When liberals ask me why they should oppose physician-assisted suicide (PAS), I always reply, "I can summarize a big reason in just three letters: HMO."
That always raises an eyebrow. Liberals hate HMOs.
Then I ask, "Do you know how much it costs for the drugs used in an assisted suicide?" They usually shake their heads, no. Answering my own question, I say, "About forty bucks," adding, "Since HMOs make money by cutting costs, and it could cost $40,000 (or more) to provide suicidal patients with proper care so that they don't want assisted suicide, the economic force of gravity is obvious." More often than not, my liberal interlocutor will say, "Gee, I never thought about that before," and agree that the HMO factor is a very serious problem confronting the assisted-suicide movement.
Most people haven't yet made the money connection between assisted suicide and the increasing strains on health-care budgets. That may be because reporters, who are usually eager to expose potential financial conflicts of interest in other public-policy issues, tend to be blind to the economic stakes involved in the assisted-suicide controversy. They prefer to see it as a matter of "choice," or of "compassion," or of modernism-versus-religion. Yet, the realization that assisted suicide will, in the end, be largely about money, is becoming increasingly difficult to ignore.
Take Oregon, where assisted suicide is legal. While the assisted-suicide law does not compel any doctor or HMO to participate in the self-destruction of patients, only Catholic HMOs have said no. Indeed, Kaiser/Permanente Northwest's doctors are known to have written lethal prescriptions under the Oregon law.
But now, Kaiser isn't merely permitting doctors to assist in patient suicides, it is actively soliciting its doctors to participate in the deadly practice. As revealed by the anti-assisted-suicide medical group Physicians for Compassionate Care, a Kaiser executive recently e-mailed a memo to more than 800 Kaiser doctors soliciting PAS-doctor volunteers.
The memo reveals that to the apparent chagrin of Kaiser, to their credit, few plan doctors are willing to participate in the killing of their own patients. Hence, the executive urges any Kaiser doctor willing to "act as Attending Physician under the [assisted suicide] law for YOUR patients" and doctors "willing to act as "Attending Physician under the law for members who ARE NOT your patients" to contact "Marcia L. Liberson or Robert H. Richardson, MD, KPNW Ethics Services." (Emphasis in the memo.) Since "attending physicians" write the lethal prescriptions under the Oregon law, Kaiser is apparently willing to permit its doctors to write lethal prescriptions for patients they have not treated.
For opponents of assisted suicide who are closely following events in Oregon, Robert Richardson is already notorious as the HMO administrator who green-lighted the assisted suicide of Kate Cheney. Cheney, as reported by the Oregonian, was a terminal cancer patient who was probably suffering from dementia when she asked for a lethal prescription, raising serious and significant questions about her mental competence. Rather than prescribe lethal drugs, her doctor referred her to a psychiatrist who reported that "she does not seem to be explicitly pushing for this." He also determined that she did not have the "very high capacity required to weigh options about assisted suicide." Accordingly, the psychiatrist nixed the lethal prescription.
Advocates of legalized assisted suicide might, at this point, smile happily and say that this is the way the law is supposed to operate: a vulnerable and perhaps incompetent woman's life had been protected. But proving that "protective guidelines" don't really protect, that wasn't the end of Cheney's story. Her daughter insisted that Kaiser permit another psychiatric opinion. Kaiser agreed to the request.
This time, the consultation was a clinical psychologist rather than an M.D. psychiatrist. Like the first report, the psychologist found that Cheney had significant memory problems. For example, she could not recall when she had been diagnosed with terminal cancer. The psychologist also worried that Cheney decision to die "may be influenced by her family's wishes." Still, despite these reservations, the psychologist determined that Cheney was competent to commit suicide.
The final decision to approve the assisted suicide was made by Richardson. Despite two mental-health professionals significant concerns about Cheney's mental state and the potential that familial pressure was involved in her decision, after he interviewed Cheney, Richardson approved the writing of a lethal prescription.
It is worth noting that Cheney did not take the poison pills right away. Her assisted suicide took place only after she was sent to a nursing home for a week. Tellingly, she took the pills on the very day of her return home. No doctor was present. Nor was her mental status assessed at that time. That is because under the Oregon law, once the prescription is written, death doctors need have no more to do with the suicidal patient.
When the Cheney case became public, Richardson angrily claimed that his decision had nothing to do with money. And, to be fair, there is no doubt that if the relatively few people reported as committing assisted suicide so far in Oregon is correct, Kaiser and other participating HMOs have not yet saved a great deal of money by agreeing to facilitate the assisted suicides of their terminally ill members. But if the reluctance of good doctors such as those currently refusing to participate in-patient self-killing at Kaiser is ever overcome, the financial facts could change. Indeed, if assisted suicide ever became nationalized and a routine "medical treatment," significant money could be saved — and hence made — by the HMO industry from the hastened deaths of their patients.
This is the view of none other than assisted-suicide guru, Derek Humphry, cofounder of the Hemlock Society and a heavy lifter in support of the Oregon law. Humphry now claims that money is the "unspoken argument" in favor of legalizing assisted suicide. Specifically, in his most recent book Freedom to Die, co-authored with Mary Clement, the authors write that "the hastened demise of people with only a short time to left would free resources for others," an amount they predict could run into the "hundreds of billions of dollars." Moreover, the authors claim that "economic necessity" is the ultimate force driving the assisted-suicide movement, to the point that it "is the main answer to the question [about legalizing PAS], 'Why Now?'"
Logic is certainly on their side. With the advent of managed care, profits in health care increasingly come from cutting costs. With assisted suicides costing such little money, what "treatment" could be more cost effective than assisted suicide? And since it is a well-known human failing that our values often follow our pocketbooks, ignoring the significant financial stakes involved in the assisted-suicide debate is to overlook a crucial part of the story.
— Wesley J. Smith is an attorney for the International Task Force on Euthanasia and Assisted Suicide and a senior fellow at the Discovery Institute. He is the coauthor of Power Over Pain: How To Get The Pain Control You Need.