,] [our Supreme Court is] not bound to give the same meaning to the New Mexico Constitution as the United States Supreme Court places upon the United States Constitution"). We have previously recognized that under circumstances where it appears "that an uncertain state of law should not exist and because avoidance of the same involves an issue of substantial public interest, the matters raised on appeal should be resolved by the Supreme Court." Archibeque v. Homrich, 1975-NMCA-023, ¶ 5, 87 N.M. 265, 531 P.2d 1238 (per curiam). Such a constitutional shift from the United States Supreme Court decision in Glucksberg, one that was recently referenced anew in Obergefell, shouldbe addressed by our state's highest court. See Archibeque, 1975-NMCA-023, ¶ 5; see also Quill v. Vacco, 80 F.3d 716, 725 (2d Cir. 1996) ("We . . . decline the plaintiffs' invitation to identify a new fundamental right [to physician-assisted suicide], in the absence of a clear direction from the Court whose precedents we are bound to follow. The limited room for expansion of substantive due process rights and the reasons therefor have been clearly stated[.] . . . Our position in the judicial hierarchy constrains us to be even more reluctant than the [United States Supreme] Court to undertake an expansive approach in this unchartered area." (internal quotation marks and citation omitted)), rev'd on other grounds, Vacco v. Quill, 521 U.S. 793 (1997) (internal quotation marks and citation omitted)). Similar to our New Mexico Supreme Court, we are not heedless to changes occurring over time but are careful to expand constitutional interpretations of the law to satisfy our own concepts of right or wrong. See State v. Pace, 1969-NMSC-055, ¶ 23, 80 N.M. 364, 456 P.2d 197 ("We are not heedless of the plea that this is a more enlightened day than were those of years gone by, and that views of what is and what is not right have changed with the passage of time. However, we perceive our responsibility as being confined to interpreting the law as we understand it, not to making of new law to satisfy our conceptions of right or wrong."). From the perspective of constitutional interpretation, Glucksberg'' s holding still provides this Court with principled authority. Given our analysis, and consistent with Glucksberg, we conclude that there is no fundamental right to aid in dying under Article II, Section 18 of the New Mexico Constitution. Therefore, interstitial departure to declare such a right would be inappropriate. See Gomez, 1997-NMSC-006, ¶ 19 (allowing interstitial identification of a right when existing federal precedent is flawed).
2. Inherent Rights Under Article II, Section 4
{39} Article II, Section 4 specifically identifies three broad categories of individual interests that are entitled to constitutional protection in New Mexico — life, liberty, and happiness. However, Article II, Section 4 has been sparsely interpreted. See Reed v. State ex rel. Ortiz, 1997-NMSC-055, ¶ 105, 124 N.M. 129, 947 P.2d 86 (recognizing that "[o]ur courts have not fully defined the scope of this constitutional provision"), rev'd sub nom. on other grounds by N.M. ex rel. Ortiz v. Reed, 524 U.S. 151 (1998). The Oxford English Dictionary defines "life" as "[t]he condition or attribute of living or being alive; animate existence. Opposed to death." 8 Oxford English Dictionary 910 (2d ed. 1989, reprinted with corrections 1991). Plaintiffs ask us to interpret Article II, Section 4's express protections of liberty and happiness as encompassing an implied inherent right to oppose the protected principle of life by constitutionally allowing third-party physicians to intentionally hasten another person's death. We decline to recognize Article II, Section 4 as protecting a fundamental interest in hastening another person's death because such an interest is diametrically "[o]pposed" to the express interest in protecting life. 8 Oxford English Dictionary, supra, at 910.
{40} At its core, aid in dying challenges the longstanding and historic interest in the protection of life until its natural end as well as the equally longstanding prohibition against assisting another in hastening that process. See Glucksberg, 521 U.S. at 710-16 (observing that our nation's historical approach has been to disallow assisting another person in the taking of his/ her own life regardless of the circumstances). This treasured right to life is not only considered sacred under the common law but is also recognized as an inalienable right, even for those condemned to death. See id. at 714-15 (citing Martin v. Commw., 37 S.E.2d 43, at 47 (Va.1946) ("'The right to life and to personal security is not only sacred in the estimation of the common law, but it is inalienable.'") and Blackburn v. State, 23 Ohio St. 146, 163 (1872) ('"[E]ven the lives of criminals condemned to death, [are] under the protection of the law[.]'"), overruled in part on other grounds by State v. Staten, 247 N.E.2d 293 (Ohio 1969)). Assisting a condemned criminal in taking his/her own life has also been subjected to punishment. Commw. v. Bowen, 13 Mass. 356 (1816). The inalienable right that defends life is also a prioritized constitutional interest in New Mexico. See Reed, 1997-NMSC-055, ¶ 103 ("When a person's life is jeopardized by the actions of the state without due process, no constitutional interest is of greater consequence____The transgression is not only against a single human being but also the most basic principles upon which our system of government was founded." (emphasis added) (citation omitted)); Trujillo v. Prince, 1938-NMSC-024, ¶ 15, 42 N.M. 337, 78 P.2d 145 (1938) ("The [constitution and statute, allowing compensation for life lost through negligence of another, adopt a policy touching the most important subject of all government, in which it is recognized that human life should be protected as well from negligence as from crime. . It could scarcely be said that a man has any greater right in his own life now than he had before the adoption of the constitutional provision and statutes of a kindred nature. His right originally was above all others, save where it is forfeited for crime." (emphasis added) (internal quotation marks and citation omitted)). Although the dissent concedes, in general terms, that the government has a compelling and substantial constitutional interest in preserving life, it then concludes that this expressly prioritized constitutional interest in life was not adequately articulated by the State to address the needs of New Mexicans dying from terminal illness and, as a result, effectively disappears upon a medical determination of terminal illness. See Dissent ¶ 112-114, 117, 121 & 127.
{41} We understand Plaintiffs to assert that the process of dying during the final stages of life, defined as a terminally ill patient with six months or less to live, is now an accepted constitutional priority that falls within an intimate zone of privacy and that contemporary generations view aid in dying as a fundamental constitutional interest that deserves strict protection from governmental intrusion. However, death and the process of dying are not rights expressly enumerated within Article II, Section 4 and can only qualify as inferences that might exist within the categories of liberty or happiness. Plaintiffs cite no American case law that interprets the interests of constitutional liberty and happiness as extending protection to a third-party that assists another with intentionally taking his or her own life. See In re Adoption of Doe, 1984-NMSC-024, ¶ 2 ("We assume where arguments in briefs are unsupported by cited authority, counsel after diligent search, was unable to find any supporting authority."). The leap from a general societal concern about pain, suffering, and/or loss of autonomy and dignity during the final months of a terminally ill person's life into the creation of an Article II, Section 4 fundamental constitutional right to protect physicians who practice aid in dying is unprecedented. See Pace, 1969-NMSC-055,¶ 23 (recognizing the need for judicial restraint when society may have changed over time and adhering to the preference for deferring to the legislative process for legal changes to keep "our existing laws in step with current thinking"). The Dissenting Opinion's analysis of how this Court should achieve the creation of this new fundamental interest under the New Mexico Constitution is also vague. See Dissent^ 110-114.
{42} The Dissenting Opinion appears to argue that a new constitutionally recognized event now occurs upon the diagnosis of terminal illness. Id. First, a patient's right to privacy automatically creates an inferred end-of-life liberty interest under Article II, Section 4 in the event of terminal illness. Id. Next, this new liberty interest ascends to constitutional priority over life itself. Id. Ultimately, the Dissenting Opinion harshly criticizes the majority for failing to agree with this new constitutional result. Id. at ¶ 114. It then extends this criticism by asserting that the majority is cavalier about the needs of the terminally ill, to the point it asserts that the majority is shockingly disrespectful to both physicians and the terminally ill. Id. References of ignorance, disrespect, or miscreance leveled at one's colleagues by the Dissenting Opinion are improper and unnecessarily harmful to our judicial process. See id.
{43} We are not persuaded by Plaintiffs' position that a modern desire to hasten death under the rubric of medical privacy can be inferred to take priority over the express fundamental interest in life set forth in Article II, Section 4. Medical privacy has never been constitutionally extended to such a high constitutional level, especially when "[i]t cannot be disputed that the Due Process Clause protects an interest in life." Cruzan, 497 U.S. at 281. Any development of the importance that society may eventually attribute to dying with autonomy and dignity remains inferential and secondary to life under the enumerated language set forth in Article II, Section 4 as well as our New Mexico precedent. See Reed, 1997-NMSC-055, ¶ 103; Trujillo, 1938-NMSC-024, ¶ 15. Again, there is no basis under the Gomez factors to permit the creation of an interstitial constitutional right under Article II, Section 4 of the New Mexico Constitution. See Gomez, 1997-NMSC-006, ¶ 19.
3. The Exclusionary Defects in Plaintiffs' Proposed Right to Aid in Dying
{44} Article II, Section 4 declares that "All persons . . . have certain natural, inherent and inalienable rights" entitled to protection. N.M. Const, art. II, § 4 (Emphasis added). In arguing that the genesis of aid in dying is rooted in Article II, Section 4, Plaintiffs identify two categories of bodily integrity as the basis for fundamental constitutional protection: (1) the "right to autonomous medical decision making" and (2) the right to "a dignified, peaceful death." But the fundamental constitutional protection being sought by Plaintiffs is not a right of autonomy or dignity shared or uniformly applied to all New Mexico citizens; it is a narrow interest only favoring certain patients who meet very specific criteria during their final days of life — competence, terminal illness, physical ability to take and swallow a pill, and who are under the current care and supervision of a physician who prescribes the lethal dosage of medication. Aid in dying also provides a very narrow benefit from prosecution that exclusively favors physicians. Despite repeatedly referring to aid in dying as the liberty interest of "all New Mexicans," the Dissenting Opinion ultimately concedes that it is a narrowly defined right and its narrowly tailored application is the "question at the heart of this case." See Dissenting Opinion ¶ 73, 133, 135 & 148.
{45} Plaintiffs' experts testified that in Oregon and Washington, patients who have ingested the medication are overwhelmingly white, married, college-educated, insured, receiving hospice services, and dying of cancer or ALS. See Or. Pub. Health Div., Oregon's Death with Dignity Act Rep., at 4; Wash. State Dep't of Health, 2013 Death With Dignity Act Rep., at 1(2014). Plaintiffs do not assert that the same fundamental right exists for the remainder of New Mexicans who cannot meet the narrow definition for aid in dying. In addition, they do not claim that these excluded New Mexicans do not equally suffer from the same symptoms during the final six months of their lives — extreme pain, loss of autonomy, and loss of dignity, despite an absence of terminal illness. Under Plaintiffs' theory of substantive due process, the remainder of our citizens enduring the similar excruciating and unbearable symptoms are not entitled to equal constitutional protection. This theory would exclude the availability of aid in dying for all terminal patients suffering from a variety of disorders affecting their mental competence such as mental illness, dementia, or Alzheimer's disease. It would also exclude all patients suffering from non-terminal diseases or other medical conditions that are also causing extreme pain, indignity, and loss of autonomy during the final six months of their lives, such as multiple sclerosis and Parkinson's disease. See Mitchell, supra, at 60-61 (recognizing that a fundamental right to aid in dying may not be exercised by "people who are incapable of picking up . . . and/or swallowing the pills [by] themselves],]" or by those "patients suffering as the result of massive injuries or those inflicted with a wasting disease],]" and noting that such patients "[may] be in a far worse position than those with terminal illness, e.g. six months or a year to live" because "[t]he suffering of non-terminal patients can go on and on, while, for the terminally ill, the end is in sight").
{46} Furthermore, Plaintiffs' narrowly defined asserted right to aid in dying would provide constitutional immunity from criminal prosecution to only physicians and no one else. For example, the asserted right would not protect a non-physician from criminal prosecution under Section 30-2-4 under a circumstance in which a patient who qualifies for aid in dying seeks assistance from a loved one in addition to or instead of a physician in achieving a peaceful and dignified death. This exclusionary benefit applying only to physicians further exposes the constitutional inadequacy of Plaintiffs' asserted right. Just as a fundamental right is one that exists for all citizens, any immunity from prosecution of third parties that springs from such a right, under properly applied principles of equal protection, must exist for all citizens who assist in carrying out a patient's constitutional right to hasten death. See N.M. Const. art. II, § 4; see also Gentry v. Shug, 2012-NMCA-019, ¶ 8, 270 P.3d 1286 ("An equal protection claim arises when a state actor treats similarly situated groups or persons differently."). We decline to conclude that a fundamental right exists where it would protect only one class of citizens from criminal prosecution to the exclusion of all others.
{47} Under Article II, Section 4, we decline to recognize an inferred fundamental right benefitting only a select few New Mexicans. Fundamental constitutional rights that protect life, liberty, or happiness are "enjoyed by all New Mexicans].]" Griego, 2014-NMSC-003, ¶ 1 (emphasis added); see also Obergefell,_U.S. at_, 135 S. Ct. at 2599 (recognizing that marriage is a fundamental right "for all persons, whatever their sexual orientation" (emphasis added)). The selective discrimination embodied within Plaintiffs' concept of aid in dying is constitutionally unsound for recognition as a fundamental right embodied within Article II, Section 4 and does not protect all New Mexicans who have equal interests in dying with autonomy and dignity.
D. Whether Aid in Dying Is Protected by the New Mexico Constitution Under Plaintiffs' Other Theories
{48} Plaintiffs challenged Section 30-2-4 in the district court under five independent claims. They claimed that Section 30-2-4 (1) does not prohibit aid in dying, (2) is unconstitutionally vague, (3) violates Article II, Section 18's equal protection guarantee, (4) violates Article II, Section 18's due process guarantee, and (5) violates Article II, Section 4's inherent rights guarantee. In addition to asserting that aid in dying is a fundamental right requiring strict protection under our constitution's equal protection, due process, and inherent rights clauses, Plaintiffs asserted that Section 30-2-4's prohibition on aid in dying "is not substantially related to an important governmental interest], or] . . . is not rationally related to firm legal rationale." Plaintiffs submitted proposed findings of fact and conclusions of law pertaining to all of these theories. In its decision, the district court did not address the second and third theories listed above. Further, the district court did not fully address Plaintiffs' fourth and fifth theories, whether Section 30-2-4 would pass an intermediate or a rational basis review in the event aid in dying was ultimately determined not to qualify as a fundamental right. It recognized in its final judgment that it did not need to address these other theories because it had concluded that aid in dying was a fundamental right and that Section 30-2-4 was subject to strict scrutiny review.
{49} In applying its due process analysis under Article II, Section 18, the district court did not address whether aid in dying qualifies as the type of important individual interest entitled to heightened protection under intermediate scrutiny. See Mieras v. Dyncorp, 1996-NMCA-095, ¶ 26, 122 N.M. 401, 925 P.2d 518 (noting that important individual interests, although not fundamental, are entitled to a intermediate standard of constitutional review to test the application of the impinging legislation); Wagner v. AGW Consultants, 2005-NMSC-016, ¶ 12 n.3, 137 N.M. 734, 114 P.3d 1050 (emphasizing that the intermediate scrutiny standard applies to "either an important right or a sensitive class, contrary to what we may have suggested in dicta in [previous cases]"); see also Richardson v. Carnegie Library Rest., Inc., 1988-NMSC-084, ¶ 35-37, 107 N.M. 688, 763 P.2d 1153 (noting that heightened intermediate scrutiny allows a method of genuine judicial inquiry of important individual interests rather than the all-or-nothing choice between minimum rationality and strict scrutiny), overruled on other grounds by Trujillo v. City of Albuquerque, 1998-NMSC-031, 125 N.M. 721, 965 P.2d 305. "This level of evaluation is more sensitive to the risks of injustice than the rational basis standard and yet less blind to the needs of governmental flexibility than strict scrutiny." Marrujo v. N.M. State Highway Transp. Dep't, 1994-NMSC-116, ¶ 11, 118 N.M. 753, 887 P.2d 747 (internal quotation marks and citations omitted).
{50} Although the initial burden still rests upon a plaintiff to establish that the legislation at issue infringes upon an important individual interest, the state's burden of proof under an intermediate scrutiny analysis is different from the burden required under a strict scrutiny analysis. Compare Breen, 2005-NMSC-028, ¶ 13 (recognizing that the government bears the burden of proof under intermediate scrutiny to "prove that the classification or discrimination caused by the legislation is substantially related to an important government interest" (internal quotation marks and citation omitted)), with City of Albuquerque v. Pangaea Cinema, LLC, 2012-NMCA-075, ¶ 29, 284 P.3d 1090 (recognizing that the government bears the burden of proof under strict scrutiny "to show that it has a compelling interest in the challenged scheme and that it has accomplished its goals by employing the least restrictive means"), rev 'd on other grounds, 2013-NMSC-044, 310 P.3d 60; see also Griego, 2014-NMSC-003, ¶ 56 (applying intermediate scrutiny in an equal protection context and considering "whether the legislation is over- or under-inclusive in its application" and "whether the legislation is the least restrictive alternative for protecting the important governmental interest"); Breen, 2005-NMSC-028, ¶ 32 ("While the least restrictive alternative need not be selected if it poses serious practical difficulties in implementation, the existence of less restrictive alternatives is material to the determination of whether the [restriction] substantially furthers an important governmental interest." (alteration, internal quotation marks, and citation omitted)). The standard of proof differs even further when the district court applies rational basis testing. See id. ¶ 11 (recognizing that the party challenging the legislation bears the burden to prove that the statute is not rationally related to a legitimate governmental purpose). The alternative standards of proof that were included in Plaintiffs' proposed findings and conclusions were not addressed by the district court in its original ruling and the corresponding findings that it entered. See State ex rel. King v. UU Bar Ranch Ltd., 2009-NMSC-010, ¶ 44, 145 N.M. 769, 205 P.3d 816 ("When a trial courtrejects proposed findings of facts or conclusions of law, we assume that said facts were not supported by sufficient evidence.").
{51} We have discretion under certain circumstances to resolve any issue raised on appeal, regardless of whether the district court had an opportunity to resolve that issue. See Rule 12-216(A) (limiting appellate scope of review to issues where it "appear[s] that a ruling or decision by the district court was fairly invoked," but granting appellate courts the discretion to consider unpreserved questions involving jurisdiction, general public interest, fundamental error, or fundamental rights of a party). However, we also have the discretion to remand a case to the district court to address alternative claims or theories raised by the parties that it declined to address at the trial level. See Pruyn v. Lam, 2009-NMCA-103, ¶ 17, 147 N.M. 39, 216 P.3d 804 (declining to address on appeal an alternative theory raised in the district court because the district court did not address the alternative theory and remanding the case to the district court to address that theory); State ex rel. Children, Youth & Families Dep't v. Frank G., 2005-NMCA-026, ¶ 40, 137 N.M. 137, 108 P.3d 543 ("The general rule in New Mexico for determining the finality of a judgment is whether all issues of law and fact have been determined and the case disposed of by the [district] court to the fullest extent possible." (internal quotation marks and citation omitted)).
{52} To the extent that aid in dying may be an important interest on par with other important interests recognized by our courts, such as the right to access the courts and the right to an appeal, see Wagner, 2005-NMSC-016, ¶ 14, and the right to run for elected office, see Alvarez v. Chavez, 1994-NMCA-133, ¶ 21, 118 N.M. 732, 886 P.2d 461, overruled on other grounds by Trujillo v. City of Albuquerque, 1998-NMSC-031, the district court should have analyzed Section 30-2-4 under intermediate scrutiny and determined whether the State has satisfied its lower burden of persuasion. Furthermore, it should have determined whether Section 30-2-4 passes a rational basis test as applied to aid in dying and have rendered a decision on Plaintiffs' remaining constitutional claims so as to avoid potential piecemeal appeals in this case.
{53} Although these and Plaintiffs' other alternative claims involve matters of profound public interest, see Rule 12-216, it is more appropriate in this case to require the district court to render its decision on these claims and explain the grounds for those decisions prior to our review. The district court, as the sole fact finder in this case, was present for all of the testimony and arguments presented at trial. In considering the claims that it thought unnecessary to consider in the first instance, it will have an opportunity to make any additional factual findings that are more specific to the unaddressed issues and to require further hearings and/or briefing on these issues. Our Court is not in the position to make factual findings relevant to issues left unaddressed by the district court. See generally Maloof v. San Juan Cnty. Valuation Protests Bd., 1992-NMCA-127, ¶ 17, 114 N.M. 755, 845 P.2d 849 ("The findings of fact adopted below, if supported by substantial evidence, are controlling on appeal."). Therefore, I would remand this case to the district court for further proceedings it deems necessary to result in the entry of findings of fact and conclusions of law concerning Plaintiffs' remaining claims.
CONCLUSION
{54} We reverse the district court's ruling that aid in dying is a fundamental liberty interest under the New Mexico Constitution. Accordingly, we reverse the district court's order permanently enjoining the State from enforcing Section 30-2-4. We affirm the district court's determination that, for statutory construction purposes, Section 30-2-4 prohibits aid in dying. Separate from the Concurring Opinion, I would also remand this case to the district court to make any further findings it deems necessary, to conduct both an intermediate scrutiny and rational basis review of Section 30-2-4, as well as dispose of Plaintiffs' remaining claims.
{55} IT IS SO ORDERED.
TIMOTHY L. GARCIA, Judge
J. MILES HANISEE, Judge (concurring in part)
LINDA M. VANZI, Judge (dissenting)
Although two Plaintiffs are doctors, the right at issue is assorted to belong to their patients, and doctors are typically deemed to have standing to assert the constitutional rights of their patients. See Singleton v. Wulff, 428 U.S. 106, 108, 117 (1976); Doe v. Bolton, 410 U.S. 179, 188 (1973).
Or. Pub. Health Div., Oregon's Death with Dignity Act Rep. (2014) available at https://public.health.oregon.gov/ProviderPartnerResour ces/EvaluationResearch/DeathwithDignityAct/Docume nts/Yearl 7.pdf; Wash. State Dep't of Health, 2013 Death With Dignity Act Rep. Exec. Summary (2014) available at http://www.doh.wa.gOv/portals/l/Documents/Pubs/ 422-109-DeathWithDignityAct2013 .pdf
Rule 12-201(C) reads:
An appellee may, without taking a cross-appeal or filing a docketing statement or statement of the issues, raise issues on appeal for the purpose of enabling the appellate court to affirm, or raise issues for determination only if the appellate court should reverse, in whole or in part, the judgment or order appealed from.
We note that interstitial review in this instance must be utilized to resolve Plaintiffs' claim that Article n, Section 18 provides New Mexicans with a due process right to aid in dying that was denied under the federal constitution. Regarding Article H, Section 4, no federal analogue exists and our analysis is initially interpretive and it potentially becomes interstitial only if substantive due process recognition is also required to establish Plaintiffs' proposed interest under Section 4.
See Or. Rev. Stat. Ann. § 127.800 to .897. Despite the Supreme Court's invitation to utilize the democratic process to allow aid in dying in 1997, only three states have presently enacted such enabling legislation. Significantly, at least thirteen other states — Alaska, California, Colorado, Connecticut, Delaware, Maine, Maryland, Massachusetts, Missouri, Nevada, Utah, Wisconsin, and Wyoming — have rejected aid in dying by referendum or have failed to pass aid in dying legislation through each state's legislative process. See Patients Rights Council, available at http://www.patientsrightscouncil.org/site/assistedsuicide-the-continuing-debate/ (last visited July 10,2015) (tracking ballot initiatives and legislation regarding aid in dying).