By Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition
Canada legalized euthanasia on June 17, 2016. On January 23, 2017, the Canadian Medical Association Journal (CMAJ) published a study by Aaron J. Trachtenberg MD DPhil, Braden Manns MD MSc titled: “Cost analysis of medical assistance in dying.”
The researchers in that study found that Canada’s healthcare system would save between 34.7 and 138.8 million dollars per year, depending on the number of euthanasia deaths, now that euthanasia was legal. Canada has a universal healthcare system, where the financial cost for healthcare is primarily paid by governments.
In Canada there were 5,000 euthanasia deaths in 2019 and 13,000 altogether since legalization. I suggest that the higher estimates by Trachtenberg and Manns were probably more accurate.
The Journal of Clinical Ethics recently published a study by Scottish researchers David Shaw and Alec Morton titled: Counting the cost of denying assisted dying.
(The authors use the term assisted death to refer to both euthanasia, which is done by lethal injection, and assisted suicide, which is done by providing a lethal prescription that a person “self-administers.” )
The authors argue:
First: permitting assisted dying allows consenting patients to avoid negative quality-adjusted life years, enabling avoidance of suffering. Second: the resources consumed by patients who are denied assisted dying could instead be used to provide additional (positive) quality-adjusted life years for patients elsewhere in the healthcare system who wish to continue living and to improve their quality of life. Third: Organ donation may be an additional potential source of quality-adjusted life years in this context.
The authors suggest that people who are denied an assisted death should be compensated. They state:
Competent adults may claim that their life is not worth living and that they wish their life to end. Such claims must be investigated sympathetically. If the claims persist despite optimum care and in the absence of depression healthcare professionals must find ways to compensate such patients for the fact that society has denied them the means to exercise their autonomy. How patients could or should be compensated has not been determined.
In their analysis, the researchers examine “positive” gains if assisted death is legalized in relation to a person’s QALY (Quality Adjusted Life Year). They suggest that a nations QALY is improved because some health conditions are worse than death.
Most health states are preferable to death, and so attract a quality of life score which is greater than zero, indicating that life in that health state is preferable to no life at all… However, some limited literature has examined the value of health states worse than death.
Similar arguments were made by Karl Binding and Alfred Hoche in their book (1920): Allowing the Destruction of Unworthy Life: Its Extent and Form. This is the book that led to the Nazi euthanasia program and it was based on very similar arguments to Shaw’s and Morton’s.
The authors then assess the financial savings by legalizing assisted death. The authors are very precise in their financial calculations by stating:
What quantity of resources might be saved from legalising assisted dying? It is possible to get a rough sense of the magnitude. Many patients who seek assisted dying are suffering from cancer (e.g. around two-thirds in the Netherlands) and Round et al. estimate that 12 months of care for a cancer patient at the end of life costs £9914, including health, social, charity and informal care. If only one-third of these costs could be saved through assisted dying, at the UK level, this would translate to £74m in the high scenario and £7.4m in the low scenario.
The authors assess the issue of organ donation and assisted dying. They state:
Allowing patients to access assisted dying enables many of them to become organ donors. Despite the assumption that donation is not possible after assisted suicide or euthanasia, in many countries, this is a reality for patients.
Finally, they argue
First, if patients are denied assisted dying, organ function will gradually deteriorate until they die naturally, meaning that transplantation is less likely to be successful. Second, patients who choose assisted dying have to go through a lengthy process, and organ donation can be easily integrated into that process (non-coercively), decreasing the risk that family members will attempt to overrule donation, which often occurs when a patient dies in a way that is not planned. Finally, because of the planned nature of the death, it is even possible that a tissue match could be found before the organs are explanted. For all these reasons, enabling assisted dying could also enable an additional, highly beneficial source of organs for transplantation.
Organs obtained from euthanasia are healthier because the donor didn’t experience the dying process. These arguments also justify euthanasia by organ donation. Why kill a person and then remove the organs when you can remove the organs which kills the person?
The authors argue that they are not promoting assisted dying but only analyzing the cost benefits associated with assisted dying and the benefits and improves access to healthy organs for donation. This is not true.
First, they argue in the study that people who are denied an assisted death should be financially or otherwise compensated. In other words, the authors begin with a concept that people not only have a “right to die” but society has a “duty to kill them”.
Secondly, they are undermining the cultural reality that many people feel like a burden on society. The argument that some people are better off dead than living with certain health conditions reinforces this ideology.
Ideas have consequences. Yes, euthanasia and assisted suicide are financially cheaper to the healthcare system than living, but legalizing assisted death changes the way society views human life.
Society will change overtime and soon the “right to die” becomes the “Duty to Die” especially when the analysis is based on the utilitarian concept of the greatest “happiness for all”.
Editor’s note. This appeared on Mr. Schadenberg’s blog and is reposted with permission.