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Follow the Money

Original Article

The United States is slowly becoming pro-suicide. No, not all suicides. No one favors troubled teens or healthy adults killing themselves. But our society can no longer be described as unequivocally antisuicide.

Look at the celebration of the late Brittany Maynard, who received the full celebrity treatment—including being named by CNN as one of the most extraordinary people of 2014—because she committed suicide after being diagnosed with terminal brain cancer. Indeed, the emotionalism generated by Maynard’s death—orchestrated by the assisted suicide advocacy organization Compassion and Choices (once known, more honestly, as the Hemlock Society)—sparked legalization proposals in half the country. That campaign mostly failed but may have borne poisonous fruit in California, where the state senate two weeks ago passed a legalization bill.

Compare all the cheering over Maynard’s manner of death with the sharply contrasting mild coverage of Lauren Hill, who had the same disease but eschewed suicide in favor of hospice, striving to overcome her illness to play college basketball, and raising money to fight cancer. It is disturbing but true: Maynard was far more celebrated for pushing “death with dignity” than was Hill, who promoted life with dignity.

The recent experiences and current policies of Oregon, the second government jurisdiction in the world to explicitly legalize physician-assisted suicide (behind Switzerland, which does not require doctor participation), also illuminate our slouch toward a pro-suicide culture. Perhaps partly as a consequence of legalization, Oregon has the second-worst suicide rate in the country, 41 percent higher than the national average, with the frequency increasing steadily since 2000. Even that unhappy number doesn’t tell the full tale. Because the law does not consider assisted suicide to be “suicide,” Oregon’s toll excludes the 859 people who are known to have killed themselves using lethal drugs prescribed by a doctor between 1998 and 2014.

A government’s priorities dictate its spending choices. Oregon uses federal and state money for youth suicide prevention. But even though one in five suicides in Oregon occurs among “older adults,” the anti-assisted-suicide Physicians for Compassionate Care found that the Oregon Health Authoritydoes not fund adult suicide prevention services. As an OHA bureaucrat responded when answering an inquiry from a state legislator, “Staff resources to work on older adult suicide development have not been developed in OHA.”

In contrast, Oregon does fund assisted suicides under Medicaid, using state funds (federal Medicaid dollars cannot legally pay for assisted suicide). So Oregon taxpayers pay the costs of terminally ill adults seeking death, but no state funds are dispensed to prevent adults from killing themselves.

Not only that, but Medicaid is explicitly rationed under Oregon law. As one example, some poor patients with late-stage cancer are denied life-extending (as opposed to curative) chemotherapies, but assisted suicide is never rationed. Indeed, readers might recall that Barbara Wagner and Randy Stroup—two terminally ill cancer patients—were denied Medicaid coverage for chemotherapy in 2008, but told in their rejection letters that the state would fund their suicides.

Regulators are so in the tank for assisted suicide that the OHA has explicitly stated that doctor-prescribed death would always be subsidized for the poor. The announcement read:

It is the intent of the Commission that services under [the Oregon Death with Dignity Act] be covered for those that wish to avail themselves to those serv­ices. Such services include but are not limited to attending physician visits, consulting physician confirmation, mental health evaluation and counseling, and prescription medications.

No poor Oregonian will ever be rationed out of assisted suicide—after all, what “end of life treatment” could be more cost effective? The message is unequivocal: The state will always pay the tab of the poor wanting to kill themselves, but will not necessarily pay for their fight to remain alive.

Apologists for assisted suicide claim that none of this matters because people have to be terminally ill to qualify for doctor-hastened death in Oregon. But suicide is suicide. And we’ve all known people with a terminal diagnosis who didn’t actually die as expected. The famous humorist Art Buchwald is a case in point. He entered hospice diagnosed with less than six months to live from kidney failure. Not only did he not die when predicted, but he left the program and wrote his final book before finally succumbing.

Asked about Oregon’s funding priorities, oncologist Dr. Kenneth Stevens, president of Physicians for Compassionate Care, lamented, “You would think with the concern about the state’s high geriatric suicide rate and the similar crisis among military veterans, the state would fund suicide prevention for adults and the elderly.”

That would be true in an anti-suicide culture. But that isn’t Oregon. By following the money, we can see what the state cares most about: facilitating some—rather than preventing all—adult suicides.