- The ‘unthinkable’ idea that older people cost too much to be cared for, and that this is a sufficient reason for legalising euthanasia or assisted suicide, is taking hold in New Zealand as evidenced in numerous public submissions to the recent Health Select Committee Investigation into Ending One’s Life in NZ, mostly from older people. The following excerpts from submissions to the Health Select Committee are illustrative of this thinking:
“This drive to keep people alive at all costs soaks up a huge amount of resources – human as well as financial – which could be better invested in vulnerable children at the beginning of their lives.”
“The cost of both Nursing Homes and Palliative care is enormous and we believe that the money spent on this could be used for medical research or for patients that can get long term benefit.”
“Many people who would opt for medically assisted dying (MAD) depend heavily on the Health Services. When they would make use of MAD the Health Services would save much money, They can use that for people urgently needing the Health Services. Wait ing lists could be reduced and subsequently the suffering of patients.”
- It has been estimated that euthanasia and assisted suicide will reduce annual health care spending in Canada by between $34.7 million and $138.8 million. The very existence of this report highlights the frightening prospect that money and markets are likely to influence the scope and reach of euthanasia and assisted suicide in the event that it was ever legalised in New Zealand.
- There is evidence from physicians that “insurance companies in states where assisted suicide is legal have refused to cover expensive, life-saving treatments for [their] patients but have offered to help them end their lives instead … The patients were not terminal, but ‘would have become terminal without the procedures. It was estimated that their chance for cure — cure, not just adding time — [was] about 50 percent in one case and 70 percent in the other case.’” In 2008, two patients from Oregon who were on Medicaid – ‘the state’s health insurance plan for the poor’ – were denied state-sponsored treatment but told the state would pay for assisted suicide.
- The language used to refer to our elders all too frequently draws on pejorative descriptors (such as ‘tsunami’ – see here p. 181 and here) when commenting on the growing numbers of elders. In a context where there is increasing pressure on healthcare resources, it is telling that media reports routinely focus on the future financial ‘cost’ and ‘burden’ of caring for older people – for example dementia. In a regime where euthanasia and assisted suicide were legal, this could, in the future, play into the hands of health administrators and politicians wanting to find “easy” savings in the health budget and be seen as ‘not unreasonable’ by a public who have gradually bought into the same negative ideas about the burdens (personal, familial and societal) of ageing.
- Studies show that there is a strong link between cost-cutting pressure on physicians and their willingness to prescribe lethal drugs to patients in the event these drugs could be legally prescribed (p. 18).
- In the context of a healthcare system that is stretched and in which some people have better access to quality palliative care than others, it is foreseeable that the introduction of euthanasia and assisted suicide would have a potentially greater negative impact on those with fewer resources to navigate the health system. As Hirini Kaa has written: “The problem is, what is ‘choice’? For the middle class advocates who have been pushing this issue, ‘choice’ is a wonderful thing … But what I also know will happen is that those on the margins will have less ‘choice’. When their whanau can’t afford the petrol to come and visit them in hospital, when they don’t like the nurses and doctors, when the power bill is due at home, when you are whakama (ashamed) of your situation – you name it, the problems mount up for poor sick people far beyond the medical … Then, the ‘choice’ becomes much clearer.” In other words, euthanasia and assisted suicide, if legalised, will be practiced through the same prisms of social inequality, prejudice and discrimination that currently characterises the delivery of other state-funded services (such as education and health) in our society and which lead to poorer outcomes for certain (less advantaged) groupings.
Conclusion: There will be ongoing and increasing pressure on future governments to control healthcare spending. When taxpayer money is involved, moral, social and public policy issues will arise beyond those presently recognised and intended by advocates of euthanasia and assisted suicide.
A law change allowing euthanasia or assisted suicide will be permanent but health policies and health services will be subject to the vagaries of insurance companies, future parliaments and economic climates. The scope of a euthanasia and assisted suicide policy that is implemented in a society increasingly shaped by negative perceptions of the elderly as a ‘burden’ will be influenced by discussions related to the affordability of end-of-life care.
Even if politicians reassure us now that cost savings are not part of the motivation for euthanasia and assisted suicide, this could easily change in the event such deaths become more and more the norm. In this context, economic considerations would contribute to a strong climate of coercion for a premature death for many people.