Monday, August 10, 2009

Cheaper to help them die

Britain is considering legalizing assisted suicide and advocates use Oregon's experience as evidence that such laws are beneficial. An article in The Daily Mail explains at least one of the reasons for opposing that course. We also should pay particular attention since a nationalized health care regime would probably have the same incentives that have proven so problematical in Oregon.
...[M]ost worrying of all, say critics, is the trend for other treatment to be denied to those who are terminally ill. Instead of being given the medicines that might prolong their lives, they are being offered £30 to cover the cost of drugs that will end their days in a matter of hours. ....

.... One of the great concerns about Oregon is the suggestion that the very existence of the right-to-die law means the state's health system now has less of an incentive to provide terminally-ill people with proper care.

It is something that came to blight 64-year-old Barbara Wagner's last days. Diagnosed with lung cancer in 2005, the former bus driver vowed to fight the disease so she could spend as long as possible with her family.

Even after her doctor warned last year that she had less than six months left, she refused to give up, pinning all her hopes on a new life-prolonging treatment.

But her request, at the beginning of last year, for the £2,500-a-month drug was refused by Oregon's state-run health plan as being too expensive. Instead, she was offered lethal medication to end her life.

'It was horrible,' Barbara told reporters. 'I got a letter in the mail that basically said if you want to take the pills we will help you get them from a doctor and we will stand there and watch you die - but we won't give you the medicine to live.

'I told them: "Who do you think you are to say that you will pay for my dying, but you won't pay for me to possibly live longer?"

'I am opposed to the assisted suicide law. I haven't considered it, even at my lowest ebb.'

Hearing of her plight, pharmaceutical company Genentech decided to give her the drug, Tarceva, free for one year. Barbara died in October last year and her family believes the added stress of her brush with the state hastened her end.

'She felt totally betrayed,' her ex-husband Dennis, 65, said this week. 'It comes down to the buck. It's not about compassion and understanding. The bottom line is that it is all about money and Barbara fell into the middle of it.' ....

...Baroness Finlay and other opponents of doctor-assisted suicide remain unconvinced.

.... You also have to ask why is it that so many people working in palliative medicine in this country see what is going on in places such as Oregon as being so fundamentally dangerous.

'The reason is that we are looking after terminally-ill patients day in and day out - and we know how vulnerable and frightened they are.' [more]
Put that together with a concern about the health reform bill raised by Charles Lane in a Washington Post column two days ago:
Section 1233, however, addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they're just trying to facilitate choice — even if patients opt for expensive life-prolonging care. I think they protest too much: If it's all about obviating suffering, emotional or physical, what's it doing in a measure to "bend the curve" on health-care costs?

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren't quite "purely voluntary," as Rep. Sander M. Levin (D-Mich.) asserts. To me, "purely voluntary" means "not unless the patient requests one." Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that's an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they're in the meeting, the bill does permit "formulation" of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would "place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign," I don't think he's being realistic.

What's more, Section 1233 dictates, at some length, the content of the consultation. The doctor "shall" discuss "advanced care planning, including key questions and considerations, important steps, and suggested people to talk to"; "an explanation wills and durable powers of attorney, and their uses" (even though these are legal, not medical, instruments); and "a list of national and State-specific resources to assist consumers and their families." The doctor "shall" explain that Medicare pays for hospice care (hint, hint).

Admittedly, this script is vague and possibly unenforceable. What are "key questions"? Who belongs on "a list" of helpful "resources"? The Roman Catholic Church? Jack Kevorkian?

Ideally, the delicate decisions about how to manage life's end would be made in a setting that is neutral in both appearance and fact. Yes, it's good to have a doctor's perspective. But Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party — the government — recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don't have to be a right-wing wacko to question that approach.
The chilling truth about the city where they pay people to die | Mail Online, Charles Lane - House Health-Care Reform Bill Oversteps on End-of-Life Issues -

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