The United States Supreme Court followed Montana’s lead in 2003 in reversing one of its own decisions that had found no such protections for same-sex couples under the United States Constitution. In 1999 the Montana court held that a woman’s right to choose abortion was protected, including the choice of her medical provider.

Because the Baxter case involves only the State Constitution, the Montana Supreme Court will have the final word, with no appeal possible to the United States Supreme Court.

But a legal case like the one now under consideration ventures to the frontiers of the human experience  why people choose to die and what role government should play at such moments  and invariably pulls on diverse social and political threads. And here again, a list of unusual Montana factors have elevated and complicated the debate.

Montana already has one of the highest suicide rates in the nation, for example. As a huge state with a small population  about one million people in an area more than half the size of Texas  there are pockets of deep rural life where access to health care, in living or dying, is severely limited.

A substantial American Indian minority, with health care and suicide issues of its own, has also weighed in as to whether a right for some is a right for all.

“There are moral arguments, philosophical arguments on both sides, bioethical arguments on both sides, even medical and public health arguments on both sides,” Anthony Johnstone, the state solicitor at the Montana attorney general’s office, who will argue the case for the state, said in defense of current laws that prohibit physician-assisted death.

The state argues that the Constitution confers no right to aid in ending one’s life.

Some people speaking out about the case, like Bob Liston, are also expressing sentiments that one might not expect.