Economic arguments and assisted dying.
by Dominic Wilkinson (@NeonatalEthics)
Lord Falconer’s assisted dying bill is being debated today in the House of Lords. In the past week or two there has discussion in the media of many of the familiar arguments for and against such a proposal. As Roger Crisp noted in yesterday’s post, there have been relatively few new arguments. Supporters of the bill refer to compassion for the terminally ill, the difficulty of adequately relieving suffering, and patients’ right to make fundamental choices about the last stage of their lives. Opponents of the bill express their compassion for the terminally ill and those with disabilities, fear about coercion, and the omnipresent slippery slope.
One concern that has been raised about the assisted dying bill is the fear of abuse in the setting of an overstretched public health system. For example, Penny Pepper, writing in the Guardian notes that “Cuts to social care are monstrous…How would the enactment of the Falconer bill work if brought to our harassed NHS?”
There are two related fears. The first of these is that doctors will be motivated to offer assisted suicide in order to save money for the NHS. For example, doctors might underestimate how long a patient would be likely to survive, where the patient has an existing costly disability or medical illness. The second fear is that allowing assisted suicide would lead to resources being siphoned away from palliative care. Why bother investing in palliative care if terminally ill patients have access to assisted dying?
It is not clear whether these fears would be realized if the Falconer bill were passed. Doctors’ ability to predict duration of survival for terminally ill patients is imperfect (though studies suggest that they are more likely to overestimate than underestimate survival time). It is hard to know whether doctors’ assessment of terminally ill patients would be influenced by cost-considerations, though such fears would apply equally to withholding/withdrawal of life-prolonging treatment in hospital. In a a very large study of end-of-life decisions in more than 3000 intensive care patients in 17 European countries, cost effectiveness was the stated primary reason for decisions in less than 1% of all cases. A recent report found that palliative care services in Belgium and the Netherlands, two countries that permit euthanasia, were better developed and resourced than in neighbouring European countries that prohibit euthanasia. Belgian funding for palliative care grew by 10% per year in the five years after introduction of a law permitting physician assisted dying.
However, it is important not to dismiss these fears. The medical profession and politicians must pay heed to the voices of disabled individuals, who frequently feel marginalized and devalued by the rest of society.
Yet, there is simple a way to avoid the potential economic concerns outlined above. We could ensure that provision of assisted dying cannot save money overall for the health system, and cannot lead to reduced availability of palliative or social care. Additional (on top of current) funding for palliative care and social care would be tied to provision of assisted dying. For every patient that chooses assisted dying, additional funds would be provided from specialist commissioning services to regional palliative care.
Society should not be attempting to save money by providing assisted suicide for terminally ill patients. That is not the motivation of the many who have spoken out in favour of the Falconer bill. There is an easy way to prove it.