Are the economic pressures in the American health care system too great to safely legalize euthanasia and physician-assisted suicide?
PRO (yes)
CON (no)
Daniel P. Sulmasy, MD, Director of the Bioethics Institute at New York Medical College, wrote in his 1998 article "Physician Resource Use and Willingness to Participate in Assisted Suicide," published in the Archives of Internal Medicine:
"This study has identified a significant, strong, linear association between the tendency of general internists to choose resource-conserving treatment options and their willingness to assist a terminally ill patient with suicide, as assessed by their responses to hypothetical cases…The association we report does not constitute proof that abuse of PAS [physician assisted suicide] will result from the legalization of this practice in a cost-constrained environment. Nonetheless, it suggests a sobering degree of caution in legalizing PAS in a medical care environment that is characterized by increasing pressure on physicians to control the cost of care. This information should be carefully considered and studied further as policymakers, lawyers, and judges debate whether PAS should be legalized."
Yale Kamisar, JD, the Clarence Darrow Distinguished University Professor of Law at the University of Michigan Law School, wrote in his Spring 1998 article, "Physician-Assisted Suicide: The Problems Presented By the Compelling, Heartwrenching Case," that appeared in the Journal of Criminal Law & Criminology:
"The government is under no constitutional obligation to minimize the influence of poverty or poor economic circumstances on the administration of the laws governing physician-assisted death…
It is all very well to point out that…patients who ask for a physician's assistance in committing suicide should be seen by a psychiatrist. But who will pay for the psychiatrist's services?
It is all very well to emphasize that 'independent and impartial oversight by a certified palliative-care consultant is a vital safeguard in [a] proposed policy of legalized physician-assisted death' and that, if necessary, these consultants should be able to obtain the services of additional experts to ascertain the patient's competence or medical condition or the adequacy of her palliative care. But once again, who will pay for these services? And who will pay for more effective palliative measures if existing measures are deemed to fall short?
We should keep in mind that the United States is one of the very few industrialized nations in the world which lacks a system of national health insurance or national health care. Thus the financial aspects of death and dying loom large in this country and the situation is grim."
Pieter Admiraal, MD, a leader of the Dutch euthanasia movement, was quoted in an Oct. 10, 1997 article titled "Euthanasia in U.S. 'Ridiculous'," published in the National Catholic Reporter:
"I have always said that...starting with euthanasia in a country with about 30 million uninsured people is, in my opinion, ridiculous."
Wesley Smith, JD, Consultant to the International Anti-Euthanasia Task Force, wrote in his 1997 book Forced Exit:
"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...
In this context, euthanasia would be a potential form of oppression against the uninsured, the working poor, divorced persons, minorities, the unemployed, the mentally ill, and those lacking education who may not even speak English. 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. If euthanasia advocates really believed that doctor-hastened death should be performed only if there is no other way to alleviate suffering, they would put their issue on the shelf until the structural flaws in American medicine are solved."
The United States 9th Circuit Court of Appeals stated in its 1996 Opinion from Compassion in Dying v. Washington :
"One of the majority's [the majority ruling overturned in this decision] 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. In fact, as with abortion, there is far more reason to raise the opposite concern: the concern that the poor and the minorities, who have historically received the least adequate health care, will not be afforded a fair opportunity to obtain the medical assistance to which they are entitled -- the assistance that would allow them to end their lives with a measure of dignity. 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...
We would be inclined to agree that the country's refusal to provide universal health care, and the concomitant suffering so many Americans are forced to undergo, demonstrates a serious flaw in our national values... On the other hand, we are certainly not obligated to pile injury upon injury by holding that all of our citizens may be subjected to the prospect of needless pain, suffering, and degradation at the end of their lives...because of our concern over Congress' failure to provide government-insured health care..."
[Editors Note: This opinion was later overturned by the US Supreme Court in Washington v. Glucksberg]
Laurence Tribe, JD, Professor at Harvard Law School and expert on health law, was quoted in an Apr. 7, 1996 article titled "The Right to Suicide, Some Worry, Could Evolve Into a Duty to Die." published in the New York Times:
"There are far greater economic pressures on patients who must maintain expensive life-sustaining treatment than on those forced to endure painful, drawn-out illnesses where no such therapy is available...and there has been no evidence that people in those situations are being pushed to withdraw treatment because of the high cost."
Compassion and Choices wrote in the "Frequently Asked Questions" portion of its website (accessed Aug. 31, 2006):
"Is the choice in dying movement partly driven by the financial burdens of the nation's health care system?
No. There are very little, if any, cost savings associated with aid in dying, since it occurs at a point when all but palliative treatment has already ceased..."
Merrill Matthews, PhD, Director of the Center for Health Policy Studies at the National Center for Policy Analysis, wrote in his article, "Would Physician-Assisted Suicide Save the Healthcare System Money?" that appeared in the 1998 book Physician Assisted Suicide: Expanding the Debate:
"Even though the various elements that make up the American healthcare system are becoming more circumspect in ensuring that money is not wasted, the cap that marks a zero-sum healthcare system is largely absent in the United States... Considering the way we finance healthcare in the United States, it would be hard to make a case that there is a financial imperative compelling us to adopt physician-assisted suicide in an effort to save money so that others could benefit..."
