Morals Meets Finance: Doctor-Assisted Suicide

Cartoon following the failure of a Massachusetts ballot measure that would have legalized doctor-assisted suicide, by Dan Wasserman

Cartoon following the failure of a Massachusetts ballot measure that would have legalized doctor-assisted suicide, by Dan Wasserman

Other than marijuana (see last week’s post), my home state of Oregon is known for its Doctor Assisted Suicide.

Currently doctor-assisted suicide in Oregon is dealt with the Death with Dignity Act. In order to qualify for the life-ending medication, the patient must be diagnosed as terminally ill with a prognosis of less than six months to live. It is, of course, completely voluntary on both the patient’s part and the doctor’s part. The Death with Dignity Act does not qualify legally as “suicide.”1

How frequent is this program? The 2012 Oregon Health Authority reported that 115 prescriptions were written last year in Oregon. The median age was 69 years old, and the most frequent diagnosis was cancer.2

Is right for our doctors to aid in ending a life? According to the 2011 Gallup poll, 45% of respondents agreed it was morally acceptable and 48% found it morally unacceptable, making it the most hotly debated topic in the survey.3 The moral debate can go on for ages –some will always view doctor-assisted suicide as cold-hearted justification for taking a life too soon while others will be comforted by the option of choosing death rather than being forced to live in pain.

So instead of telling you my opinion, I turn instead to the economics of doctor-assisted suicide. As we all know, end of life care can be expensive. So economically speaking, such measures could ultimately decrease the costs of terminal illness in cases where the patient will not recover and does not want to be sustained. According to an estimate from Emanuel and Battin, legalizing physician-assisted suicide could save as much as $627 million annually in the United States.

It is precisely because of its cost effectiveness that causes some to worry. The New York State Task Force on Life and the Law explains that “patients may be pressured to consent… when their care is expensive or burdensome to others.”  Even if not explicitly pressured by others, they may feel guilty about continuing their life for financial reasons.

Furthermore, those in the health care sector might be a source of pressure. Emanuel and Battin calculate, for example, that a large managed care plan could save around $3.3 million a year from doctor-assisted suicide. More than just care plans, hospitals also stand to save money from such a program.4

How should we deal with these competing economic factors? A bioethics and law expert Maxwell J. Mehlman, J.D., urges us to think about how a financial motivation would affect the situation. Suppose a patient is poor and seeks to participate –should we stop him or her from participating? Are we forcing them to die? But then, does denying the option of doctor-assisted suicide improve their condition in any way?5

Many questions can be asked about doctor assisted suicide, and they should be if we wish to develop comprehensive health-care for the terminally ill.

Links:

1.http://public.health.oregon.gov/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/faqs.aspx

2.http://public.health.oregon.gov/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/faqs.aspx

3.http://www.gallup.com/poll/147842/doctor-assisted-suicide-moral-issue-dividing-americans.aspx

4.http://www.nejm.org/doi/full/10.1056/NEJM199807163390306

5.http://www.thedoctorwillseeyounow.com/content/bioethics/art1976.html?getPage=4

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