Questions of Life and Death

Anyone who thinks that fixing the American healthcare industry will be easy should consider the story of Barbara Wagner.

Wagner, as ABC News reported in August, was in the final stages of lung cancer, her only hope of prolonging her life being “a $4,000-a-month drug that her doctor prescribed for her.” Her insurance company, the Oregon Health Plan, refused to pay for the drug and instead offered a substitute—“drugs for a physician-assisted death” that “would cost about $50.”

A heartless response, to be sure, but one that is wholly consistent with a medical system designed to generate profit and not necessarily to provide care.

I have always been ambivalent about legalizing assisted suicide. On the one hand, I don’t believe that we should empower anyone to help another take a life, especially doctors who take an oath to protect life. But I can understand the argument that, when faced with severe, long-term pain, someone may choose a painless end.

At the same time, I’m uncomfortable with the notion that the federal government can legislate against such a personal choice.

But the state does have a compelling interest in the issue of assisted suicide, in protecting the patient from a doctor, family member or even an insurance company that may be pushing death as a cheaper alternative than treatment.

I am not prepared to take a position on Oregon’s assisted-suicide law, or the ballot question being debated in Washington state. There are compelling arguments on both sides. But it is pretty clear to me that we cannot continue to allow corporate interests to decide these questions.

Speaking of Barbara Wagner, a Michigan lawyer who defended Jack Kervorkian in what ABC called his “crusade to legalize physician-assisted deaths” told ABC that “her case is hardly unique.”

“In the rest of the country insurance companies are making these decisions and are not paying for suicide,” Geoffrey Fieger said. “Involuntary choices are foisted on people all the time by virtue of denials.”

It would be easy to paint the insurance companies as the villains in this mess. After all, they sent a horribly insensitive letter and have crafted rules that limit the use of expensive drugs. But they are only acting in the role we’ve assigned them—as gate-keeper of care. So, it really shouldn’t be a huge surprise that companies that boost profits by increasing premiums and limiting care would allow financial decisions to trump medical ones.

That’s one reason we have to take the system back and remove profit as its guiding principle. As long as the goal is to maximize the earnings of insurance companies, drug companies and others with their fingers in the pudding, we will be looking for ways to cut costs for the sake of cutting costs. That could mean, as in this case, opting for a cheaper drug and a “humane” death over an expensive one that adds a few months to a woman’s life.

ABC cited a 1998 study from Georgetown University’s Center for Clinical Bioethics that “found a strong link between cost-cutting pressures on physicians and their willingness to prescribe lethal drugs to patients—were it legal to do so.”

“(A) sobering degree of caution (must be used) in legalizing (assisted death) in a medical care environment that is characterized by increasing pressure on physicians to control the cost of care,” the study warned, according to ABC, especially when the cost of lifesaving drugs is compared with those used in assisted suicide.

“Cancer drugs,” ABC said, “can cost anywhere from $3,000 to $6,000 a month. The cost of lethal medication, on the other hand, is about $35 to $50.”

That’s a huge disparity that can result in a distorted decision-making process.

Strict guidelines are needed, but they can only be arrived at via public debate that asks how much life is worth, how much we would be willing to pay to extend our lives by a month, by six months, a year.

And who pays? Should the answers to these questions depend on a patient’s financial situation, as they do now? (The wealthy can by medical services not available to the poor, meaning that the same $4,000 life-extender that was out of reach for Ms. Wagner might be easily obtainable for someone else—and not necessarily Donald Trump.)

The questions are not easy ones, but they have to be asked — especially with the accelerating pace of technological change creating treatment opportunities everyday that were not available in the past.

Hank Kalet is a poet and managing editor of the South Brunswick Post and The Cranbury Press in central New Jersey. Email and see his blog, Channel Surfing, at

From The Progressive Populist, Sept. 15, 2008

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