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.
Docket No. 33,630
IN THE COURT OF APPEALS OF THE STATE OF NEW MEXICO
August 11, 2015
2015-NMCA-100
GARCIA, Judge.
Certiorari Granted, August 31, 2015, No. 35,478
APPEAL FROM THE DISTRICT COURT OF BERNALILLO COUNTY
Nan G. Nash, District Judge
Kennedy
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
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. Strickler; 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
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.”
BACKGROUND
{2} Plaintiffs are Dr. Katherine Morris, a surgical oncologist at the University of New Mexico (UNM); Dr. Aroop Mangalik, a UNM physician; and Aja Riggs, a patient who has been diagnosed with uterine cancer.1 In the course of their practices, Drs. Morris and Mangalik provide medical care to mentally
{3} Aid in dying has been legal in Oregon for nearly two decades.
{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 prosecuted under
{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[s]” 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
{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
{8} Plaintiff Aja Riggs, who has been diagnosed with life-threatening uterine cancer, testified that she did not know if she “want[ed] 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.
{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
{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 [
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
DISCUSSION
I. Statutory Construction: Section 30-2-4
{15} We begin with the text of the statute, which provides, “[A]ssisting suicide consists of deliberately aiding another in the taking of his own life. Whoever commits assisting suicide is guilty of a fourth degree felony.”
{16} Plaintiffs contend that the statute does not prohibit aid in dying. Citing
{17} The central point of Plaintiffs’ statutory argument is that the Legislature‘s use of the term “suicide” in
{18} As a textual matter, the State is correct. In defining the proscribed conduct—“assisting 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.”
{19} Citing the Uniform Health-Care Decisions Act,
{20} Plaintiffs’ arguments are unavailing in any event. Since enacting
II. The New Mexico Constitution
{21} Plaintiffs argue that
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
Under the interstitial approach, the court asks first whether the right being asserted is protected under the federal [C]onstitution. 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
- 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). - 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 non-custodial parent).
- 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 theFourteenth 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
{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
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.”
{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
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[.]”
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
{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
{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 a physician‘s “assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause” of the
{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.5 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, 576 U.S. at 672, 135 S. Ct. at 2596.
{34} Before addressing Plaintiffs’ due process claim under
{35} Obergefell suggests that the assisted suicide analysis in Glucksberg remains unchanged. See Obergefell, 576 U.S. at 678, 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, 576 U.S. at 678, 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, 576 U.S. at 678, 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, 576 U.S. at 678, 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
{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
{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 New 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
2. Inherent Rights Under Article II, Section 4
{39}
{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, 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 [c]onstitution 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
{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
{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
3. The Exclusionary Defects in Plaintiffs’ Proposed Right to Aid in Dying
{44}
{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,
{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
{47} Under
D. Whether Aid in Dying Is Protected by the New Mexico Constitution Under Plaintiffs’ Other Theories
{48} Plaintiffs challenged
{49} In applying its due process analysis under
{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 court rejects 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
{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
{53} Although these and Plaintiffs’ other alternative claims involve matters of profound public interest, see
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
{55} IT IS SO ORDERED.
TIMOTHY L. GARCIA, Judge
J. MILES HANISEE, Judge (concurring in part)
LINDA M. VANZI, Judge (dissenting)
HANISEE, Judge (concurring in part).
{56} I view the New Mexico Constitution to incorporate no right—fundamental or otherwise—to lethal narcotics medically prescribed for the sole purpose of causing the immediate death of a patient. I therefore concur in reversing the judgment of the district court, and join the majority conclusion that neither
{57} In proposing to affirm the district court, the Dissenting Opinion would adjudicate New Mexico to be just the fourth state to legalize aid in dying, yet the only one to do so extra-statutorily and in a manner broadly circumventive of democratic processes.7 Such a ruling would stand troublingly alone nationally, and would simultaneously contravene: (1) the United States Supreme Court‘s unanimous declaration that there is no such constitutional right; (2) the New Mexico Legislature‘s longtime prohibition of suicide assistance and far more recent establishment of end-of-life standards of medical care that expressly disallow aid in dying; and (3) principles of judicial reasoning that rarely compel, and even more rarely permit, the unilateral and permanent imposition of robed will upon coequal branches of government and society at large. The institution tasked with ensuring legal order ought to be measurably cautious before strong-arming into existence instant, precipitous, and profound social change.
Aid in Dying Is Not A Fundamental Right
{58} I agree with the Majority Opinion‘s analysis holding there to be no
and intimacy“). It would be a mistake to disregard as dicta the Court‘s own recognition that not all interests asserted to be of constitutional dimension require identical analyses. See Obergefell, ___ U.S. at ___, 135 S. Ct. at 2602 (prohibiting the unequal disallowance of a recognized class of Americans from exercising a 48-year-long established fundamental constitutional right); see also Loving v. Virginia, 388 U.S. 1, 12 (1967) (declaring marriage to be “one of the vital personal rights essential to the orderly pursuit of happiness“).
{59} Secondly, among other inherent rights,
Aid in Dying Is Not An Important Right To Which Intermediate Scrutiny Applies
{60} It seems innately sensible that a constitutional right of any sort, even one that is non-fundamental but “important,” must be meaningfully rooted within some specific protection afforded by the document being interpreted, or elsewhere by law. Yet the theoretical constitutional origin of an important such right does not automatically emerge from an otherwise flawed constitutional assertion. As noted above, the interest that is aid in dying is not merely one unmentioned by the New Mexico Constitution, but one that contradicts its very language and a first principle for which it stands. See
{61} Furthermore, even were aid in dying suited for a determination of constitutional importance, it would squarely conflict with the State‘s own important and legitimate contrary interests. See Marrujo, 1994-NMSC-116, ¶ 11 (holding that an “important—rather than fundamental—individual interest” yields to legislation that “substantially relate[s] to an important governmental interest“)(internal quotation marks and citation omitted). Those include:
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.
Majority Op. ¶ 37. It is difficult to envision legislation designed to foster indisputably legitimate state interests such as these to give way to a limited interest that is, as the Majority Opinion points out, societally undeveloped and within its legal infancy in state courts. Id. Of yet greater concern would be
{62} Notably also, aid in dying negates not one but three contrary expressions of law passed by our citizen legislature, the constitutional branch of government elected by New Mexicans to represent their perspectives as lawmakers. See
{63} Regarding intermediate scrutiny, Griego is our New Mexico Supreme Court‘s most recent topical jurisprudence. Prior to Obergefell‘s ruling that same-sex marriage is protected by the United States Constitution, Griego applied intermediate scrutiny to hold that same-gender couples in New Mexico cannot be denied the “rights, protections and responsibilities of civil marriage solely because of their sexual orientation.” Griego, 2014-NMSC-003, ¶ 6. But three circumstances distinguish Griego from the issue before us. First, Griego made clear that “none of [the] New Mexico[] marriage statutes specifically prohibit same-gender marriages“; however, each “reflect[ed] a legislative intent” to do so. 2014-NMSC-003, ¶¶ 4, 23. Here,
{64} With no sensitive class or equal protection consideration like was present in Griego, application of intermediate scrutiny in this instance can only be premised upon the identification of aid in dying as a freshly minted constitutionally important right. See Wagner, 2005-NMSC-016, ¶ 12 n.3 (application of intermediate scrutiny “requires either an important right or a sensitive class“) (emphasis in original). If found to be such, aid in dying would immediately violate the very equality of application demanded of rights guaranteed by the New Mexico Constitution. One class of citizens—terminally ill, mentally competent adults—would possess a right that would be denied to other similarly but not identically situated New Mexicans at the end of their lives.9 New Mexico courts should be particularly wary of constitutionalizing interests that would be unavailable to inexactly situated members of the broader public at the end of their lives. See Quill, 521 U.S. at 799 (rejecting equal protection challenge to New York‘s statutes banning aid in dying that apply to “all New Yorkers alike [and do not] . . . infringe fundamental rights [or] suspect classifications.” (emphasis added)). Likewise, the constitutional infirmity of protecting some New Mexicans (physicians) but not others (family members of terminally ill patients) from
Section 30-2-4 Is Reasonably Related To A Legitimate Government Purpose
{65} A constitutional challenge to governmental interference with an asserted right bestirs a process of review both federally and in New Mexico whereupon courts “decide what interest is involved or to whom the interest belongs[,]” Marrujo, 1994-NMSC-116, ¶ 9, ascertain state interest in prohibiting or curtailing the asserted right, Griego, 2014-NMSC-003, ¶¶ 56-62 (identifying and rejecting the state‘s interest in denying same-gender couples the right to marry), and apply whichever of three ensuing standards of legal scrutiny is warranted to fairly balance the interests of the proponent with those of the State: strict, intermediate, or “rational basis.” Marrujo, 1994-NMSC-116, ¶¶ 9-12 (explaining each standard of review and stating that in New Mexico “the same standards of review are used in analyzing both due process and equal protection guarantees“). The rational basis test is “triggered by . . . interests . . . that are not fundamental rights, suspect classifications,
{66} To justify its ban on aid in dying, the State relies on many of the same “unquestionably important and legitimate” governmental interests identified to be valid by Glucksberg: (1) preserving life; (2) “protecting the integrity and ethics of the medical profession“; (3) “ensuring adequate regulation of the practice“; and (4) preventing suicide and treating its causes. 521 U.S. at 703, 729-35. Without “weigh[ing] exactingly the relative strengths of these various interests,” Glucksberg concluded Washington‘s prohibition of “assisting another in the commission of self-murder[,]” to be “at least reasonably related to their promotion and protection.” Id. at 707, 735 (internal quotation marks omitted). Therefore, pursuant to rational basis review, the Washington statute did not violate the Fourteenth Amendment. Id. at 735; see also Marrujo, 1994-NMSC-116, ¶ 12 (“The opponent‘s burden is difficult because they must demonstrate that the challenged legislation is clearly arbitrary and unreasonable, not just possibly so. The court will uphold the statute if any state of facts can be discerned that will reasonably sustain the challenged [legislation.]” (internal quotation marks and citation omitted)). Here,
{67} Lastly, I note that the rational basis test reflects the deference owed by our third branch of government when legislative and executive processes combine to produce laws that govern society. Our uneven decision today amply illustrates why those processes provide better answers to societal questions such as the legality or illegality of aid in dying. Pursuant to them, the New Mexico Legislature may, upon consultation with constituents and citizens, study and propose any bill it deems to be in the best interest of New Mexicans. If such legislation withstands the rigors of bicameral scrutiny, it is next subjected to executive review, after which a governor may sign or veto it. By this exacting process, the people of our state speak to declare their wishes. If an ensuing enactment is legally challenged, courts are then far better positioned to exercise their constitutional role in a properly judicial context.
CONCLUSION
{68} It can be difficult to repress—as judges sometimes must—the innately human inclination to act when invited to provide a decisional option in circumstances where options are sadly few. By declining such an invitation today, I mean not to assail aid in dying or to thwart what Plaintiffs hope to accomplish for gravely ill New Mexicans. The role of the judiciary is not always to determine a victor between competing extremes, particularly when answers to questions of law are attainable on narrower grounds. See Allen v. LeMaster, 2012-NMSC-001, ¶ 28, 267 P.3d 806 (citing Baca v. N.M. Dep‘t of Pub. Safety, 2002-NMSC-017, ¶ 12, 132 N.M. 282, 47 P.3d 441, for the proposition that “courts exercise judicial restraint by deciding cases on the narrowest possible grounds and avoid reaching unnecessary constitutional issues“). Those that may be disappointed or pleased by today‘s decision should also know that three judges can
{69} The question before this panel is not whether aid in dying should be legal, nor whether it can be legalized in a manner consistent with the New Mexico Constitution; we must simply answer whether the legality of aid in dying is constitutionally compulsory. It is not. The correct answer does not spring from our own individual or collective “policy preferences [as m]embers of this Court,” Glucksberg, 521 U.S. at 720, but from our informed fidelity to constitutional precedent, institutionally advisable notions of restraint, required respect for the roles of co-equal branches of government, and awareness of the often arduous, and yet enduring, people-driven process by which societies evolve within our nation‘s immortality-minded experiment in democracy. See Schuette v. BAMN, ___ U.S. ___, 134 S. Ct. 1623, 1636-37 (2014) (noting by plurality the “right of citizens to debate so they can learn and decide and then, through the political process, act in concert to try to shape the course of their own times“). Inevitably, the value of rights chosen by citizens will exceed that of rights prematurely directed by judges. To spare aid in dying that which is normally required to effectuate significant change to New Mexico law would deprive it of both the legitimacy of public inclusion and the opportunity for consensus invaluable to the determinative process. See Obergefell, ___ U.S. at ___, 135 S. Ct. at 2605 (noting with approval the “referenda, legislative debates, and grassroots campaigns, as well as countless studies, papers, books, and other popular and scholarly writings [alongside] extensive litigation in state and federal courts” regarding same-sex marriage). Such would also wrongly short-change citizens across our state who wish to voice their opinion prior to being told the outcome of matters about which they care. Our preference today simply does not belong alongside historic, hard won, and transcendent rights that warrant constitutional guarantee to the exclusion of countervailing governmental interests.
{70} Based on my agreement that the New Mexico Constitution provides no fundamental right to aid in dying, I concur in the Majority Opinion‘s reversal of the district court‘s final declaratory judgment and order of permanent injunction. I would extend our ruling to additionally conclude that aid in dying is not a constitutionally protected important right or interest. Lastly, I would uphold
J. MILES HANISEE, Judge
VANZI, Judge (dissenting).
{71} The question presented is whether NMSA 1978,
I. BACKGROUND
{72} Plaintiffs contend that the right to aid in dying is “fundamental or, at the very least, important under the New Mexico Constitution.” I understand the parties’ agreed definition of “aid in dying” to limit the right such that it is implicated only where: (1) a mentally competent adult who is capable of giving consent, and (2) who is terminally ill with a grievous and irremediable medical condition, (3) chooses to request a prescription for medication
{73} I pause to address the majority and concurring opinions’ attempt to use these limitations in support of the argument that there is no fundamental right to aid in dying, suggesting that recognizing the right would somehow be an act of “selective discrimination” because only “a select few” would have it and because it “also provides a very narrow benefit from prosecution that exclusively favors physicians.” See Majority Op. ¶¶ 44-47 (referring to the limitations as “exclusionary defects“); see also Concurring Op. ¶¶ 62, 64. The contention is untenable. The right to aid in dying, which I would hold is protected under our Constitution, belongs to all New Mexicans. The fact that it may be invoked only by some people who find themselves in certain circumstances is also true of other constitutional rights. The parental autonomy rights recognized by the Constitution (discussed below) apply to all citizens, even though not all citizens will exercise them. So too, the reproductive autonomy rights to use contraception and to terminate a pregnancy belong to every citizen, notwithstanding that every citizen might not be in a situation that would bring about their exercise. The right to terminate a pregnancy, moreover, cannot be exercised beyond a certain point in the pregnancy. Viability marks “the earliest point at which the State‘s interest in fetal life is constitutionally adequate to justify a legislative ban on nontherapeutic abortions“; before then, “the State‘s interests are not strong enough to support a prohibition of abortion or the imposition of a substantial obstacle to the woman‘s effective right to elect the procedure.” Planned Parenthood of Se. Pa. v. Casey, 505 U.S. 833, 835, 846 (1992). Those who are on life support have the constitutional right to have their lives ended, although not everyone will be on life support. See Cruzan ex rel. Cruzan v. Director, Missouri Dep‘t of Health, 497 U.S. 261, 279, 287, 302, 344 (1990) (majority opinion assumed that “a competent person [has] a constitutionally protected right to refuse lifesaving hydration and nutrition“; five Justices concluded that there is a due process right to refuse medical treatment). And there is a fundamental right to marry, even though not everyone will claim it. All asserted rights must be considered in the context in which the allegedly protected conduct takes place. The right to aid in dying is no different in this respect. The fact that the right is exercised in a specific context, during a limited time period, does not defeat its existence. Nor is the recognition of the right precluded because it would protect physicians who provide aid in dying from prosecution but not non-physicians. For one thing, Plaintiffs do not assert a right to the assistance of anyone but a physician in providing aid in dying. For another, the protection of physicians from criminal liability in this context is required for the same reasons it is required in any context in which the assistance of a physician is necessary (under the medical standard of care or otherwise) to effectuate the constitutional right of the patient. As discussed below, the patient‘s choice and the assistance of the physician to actualize it are both protected. This does not vitiate the right asserted here any more than it does the right to terminate a pregnancy, or to administer terminal sedation, or withdraw life sustaining medication and equipment.
{74} Plaintiffs invoke two provisions of the New Mexico Constitution: the due process clause of
{75} The district court concluded that
{76} The district court held that “[a] terminally ill, mentally competent patient has a fundamental right to choose aid in dying pursuant to the New Mexico Constitution‘s guarantee to protect life, liberty, and seeking and obtaining happiness,
{77} On appeal, the State argues that: (1) there is no fundamental constitutional right to the deliberate assistance of a third party in ending one‘s own life; and (2) the district court‘s ruling violates the doctrine of separation of powers by legalizing conduct that was designated as a crime by the Legislature. Here, as in the district court, the State makes no attempt to justify
II. DUE PROCESS
{78} 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[.]”
A. Federal Due Process Precedents
{79} Long before it decided Glucksberg, the United States Supreme Court interpreted the substantive component of the due process clause to protect aspects of personal autonomy as “fundamental rights,” notwithstanding that they are not mentioned in the text of the Bill of Rights, with which the government may not interfere unless it meets its burden under the strict scrutiny standard to prove that the infringing statute is narrowly tailored to serve a compelling governmental interest. See Casey, 505 U.S. at 847 (explaining that the United States Supreme Court has never accepted the view that “liberty encompasses no more than those rights already guaranteed to
{80} These previously recognized fundamental rights include the right to marry, see Loving v. Virginia, 388 U.S. 1, 2 (1967), and aspects of parental autonomy, see, e.g., Santosky v. Kramer, 455 U.S. 745, 753 (1982) (recognizing the rights to the companionship, care, custody, and management of one‘s children); Stanley v. Illinois, 405 U.S. 645, 651-52 (1972) (preserving the right to conceive, raise, and retain custody of one‘s children); Skinner v. Oklahoma ex rel. Williamson, 316 U.S. 535, 541 (1942) (decided on equal protection grounds, emphasizing the “fundamental” nature of individual choice about procreation and the corresponding standard of “strict scrutiny“); Pierce v. Soc‘y of Sisters, 268 U.S. 510, 534-35 (1925) (recognizing the right to raise one‘s children); Meyer v. Nebraska, 262 U.S. 390, 400 (1923) (discussing the parental right to control children‘s education). The Court has also recognized a fundamental due process right to bodily integrity. See Casey, 505 U.S. at 849 (citing Washington v. Harper, 494 U.S. 210, 221-22 (1990); Winston v. Lee, 470 U.S. 753 (1985); Rochin v. California, 342 U.S. 165 (1952)).
{81} The Court has held that there is a fundamental due process right to reproductive autonomy, which includes the right to purchase and use contraceptives, see Griswold v. Connecticut, 381 U.S. 479, 499 (1965) (recognizing a married couple‘s privacy right in their intimate relationship); Eisenstadt v. Baird, 405 U.S. 438, 443-44 (1972) (extending Griswold, under the Equal Protection Clause, to invalidate a state law against distributing contraceptives to unmarried persons), and the right to terminate a pregnancy, see Roe v. Wade, 410 U.S. 113, 165-66 (1973); Casey, 505 U.S. at 833. In Roe and its progeny, the Court recognized and then affirmed the right of a woman to choose whether or not to terminate her pregnancy, reasoning primarily from the personal nature of the decision and its consequences, which are best left to “the woman and her responsible physician.” 410 U.S. at 153; see Casey, 505 U.S. at 846 (affirming Roe‘s central holding).
{82} Writing separately in Roe and its companion case, Bolton, Justice Douglas broadly described, among other liberties, a “freedom to care for one‘s health and person[.]” Doe v. Bolton, 410 U.S. 179, 213 (1973) (Douglas, J., concurring). These cases establish that individuals have an “interest in independence in making certain kinds of important decisions[,]” Whalen v. Roe, 429 U.S. 589, 599-600 (1977) (footnote omitted); see Carey v. Population Servs. Int‘l, 431 U.S. 678, 684-85 (1977), and that “[i]t is a promise of the Constitution that there is a realm of personal liberty which the government may not enter[,]” Casey, 505 U.S. at 847. This interest in self-definition, which is “the heart of liberty,” is no less than “the right to define one‘s own concept of existence, of meaning, of the universe, and of the mystery of human life.” Id. at 851. Casey described Roe “not only as an exemplar of Griswold liberty but as a rule . . . of personal autonomy and bodily integrity, with doctrinal affinity to cases recognizing limits on governmental power to mandate medical treatment or to bar its rejection.” Casey, 505 U.S. at 857.
{83} Substantive due process decisions pre-dating Glucksberg also clearly recognized, as part of the protected liberty interest, the right to the necessary assistance of a physician. In Carey, 431 U.S. at 684-90, the Court emphasized, in holding that restrictions on the distribution of contraceptives must satisfy strict scrutiny because they clearly burden the fundamental right to make decisions concerning reproduction, that strict scrutiny also applies to state regulations that burden the fundamental right to
{84} Casey further clarified that, although “[i]t is . . . tempting . . . to suppose that the Due Process Clause protects only those practices, defined at the most specific level, that were protected against government interference by other rules of law when the Fourteenth Amendment was ratified . . . such a view would be inconsistent with our law.” 505 U.S. at 847; see also Rochin, 342 U.S. at 171 (“To believe that this judicial exercise of judgment could be avoided by freezing ‘due process of law’ at some fixed stage of time or thought is to suggest that the most important aspect of constitutional adjudication is a function for inanimate machines and not for judges[.]“).
{85} In Cruzan, 497 U.S. at 278, the Court stated that “[t]he principle that a competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment may be inferred from our prior decisions” and “assume[d] that the United States Constitution would grant a competent person a constitutionally protected right to refuse lifesaving hydration and nutrition.” Id. at 279; see id. at 281 (“[T]he Due Process Clause protects . . . an interest in refusing life-sustaining medical treatment.“). As Justice O‘Connor explained in her concurring opinion, “The State‘s imposition of medical treatment on an unwilling competent adult necessarily involves some form of restraint and intrusion. A seriously ill or dying patient whose wishes are not honored may feel a captive of the machinery required for life-sustaining measures or other medical interventions. Such forced treatment may burden that individual‘s liberty interests as much as any state coercion. The State‘s artificial provision of nutrition and hydration implicates identical concerns.” Id. at 288 (O‘Connor, J., concurring) (citations omitted). “Requiring a competent adult to endure such procedures against her will burdens the patient‘s liberty, dignity, and freedom to determine the course of her own treatment. Accordingly, the liberty guaranteed by the Due Process Clause must protect, if it protects anything, an individual‘s deeply personal decision to reject medical treatment, including the artificial delivery of food and water.” Id. at 289 (O‘Connor, J., concurring).
{86} In Bowers v. Hardwick, 478 U.S. 186, 190-91 (1986), overruled by Lawrence v. Texas, 539 U.S. 558 (2003), the Court did an about-face, rejecting the substantive due process analysis it had previously applied in addressing fundamental rights. Recasting the respondent‘s claim as an asserted “fundamental right to engage in homosexual sodomy,” id. at 191, the Court dismissed the right as “at best, facetious,” because homosexual sodomy was not “deeply rooted in this Nation‘s history and tradition.” Id. at 192, 194 (internal quotation marks and citation omitted). In Glucksberg, the Court applied the same tactics, redefining the right asserted and rejecting it for lack of a “deeply rooted” historical antecedent. Before examining Glucksberg, I consider the Court‘s most recent substantive due process decisions, which make plain that the Bowers/Glucksberg analysis does not control substantive due process analysis as a matter of federal constitutional law.
{87} In Lawrence, the Court overruled Bowers, emphatically rejecting its narrow characterization of the right at issue and its rigid adherence to, and exclusive focus on, an historical analysis in deciding substantive due process claims. Lawrence, 539 U.S. at 567, 577-78. The Lawrence Court adopted Justice Stevens’ dissent in Bowers, which recognized that “the fact that the governing
{88} Bowers, the Lawrence Court held, “was not correct when it was decided, and it is not correct today.” Lawrence, 539 U.S. at 578. Reiterating Casey‘s pronouncement that “‘[i]t is a promise of the Constitution that there is a realm of personal liberty which the government may not enter[,]‘” Lawrence, 539 U.S. at 578 (quoting Casey, 505 U.S. at 847), Lawrence concluded,
Had those who drew and ratified the Due Process Clauses . . . known the components of liberty in its manifold possibilities, they might have been more specific. They did not presume to have this insight. They knew times can blind us to certain truths and later generations can see that laws once thought necessary and proper in fact serve only to oppress. As the Constitution endures, persons in every generation can invoke its principles in their own search for greater freedom.
{89} The Court cemented its rejection of a rigid historical analysis as dispositive of substantive due process rights in Obergefell v. Hodges, ___ U.S. ___, 135 S. Ct. 2584 (2015), in which the Court held that the federal due process clause protects a liberty interest in marrying a person of the same sex and requires states to license and recognize such marriages. See id. at 2604-05, 2608. The Court explained that the liberty interests protected by the federal due process clause “extend to certain personal choices central to individual dignity and autonomy, including intimate choices that define personal identity and beliefs[,]” id. at 2597 (citing Eisenstadt, 405 U.S. at 453; Griswold, 381 U.S. at 484-86), and that “[t]he identification and protection of fundamental rights is an enduring part of the judicial duty to interpret the Constitution[,]” id. at 2598. The Court emphasized that the task of fulfilling that judicial responsibility “has not been reduced to any formula,” but rather “requires courts to exercise reasoned judgment in identifying interests of the person so fundamental that the State must accord them its respect.” Id. (internal quotation marks and citation omitted). “History and tradition guide and discipline this inquiry but do not set its outer boundaries.” Id. (citing Lawrence, 539 U.S. at 572). The proper method of analysis “respects our history and learns from it without allowing the past alone to rule the present.” Id. The Court reasoned:
The nature of injustice is that we may not always see it in our own times. The generations that wrote and ratified the Bill of Rights and the Fourteenth Amendment did not presume to know the extent of freedom in all of its dimensions, and so they entrusted to future generations a chapter protecting the right of all persons to enjoy liberty as we learn its meaning. When new insight reveals discord between the Constitution‘s central protections and a received legal stricture, a claim to liberty must be addressed.
Id.
B. Washington v. Glucksberg
{90} In Glucksberg, which was decided after Bowers but before Lawrence and Obergefell, an alliance of physicians and terminally ill patients sought a declaration that a Washington statute criminalizing “promoting a suicide attempt,” defined as “knowingly caus[ing] or aid[ing] another person to attempt suicide,” violated the federal due process clause. Glucksberg, 521 U.S. at 707-08 (internal quotation marks and
withstand the immediate challenge under rational basis review. Id.
{91} The Court distinguished Cruzan on the ground that the right the Court assumed existed in that case was rooted in “the common-law rule that forced medication was a battery, and the long legal tradition protecting the decision to refuse unwanted medical treatment,” and thus “was entirely consistent with this Nation’s history and constitutional traditions,” while “[t]he decision to commit suicide with the assistance of another . . . has never enjoyed similar legal protection.” Glucksberg, 521 U.S. at 725. The Court characterized the broad, rights-protective language of Casey as a general description of personal activities that had previously been identified as “so deeply rooted in our history and traditions, or so fundamental to our concept of constitutionally ordered liberty, that they are protected by the
{92} Five Justices wrote separately, reserving the possibility that the Court might recognize a constitutional right to “physician-assisted suicide” in certain circumstances, while relying on different grounds and different reasoning. Justice Stevens concurred in the result, explaining that all of the patient plaintiffs had died during the litigation and that the majority opinion held that “Washington’s statute prohibiting assisted suicide is not invalid ‘on its face[.]’ ” Id. at 739 (Stevens, J., concurring). Justice O’Connor joined the majority opinion “because [she] agree[d] that there is no generalized right to ‘commit suicide[,]’ ” stating that there was no need to reach “the narrower question whether a mentally competent person who is experiencing great suffering has a constitutionally cognizable interest in controlling the circumstances of his or her imminent death” in the context of what she characterized as the facial challenges presented in Glucksberg and the related case, Vacco v. Quill, 521 U.S. 793 (1997).11 Glucksberg, 521 U.S. at 736 (O’Connor, J., concurring).
Justice Ginsburg concurred “substantially for the reasons stated by Justice O’Connor.” Id. at 789 (Ginsburg, J., concurring). Justice Breyer also joined Justice O’Connor’s opinion, “except insofar as it joins the majority[,]” writing separately to say that our legal tradition might protect a “right to die with dignity,” at the core of which “would lie personal control over the manner of death, professional medical assistance, and the avoidance of unnecessary and severe physical suffering—combined[,]” and to emphasize that terminally ill patients experiencing “severe physical pain”
{93} Thus, Justices O’Connor and Stevens, and Justices Ginsburg and Breyer (to the extent they joined Justice O’Connor’s concurrence) viewed the majority opinion as having rejected a facial challenge. The majority opinion, moreover, agreed that its holding “would not ‘foreclose the possibility that an individual plaintiff seeking to hasten her death, or a doctor whose assistance was sought, could prevail in a more particularized challenge[.]’ ” Id. at 735 n.24 (quoting id. at 750 (Stevens, J., concurring)).12
{94} I need not discuss Glucksberg in exegetical detail. Given that Lawrence and Obergefell emphatically rejected an analysis of unenumerated due process liberty interests upon which Glucksberg, like Bowers, relied (an analysis focusing solely on the historical roots of the asserted right) and just as emphatically embraced analytical principles that Glucksberg rejected (the liberty rights analysis of Casey and other decisions addressing due process liberty interests), it is impossible to conclude that the due process analysis applied in Glucksberg is dispositive of the issue today, even as a matter of federal law.
{95} The assumption that a fundamental right exists only if there is a history and tradition of protecting it, shared by Bowers and Glucksberg, does not comport with the Supreme Court’s analysis of due process liberty rights in decisions issued before and afterward. As one noted constitutional scholar has pointed out, “laws prohibiting interracial marriage were far more ‘deeply rooted in this Nation’s history and tradition’ than the right to interracial marriage, but in Loving v. Virginia, the Court held that such a right is protected by the Due Process Clause. And there was no deeply rooted tradition of protecting a right to abortion before Roe v. Wade. In fact, abortion was illegal in forty-six states when Roe was decided.” Erwin Chemerinsky, Washington v. Glucksberg Was Tragically Wrong, 106 Mich. L. Rev. 1501, 1505 (2008) (footnotes omitted). Furthermore, “the fact that laws have long existed does not answer the question as to whether the interest the laws regulate is so integral to personhood as to be worthy of being deemed a fundamental right.” Id.
{96} The opinion of the Court in Obergefell briefly addressed Glucksberg, in rejecting respondents’ argument that petitioners’ assertion of “a new and nonexistent” right was inappropriate in light of Glucksberg. See Obergefell, ___ U.S. at ___, 135 S. Ct. at 2602. The Court said that, although Glucksberg’s requirement that liberty “must be defined in a most circumscribed manner, with central reference to specific historical practices . . . may have been appropriate for the asserted right there involved (physician-assisted suicide), it is inconsistent with the approach this Court has used in discussing other fundamental rights[.]” Id. The majority and concurring opinions in this case seize on this statement as supporting their contention that Glucksberg’s analysis still applies to aid in dying. See Majority Op. ¶ 35; Concurring Op. ¶ 58. Stating that “[i]n Obergefell, every member of the United States Supreme Court . . . passed upon an opportunity to
{97} If the Obergefell Court had applied a Glucksberg analysis, it could not have identified a history and tradition protecting the right to marry another of the same sex, just as it could not identify a history and tradition protecting the right to engage in same-sex sodomy when it applied that restrictive analysis in Bowers. I can think of no principled reason why there should be two tests for substantive due process rights; one for aid in dying, and one for everything else. Although the opinion of the Court in Obergefell left Glucksberg untouched (again it had no reason to reach out to overrule it), the dissent correctly acknowledged that the majority’s position “require[d] it to effectively overrule Glucksberg.” Obergefell, ___ U.S. at ___, 135 S. Ct. at 2621 (Roberts, J., dissenting). It remains to be seen, of course, what the outcome would be if the Court were to address aid in dying again, but the conclusion is inescapable that the United States Supreme Court itself has disclaimed the substantive due process analysis upon which Glucksberg’s holding rests.
{98} Reams of critical analysis by numerous commentators, preeminent constitutional scholars among them, also belie the State’s conclusory contention that Glucksberg is not “flawed,” and so should be followed under our interstitial approach to analysis of rights afforded by provisions of our Constitution that have federal analogues (more on that later). See, e.g., Chemerinsky, supra, at 1506 (“The methodology of Lawrence . . . cannot be reconciled with Chief Justice Rehnquist’s restrictive view of rights under the Due Process Clause [in Glucksberg].”); Yale Kamisar, Foreward: Can Glucksberg Survive Lawrence? Another Look at the End of Life & Personal Autonomy, 106 Mich. L. Rev. 1453, 1455-56 (2008) (noting commentary that, although the Lawrence majority did not cite Glucksberg, “the aspersions Lawrence cast on Bowers inevitably fell with equal force on Glucksberg—especially the narrow view of substantive due process Glucksberg shared with Bowers” (footnote, internal quotation marks, and citation omitted)); Tribe, supra, at 1923 (stating that Lawrence demonstrates that “[n]othing in Glucksberg can fairly be understood to have cemented the Bowers transmutation into our constitutional law”).
{99} Commentators have noted, for example, the majority’s recharacterization of the right asserted by the plaintiffs. See, e.g., Ruth C. Stern & J. Herbie Difonzo, Stopping for Death: Re-Framing Our Perspective on the End of Life, 20 U. Fla. J.L. & Pub. Pol’y 387, 418 (2009) (“In neither the majority nor in the five concurring opinions did the justices correctly or coherently define the questions presented.”). Even scholars who have questioned whether Lawrence necessarily means that the United States Supreme Court will recognize a right to aid in dying have described Glucksberg’s “fragility” in light of the obvious lack of agreement among the justices, even as to the precise question answered. See Kamisar, supra, at 1459-60 (noting, inter alia, that Justice O’Connor really did not join the majority; that the five concurring opinions “make for frustrating
{100} The State does not address the fractured nature of Glucksberg’s concurring opinions. Indeed, counsel for the State said at oral argument that he was not “properly equipped to discuss . . . some of the nuanced views” stated in those opinions. And, although Obergefell was not decided until after oral argument, Lawrence had been decided, yet the State did not acknowledge that Lawrence unequivocally rejected the rigid historical analysis upon which Bowers and Glucksberg relied exclusively, and instead embraced a concept of liberty that protects “an autonomy of self,” which Glucksberg disavowed.
{101} The majority and concurring opinions in this case also say nothing about the impact of Glucksberg’s fractures and fragility on its authoritative value; like the State, they essentially say that we should give the decision dispositive effect because it exists and has not been overruled. See Majority Op. ¶ 34; Concurring Op. ¶ 58. These opinions also do not address the critical commentary, offering only that “[t]he fact that Glucksberg’s analytic methodology has been questioned by some legal scholars does not mean the opposite of its holding must be true.” Majority Op. ¶ 34.
{102} But even accepting the State’s conclusory assertion that Glucksberg is not “flawed,” neither the State nor the majority or concurring opinions offer any reason why it should be treated as persuasive, given the United States Supreme Court’s current analysis of due process liberty interests and over seventeen years of experience (and evidence) with aid in dying, which the Glucksberg Court did not have before it. Whatever the status of Glucksberg in the federal courts, the bottom line is that it does not bind us here, and our analysis of rights afforded by the New Mexico Constitution—the only source of rights invoked by Plaintiffs—is not “inextricably tied” to it. See, e.g., N.M. Right to Choose/NARAL v. Johnson, 1999-NMSC-005, ¶ 37, 126 N.M. 788, 975 P.2d 841; State v. Gutierrez, 1993-NMSC-062, ¶ 16, 50-56, 116 N.M. 431, 863 P.2d 1052.
C. Article II, Section 18 and Our Interstitial Approach
{103} Our Supreme Court has previously interpreted the New Mexico due process clause more expansively than the United States Supreme Court has interpreted the federal due process clause, holding in Montoya v. Ulibarri, 2007-NMSC-035, ¶ 23, 142 N.M. 89, 163 P.3d 476, that New Mexico’s due process clause requires that habeas petitioners must be permitted to assert freestanding claims of actual innocence. See also State v. Vallejos, 1997-NMSC-040, ¶ 32, 123 N.M. 739, 945 P.2d 957 (holding that all forms of entrapment violate New Mexico’s due process clause; rejecting widely criticized U.S. Supreme Court precedent to the contrary as to the federal counterpart).13 And nothing in our Supreme Court’s most recent interpretation of
internal quotation marks, and citation omitted)). Indeed, Griego acknowledged both Lawrence, see Griego, 2014-NMSC-003, ¶ 58, and the privacy right recognized in Eisenstadt, 405 U.S. at 453, see Griego, 2014-NMSC-003, ¶ 60 n.10.
{104} Thus, to the extent it is appropriate to be guided by federal law in determining whether New Mexico’s due process clause protects aid in dying, the sound and persuasive analysis is that which embraces the view of liberty, autonomy, and privacy elucidated in the Casey/Lawrence/Obergefell line of cases and rejects the analysis of Bowers and Glucksberg. Even if Glucksberg remains good law, as a matter of federaldue process analysis, I would reject it as unpersuasive, flawed, and inadequate to protect the rights of New Mexicans. Garcia, 2009-NMSC-046, ¶ 57 (Bosson, J., specially concurring) (“In a government of dual sovereigns, it is imperative that our state Constitution develop to its full potential and protect the rights of our citizens where we deem federal law lacking.”). The State has conceded that citizens have a fundamental right to make their own end-of-life decisions and stated at oral argument before this Court that citizens have a fundamental right to bring about their own deaths, even by stockpiling morphine prescribed by a physician and ingesting a lethal dosage. The State further conceded at oral argument that it had no interest in preventing suffering, mentally competent, terminally ill patients from obtaining aid in dying. See Oral Argument, No. 33,360 at 4:19:15-4:19:30 (Jan. 26, 2015) (“The State interest does not lie in prolonging the suffering of people who are in fact terminally ill, and have made an informed, competent decision to request this sort of medication. I will readily concede that the State has no interest in preventing that person from obtaining this sort of assistance.” (emphasis added)); supra, at 4:18:40-4:19:00 (“I don’t think there would be a compelling state interest in preventing a person at the very end of their life who is, in fact, terminally ill and mentally competent from obtaining this sort of assistance. I don’t think the statute would survive strict scrutiny analysis. I don’t think the statute would survive an intermediate scrutiny analysis, either, for largely the same reasons.”). According to the State, the only conduct proscribed by
administering terminal sedation and removing life-sustaining nutrition, hydration, or mechanical life support—undertaken with knowledge that these acts will hasten death—should be legal, while a physician’s affirmative act of writing a prescription that will bring about the same result should be criminalized.15 I would hold that
{105} The majority opinion asserts that “[i]n order to justify a departure from Glucksberg, Plaintiffs must have shown precisely why greater fundamental due process protections exist under Article II, Section 4.” Majority Op. ¶ 34. It asserts 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.” Id. ¶ 35. It assigns Plaintiffs the burden to cite authority for the proposition 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.” Id. ¶ 36. No authority is cited for any of these propositions. I am aware of none. These and other statements in the majority and concurring opinions reflect a profound misunderstanding of our interstitial approach to state constitutional analysis.
{106} For example, the majority opinion asserts that “there is no basis under the Gomez factors to permit the creation of an interstitial constitutional right under
{107} I also reject the concurring opinion’s characterization of our interstitial approach as “narrow” and as permitting departure from federal precedent based only on a flawed federal analysis, structural differences between state and federal government, or distinctive state characteristics. See Concurring Op. ¶ 58. These grounds were stated in Gomez, of course, 1997-NMSC-006, ¶ 19, and have been frequently cited since then. But our Supreme
{108} The majority opinion appears to confuse the requirements for preserving a claim predicated on a provision of our Constitution that has a federal counterpart with the parameters that inform our decision whether to follow federal precedent in determining whether the state constitutional provision protects the right asserted. See Majority Op. ¶¶ 23, 34. There is no preservation issue here. Plaintiffs have not brought a claim under the federal Constitution. They have identified the provisions of our Constitution that they believe protect the right they assert. They have explained why they believe that each provision protects the right. They have stated reasons why we should not follow Glucksberg and why they believe that our Constitution provides broader protection than the federal Constitution. Our interstitial approach requires no more; in fact, it requires less. See Leyva, 2011-NMSC-009, ¶ 49 (noting that citation to the state constitutional provision invoked is sufficient).
{109} Our interstitial approach does not require (or even permit) us to treat Glucksberg as dispositive of this case simply because it exists. See Gomez, 1997-NMSC-006, ¶ 17; see also Arizona v. Evans, 514 U.S. 1, 8 (1995) (“[S]tate courts are absolutely free to interpret state constitutional provisions to accord greater protection to individual rights than do similar provisions of the United States Constitution.”). It obligates us to consider whether the federal analysis articulated in Glucksberg is persuasive because its underlying reasoning “is better calibrated to protect the rights of individuals” in this state from unwarranted government intrusion. Leyva, 2011-NMSC-009, ¶ 53. It is not.
D. Article II, Section 4 of the New Mexico Constitution
{110} Plaintiffs also assert a right to aid in dying under the New Mexico Constitution’s inherent rights guarantee, which provides, “All persons are born equally free, and have certain natural, inherent and inalienable rights, among which are the rights of enjoying and defending life and liberty, of acquiring, possessing and protecting property, and of seeking and obtaining safety and happiness.”
{111} Nor does it mean that its scope is defined by and limited to the circumstances in which it has previously been invoked, as the State appears to suggest. The State cites Lucero v. Salazar, 1994-NMCA-066, ¶ 7, 117 N.M. 803, 877 P.2d 1106, for the proposition that “mere references to the right to enjoy life and to seek and obtain safety and happiness are not sufficient to serve as a basis for a waiver of immunity under [the New Mexico Tort Claims Act].” Lucero relied on Blea v. City of Espanola, 1994-NMCA-008, ¶ 20, 117 N.M. 217, 870 P.2d 755, which stated that “vague references to safety or happiness in [A]rticle II, Section 4 . . . are not sufficient to state a claim under [the New Mexico Tort Claims Act].” Blea made clear, however, that the issue in that case was “not what our [C]onstitution protects or does not protect[,]” but “the scope of the acts for which the [L]egislature has waived immunity.” Id. These cases have no bearing on the question presented here, which quite obviously requires us to
{112} Equally clear is that this case involves a great deal more than a vague reference to “safety and happiness.” Far more significant, and relevant here, is that the framers of our Constitution saw fit to include in their enumeration of rights guaranteed as “inherent” the right—and agency to effectuate the right—to “enjoy[] and defend[]” their own “li[ves] and liberty” against unjustified intrusions by the government.
{113} I think it is plain that
{114} Relying on a dictionary definition of “life,” the majority opinion recasts the liberty interest asserted by Plaintiffs as “an implied fundamental interest in hastening another person’s death” and then declines to recognize it “because such an interest is diametrically opposed to . . . life.” Majority Op. ¶ 39 (alteration, internal quotation marks, and citation omitted); see also Concurring Op. ¶ 59. Despite the contrary stipulated record, the opinion seems to equate the dying and suffering patient who seeks aid in dying with a person who wishes to commit suicide, and her doctor with any miscreant who counsels another to commit suicide against her will. See Majority Op. ¶ 40 (citing, inter alia, Commonwealth v. Bowen, 13 Mass. 356 (1816)). This re-characterization ignores the distinctions between suicide and aid in dying established by the trial testimony and reflects a shocking disrespect for the individuals whose circumstances would bring them to seek aid in dying, individuals who would live if they could, but whose terminal illnesses will not allow them to do so. For these individuals, “death” is imminent, and “life” means being forced to endure unbearable suffering until it ends. The majority’s characterization of aid in dying as contrary to the interest in “life” protected by the inherent rights guarantee, see also Concurring Op. ¶ 59, also misapprehends the nature of the liberty interest asserted by Plaintiffs, and ignores that
III. THE ASSERTED STATE INTERESTS
{115} The determination that our Constitution affords New Mexicans a right to aid in dying does not end the matter. The next question is whether the State has carried its burden to prove that
{116} Throughout this litigation, the State has relied exclusively on the governmental interests asserted by the State of Washington in Glucksberg: (1) preserving life; (2) “protecting the integrity and ethics of the medical profession”; (3) “ensuring adequate regulation of the practice”; and, for the first time on appeal, (4) preventing suicide and treating its causes. Beyond simply reciting these interests, the State has made virtually no effort to explain how any of them justify applying
with a ‘firm legal rationale’ or evidence in the record.”). And even under the rational basis standard, the State must do more than cite to interests asserted by another state more than seventeen years ago—at least in this case, in which it has stipulated to a record that demonstrates that the concerns raised in Glucksberg have not materialized in states that allow aid in dying. Below, I address the State’s broadly asserted interests, as well as those raised by amici for the State, in light of Plaintiffs’ uncontradicted evidence and the State’s concessions.
A. Interests in Life and Preventing Suicide
{117} No one doubts, as a general abstract matter, that the government has a compelling interest in preserving human life. The
{118} Nor does the law treat the safeguarding of human life as a governmental interest that is absolute, subject to no exceptions. For example, under current New Mexico law and United States Supreme Court precedent, any patient may refuse or withdraw life-sustaining treatment, may voluntarily stop eating and drinking, and may obtain from a qualified physician medication that will deeply sedate her—and thereby hasten death—to alleviate suffering. See generally
{119} The State’s asserted interest in “preventing suicide and treating its causes,” raised for the first time on appeal, is unquestionably significant but irrelevant in this case. Unrebutted expert testimony at trial established that the practice of aid in dying bears almost no medical or psychological overlap with suicide, as the two phenomena are fundamentally distinct mental and physical processes. Patients who request aid in dying do so because they are suffering from a terminal and incurable physical condition, rather than from a temporary, treatable mental pathology, as is typical of suicide. In addition, the collaboration between a physician and terminally ill patient over time reflects a deliberative, rational process intended to preserve the patient’s sense of self and coherent self-image; the antithesis of the impulse-driven, self-destructive behavior of the mentally unstable person who commits suicide. See, e.g., Roy F. Baumeister, Suicide as Escape from Self, Psychological Review,
{120} This unchallenged expert testimony is supported by amici New Mexico Psychological Association and the American Medical Women’s Association, American Medical Students Association, and New Mexico Public Health Association, who agree that the reasoning on which a mentally competent, terminally ill person bases a decision to end his or her life is distinct from the reasoning a clinically depressed person uses to justify suicide. As Justice James C. Nelson eloquently summarized in Baxter v. Montana,
“Suicide” is a pejorative term in our society. . . . The term denigrates the complex individual circumstances that drive persons generally—and, in particular, those who are incurably ill and face prolonged illness and agonizing death—to [seek aid in dying]. The term is used to generate antipathy, and it does. [The patients seeking aid in dying] do not seek to commit “suicide.” Rather, they acknowledge that death within a relatively short time is inescapable because of their illness or disease. And with that fact in mind, they seek the ability to self-administer, at a time and place of their choosing, a physician-prescribed medication that will assist them in preserving their own human dignity during the inevitable process of dying. Having come to grips with the inexorability of their death, they simply ask the government not to force them to suffer and die in an agonizing, degrading, humiliating, and undignified manner. They seek nothing more nor less[.]
2009 MT 449, ¶ 71, 354 Mont. 234, 224 P.3d 1211 (Nelson, J., specially concurring).
{121} I conclude that, although the State’s interests in preserving life and preventing suicide may be compelling or substantial in the abstract, these broadly stated general interests are insufficient to justify infringing the right to aid in dying. Given the State’s stipulations and concessions in this case, there is no basis for a contrary conclusion.
B. The Integrity of the Medical Profession and Adequate Regulation
{122} The State makes three arguments concerning its interest in the integrity of the medical profession and the necessity for regulations: (1) Glucksberg recognized the interest; (2) there are no preexisting legislative definitions of “mentally competent” and “terminally ill”; and (3) there is no regulation of the manner in which a patient makes the request. The stipulated factual record undercuts these arguments, and the State’s unsupported conclusions are insufficient to justify
{123} The State’s reliance on Glucksberg’s stated concerns about protecting the integrity and ethics of the medical profession is unavailing. First, to the extent that the Glucksberg Court generally accepted that “the American Medical Association, like many other medical and physicians’ groups, has concluded that physician-assisted suicide is fundamentally incompatible with the physician’s role as healer[,]” 521 U.S. at 731 (alteration, internal quotation marks, and citation omitted), that view began to shift significantly within the medical community soon after Glucksberg was decided. In fact, by 2005, two national surveys revealed that a majority of polled rank-and-file physicians believed it to be ethical for a doctor to assist a competent, dying patient hasten death.18 Two months ago, the
California
{124} Second, the stipulated record in this case includes evidence of the experience with aid in dying in Oregon, Washington, Montana, and Vermont;19 uncontroverted opinion evidence of medical ethicists and practitioners informed by the experience in United States jurisdictions with legalized aid in dying; and specific evidence concerning current palliative care and palliative/terminal sedation practices. And this evidence (almost two decades worth) proves that the medical profession has not become corrupted or compromised in any respect in jurisdictions where aid in dying is allowed. Cf. Casey, 505 U.S. at 863-64 (explaining that the decisions in West Coast Hotel Co. v. Parrish, 300 U.S. 379 (1937), and Brown v. Board of Education, 347 U.S. 483 (1954), “each rested on facts, or an understanding of facts, changed from those which furnished the claimed justifications for the earlier constitutional resolutions[,]” and that “[i]n constitutional adjudication as elsewhere in life, changed circumstances may impose new obligations, and the thoughtful part of the Nation could accept each decision to overrule a prior case as a response to the Court’s constitutional duty”).
{125} Third, the State ignores the fact that, for all practical purposes, physicians already participate in helping terminal patients to end their lives. Some doctors do this by ending medical care necessary to sustain life. And, as explained above, when doctors terminally sedate patients, they know that they are “hastening that moment at which that death will occur.”20 The State has not cited any example where the integrity and/or ethics of the medical profession have been called into question in jurisdictions in which aid in dying is practiced; the unspecified concern it adverts to here is speculative and bereft of evidentiary support.
{126} The State’s asserted interest in adequate regulation rests on the flawed premise that such legislation is required. As a legal matter, the existence of regulations is surely not a prerequisite to the recognition of a constitutional right. As a factual matter, medical care is typically governed by professional standards of practice, not by statutes or court decisions that either prohibit or
{127} Dr. Kress, who practices aid in dying in Montana, which has no regulatory framework, testified at length about how doctors in that state would be liable for malpractice were they to prescribe the medication without “tapping into” the existing standard of care for aid in dying that has developed over seventeen years of clinical experience in Oregon. Today, that established standard of care, which the State does not dispute exists and to which physicians in New Mexico would be held, includes the requirements that an eligible patient for aid in dying must be a terminally ill, mentally competent adult who has made repeated requests over multiple visits, and who is able to self-administer the medication. Mental competence means that the patient does not have any gross cognitive or psychological impairment and that she understands the nature of the illness and the proposed treatments, including any alternatives such as hospice care and pain control, and the potential risks and probable results of taking the medication that will result in her death. Thus, for example, a patient with Alzheimer’s disease or a brain cancer that affects cognition is not eligible for aid in dying. In addition, the standard of care for providing aid in dying directs, in part, that a patient is terminally ill when she has less than six months to live; that to establish terminality, two physicians must agree to the diagnosis; and that the patient must be able to understand the information presented to her and to make a reasoned decision. I also view as significant the trial testimony about a doctor’s relationship with her patient and the often lengthy process of caring for someone who has a terminal illness.
{128} In addition to civil liability for failing to comply with the standard of care, as Dr. Kress described, all doctors in New Mexico are subject to regulation by the state medical board, which has been tasked by the Legislature with protecting the public from “the improper, unprofessional, incompetent and unlawful practice of medicine,” and which supervises the profession by licensing competent physicians and by disciplining those whose performance falls below its requirements.
{129} The State’s attempt to justify the blanket prohibition of a liberty interest that it concedes is “important and fundamental,” solely on the basis that the Legislature has not enacted legislation to ward off dangers that have not before materialized, is without merit. Such an approach would obliterate constitutional recognition and protection of virtually any liberty interest requiring the intervention of the medical profession, including the right found in Roe, 410 U.S. at 155, and affirmed in Casey, 505 U.S. at 846. Although I conclude that the need for regulation of aid in dying is not necessary given the existing standard-of-care framework, the Legislature is free to enact appropriate guidelines to ensure that only the terminally ill who make a voluntary and informed decision may receive aid in dying. What it may not do is intrude upon the doctor-patient relationship21 as it relates to the constitutional right to aid in dying by criminalizing the provision of aid in dying by a willing physician at the request of a mentally competent, terminally ill patient.
{130} At oral argument, the State acknowledged that preservation of life was “a pretty weak interest” when applied to terminally ill patients but said that the interest in life extended to potential areas of abuse. Although the State admitted that this was a “phantom concern” and that “the sky has not fallen,” the State’s amici cite interests in protecting vulnerable individuals, including the elderly and disabled, from exploitation and abuse, and in avoiding a slippery slope to “non-voluntary euthanasia.”22
{131} Abuse of any sort is, of course, a legitimate governmental concern in general, but this “interest” is far too abstract to justify infringement of the constitutional right to aid in dying. First, the detailed protocols and established standard of care—requiring, among other things, the mental competence and informed consent of the patient, ability of the patient to self-administer the medication, a diagnosis of terminal illness by two physicians, and repeated requests with waiting periods in between—undeniably guard against the speculative dangers that amici raise. Moreover, amici fail to explain how the circumscribed right to aid in dying would increase the frequency of elder abuse and disproportionately affect the poor and disabled.
{132} And again, as previously noted, the State and amici have not provided a single example of abuse in any United States jurisdiction where aid in dying is legal. The record contains no such evidence, and almost two decades of substantial data from Oregon and elsewhere are to the contrary. See Or. Pub. Health Div., Oregon’s Death with Dignity Act Rep. (2014); Wash. State Dept. of Health, 2013 Death with Dignity Act Rep., Exec. Summary (2014). According to the data and evidence described above, issues of coercion, insidious bias, and societal indifference have not occurred and have not threatened the safety of people who are poor, elderly, uninsured, or disabled.23 See Oregon’s Death with Dignity Act Rep., supra, at 1-6; Wash. State Dept. of Health 2013 Death with Dignity Act Rep., supra, at 1-12; see also Margaret P. Battin, et al., Legal Physician-Assisted Dying in Oregon and the Netherlands: Evidence Concerning the Impact on Patients in “Vulnerable” Groups, 32 J. Med. Ethics 591, at 591 (2007) (finding no evidence of “heightened risk” to patients with non-terminal physical disabilities or mental disabilities or other vulnerable groups). Rather, patients who have ingested the medication are overwhelmingly white, married, college-educated, insured, receiving hospice services, and dying of cancer or ALS (commonly referred to as Lou Gehrig’s disease). See Oregon’s Death with Dignity Act Rep., supra, at 4-5; Wash. State Dept. of Health 2013 Death with Dignity Act Rep., supra, at 1. Nearly all patients pass away at home, and complications are rare, occurring in less than three percent of all cases. See Oregon’s Death with Dignity Act Rep., supra, at 2, 5; Wash. State Dept. of Health 2013 Death with Dignity Act Rep., supra, at 1, 9.
{133} Trial experts testified that the potential for mistaken diagnoses are low. Physicians have established referral pathways to learn about safe ways to prescribe the medication, including methods for ensuring terminality and competency—medical diagnoses and determinations they are historically and routinely called upon to make outside the context of aid in dying. For instance, physicians frequently assess competency in order to obtain informed consent for surgical and other medical procedures.
{134} In my view, the potential for abuse is far more likely in other circumstances not proscribed by law. For example, the State suggested at oral argument that patients could legally stockpile their medication and ingest it to end their lives. And, as discussed, doctors already help patients end their lives by withholding essential medical care and by practicing terminal sedation, neither of which are subject to statutory regulation or to any reporting or recording requirements. Further, experts presented uncontested testimony that patients are sometimes sedated to death according to the instructions of physicians or surrogate decision makers, without the patient’s explicit consent and without anyone “knowing what the patient would exactly want because the illness itself or the treatment has rendered them past [the] point of competency.” It is hard to imagine that aid in dying makes the potential for abuse any more likely than do these practices; indeed, these practices could well create a greater risk of abuse. As noted constitutional scholar Erwin Chemerinsky put it, bluntly:
Indeed, the same concern [about abuse] can be raised about the right to refuse medical care. A person could choose to terminate treatment because of pressure from family members or to reduce their emotional or financial burdens. Notwithstanding this concern, the [United States Supreme] Court recognized a right to refuse medical care in Cruzan. There is no reason why the concern is weightier or more powerful in the context of [aid in dying].
Besides, if the concern is pressure, the solution should be to lessen the risk of pressure, not to prohibit [aid in] dying. And if the government is concerned that individuals might feel pressure to save their families from large expenses, then the government should ensure that the costs of medical care are adequately covered.
Chemerinsky, supra, at 1512.
{135} The unsupported assertions of the State and its amici about potential abuses are questionable, at best. The speculative possibility that vulnerable individuals might be induced or coerced to hasten their deaths cannot justify denying to all New Mexicans the constitutional right to aid in dying.
{136} Finally, amici raise a host of slippery slope arguments, including that aid in dying will assuredly lead to such horrors as euthanasia (voluntary and non-voluntary) of adults and children, that it will be administered by non-physician third parties, and that courts will soon be asked to extend the constitutional right to aid in dying to any competent person, regardless of whether or not the person is terminally ill. These cataclysmic predictions provide no basis to deny a constitutionally protected right to aid in dying. As the United States Supreme Court observed in Cruzan, “it is the better part of wisdom not to attempt, by any general statement, to cover every possible phase of the subject.” 497 U.S. at 278 (alteration, internal quotation marks, and citation omitted); see also Marozsan v. United States, 852 F.2d 1469, 1498 (7th Cir.1988) (Easterbrook, J., dissenting) (stating that “[t]he terror of extreme hypotheticals produces much bad law”). The State has had “ample opportunity to articulate a constitutionally adequate justification” for prohibiting aid in dying. Griego, 2014-NMSC-003, ¶ 68. It has not done so.
{137} It is possible that, in another case, presenting different facts, the State might assert interests that a court might view differently. In this case, I end where I began, asking what possible interest the State could have in denying to a mentally competent, terminally ill patient whose medical condition is irreversible and irremediable, who has but a short time to live, and who is experiencing intractable suffering, the right to die peacefully, with dignity, at a time of her own choosing. The State has not advanced a sufficiently persuasive justification for denying aid in dying as that term is defined herein. Indeed, the State has acknowledged the profoundly diminished value of its asserted interests, to the extent it has not conceded that the interests do not exist at all. The factual record in this case, to which the State stipulated in its entirety—including the expert testimony, the comprehensive body of data that has been amassed since Glucksberg, and the current state of medical practice and the standard of care—taken together with the State’s significant concessions, compel the conclusion that the State’s asserted interests do not, and cannot, withstand scrutiny under any standard of review; strict, intermediate, or rational basis. I would hold that
IV. THE REMAND PROPOSAL
{138} The author of the majority opinion, having concluded that the right asserted by Plaintiffs is not a fundamental right, would remand for the district court to (1) determine whether the State has met its burden to justify
{139} First, the question whether a constitutional right exists is a pure question of law, as is the standard to be applied in determining whether a governmental infringement of that right is constitutionally justified, i.e., the level of scrutiny to be applied to the challenged statute. State v. Lucero, 2007-NMSC-041, ¶ 8, 142 N.M. 102, 163 P.3d 489 (“[The appellate courts] review issues of statutory and constitutional interpretation de novo.”); Breen v. Carlsbad Mun. Sch., 2005-NMSC-028, ¶ 15, 138 N.M. 331, 120 P.3d 413 (“The determination of which level of scrutiny is applicable under the Constitution is a purely legal question, and is reviewed de novo.”); Hyden v. N.M. Human Servs. Dep’t, 2000-NMCA-002, ¶ 12, 128 N.M. 423, 993 P.2d 740 (stating that interpretation of the state constitution is reviewed de novo). This means that we consider the legal question whether our Constitution protects the right asserted without any deference to the district court’s conclusions on the issue. In re Estate of Duran, 2003-NMSC-008, ¶ 14, 133 N.M. 553, 66 P.3d 326 (explaining that the appellate court is not bound by district court’s legal conclusions and “may
[E]ven if the court is not alerted, of what real import is that to the resolution of a pure question of law? The factual record here is not subject to any material dispute. This Court can decide the . . . issue whether or not the trial court addressed it. While in a perfect world the trial court should address each issue first, that aspiration should not be determinative. The statewide interest in development of our state Constitution tips the balance in favor of proceeding, and we should not hesitate to do so.
Garcia, 2009-NMSC-046, ¶ 63 (Bosson, J., concurring). Although Justice Bosson’s comments were made in the context of discussing the requirements for preserving a state constitutional issue for appeal (an issue not presented here, where Plaintiffs’ claims are based solely on the New Mexico Constitution), the point pertains.
{140} To the extent the author of the majority opinion believes that the district court should make further “findings,” the factual record is undisputed, and our review is de novo on this aspect of the case as well. See City of Albuquerque v. One 1984 White Chevy Ut., 2002-NMSC-014, ¶ 5, 132 N.M. 187, 46 P.3d 94 (explaining that the appellate courts review issues under de novo standard when there are no disputed material facts); State v. Esparza, 2003-NMCA-075, ¶ 13, 133 N.M. 772, 70 P.3d 762 (“Because the underlying facts . . . are not in dispute, we review the legal issues presented de novo.”). The majority opinion’s concern with factual findings in a case in which the facts are entirely undisputed is baffling in itself. But even assuming a legitimate concern, the author of the majority opinion does not identify a single fact purportedly necessary to resolve the legal issues presented in this case that is not already contained in the stipulated record; the opinion, in fact, does not address the factual record at all. Nor does the State argue that the record is incomplete, or that it lacked the opportunity to present its case in the district court. To the contrary, the State’s counsel said below that “the issues are not fact disputes but legal disputes” and that he thought he “would be willing to stipulate to any facts that Plaintiffs wanted to prove.”
{141} The contention that remand is necessary so that the district court can rule on other constitutional theories raised by Plaintiffs that the court saw no need to reach in light of its ruling is contrary to elementary legal principles. Appellate courts routinely affirm district court rulings on purely legal issues where the record allows, even when the district court relied on different reasoning, and when the court did not consider the issue at all. State v. Vargas, 2008-NMSC-019, ¶ 8, 143 N.M. 692, 181 P.3d 684 (“[W]e may affirm the district court’s order on grounds not relied upon by the district court if those grounds do not require us to look beyond the factual allegations that were raised and considered below.” (internal quotation marks and citation omitted)); State v. Snyder, 1998-NMCA-166, ¶ 8, 126 N.M. 168, 967 P.2d 843 (considering a state constitutional issue that was not considered or ruled upon in the district court); State v. Beachum, 1972-NMCA-023, ¶ 8, 83 N.M. 526, 494 P.2d 188 (“A decision of the trial court will be upheld if it is right for any reason.”). No one argues that the district court erred by
{142} The law does not require “the doing of useless things.” State ex rel. Peters v. McIntosh, 1969-NMSC-103, ¶ 9, 80 N.M. 496, 458 P.2d 222. The facts and principles necessary to a correct holding are known. A remand would be pointless and would needlessly consume the resources of the parties and the courts while delaying final disposition by our Supreme Court.
V. SEPARATION OF POWERS
{143} The State contends that New Mexico courts may not consider whether the Legislature’s criminalization of aid in dying is unconstitutional because doing so violates “separation of powers.”24 First, it argues that decisions about aid in dying are best left to the Legislature because that branch of government is directly accountable to the people, and the fact that
{144} The State’s argument based on the lack of existing regulations specifically governing the conduct of physicians who provide aid in dying has no merit. As a threshold matter, this argument has nothing to do with the separation of powers; rather, it concerns the type and scope of procedural safeguards the State says are necessary to govern the practice of aid in dying. The State’s argument, moreover, is internally inconsistent, relying on contradictory contentions. The State first contends that the district court erred by failing to implement procedural safeguards for aid in dying such as those set forth in Oregon’s Death With Dignity Act. It then argues that the court “lacks the constitutional power to put these safeguards in place” because these are exclusively legislative determinations. The State is correct that it is not the role of the court to legislate. But a ruling that the New Mexico Constitution protects the right to aid in dying in no way usurps the Legislature’s power to regulate aid in dying in a manner that comports with that ruling. To the extent the Legislature deems regulations appropriate or necessary, nothing would prevent it from enacting constitutionally permissible measures.
{145} The State’s argument that the district court impermissibly intruded upon the exclusive province of the Legislature evinces a fundamental misunderstanding of the role of judicial review. Indeed, a decision holding
{146} Just over a year ago, our Supreme Court struck down a statutory scheme dating back almost a century that effectively precluded same-sex couples from marrying. At the time, many argued that the policy debate over same-sex marriage, like the current debate over aid in dying, was best left to the legislative process and that judicial review would violate the separation of powers. Our Supreme Court did not retreat from its constitutional responsibility in favor of leaving the matter to civic discourse and legislative action. In Griego, 2014-NMSC-003, ¶ 1, Justice Chávez began by underscoring the duty of courts to interpret and apply the protections of the Constitution when the government is alleged to have threatened individual rights. The Court rejected at the outset the premise of the argument the State makes here:
The very purpose of a Bill of Rights was to withdraw certain subjects from the vicissitudes of political controversy, to place them beyond the reach of majorities and officials and to establish them as legal principles to be applied by the courts. One’s right to life, liberty, and property, to free speech, a free press, freedom of worship and assembly, and other fundamental rights may not be submitted to vote; they depend on the outcome of no elections.
Id. (quoting W. Va. Bd. of Educ. v. Barnette, 319 U.S. 624, 638 (1943)). The Court went on to recognize for the first time a right to same-sex marriage and held that our marriage laws were unconstitutional insofar as they applied only to opposite-sex couples. Id. ¶ 69; see also Obergefell, ___ U.S. at ___, 135 S. Ct. at 2605 (“The dynamic of our constitutional system is that individuals need not await legislative action before asserting a fundamental right. The Nation’s courts are open to injured individuals who come to them to vindicate their own direct, personal stake in our basic charter. An individual can invoke a right to constitutional protection when he or she is harmed, even if the broader public disagrees and even if the legislature refuses to act.”); City of Cleburne, Tex. v. Cleburne Living Ctr., 473 U.S. 432, 448 (1985) (“It is plain that the electorate as a whole, whether by referendum or otherwise, could not order city action violative of the Equal Protection Clause[.]”); Chambers v. State of Florida, 309 U.S. 227, 241 (1940) (“Under our constitutional system, courts stand against any winds that blow as havens of refuge for those who might otherwise suffer because they are helpless, weak, outnumbered, or because they are non-conforming victims of prejudice and public excitement.”).
{147} While I recognize that
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{148} The question at the heart of this case is who has the right to decide when and how a mentally competent, terminally ill New Mexican will end her life after the options for meaningful improvement of her terminal condition have been exhausted, such that “life” means being forced to endure unbearable suffering until death arrives.25 I recognize that citizens may disagree about the profound implications of a terminally ill individual’s
decision to end her suffering by ending her life, but our judicial obligation is to give effect to the liberty interests of all New Mexicans in accordance with the guarantees of our Constitution. Other choices and decisions central to personal autonomy and dignity have long enjoyed the status of constitutionally protected liberty interests. I would hold that the New Mexico Constitution protects aid in dying as a liberty interest subject to heightened scrutiny. While it is impossible for me to conclude that governmental infringement of the right to aid in dying could be justified by any lesser interest than that required for constitutional rights previously recognized as “fundamental,” the required level of scrutiny need not be determined in this case. For the State concedes that mentally competent, terminally ill citizens have a fundamental right to decide for themselves when and how to end their lives, and it provides no acceptable justification for denying them the only means available to effectuate that right in a peaceful and dignified manner—a lethal dosage of medication prescribed by a willing physician acting in accordance with the established standard of care for aid in dying. It is beyond dispute that the suffering of these citizens “is too intimate and personal for the State to insist, without more, upon its own vision . . . , however dominant that vision has been in the course of our history and our culture.” Casey, 505 U.S. at 852.
LINDA M. VANZI, Judge
Notes
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.
There is . . . [another] reason for claiming that a physician’s assistance here would fall within the accepted tradition of medical care in our society, and the abortion cases are only the most obvious illustration . . . . While the Court has held that the performance of abortion procedures can be restricted to physicians, the Court’s opinion in Roe recognized the doctors’ role in yet another way. For, in the course of holding that the decision to perform an abortion called for a physician’s assistance, the Court recognized that the good physician is not just a mechanic of the human body whose services have no bearing on a person’s moral choices, but one who does more than treat symptoms, one who ministers to the patient. This idea of the physician as serving the whole person is a source of the high value traditionally placed on the medical relationship. Its value is surely as apparent here as in the abortion cases, for just as the decision about abortion is not directed to correcting some pathology, so the decision in which a dying patient seeks help is not so limited. The patients here sought not only an end to pain (which they might have had, although perhaps at the price of stupor) but an end to their short remaining lives with a dignity that they believed would be denied them by powerful pain medication, as well as by their consciousness of dependency and helplessness as they approached death. In that period when the end is imminent, they said, the decision to end life is closest to decisions that are generally accepted as proper instances of exercising autonomy over one’s own body, instances recognized under the Constitution and the State’s own law, instances in which the help of physicians is accepted as falling within the traditional norm.
Glucksberg, 521 U.S. at 779 (citations omitted).The powers of the government of this state are divided into three distinct departments, the legislative, executive and judicial, and no person or collection of persons charged with the exercise of powers properly belonging to one of these departments, shall exercise any powers properly belonging to either of the others, except [where constitutionally excepted].