Healthcare Rationing

There are fears that legalising Euthanasia and Assisted Suicide will lead to patients being pressured into chosing EAS as healthcare rationing becomes more inevitable. EAS advocates say "the hastened demise of people with only a short time to live, would free resources for others'.
  • Economic necessity will be the main driving factor for social change.
  • In Oregon a prescription for a lethal overdose costs US$45, compared with the many thousands of dollars that would be spent on continuing health care
  • If there is little or no palliative care available, the patient is forced to contemplate potential suffering, or assisted suicide.
  • Hospitals in New Zealand are already underfunded and administrators are obliged to cut costs.
  • Most of the NZ beds are occupied by the elderly, but in the coming years there will be huge increase in younger patients with diabetes needing expensive dialysis treatment.
Those opposed to the legalisation of Euthanasia and Assisted suicide (EAS) often predict that law changes will lead to their use as acceptable healthcare economics. Derek Humphrys, the leading euthanasia advocate and founder of the Hemlock Society argues that it is inevitable, and says it will be the main driving factor for social change.

Rita Marker of the International Task Force on Euthanasia has written on assisted suicide and cost containment. Her case is summarised here:
  • The law or medical ethics does not require that a person be kept alive by unwanted medical treatment
  • The current debate is about transforming public policy to permit prescriptions for poison as "medical treatment"
  • In Oregon, assisted suicide with lethal drugs is funded by some health insurance plans, or paid by the state Medicaid programme under "comfort care"
  • A prescription for a lethal overdose costs US$45, compared with the many thousands of dollars that would be spent on continuing health care
  • In the United States, patients used to be subjected to unneeded tests and treatments. This was money-driven because health providers were reimbursed by health insurance companies. The situation has now been reversed with the introduction of "managed care"
  • Many managed care deliverers are profit driven, focused on shareholder value. Managers can delay or deny resources for services and "gag rules" prohibit doctors telling what interventions might be helpful. Some plans limit coverage for pain relief, or hospice care
  • Many potential patients are unaware that their health insurance coverage is limited in the "fine print"
  • Managed care guidelines strictly limit the time a doctor can spend with a patient (e.g. 20 minutes for first consultation, ten minutes for subsequent visits). This disallows the time needed to properly discuss assisted suicide with a patient
  • Some health care programmes reward doctors who conserve economic resources to patients, thus establishing a potential conflict of interest
  • A 1998 survey published in the Archives of Internal Medicine, revealed that the doctors most thrifty in saving medical costs, would be six times more likely than their counterparts to provide lethal prescriptions
  • If there is little or no palliative care available, the patient is forced to contemplate potential suffering, or assisted suicide 1
Health Insurer recruits doctors for assisted suicide
An anti-assisted suicide group, Physicians for Compassionate Care, has reported that a leading US health insurer, Kaiser Permanente emailed 800 Kaiser doctors in Oregon seeking volunteers to administer assisted suicide.

Wesley Smith, an attorney for the International Task Force on Euthnanasia reported in 2002, that Derek Humphry, co-founder of the Hemlock Society has written in his latest book "Freedom to Die", "the hastened demise of people with only a short time to live, would free resources for others".

They estimate that hundreds of billions of dollars could then be spent on improving healthcare. They claim that "economic necessity" is the ultimate driving force behind the assisted-suicide movement.

The late Justice Rehnquist, writing for a majority of the US Supreme Court in Washington v. Glucksberg, noted the state's interest in protecting patients from "the real risk of subtle coercion and undue influence in end-of-life situations," particularly those patients "whose autonomy and well-being are already compromised by poverty."

Rehnquist went on to object that, "[i]f physician-assisted suicide were permitted, many might resort to it to spare their families the substantial financial burden of end-of-life health-care costs." Justice Souter, in his concurrence, pointed out that "[p]hysicians, and their hospitals, have their own financial incentives, too, in this new age of managed care."

Physicians also may feel that they must represent the interests of society in encouraging patients to choose less costly alternatives. Physicians may see themselves as instruments of "bedside" health care rationing. They may favor assisted suicide, particularly for older patients, in line with the beliefs of those like Daniel Callahan, a Director of The Hastings Center, who think that the elderly have enjoyed enough of the resources of society and should make way for the young.

The Hastings Center is a bioethics research institute founded in 1969 to"explore fundamental and emerging questions in health care, biotechnology, and the environment." 2

The situation in New Zealand
A senior doctor with much experience in palliative care was interviewed for this section. He said it has not been raised yet, but if assisted suicide and voluntary euthanasia were legalised, it would be inevitable. Hospitals are already underfunded and administrators are obliged to cut costs.

Most of the beds are occupied by the elderly, but in the coming years there will be huge increase in younger patients with diabetes needing expensive dialysis treatment. Treatment is expected to be rationed, with those not making the list potentially facing palliative care in the later stages or assisted suicide.

It is feared that physicians and other health care providers, will pressure patients to request assisted suicide.

References:
  1. www.internationaltaskforce.org/ascc.htm
  2. http://www.thehastingscenter.org/about.asp