Tuesday, October 28, 2008

Worthless babies and old people - the economics of assisted suicide and euthanasia

I've previously discussed various aspects of a "pro-life" philosophy (which could not only encompass abortion, but also the death penalty and war), but haven't recently delved into the so-called "right to die."

The state of Oregon is a "leader" in this area, with its assisted suicide law. The theoretical idea behind this is that a person who does not want to prolong his or her life may choose an alternate solution.

But what if someone DOES want to prolong his/her life, but you're encouraged to off yourself anyway?

Rod Dreher links to an ABC story:

The news from Barbara Wagner's doctor was bad, but the rejection letter from her insurance company was crushing.

The 64-year-old Oregon woman, whose lung cancer had been in remission, learned the disease had returned and would likely kill her. Her last hope was a $4,000-a-month drug that her doctor prescribed for her, but the insurance company refused to pay.

What the Oregon Health Plan did agree to cover, however, were drugs for a physician-assisted death. Those drugs would cost about $50.

Now before I continue, I should note that this doesn't necessarily have anything to do with "socialized medicine," or the fact that the Oregon Health Plan is state-run. Either a government-provided health care system or a privately-owned health care system can arrive at this type of financial decision. Private companies, naturally, must meet stockholder demands for improved revenues, and this often involves cost-cutting measures. So whether it's a government worker trying to balance the budget, or a corporate CFO trying to do the same, the institution is going to take advantage of anything, including an assisted suicide law, to cut costs.

Critics of Oregon's decade-old Death With Dignity Law -- the only one of its kind in the nation -- have been up in arms over the indignity of her unsigned rejection letter. Even those who support Oregon's liberal law were upset.

The rationale for not supporting the claim for the $4,000 a month drug?

[T]he drug does not meet the "five-year, 5 percent rule" -- that is, a 5 percent survival rate after five years....

The median survival among patients who took erlotinib was 6.7 months compared to 4.7 months for those on placebo. At one year, 31 percent of the patients taking erlotinib were still alive compared to 22 percent of those taking the placebo.

Another patient (Randy Stroup) who was denied medical care framed the question wonderfully:

"What is six months of life worth?"

And that, like it or not, is something that all of us have to struggle with. Even if Wagner and Stroup move out of state to a place that does not support assisted suicide, that doesn't necessarily mean that the medical care that they want will be approved.

But the scarier possibility - which is hopefully only theoretical - is that insurance carriers may encourage patients in other states to relocate to Oregon, or to the Netherlands, to receive...um...treatments not available elsewhere.

Hey, if it balances the budget and/or increases revenues, it may be...um..."worth it."

P.S. By the way, remember at the beginning of the post when I said that I haven't recently delved into the "right to die"? My statement was accurate as long as "recent" only means a few months. Back in February I blogged about, among other things, the fact that Netherlands doctors were using the Groningen Protocol to...um..."euthanize" newborn infants with Spina Bifida and other conditions. However, many of you will not want to read the rest of my post, so I'll just provide you with a summary of the Groningen Protocol:

The Groningen Protocol has five criteria: the suffering must be so severe that the newborn has no prospects of a future; there is no possibility of a cure or alleviation with medication or surgery; the parents must always give their consent; a second opinion must be provided by an independent doctor who has not been involved with the child’s treatment; and the deliberate ending of life must be meticulously carried out with the emphasis on aftercare.

But even if you accept the Groningen Protocol as valid, you must admit that certain aspects of the protocol are open to interpretation. What exactly does "no prospects of a future" mean?

But there are those who do NOT accept the Groningen Protocol. Here is part of something at the Evangelical Outpost:

Just two weeks ago I wrote about bioethicist Peter Singer taking his freshman ethics students on a field trip to a hospital neonatal unit. Singer, who is often cited as the world's most famous ethicist, not only advocates killing terminally ill infants but endorses parental rights to kill newborns for any reason at all.

(Singer believes that killing a disabled infant is not morally equivalent to killing a person. Very often it is not wrong at all. Such extreme views, however, have not made him a social pariah. In fact, he holds the prestigious chair at Princeton University in the ironically (or Orwellian) named University Center for Human Values.)

What sets Singer apart from the mainstream is not his views but his consistency. Like many bioethical issues, the controversy stems from a disagreement over philosophical anthropology and the role of personhood. Singer, a utilitarian, openly rejects the substance view, the most dominant tradition from Christian thought.

The substance view, according to Francis Beckwith, claims that a human being is intrinsically valuable because of the sort of thing it is and that the human being remains that sort of thing as long as it exists. Opponents of this view agree that the a human remains the same substance from conception to adulthood but disagrees on the question of whether intrinsic value is a property had by the human as long as it exists.

In this view, intrinsic value (IV) is not an inherent property of human substance but is predicated on other properties or functions (rationality, sentience, self-awareness, etc.). Once we accept the notion that the fetus does not possess IV, it becomes obvious that the lives of terminally ill newborns are not inherently valuable either. Instead, the value of their existence is subordinate and dependent on other factors, such as quality of life.

But let's let Singer respond, and, more importantly, establish the vocabulary:

Q. You have been quoted as saying: "Killing a defective infant is not morally equivalent to killing a person. Sometimes it is not wrong at all." Is that quote accurate?

A. It is accurate, but can be misleading if read without an understanding of what I mean by the term “person” (which is discussed in Practical Ethics, from which that quotation is taken). I use the term "person" to refer to a being who is capable of anticipating the future, of having wants and desires for the future. As I have said in answer to the previous question, I think that it is generally a greater wrong to kill such a being than it is to kill a being that has no sense of existing over time. Newborn human babies have no sense of their own existence over time. So killing a newborn baby is never equivalent to killing a person, that is, a being who wants to go on living. That doesn’t mean that it is not almost always a terrible thing to do. It is, but that is because most infants are loved and cherished by their parents, and to kill an infant is usually to do a great wrong to its parents.
Sometimes, perhaps because the baby has a serious disability, parents think it better that their newborn infant should die. Many doctors will accept their wishes, to the extent of not giving the baby life-supporting medical treatment. That will often ensure that the baby dies. My view is different from this, only to the extent that if a decision is taken, by the parents and doctors, that it is better that a baby should die, I believe it should be possible to carry out that decision, not only by withholding or withdrawing life-support – which can lead to the baby dying slowly from dehydration or from an infection - but also by taking active steps to end the baby’s life swiftly and humanely.

And returning to our initial question:

Q. Elderly people with dementia, or people who have been injured in accidents, may also have no sense of the future. Can they also be killed?

A. When a human being once had a sense of the future, but has now lost it, we should be guided by what he or she would have wanted to happen in these circumstances. So if someone would not have wanted to be kept alive after losing their awareness of their future, we may be justified in ending their life; but if they would not have wanted to be killed under these circumstances, that is an important reason why we should not do so.

Q. What about voluntary euthanasia and physician-assisted suicide?

A. I support law reform to allow people to decide to end their lives, if they are terminally or incurably ill. This is permitted in the Netherlands, and now in Belgium too. Why should we not be able to decide for ourselves, in consultation with doctors, when our quality of life has fallen to the point where we would prefer not to go on living?

One question was missing from Singer's FAQ page:

Q. So what should we do to YOU?

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