I am not against medically assisted deaths, but I will say it is hyperbolic to say they are a good idea all around. Like many things that have positive sides, there are places to be mindful or concerned.
Some major points of concern are abuse and misuse- doctors, relatives, conservators etc. could abuse a system of medically assisted death for numerous reasons ranging from personal grudges, agendas of politics or prejudice, where money or other gains are concerned, or even just because they want to kill- none of these are unheard of, for example one man in the medical field is believed to have killed over 400 patients by spiking IV bags simply because he liked to kill people. He was able to rack up a substantial body count before he was discovered. A system which has a built in way for patients to legally request death could create all sorts of ways to “get away with murder” if it isn’t designed and implemented carefully.
We need to be careful to legislate the process in other ways too to prevent things like an insurance company or employer/plan operator, or medical provider from being able to essentially force a patient or coerce a patient into medically assisted death as a cost cutting measure.
As an example- the FSA/HSA both count as “low cost” health care in the USA as do “high deductible” plans with deductibles over $6000. For low income persons these plans are essentially like having no insurance at all, and they often cannot benefit from any sort of tax or financial breaks these types of plans can offer. So if we allowed medically assisted death to be a valid course of treatment and did not pay attention to these other aspects, people could easily find themselves in situations where plan coverage would refuse “treatments” other than these.
This is especially true with services like hospice or lengthy and uncertain recovery and therapy programs where providers have already deeply cut things like the length of time and extent of care offered to stroke victims, heart patients, and those undergoing joint replacements for example.
One metric used to discontinue or deny therapy is if a doctor or therapist notes they do not believe the patient will make “meaningful recovery.” While individual people and or their families may choose medically assisted death for financial reasons the same as they may choose not to undergo treatments that are costly and lengthy, we do need to do our best to make sure that it is the patients choice and not a financial or logistical decision made by institutions protecting their profits and metrics. Like any business the medical field has metrics and is incentivized to them.
Using therapy as an example- higher level rehabilitation facilities that generally offer a better chance at recovery and care have certain requirements. They cannot discharge a patient into an unsuitable care environment- a home where they won’t have care or the facilities they need for their condition on release. If a patient is admitted to a higher level rehab and then their term of stay as per insurance is used up or their treatment completed and they are to be released and cannot be, the high level facility must then transfer the patient to a lower level rehab which is less regulated and can release the patient to an unsuitable home or environment. This hurts the metrics for the high level facility. As such they often refuse patient admittance to those they think have a risk of needing to be referred to a lower level facility for reasons of release environment or recovery length. The lower level facilities are known for holding patients as long as possible to collect insurance..
.. payments for care. These are examples of the sorts of money and numbers games played in the medical industry. We could reasonably expect that medically assisted deaths might become another numbers and money game if not handled carefully- and from my above example you can see a place where medical providers and insurers might see a huge savings by incentivizing assisted death over 20+ days of in patient care followed by outpatient and home care and therapy among the other costs of recovery in cases like strokes- especially among the elderly.
The picture doesn’t get brighter with “universal health care” as many government insurance plans are already woefully inadequate and limiting in terms of options and scope or depth of care. In a tax payer funded system where the majority of people do not suffer from long term or expensive health care needs and where the majority of political capital is concentrated with those whom are financially independent enough to navigate the current medical care system- the options for care to others would largely be based upon voter sentiment. Meaning we could see able bodied and financially stable majorities essentially forcing assisted death on the vulnerable because they don’t want to be taxed to pay for their care. When you look at current and recent attempts at tax payer funded medical care the danger there should be obvious as the present systems of government welfare in health make clear the public and administrative stance.
The people in the most danger are those most “at risk” or “vulnerable” in society- the lower income brackets, the un-housed, prisoners, the elderly- and especially those elderly whom don’t have any support or advocacy from family or dedicated care persons, and the mentally challenged. There is often overlap among some or all of those categories as well making those people very much at risk. We must be particularly careful about creating a system which essentially provides an easy and “invisible” way to essentially rid society of “undesirables” unless that is the society we want to create. They don’t really teach civics in primary school anymore but two essential lessons of civics are:
1. To judge a society not by what it offers to the “top” people but how it treats its “least desirable” and “lowest” members.
2. To be wary of any society which is harsh to these “lesser” citizens and people as it is merely politics and convenience that separates you or I or anyone from being labeled
“Undesirable” tomorrow. By the same laws our former president would have wanted to pass in office, today he would be dead or in political prison. No matter what one’s politics are, and without taking any jabs at the man- the point is valid that the president of the United States isn’t even immune from being a popular leader with the highest position in government one day, and being on the outs with his very own group and facing criminal charges the next. Wether one believes the struggles of Mr. Trump to be real or political witch hunting- if it can happen to him or can happen to you because you aren’t a former president and mogul.
So we must be careful. I think there is humanity and dignity in allowing medically assisted death. I think that the principles of personal freedom demand that be an option, but I think that we must be careful and thoughtful because it is full of potential issues. How do we handle prisoners for example? If a prisoner wants medically assisted death? Speaking of prisoners and ethics- a death sentence for prisoners, where such things are even legal, can take decades and is subject to repeated review and lengthy and expensive due process. So we need to think about what a self imposed death sentence for a patient looks like, what oversight or conditions apply? What if any external review is there to their mental state? A “cooling off” or “monitoring” period to ensure they are committed and not being impulsive? That they have all the information and ability for informed consent?
Going back to prison- do we allow a prisoner serving life sentences to take medically assisted death? In our prisons where medical care and respect of policy and law to medicine are questionable at best, where inmates are often subjected to abuses and violations of law and rights and human dignity for reasons of profit or convenience or practicality or just sadism and malice by their keepers- how would we ensure medically assisted death was properly handled? That it was given to those who wanted it and qualified or that it wasn’t used as a tool of execution against the will of prisoners?
What happens if a medical provider or an entire large medical group, insurer, etc. refuse to have a part in assisted death?
Can we force a doctor to offer the process or to sign their patient over or issue referrals to a patient knowing that will result in a patient death? This isn’t a direct mirror to abortion but it touches on some similar soft spots. Speaking of referrals- many healthcare systems create what can be pretty large barriers to achieving desired care or recieving second opinions or ensuring patient access. That could be a problem. We also have to consider insurance. Life insurance. If we ONLY allow medically assisted death in cases where a terminal prognosis is given with high certainty and where the death is expected within a relatively short window of time- say 12 months or something- we can essentially say death by natural causes was inevitable. That said though- the patient made the choice to die.
Essentially all life insurance does not pay out in the event of suicide or self inflicted death. We would need address how insurance would be handled and if we decided insurance must pay out in the case of medically assisted death- how to codify that. We also would need to look at other types of insurance like supplementary coverages for death/disease/etc. and how those should be applied and how to codify that. What I mean is this- a patient could easily find themselves wanting to die and facing pain and suffering for months or years, but knowing that if they seek medically assisted death their family or loved ones would be left financially devastated because their insurance policies wouldn’t pay out.
There is much to consider and worry about when one is ill, especially terminally so, and often times one is stressed and stretched thin mentally, more so when their condition and related pain etc. impairs their ability to think, focus, remember, or even stay awake. We probably do not want to implement a system of medically assisted death which puts someone in a hospital bed pouring through insurance fine print and making lawyer calls and calculated spreadsheets to determine the exact length or duration of unnecessary suffering they need to endure in order to maximize their chances of not burdening their loved ones. That’s on top of the balancing of the books on costs of continued care and placing a dollar value on one’s own life.
To ethics we do need to make some considerations. It was quite vogue for a time to lobotomize. You weren’t killing a person per se so it side stepped the ethics of taking a life, but the procedure could be used to theoretically lessen an individuals suffering while also mitigating the burdens of society from “at risk” and “undesirables” like the “mentally unsound” or the criminally violent. Looking back through the lens of history the entire affair is almost universally viewed as a nightmarish horror and extreme and obvious failing of ethics.
We can draw many parallels to potential implementations of medically assisted death. That isn’t to say we should forget the entire idea, but we should be mindful of history and very careful not to repeat its mistakes if we were to proceed.
Medically assisted deaths are a good idea all around.
Some major points of concern are abuse and misuse- doctors, relatives, conservators etc. could abuse a system of medically assisted death for numerous reasons ranging from personal grudges, agendas of politics or prejudice, where money or other gains are concerned, or even just because they want to kill- none of these are unheard of, for example one man in the medical field is believed to have killed over 400 patients by spiking IV bags simply because he liked to kill people. He was able to rack up a substantial body count before he was discovered. A system which has a built in way for patients to legally request death could create all sorts of ways to “get away with murder” if it isn’t designed and implemented carefully.
As an example- the FSA/HSA both count as “low cost” health care in the USA as do “high deductible” plans with deductibles over $6000. For low income persons these plans are essentially like having no insurance at all, and they often cannot benefit from any sort of tax or financial breaks these types of plans can offer. So if we allowed medically assisted death to be a valid course of treatment and did not pay attention to these other aspects, people could easily find themselves in situations where plan coverage would refuse “treatments” other than these.
One metric used to discontinue or deny therapy is if a doctor or therapist notes they do not believe the patient will make “meaningful recovery.” While individual people and or their families may choose medically assisted death for financial reasons the same as they may choose not to undergo treatments that are costly and lengthy, we do need to do our best to make sure that it is the patients choice and not a financial or logistical decision made by institutions protecting their profits and metrics. Like any business the medical field has metrics and is incentivized to them.
1. To judge a society not by what it offers to the “top” people but how it treats its “least desirable” and “lowest” members.
2. To be wary of any society which is harsh to these “lesser” citizens and people as it is merely politics and convenience that separates you or I or anyone from being labeled
Can we force a doctor to offer the process or to sign their patient over or issue referrals to a patient knowing that will result in a patient death? This isn’t a direct mirror to abortion but it touches on some similar soft spots. Speaking of referrals- many healthcare systems create what can be pretty large barriers to achieving desired care or recieving second opinions or ensuring patient access. That could be a problem. We also have to consider insurance. Life insurance. If we ONLY allow medically assisted death in cases where a terminal prognosis is given with high certainty and where the death is expected within a relatively short window of time- say 12 months or something- we can essentially say death by natural causes was inevitable. That said though- the patient made the choice to die.
We can draw many parallels to potential implementations of medically assisted death. That isn’t to say we should forget the entire idea, but we should be mindful of history and very careful not to repeat its mistakes if we were to proceed.