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HELENA — It could be a while before Montana doctors are willing to help terminally ill patients die, despite the recent state Supreme Court decision that nothing in state law prevents physician-assisted suicide.

The court decision made Montana the third state where it is legal, but the state has no specific laws outlining guidelines for doctors like they do in Oregon and Washington. That will leave Montana doctors on their own to determine how to proceed if they choose to help a dying patient commit suicide.

The Supreme Court said nothing in the law prevents a doctor from prescribing death-inducing drugs to terminally ill, mentally competent patients. And the court said doing so would be a defense against homicide charges.

But doctors, just because they could have a defense to charges of murder, aren't likely to rush into the process. They are hoping the Legislature — until now hesitant to wade into the debate — will craft a legal framework for assisted suicide.

"I think legally they could proceed, but I think they would need to do so with an extreme mount of caution and substantial guidelines on whether that was a proper thing to do," Missoula doctor Stephen Speckart said.

The Montana Legislature has been closely divided in recent years along partisan lines, making it very difficult for controversial legislation of any type. If that continues into 2011, there are no guarantees that lawmakers will provide any guidance at all.

Supporters of assisted suicide, which they refer to as death with dignity, will be seeking legislation. But so will opponents, led by religious groups of many types that would like it abolished conclusively.

In the meantime doctors could be facing some tough choices.

Dr. Margaret Stockwell, who helps run hospice care for dying patients at St. Peter's Hospital in Helena, said no patient has ever asked her to help them commit suicide — but she recognizes it may happen now that the Supreme Court has said it's legal.

She is not sure exactly how she would react.

"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," said Stockwell. "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."

Stockwell has worked in family practice in rural Nebraska where farmers and ranchers "just know that stuff dies" and seem better able to accept death. She has worked in large cities and seen colleagues prolong imminent death by putting patients on ventilators and feeding tubes for far too long.

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The doctor said that while death comes, she is not sure prescribing the drugs to kill immediately is the solution. Current hospice practices work well, she said.

"Frequently we give medications that provide comfort with the possibility of hastening death, but that's not the point to hasten death, the point is to provide comfort," she said. "Feeding tubes and machinery are not a very good idea at that point. There are situations where enough is enough."

The ACLU of Montana plans an April 10 conference to help the public hash out such issues. The group also hopes the Legislature will bring clarity to the issue.

"Right now it is pretty unclear for doctors," said spokeswoman Amy Cannata. "The court said death with dignity is a defense in homicide. I don't think that will put many doctors at ease to help patients who want and need this aid in dying. I don't know that if I was a physician that would be enough safeguard for me to say, 'yeah I will help you.'"

States like Washington have all sorts of legal requirements, such as minimum age and a waiting period along with the prescription rules for doctors. Supporters in Montana say doctors could follow the guidelines set in those other states.

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