Though a relative “latecomer” in the legalization of physician-assisted suicide (PAS), Canada seems determined to make up for lost time. Already the question of organ donation after PAS has been raised. Very recently, the medical “savings” made possible by the legalization of PAS in 2016 was brought to light.
The January 23, 2017 volume of the Canadian Medical Association Journal (CMAJ) published the results of a study by Aaron J. Trachtenberg and Braden Manns titled, “Cost Analysis of Medical Assistance in Dying in Canada.” The authors stated that the aim of the study was “to determine the potential costs and savings associated with the implementation of medical assistance in dying.”
The study found that the legalization of PAS will save the Canadian healthcare system between $34.7 and $138.8 million per year; a savings far exceeding the $1.5 to $14.8 million in direct costs associated with the implementation of PAS (physician consultations, drug costs, etc.). Following the lead of a study conducted in the Netherlands (where both PAS and voluntary active euthanasia are legal), the researchers considered the following factors in their calculation: (1) the effect of PAS on patients’ longevity of life (patients requesting PAS would not live as long as patients choosing palliative care); (2) the average cost of care for end-of-life patients suffering from various diseases, especially cancer; and (3) the expected number of PAS deaths. The conclusion was that patients electing PAS will “save” the healthcare system millions of dollars that otherwise would have been spent on their palliative care.
The obvious first question is why would the CMAJ, Canada, or the authors be interested in the cost savings associated with PAS? More than curiosity must have driven the study. Seemingly, the main impetus was to gain assurance that the implementation of PAS was not costing more money than offering palliative care: “Our analyses suggest that the savings will almost certainly exceed the costs associated with offering medical assistance in dying to patients across the country, and that the inclusion of medical assistance in dying in the services covered by universal health care will not increase health care spending.”
Nevertheless, the researchers must have felt some uneasiness about the perceptions this study might generate. Thus, they assure readers of the study: “We are not suggesting medical assistance in dying as a measure to cut costs. At an individual level, neither patients nor physicians should consider costs when making the very personal decision to request, or provide, this intervention.”
Alex Schadenberg, the executive director of the Euthanasia Prevention Coalition, doesn’t feel assured (“Awful Study Says Euthanizing More Patients Will Save the Government Money,” Ottawa, Canada, January 24, 2017). First, he points out that associating PAS with cost savings implies that it is a social good. I agree. When health care costs are covered primarily by the government, as they are in Canada, the prospect of “saving” tens of millions of dollars might easily be seen as best decision for the (financial) good of the country. Second, connecting PAS with significant financial savings pressures patients to elect PAS rather than continuing to live. Again, I agree that this is a legitimate concern. There is evidence that some patients, at the end of life, worry about being an emotional and a financial burden to their loved loves. If patients are aware of the findings of this study, they might also come to feel that their continuing existence is a burden to State as well.
The study might well assure Canadian power brokers that PAS will greatly strengthen the financial stability of the health care system. As Schadenberg points out, “Dead people don’t need palliative care.”
However, the study does little to encourage sick and dying patients to live out their remaining days, convinced that a willing and compassionate healthcare system will provide necessary and effective palliative care. When patients are struggling with the decision to request PAS or to continue living, I wonder if the findings of this study will ever rattle around their minds. Will any patients think at this very vulnerable moment, “But I could save the country a lot of money and my family a lot of trouble if I would just go ahead and die”? I hope not. But with the publication of the findings of this study, it is not unimaginable that they would.