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My prediction is that assisted suicide will someday become legal in the United States for mostly economic reasons. We can already keep old bodies alive for decades beyond the expiration date for healthy brains. That's not a sustainable system, economically or otherwise. We're burying future generations in debt and burdening them with the responsibility of caring for our zombie bodies and rotted brains.

I understand all of the moral and social arguments against assisted suicide. Some people say life is sacred, and I respect that. I will also stipulate that if assisted living were legal, some people would attempt to pressure their grandmothers into early graves to collect the inheritance.

But let's assume that if assisted suicide were legal it would have a number of safeguards. Perhaps a person who wants assisted suicide services would have to get sign-offs from at least two direct family members, two doctors, and a psychologist. I would think you could devise a system to thwart all but the cleverest schemers.

In the past few years, several of my relatives and in-laws have shed their mortal coils under our current system. Each of them experienced a final year of life that was quite awful. If you haven't observed a close relative suffering for months, or even years, with dementia and illness, you probably shouldn't have an opinion on assisted suicide. You really need to be in the room. 

You might also want to walk down the hall of a medical facility that handles people in their final months of life. You won't see anything in the eyes of the patients that looks like happiness. It's truly horrifying. Our local facility is upscale and well-run, but it still feels like walking through a meat storage facility in which the meat feels pain and depression.

All of this makes me wonder if any economist has studied the economics of assisted suicide. My best guess is that assisted suicide could reduce a nation's healthcare costs by 20%. And that might be conservative. I'll bet it's not unusual for someone to consume $50,000 of healthcare service up to the final year of life then consume $100,000 worth in the final year. All of that is somewhat offset by the people who die suddenly. So I wonder what the net is.

A quick Google search found one study that says so few people would choose an assisted suicide option that it would have little impact on overall healthcare costs. In the Netherlands, where assisted suicide is legal, only 2.7% of people take that route. But I expect that someday science will keep bodies alive so long that up to half of all elderly people would want assisted suicide. And in my family, including in-laws, I believe only one out of seven died quickly. The other six had expensive and unpleasant final years.

Here's my question for today: Add up the number of people in your family who have died in the past ten years. How many of them went out quickly and inexpensively? I'll bet it's fewer than half.

 
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Dec 13, 2012
I think any argument for assisted suicide should be based solely on quality of life and personal empowerment factors. Financial cost to society should not even enter into the discussion.

There is more to life than economics.
 
 
Dec 13, 2012
I would tend to think that having a living will for those still in control of their mental capacities would greatly help alleviate a lot of end of life suffering and needless expense.

I have a family member that when he was 29 year old high school science teacher and recently married,with a one year old child was run over in his car by a semi tractor trailer on the interstate highway. For over 4 years now he has been in an extended care facility in a persistive vegetative state with absolutely no chance of recover. He's awake but no one's home inside. I doubt there is anything anyone can do to help the situation at this point. A living will may have provided the opportunity to end the suffering for himself and all of his loved ones. Yet on the other hand I also believe that nothing happens in this world by accident or completely random. I'm quite sure there is a greater purpose to this event occurring and unfolding as it has. Yet, its still very hard to accept and deal with and it would be nice to have additional options available to consider at such a time as this.
 
 
+28 Rank Up Rank Down
Dec 13, 2012
I'm not sure that lack of access to assisted suicide is our biggest problem. I support it with appropriate protections -but I think a much bigger issue is too much medical intervention and too few frank discussions of prognosis. My mother had an expensive illness that resulted in her death two years ago. About ten years ago she had stem cell transplant that gave her five or six years of good health in which she was able to travel and enjoy life. That was expensive but worthwhile.

When she relapsed, my parents both believed they had a chance at something similar to the same outcome. They did not. There was no chance of a similar outcome. The doctor hinted at as much - but otherwise let them believe what they wanted to believe. I attended many doctor consultations and I often came away with a much different idea of what the doctor was saying than they did. Unfortunately - it was always a matter of interpretation.

The medical bills and inability to focus on their small business ruined them financially. (There was more to the story - but the medical issues were a big part of it.) I helped them move out of the house they loved two months before my mother died. It was traumatic for everyone. At that point my mother was getting weekly blood transfusions - and they had "come to terms" with the idea that she only had a few years left. Weekly blood transfusions - that quickly became 2x weekly - and they still thought she had a few years?

The doctors knew better but never made an effort to help them face reality. It was always, "here is what we can do next." Had my parents realized the truth, they could have stretched to stay in their home until after my mother died -and not subjected her to the trauma of the move. They might have made different treatment decisions as well. She might have chosen to say her goodbyes on her own terms -and not continued with the transfusions and other intensive interventions.

They were fortunate that she began her treatment at Stanford medical center - and more than a million dollars in personal and insurance payments later, Stanford continued to treat her even she was reduced to medicare-only. The care she received at another hospital - after an ambulance transfer was appalling. As soon as they realized she was medicare-only they did the minimum legally required (not much) and sent her home.

Clearly - over treatment is not as big of an issue for the poor...

There has to be some middle ground between too-much, needlessly expensive, denial-driven care and the kind of callous minimalist approach taken by the other hospital.

A lot of it comes down to all of us being willing to face reality. Life does not last for ever. Resources are limited and pouring them into useless treatments that don't offer real value is not wise. Doctors are human. They don't want to tell patients its over - when there is something else they could try that could work. They aren't the bad guys. It's a cultural problem. We need a cultural change - that puts more emphasis on a "good death" than on attempting to cheat death.
 
 
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Dec 13, 2012
In the late nineteenth century, Guy de Maupassant grasped the economics, and humanity, of assisted suicide and offered what seems to me to be a viable model for financing it. In his short story 'The Magic Couch' (http://www.classicreader.com/book/1255/1/) he writes of a membership-based institution that provides suicide assistance for patrons and, at no cost, for the indigent. De Maupassant evens provides an explanation as to how an establishment of this nature could come about. It's a lovely dream, all the more touching in view of the author's own anguished end of life.
 
 
+11 Rank Up Rank Down
Dec 13, 2012

We don't need assisted suicide, just the realization that doing everything possible to prolong life is not the best (nor the most economic) approach.

One exception to the rule that the last year is expensive is doctors. They know that 'all out' attempts to prolong life are worthless, and they make sure that it doesn't happen to them.

 
 
Dec 13, 2012
 
 
Dec 13, 2012
 
 
-12 Rank Up Rank Down
Dec 13, 2012
Heck, why do we even need assisted suicide now? We're going to have health care rationing to old people due to the "Obamacare" health care reform. There's your not keeping people alive due to economic reasons right there.
 
 
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Dec 13, 2012
In all of them, it was expensive. Only 1 of the 6 had dementia. None of them would have chosen assisted suicide. That's probably partly due to their Catholicism, but also because they were very active in their grandchildren and great-grandchildren's lives.
 
 
Dec 13, 2012
You're talking about people who have the wherewithal to make a conscious decision about life and death. I would bet we spend more on people who have to rely on the first relative in the E.R. Life-saving procedures are the most expensive, at least up front.

I saw a recent news piece from NBC's "Rock Center" about a hospital that has an interview with those who know they have terminal illness, and old folks, and directly asking them and their loved ones what steps they should and should NOT take when a medical event happens. This is simple, cheap, and prevents that lingering, vegetative state that we see so often in our final years of a long life.

 
 
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Dec 13, 2012
We already have a form of assisted suicide. My father could have been kept alive indefinitely. With zero quality of life. In one of his few semi-lucid moments we decided he had agreed to the withdrawal of interventions. So in some sense he agreed to being killed (to be brutal). The only form of assisted suicide not allowed is where the mere withdrawal of extraordinary efforts will not result in death. An excellent post byy Scott. This is a terrible issue.
 
 
Dec 13, 2012
The last family member I lost was my dad to the side effects of the throat cancer he had. It was very painful for him. My mother had several heart attacks and died in the surgery to have a pacemaker implanted (never woke up). I've also read that the last six months of your life tend to be the most medically expensive.

There's one important thing that happened with my father, he was given 6 months and he lived more than a year (closer to 18 months I think) so he was able to not only see one final Christmas and a round of birthdays of everyone else, he also lived long enough for his favorite football team to win the SB. So there are things he would have missed out on if he decided to call it quits at the 3 month mark.

One of the problems with assisted suicide is that the life expectancies of those involved isn't definite and there is a chance with some conditions that they survive it and can live on for quite awhile. We also don't know what treatments are just around the corner. I just read this yesterday a girl was dying of cancer so they used a modified version of AIDS of all things to cure her:

http://www.telegraph.co.uk/news/worldnews/northamerica/usa/9738355/Emily-Whitehead-girl-whose-cancer-was-cured-by-HIV.html

If they offed her when it started getting painful, she wouldn't be a happy, healthy child now with a full life ahead of her.

Think about it from that perspective and while dying is ultimately a painful and traumatic process, society does benefit from the new treatments and medicines. If anything, I see the pain of death as a source of motivation we can use to help our fellow man more than just shortening the period of suffering. Let's make death cheaper and less painful without denying anyone more of their limited time on Earth.

I could go another root, and I might a little later, for now I'd like to stay focused on the positives and the potentials of trying to keep people around.
 
 
Dec 13, 2012
Most of people's lifetime healthcare expenditures and costs are spent during the last year(s) of their lives or 'end of life' care. It's insane.

http://online.wsj.com/article/SB10001424052702304441404577483050976766184.html

http://www.nursingeconomics.net/ce/2014/article3003127134.pdf

http://thehealthcareblog.com/blog/tag/end-of-life-care/
 
 
+8 Rank Up Rank Down
Dec 13, 2012
This is reasonable, gives people a choice, and saves money; and so The U.S. will never implement it.
 
 
Dec 13, 2012
In my family's case, exactly half of them died siddenly and without care-related expense. I can't agree with your overall supposition here though - the combination of religious taboo and professional-ethical taboo is too extreme for assisted suicide to become a trend based on economic practicality. I agree that current costs of final-year medical care are not sustainable under the current cartel-based "illness maintenance" system, but it's more likely that we'll throw the baby out with the bathwater, e.g. dying people will get the level of care they can pay for, and will die when the $ runs out. It will NOT become easier for them to check out at will, because in addition to the above-mentioned taboos, the cartel will not allow their cash cows to die while there is still money to be made.
 
 
Dec 13, 2012
Not including the second cousins and any relation further than that because I don't know them. I can think of four deaths of the top of the my head. Three were sudden heart-attacks and the other was cancer. So for my family it would be at 25%.
 
 
Dec 13, 2012
Sentence 3 in paragraph 2. I think you meant to write "I will also stipulate that if assisted *suicide* were legal...."
 
 
Dec 13, 2012
look up the Terry Prachett Dimbleby Lecture ont this. His safeguards are very similar to yours. And yes I do mean Terry Prachett the author of the Discworld novels
 
 
 
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