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Would Legalizing Physician-Assisted Suicide Endanger the Poor?

PRO (yes)

Felicia Cohn, PhD, Associate Professor at the School of Medicine, University of California, Irvine, and Joanne Lynn, MD, MA, MS, Director of The Washington Home Center for Palliative Care Studies, Washington, DC, wrote in their chapter "Vulnerable People: Practical Rejoinders to Claims in Favor of Assisted Suicide" that appeared in the 2002 book The Case Against Assisted Suicide: For the Right to End-of-Life Care:

"Physician-assisted suicide conjures fear that someone else will determine what is to be considered excessive suffering or costs, and that others might seek to eliminate the suffering or the costs by eliminating those persons who are perceived to be suffering or costly... The poor are particularly vulnerable to the effects of inadequate health care resources and the attendant constraints on medical decision making...

Those with adequate personal finances may be able to purchase supplemental insurance or pay for services. Those without such resources, however, may have to choose among recommended services, face bankrupting their families, or go without much-needed health care altogether. The 'haves' in our society may be immune to the potential for coercion that the choice of assisted suicide creates for the 'have nots.' However, the majority of the population, the 'have nots' or the 'have not enoughs' and their families, living with the reality of unaffordable healthcare needs, remain vulnerable to the possibility of avoidable suffering and premature death. In fact, the argument that a duty to die exists when a seriously ill individual faces the likelihood of financial hardship has made its appearance in the bioethics and policy debate...

As people approach death, they commonly have very few financial resources and often are profoundly dependent on the arrangements others make for their care. Which services are available largely reflects federal financing, including the coverage gaps when Medicare and medicaid do not pay for services. Many people's poorest years are those nearest death, when income is low, care needs are high, and lack of community support for personal care during disability takes its largest toll...

For many, no reasonably desirable choices may exist. Then, physician-assisted suicide may not merely be a choice, one option among others; rather, it may become a coercive offer. If physician-assisted suicide becomes a more popular choice, ending one's own life could come to be perceived as an obligation, that is, a societally endorsed course of action that is the only way to avoide suffering, indignity, and impoverishment."

2002 - Felicia Cohn, PhD 
Joanne Lynn, MD, MS, MA 

Wesley Smith, JD, Consultant to the International Anti-Euthanasia Task Force, wrote in his 1997 book Forced Exit:

"Money drives the American health-care system...

At last count, 42 million Americans had no health insurance, and this figure doesn't include tens of millions of other Americans who are temporarily uninsured at any given time...

Almost by definition, being uninsured means that one lacks sustained access to quality health-care services. Most doctors refuse to accept new patients who do not have health insurance, and most private hospitals will only help uninsured ill people when required to do so by law in a life-threatening emergency. Being uninsured means that health care, when it is received, is generally delivered in a public hospital emergency room, where, after hours of waiting, a harried doctor (often in training) will be assigned to deal as quickly and cheaply as possible with the problem. Those with chronic conditions often face similar barriers to effective care, relying on free clinics or emergency rooms where the lack of consistent treatment can cause complications requiring an expensive emergency response later...

With the near geometric growth of for-profit hospitals and health-care financing systems, even this meager measure of care for the uninsured poor is now actively threatened...

In this context, euthanasia would be a potential form of oppression against the uninsured, the working poor... For these people, the presumption that assisted suicide would be considered only after every other conceivable method of care has been tried is unlikely to apply."

1997 - Wesley J. Smith, JD 

CON (no)

In Compassion in Dying v. Washington (1996), the United States 9th Circuit Court of Appeals, in a decision delivered by Circuit Judge Stephen Reinhardt, stated:

"One of the [lower court] majority's prime arguments is that the statute [outlawing physician-assisted suicide] is necessary to protect 'the poor and minorities from exploitation,'-- in other words, to protect the disadvantaged from becoming the victims of assisted suicide. This rationale simply recycles one of the more disingenuous and fallacious arguments raised in opposition to the legalization of abortion. It is equally meretricious here... The argument that disadvantaged persons will receive more medical services than the remainder of the population in one, and only one, area -- assisted suicide -- is ludicrous on its face. So, too, is the argument that the poor and the minorities will rush to volunteer for physician-assisted suicide because of their inability to secure adequate medical treatment."

1996 - Compassion in Dying v. Washington (278KB)  

Ronald Dworkin, MA, the Frank Henry Sommer Professor of Law at New York University School of Law, wrote in his Mar. 27, 1997 introduction to "Assisted Suicide: The Philosophers Brief," which appeared in The New York Review of Books:

"If assisted suicide were permitted in principle, every state would presumably adopt regulations to insure that a patient's decision for suicide is informed, competent, and free. But many people fear that such regulations could not be adequately enforced, and that particularly vulnerable patients-poor patients dying in overcrowded hospitals that had scarce resources, for example - might be pressured or hustled into a decision for death they would not otherwise make. The evidence suggests, however, that such patients might be better rather than less well protected if assisted suicide were legalized with appropriate safeguards.

More of them could then benefit from relief that is already available-illegally-to more fortunate people who have established relationships with doctors willing to run the risks of helping them to die. The current two-tier system - a chosen death and an end of pain outside the law for those with connections and stony refusals for most other people - is one of the greatest scandals of contemporary medical practice...

The most important benefit of legalized assisted suicide for poor patients however, might be better care while they live...

Doctors and hospitals anxious to avoid expense would have very little incentive to begin a process that would focus attention on their palliative care practices. They would be more likely to continue the widespread practice of relatively inexpensive terminal care which is supplemented, perhaps, with terminal sedation. It is at least possible, however, that patients' knowledge of the possibility of assisted suicide would make it more difficult for such doctors to continue as before."

Mar. 27, 1997 - Ronald Dworkin, MA 

Susan Okie, MD, Contributing Editor of the New England Journal of Medicine, wrote in her Apr. 21, 2005 article "Physician-Assisted Suicide - Oregon and Beyond" that appeared in the New England Journal of Medicine:

"The [Oregon assisted suicide] law has not had the the dire social consequences that some opponents predicted. There is no evidence that it has been used to coerce elderly, poor, or depressed patients to end their lives... As compared with Oregonians who died naturally from similar diseases in 2004, those who died by means of physician-assisted suicide tended to be...more highly educated...

Only 2 of the 208 patients who died by means of lethal medication were uninsured."

Apr. 21, 2005 - Susan Okie, MD