Photo: la cola de mi perroSupporters and critics of physician-assisted suicide agree on at least one thing: terminally ill patients who take an early exit save the health care system money.
Nationally, legal euthanasia for terminally ill patients could cut American health-care costs by $627 million per year (less than one-tenth of 1 percent of total expenditures), according to a New England Journal of Medicine article by doctors Ezekiel Emanuel and Margaret Battin, who each come down on opposite sides of the ethical argument over assisted suicide.
But could the business case for managed death push health insurance companies to pressure their customers into taking their own lives before they’re ready?
That’s one of the questions in a debate raging in Washington State right now, as voters there are set to decide on a ballot measure that would allow doctors to prescribe their terminally ill patients lethal doses of drugs on request.
Critics of the measure point to the story of Barbara Wagner, a cancer patient in neighboring Oregon, whose insurance company denied her request for coverage of potentially life-saving drugs, and instead offered her money for lethal drugs. Oregon is currently the only state where doctor-assisted suicide is legal.
Does the legalization of physician-assisted suicide incentivize early death?
and 
. You can also watch it on 
It might be the case that if this were available, the notion of dying on one’s own terms, without enduring blinding pain, would be all the incentive that many people need to act. That is, the insurance companies wouldn’t need to add any incentives/disincentives.
The lost goodwill of a company that would do such a thing would likely put them out of business. Instead of putting patients in the grave, they’d dig their own.
I don’t think I could do this. But I had an uncle that I think would rather have went on his own terms, without his family seeing him gasp to death.
The health-care system is so biased towards prolonging life, no matter how little quality of life, that there needs to be *some* kind of balance.
I had an elderly relative who had a DNR but still was put on life support, twice. Her children had to make the decision to respect or oppose her wishes. They took her off support both times, the first time she recovered (mostly), the second time she didn’t. But she told them very clearly that she was glad they hadn’t kept her on the machines the first time.
Hospice is a good idea, and works when people’s systems are shutting down quickly. Maybe that model could be part of a solution for end-of-life care that would not go to extreme lengths for a little more time.
Oregon’s health care rationing is a logical way of allocating scarce funds, a transparent and reasonable listing. For everyone else, it’s the vagaries of the “free” market or the public health system doing the best it can. We have rationing already, by money rather than logic, and bankruptcies coming from medical bills — how can that be a good way to run anything???
This is not an economic issue nor is it a political issue it is a moral issue. Thus economic and political arguments are irrelevant.
“If I were spending my own money”
Nuff said.
Dear Joe Smith:
I have an 87 year old mother. She cannot feed herself, has 2 help round the clock- but let me tell you, her zest for life is no less, perhaps even stronger than it was when my dad was alive. Why shouldn’t she be helped to live (if that is her dignified way of leaving this planet). She has learned in the last few years how to use a computer, has her own website and every day takes on a new challenge. I started to think in negative terms lately too- until I heard a marvelous story this past Jewish holiday. The story, as I recall it, was told to my congregation by the new rabbi. He had not visited his mother for a while, had given up on her until he participated in a “game” where he played G-d. And it popped into his head, as long as there’s life, there is hope. Who has the right to play G-d. He went to visit his mom immediately and changed his’ attitude of waiting for her to die. What a terrible way to leave this earth to be viewed as expendable. I remember reading about the ancient chinese before there was civilization there, they would leave their warriors who were feeble on the road to die- no respect for life or for their lives. Again- one more “Protestant Ethic” attitude that is cruel and inhumane- if you are not useful, you are useless. No wonder why some people place their parents in nursing homes to die out their lives. It is true that as people live longer, they need care and a system back up. I just wish we would value the elderly for their knowledge, experience and lives. They deserve to be honored. And well if someone wants to die, they too should be entitled – But not without a fight presumably by loved ones.
So Ben, I agree- I would not want an insurance company to decide my fate. They would kill us before laying out a dime.
Is there anyone left in this country who values anything other than money? I certainly hope so. This is exactly why so-called assisted suicide should never be permitted. Money is the god of these United States, and we human beings are all vulnerable enough to wind up as human sacrifices to it. It’s a sick game in which people are sacrificed to prop up the false appearance of earthly immortality and omnipotence of business entities.
Cost would not be a reason to do this–as you noted, it would save the system only a fraction of a percent.
The reason to do this would be to restore some semblance of balance in the system. As Avi @10 mentions, we are so incredibly biased to prolonging life no matter what.
I do not think this would incentivize early death. We would not be letting the insurance company or the state make the call here, we would simply be making it legal for the patient and physician to make this choice. I think physician assisted death goes on today under the table (ie “here is a 30 day fill of a script, but please don’t take 10 of these at once as it would kill you”). Lets let it be legal.
Health insurance really is a different business than other insurance. Much of health insurance is non-profit or government run. The central mission is usually to get the best care at the lowest cost to their members – or to take it a step further – to improve their members overall quality of life. Health insurance companies don’t and won’t decide who should be getting physician-assisted suicide. Furthermore, it is a quite a stretch to say that insurance companies ‘decide your fate’. They use good science to determine which procedures and medications will be covered at what rates for different plans. If you or the company you worked for wished to pay the insurance premiums for a plan that would cover all kinds of procedures and medications, you could surely find an insurance company who would be willing to sell it to you. Health insurance does wrestle with a growing problem of the very high and rising costs of end-of-life care. At present decisions are made by patients and their doctors.
It is reasonable to acknowledge the potential conflict of interest here, but we should remember that the company’s margin is more dramatically affected by revenues than expenses, so taking the risk of public outcry over the reprehensible step of incentivizing suicide and put at risk massive cancellations of membership just wouldn’t make business sense.