The promotion of death is big business in the United States. The abortion industry alone generates revenues of nearly $1 billion annually. Now there is also a movement to reduce health care costs for the very elderly or terminally ill through the premature termination of life -- or euthanasia.
As Pope John Paul II so clearly stated in his encyclical "Evangelium Vitae": "[W]e are facing an enormous and dramatic clash between good and evil, death and life, the 'culture of death' and the 'culture of life.' We find ourselves not only 'faced with' but necessarily 'in the midst of' this conflict."
Thousands of people currently make their living destroying unborn babies. It is not compassion, but money that is the driving force. Does anyone think LeRoy Carhart travels from Nebraska to Germantown, Md., each week to perform late-term abortions because of his empathy for pregnant women? A second- or third-trimester abortion can be priced between $1,500 and $10,000. Depending upon the child's age in the womb, there are large sums to be made.
In 2012, approximately 1.2 million abortions were performed in the United States, 88 percent of them in the first trimester of pregnancy. According to average costs published by the Guttmacher Institute, these abortions generated more than $500 million in fees. The remaining abortions were performed after 12 weeks of gestation. Although average figures are not available for these later-term procedures, it is not unreasonable to estimate that they provided more than $400 million in additional revenue. With fewer than 1,800 providers of abortion in the nation, and only about 200 who will perform one in the third trimester of pregnancy, the financial incentives for terminating the lives of the unborn are alluring.
Among abortion providers, the Planned Parenthood Federation of America is a giant. In fiscal 2011-12, it performed 333,964 abortions, which is more than one-quarter of all abortions in the nation. This dominance probably will expand, as the organization has increased its emphasis on feticide in its business approach. It has issued a mandate that each of its affiliates must have at least one clinic offering abortion services by 2013, while clinics that do so are given monthly abortion quotas.
Planned Parenthood is being abetted in its life-destroying activities by the federal government, and to an increasing degree. In fiscal 2008-09, when the Obama administration took office, the organization received $363 million in federal funds. In fiscal 2011-12, it received $542 million. Given the president's frequent, very favorable comments about the organization in the recent election campaign, taxpayer support is likely to escalate.
While the business of procuring death at the beginning of life is well established, it is in a nascent stage at the latter phases. Under the guise of terms such as "compassion," "human dignity" and "quality of life," the very elderly and the terminally ill are becoming subjects for euthanasia. The emphasis here is on cost reduction, rather than revenue generation. It is more economical to help people die prematurely than to provide treatment or palliative care for an indefinite period.
Euthanasia currently may be more prevalent in Europe, but it is increasing in the United States. It takes several forms. In Oregon and Washington, it is legal for a physician to prescribe a lethal dose of medication so that a terminally ill person can voluntarily commit suicide. Several states, including New Jersey, Massachusetts and Vermont, are considering similar legislation.
A second approach is involuntary euthanasia, which substitutes another person's judgment for that of the patient. In 1976, the New Jersey Supreme Court sided with the parents of Karen Quinlan, who was in a long-term coma, that her life-sustaining equipment be removed. Although done, she remained alive for almost another decade. In 2005, a Florida court ruled that Terri Schiavo, who also was in a lengthy coma, should have her feeding tubes disconnected at the request of her husband. She literally starved to death over a two-week period.
A third approach -- and perhaps the most callous -- is nonvoluntary euthanasia, in which a third party makes a decision about whether a seriously ill person should receive life-saving treatment or only palliative care. In England, the National Health Service (NHS) conducts a program called the Liverpool Care Pathway, which provides the elderly and terminally ill with end-of-life care while discontinuing therapeutic treatment. More than half of the participating hospitals receive stipends for each person they place on the list, which calls into question the objectivity of their medical decisions. In the Netherlands, doctors provide lethal drugs to people with chronic illnesses, depression, dementia and other forms of mental illness. A movement is under way there to make euthanasia available to any individual over 70 years of age who requests it. In the United States under Obamacare, there soon will be bureaucratic, cost-containment panels thatwill be empowered to determine a patient's eligibility for life-saving treatments.
Obamacare calls for the establishment of a Patient-Centered Outcomes Research Institute, which is to evaluate and compare health outcomes and clinical effectiveness, risks and benefits of various medical treatments or services. The purpose of the research is to allow the government to determine which regimens work best so that money is not spent on less effective approaches. The secretary of Health and Human Services is empowered to use that information to limit coverage or reimbursement for treatments based upon their effectiveness "in extending an individual's life due to the individual's age, disability or terminal illness."
One may gain insight into the role of such an institute by looking at England, which has had an equivalent organization, the National Institute for Health and Clinical Excellence (NICE), since 1999. NICE recently declined to approve the use of a new drug to treat advanced kidney cancer, even though it "met the criteria for being a life-extending end-of-life treatment." The drug's cost-effectiveness ratio in terms of health quality gained compared to money spent did not meet the agency's standard. Commenting on the decision, the NICE chief executive said, "We do not want to divert NHS funds to a treatment that costs more but doesn't help people live longer."
There are strong forces with significant resources promoting the business of procured death. When large sums of money are to be made through abortion, when "quality of life" is considered more important than life itself, when efficiency and cost containment become criteria for medical decisions, and when euthanasia becomes a therapeutic option for physicians, a culture of death rules. Life is no longer an unalienable right endowed by the Creator.
Lawrence P. Grayson is a visiting scholar in the School of Philosophy at the Catholic University of America.