The law may say that assisted suicide is permissible only for people who decide on it because of physical distress, not economic distress, but economic considerations will inevitably play a role.
By ASHER MEIRBusiness ethics 88(photo credit: )
Can economic considerations lead institutions to encourage people to take their lives? This question was provoked by the 1973 movie Soylent Green, and more recently by the 2008 case of Oregon cancer patient Barbara Wagner.
Soylent Green is set in an overcrowded, underfed Malthusian New York City of the distant future. In 2022 (that was distant in 1973), 40 million people live in the city, subsisting primarily on meager synthetic Soylent rations of various colors, including the high-end Soylent Green.
The movie stars Charlton Heston as a NYPD detective; Edward G. Robinson plays his roommate, a cultured, elderly Jewish man (which is exactly what he was). In an effort to ease the overpopulation problem, the authorities encourage people to commit assisted suicide.
Fourteen years before the setting of the film, it seems that our society is already trying to come to terms with the fact that suicide can bring economic benefits, and the possibility that this could lead to encouraging people to take their own lives.
A decade ago, the prestigious New England Journal of Medicine published a study trying to quantify the savings from legalizing assisted suicide for terminally ill patients. The authors, though differing in their views on the practice, agreed that the cost savings would be at most a relatively "modest" $600 million each year.
But a recent New York Times article didn't agree that over half a billion 1998 dollars is such a small sum. They summarized the article as follows: "Supporters and critics of physician-assisted suicide agree on at least one thing: terminally ill patients who take an early exit save the health care system money."
On the practical side, it seems that death as an option for ill patients is already being packaged and offered for sale - at bargain prices.
When Oregon cancer patient Barbara Wagner requested coverage for a $4,000 a month drug that has the potential to prolong her life, insurer LIPA refused to cover the drug, but they had a counteroffer: they wrote her that they would agree to cover drugs for palliative care, or for an assisted suicide (at a one-time cost of $150). Oregon is currently the only state in the US where assisted suicide is legal.
The insurer declined to retract or otherwise limit their shocking letter. On the contrary, they stood behind the letter completely. The senior medical director explained that the insurer is required to point out the treatment options available to Wagner under the plan.
In his view, suicide "could be considered as a palliative or comfort care measure."
I don't know of any studies showing that dead people are more comfortable than living ones, or even what methodology could credibly establish such a result. But once suicide is given legitimacy as an option for ill patients, it is only natural that it will be framed as just another "treatment option" - a highly economical one. The natural result is that this "treatment" will not only be allowed, but also offered, perhaps ultimately encouraged.
I also think that it is impractical to legitimate suicide only for one narrow subgroup of people. The arguments for allowing, and ultimately encouraging it for ill patients, will inevitably be adapted to justify taking the lives of other people who find their lives unbearable for a variety of reasons.
I think the Wagner case supports this argument. The Oregon law allows assisted suicide only for terminally ill people, but given the potential for the expensive drug to considerably prolong Wagner's life, it is questionable if she can be considered terminal at all.
I do not mean in this column to debate the merits of assisted suicide per se. I am taking for granted that it is wrong for a person to take his or her own life, and certainly wrong for the commonwealth to encourage the practice by empowering physicians to help people commit suicide. In any case, medical ethics is beyond the scope of this column.
What I want to point out is that once the step is taken of allowing this practice, it is impossible to divorce it from economic constraints. The law may say that assisted suicide is permissible only for people who decide on it because of physical distress, not economic distress, but economic considerations will inevitably play a role.
In the sad and poignant scene where Sol Roth, the character played by Robinson, ultimately decides to end his life, the impression is given that it is not because of the difficult material environment, but rather due to the unbearable social environment in which life is cheap and there is a price tag on humanity.
Permitting and cataloguing suicide are not only reactions to a view that life is cheap; they also contribute to this view.
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