DATILES: A price on your head

COMMENTARY:

In May 2008, Barbara Wagner received a chilling rejection letter from her health-care insurance company. Employing a dollar-saving tactic, Mrs. Wagner’s Oregon Health Plan denied coverage for medication that would treat her cancer and extend her life, but agreed to pay for less expensive medications to end her life.

Mrs. Wagner’s lung cancer, which had been in remission for two years, had returned. Her doctor prescribed medication which would cost $4,000 per month, but the 64-year-old retired bus driver could not afford to pay. Mrs. Wagner’s Oregon Health Plan administrators instead coldly offered to pay $50 for an assisted suicide. To them, that was all she was worth.

Mrs. Wagner and her family were devastated. “It was horrible,” she said, tears flooding her eyes. “I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor, and we will stand there and watch you die. But we won’t give you the medication to live.”

Oregon soon may not be the only state saving money by denying coverage for lifesaving medications and encouraging suicide. The State of Washington is considering a ballot initiative that would allow the same dollar-saving opportunities for health-care insurance companies. Washington Initiative 1000 (I-1000) would legalize physician-assisted suicide and allow Washington health-care plans to financially pressure vulnerable patients into “choosing” assisted suicide.

Disturbing? Unfair? Even - dare we think it - unethical? Of course it is. But to those supporting assisted suicide - euphemistically and disingenuously called “death with dignity,” that does not matter. And, if you are an over-strapped state with budget problems or a health-care insurance company looking to save money during the current economic crisis, it is a very tempting “quick fix.” And so today, it’s the citizens of Washington state being asked to put a price on the heads of the weak among them. But it’s not just the state that can profit.

As proposed, I-1000 allows patients to receive and self-administer lethal medications if they meet cursory, unprotective, and medically unsound prerequisites. But heirs looking to inherit early could participate in requesting lethal drugs for their parents, administer those drugs, and no one will ever question what happened.

For example, a written request for death-inducing medication could be witnessed by a person with a financial interest in a patient’s estate. Further, the proposed definition for “self-administer” would allow someone other than the patient - such as an heir to the patient’s estate - to administer the lethal dose. To top it all off, I-1000 does not require any witnesses to the assisted suicide. This leaves no assurance that a patient took his own life and someone else did not take it for him.

For those concerned with ensuring health care for the sick, protecting those in poverty from involuntary assisted suicide, and who would rather see the elderly cared for than knocked off for the inheritance, there is much reason for alarm.

I-1000 also requires physicians to falsify death certificates in cases of assisted suicide. Physicians must state the underlying illness as the cause of death and are prohibited from naming “suicide,” “assisted suicide,” or “drug overdose” as the cause of death. Thus, if an eager heir decides to facilitate a patient’s suicide, his tracks would be covered.

If that were not enough, I-1000 does not require family notification. Loving family members could be denied the opportunity to see and speak with loved ones who decide to prematurely end their lives. A patient’s husband or wife may not find out about their spouse’s decision until after their spouse is already dead and, even then, may not learn the true cause of death since the physician would be not be permitted to list “assisted suicide” on the death certificate.

This irreparably changes the standard of care for the mentally ill. Patients suffering from depression and other common, treatable mental illnesses are put in life-threatening danger by I-1000. Patients who request assisted suicide would not undergo routine psychological assessment or treatment. Rather, he would be given the “quick fix” - a prescription for lethal medications. Democratic Washington State Sen. Margarita Prentice has asserted “there is nothing to protect those suffering from psychological distress… [t]his very dangerous initiative would never have passed the legislature.”

Lastly, physicians are given absolute immunity from liability. According to the initiative’s “good faith” standard, physicians who are negligent, violate patient safeguards, fail to report assisted suicides or file inaccurate reports are completely immune from liability. The physician’s oath to “do no harm” would be obliterated.

If I-1000 passes in Washington, we can expect an immediate deluge of similar measures nationwide. In 2005, the Oregon-based assisted-suicide advocacy group, Death with Dignity National Center (DDNC), drew out a plan to export the practice of physician-assisted suicide beyond the borders of Oregon to the entire nation. That plan was called the “Oregon plus One” plan. According to this plan, if just one other state besides Oregon were to legalize physician-assisted suicide, it would start a domino effect and the country would soon follow.

The DDNC’s 2007 annual report revealed that the group spent the year “researching and collecting data to determine the state which is most likely to adopt a [physician-assisted suicide law]…. Through these efforts [they]… identified Washington as that state.” Since this determination, DDNC has poured all of its efforts into legalizing physician-assisted suicide in Washington, allocating $1.5 million in support of I-1000.

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