Opinion ID: 888660
Heading Depth: 1
Heading Rank: 3

Heading: The Montana Rights of the Terminally Ill Act

Text: ¶ 106 In 1991, the Legislature enacted the Montana Rights of the Terminally Ill Act (Montana Act) by substantially adopting the Uniform Rights of the Terminally Ill Act (Uniform Act). Secs. 1-16, Ch. 391, L. 1991 (codified at §§ 50-9-101 to -206, MCA). The Prefatory Note in the Uniform Act explains that [t]he scope of the Act is narrow. Its impact is limited to treatment that is merely life-prolonging .... [3] Uniform Rights of Terminally Ill Act (1989), 9C U.L.A. 311, 312 (2001) (emphasis added). The form Declaration provided by the Montana Act for patients, by its plain language, further supports the scope of the purposes articulated in the Uniform Act: If I should have an incurable or irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician or attending advanced practice registered nurse, cause my death within a relatively short time and I am no longer able to make decisions regarding my medical treatment, I direct my attending physician or attending advance practice registered nurse, pursuant to the Montana Rights of the Terminally Ill Act, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary to my comfort or to alleviate pain. Section 50-9-103(2), MCA (emphasis added). And, as the Court acknowledges, the Montana Act is careful to explain that it does not condone, authorize, or approve mercy killing or euthanasia. Section 50-9-205(7), MCA. ¶ 107 The operative words in the Montana Act are those permitting a patient to withhold and withdraw life-sustaining treatment. See §§ 50-9-103(2), -106, -204, -205, MCA. Largely self-evident, to withhold means to desist or refrain from granting, giving, or allowing. Webster's Third New International Dictionary of the English Language 2627 (Philip Babcock Gove ed., G. & C. Merriam Co. 1971). Similarly, withdraw is defined as to take back or away (something bestowed or possessed). Webster's Third New International Dictionary of the English Language at 2626. Neither word incorporates the concept of affirmatively issuing a life-ending drug to a patient. Rather, the plain language permits only the taking away of, or refraining from giving, certain medical treatmentthat which merely prolongs the dying process. Sections 50-9-102(9), -103(2), -106, -204, -205, MCA. ¶ 108 Although the Court reasons that because the Montana Act permits the withholding or withdrawal of treatment prolonging the dying process, it would be incongruous to conclude that a physician's indirect aid in dying is contrary to public policy, the opposite is true: it is incongruous to conclude there is no legal distinction between the withdrawal of life-prolonging medical treatment and the provision of life-ending treatment. This distinction is clearly recognized by the wording of our statutes, discussed above, and by the courts. See e.g. Vacco v. Quill, 521 U.S. 793, 800, 808, 117 S.Ct. 2293, 2297-98, 2302, 138 L.Ed.2d 834 (1997) (distinguishing between physician-assisted suicide and refusal of medical treatment does not violate equal protection); and compare Glucksberg, 521 U.S. at 705-06, 117 S.Ct. at 2261 (holding there is no constitutional right to physician-assisted suicide) with Cruzan v. Mo. Dept. of Health, 497 U.S. 261, 277-79, 110 S.Ct. 2841, 2851-52, 111 L.Ed.2d 224 (1990) (assuming a constitutional right for competent person to refuse unwanted medical treatment). ¶ 109 To further illustrate the Legislature's policy preference in respecting a person's right to refuse medical treatment, Montana allows a person to forego cardiopulmonary resuscitation (CPR). Sections 50-10-101 to -107, MCA. To the extent a patient refuses the receipt of CPR, physicians must either refrain from conducting CPR or transfer the patient into the care of a physician who will follow the do not resuscitate protocol. Section 50-10-103(2), MCA. As with the Rights of the Terminally Ill Act, a person may refuse treatment, but the tenor of the statute provides no support for physicians shifting from idle onlookers of natural death to active participants in their patients' suicides. ¶ 110 Thus, the law accommodating a patient's desire to die of natural causes by withholding treatment does not, as the Court posits, support a public policy in favor of the deliberate action by a physician to cause a patient's pre-natural, or premature, death.