No time to live

The Canadian House of Commons voted to advance a bill Thursday that would expand assisted suicide in the country. The legislation would extend the procedure’s availability from patients whose death is “reasonably foreseeable” to those who don’t have a terminal diagnosis. Medical providers could administer euthanasia to patients who are incapable of consenting as long as they agreed to it prior to losing mental capacity. The bill also waives the required 10-day waiting period for terminally ill patients seeking euthanasia or assisted suicide.

The vote came a week after a governmental report estimated the legislation would save Canadian provinces $149 million next year in healthcare costs—up from the estimated $86.9 million under current assisted suicide rules. The report attributes the growth in savings to the loosened eligibility requirements for euthanasia or assisted suicide: Extending the option beyond the terminally ill and removing the requirement to reflect on the decision means more patients will die, and they will die sooner.

“Many studies have shown that healthcare costs in the last year of life (and especially in the last month of life) are disproportionately high, representing between 10 percent and 20 percent of total healthcare costs despite these patients representing about 1 percent of the population,” the report says. But it adds a disclaimer: “Nevertheless, this report should in no way be interpreted as suggesting that [medical aid in dying] be used to reduce healthcare costs.”

Alex Schadenberg of the Euthanasia Prevention Coalition said healthcare makes up approximately half of the provincial budgets in Canada. This makes cutting medical costs a prime way for the country to control spending. “Physicians aren’t in control of the dollar,” he said. “But they’re being told, you know, ‘You guys are the purveyors … of the actual, budgetary dollars. When you approve something, it means that this is a cost to your province.’” He said that mindset, coupled with laws enabling assisted suicide, can lead physicians to recommend an early death to patients who would otherwise need extensive care.

Even a physician’s neutral suggestion of assisted dying can pressure a patient to end his or her life early. “The pressure comes upon me if I am sick because I am then imposing upon my nation the fact that I’m demanding healthcare until my natural death rather than dying earlier by lethal injection,” Schadenberg said. He noted most medically assisted deaths in Canada have been through euthanasia, in which the medical professional administers the lethal drug through injection. Only a small percentage of patients die from self-administering the prescribed drug in pill form, which is considered assisted suicide.

A 2008 story about an Oregon resident who felt pressured to die shocked even supporters of euthanasia. Oregon legalized physician-assisted suicide in 1997, when the state’s Death with Dignity Act took effect. Barbara Wagner received word from her health insurance company that it would not pay $4,000 a month for the drug that could save her life from lung cancer. But the Oregon Health Plan said it could cover the cost of the drugs she would need for assisted suicide. That was only about $50. “It was horrible,” Wagner told ABC News. Lois Anderson of Oregon Right to Life said the news report caused assisted death proponents to “tread very carefully when they talk about the financial aspect.”

But the financial pressure persists, and it likely motivated the March 2018 changes to the advance directive laws in her state. The legislation included a loophole that Oregon Right to Life said could allow providers to stop providing food and water to incompetent patients such as those with Alzheimer’s disease and dementia. Since patients with those conditions tend to be physically healthy, they live longer and their care costs more. Insurance companies and the Oregon Health Plan both testified in support of the legislation.

“We’re not seeing this out-and-out, ‘Hey look, physician assisted suicide is saving us all this money!’” Anderson said. “But we’re seeing that evidence of that thought process in the actions that people are taking in the legislative arena.”

Schadenberg said the financial pressures naturally arise from allowing physicians to kill in any circumstance. That’s why both he and Anderson warned against taking those first steps in legalization. “Once you say it’s okay for someone to provide lethal drugs for the purpose of that person dying or to inject that person directly … you’ve already crossed the line,” Schadenberg said. “You’ve crossed the line that it’s not okay to kill.”