Physician-Assisted Suicide Is A Bigger Problem Than We Realize
Dovie Eisner was born with a rare genetic condition called nemaline myopathy. He requires a wheelchair and has a host of other health problems. Last year at one point, he stopped breathing, passed out on the street, and was taken to the emergency room.
'I was alive—thanks to the determination of law enforcers and local medical personnel to keep me that way,' Eisner wrote recently in UnHerd. But, he warns, a law being considered in his home state of New York 'threatens to undo this presumption in favour of lifesaving' that motivated first responders to keep him alive.
The bill, called the Medical Aid in Dying Act, would allow mentally competent adults with six months or less to live 'to obtain a prescription that would put them to sleep and peacefully end their lives.'
New York is not alone. Seventeen states—including Florida, Massachusetts, and Pennsylvania—are considering so-called 'death with dignity' laws. Eleven states and the District of Columbia already have them on the books.
Advocates say these laws spare the terminally ill from unnecessary suffering. But a closer look at Europe and Canada—where physician-assisted suicide has been legal and common for years—paints a darker picture. Far from providing peace to terminal patients, these laws are often used by government-run healthcare systems to nudge sick patients toward ending their lives.
The United States may not have a completely socialized system of medicine yet. But the government covers nearly half of all healthcare expenditures in this country. Over the past 40 years, its share of the nation's health bill has been growing, slowly but surely. At some point, it may have a financial incentive in hastening people toward their demise.
Around 8,700 Americans have died by assisted suicide since 1997, when Oregon became the first state to legalize the practice. That's around 300 people annually. For comparison, some 3 million Americans die every year.
In other countries, assisted suicide is a much more common cause of death. In the Netherlands—the first country to legalize the process, in 2002—more than 5% of annual deaths are due to medically-assisted suicide. In Canada, more than 15,000 people died by physician-assisted suicide in 2023—4.7% of total deaths.
Canada only legalized physician-assisted suicide in 2016. Until last year, the rate of assisted suicide north of the border rose around 31% annually.
The majority of Canadians choosing 'medical assistance in dying' are between 65 and 80. But the number of Canadians aged 18 to 45 opting to end their lives by MAiD has been increasing each year. There were just 34 in 2017—but 139 in 2021.
Those numbers are likely to grow as Canada continues to expand the pools of people eligible for physician-assisted suicide. The government has already expanded the law to include those who are not terminally ill but living in circumstances they themselves deem 'intolerable.'
Now, the United Kingdom is considering similar legislation. Last week, the House of Commons greenlit a bill that would allow terminally ill adults in England and Wales to take their own lives with a physician's help. The legislation is moving on to the House of Lords.
Proponents of these policies may characterize them as compassionate. But it's impossible to ignore the Canadian government's financial interest in having one less person who needs government-funded health care.
The Canadian government certainly acts on that interest in other ways—most notably by denying access to cutting-edge prescription drugs. Just 45% of new drugs launched worldwide between 2012 and 2021 were available in Canada as of October 2022. Eighty-five percent were available in the United States.
The Canadian government's calculus could apply on this side of the border. The federal government already pays for Medicare coverage for 68 million people. That number will grow as the population ages.
And Medicare has shown that it will restrict access to some forms of care, through its Coverage with Evidence Development framework. Some 22 devices, services, and therapies are subject to these restrictions, as of 2023.
Medicare defends those restrictions by saying it needs more evidence of clinical benefit. But some of those restrictions have been in place for a decade or more. A skeptic might reasonably wonder whether Medicare is holding back because of unspoken concerns about cost.
There's no doubt that medical assistance in dying will be effective—if the goal is to save the government money caring for the elderly.
We may seem a long way from legalizing physician-assisted suicide in the United States. But it wasn't very long ago that such a thing seemed unthinkable in Canada, too. Let's hope lawmakers stateside change course before it's too late.
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