I told you so. I have said for almost as many years as I have engaged in anti assisted suicide advocacy that eventually killing (ending life) would come to be seen as a splendid way to save money in health care. I used to have HMOs in mind in making that argument. But now, it seems that single payer systems may be the greater danger.
Vermont has passed a single payer health plan–but hasn’t figured out how to pay for it, as I mentioned here previously. An editorial has come up with two “pragmatic” ways to cut costs. Yup, one is assisted suicide. The other is explicit health care rationing–which I have also written flows naturally from single payer systems in difficult economic times. From the Addison County (VT) Independent editorial:
Money must also be saved in services delivered to people with chronic diseases and those who frequently use emergency rooms, he said; two areas in which the community at large must help play an important role. Passing a law that allows physicians to help end a patient’s life under very controlled circumstances, known as “death with dignity,” is one such measure that could help (an effort was tried this pass session but postponed until next year). Another is approving some type of rationing measures, as Oregon has done, that help control health care costs.
Exactly. And you’ll end up with expensive care being denied in Oregon–but patients offered assisted suicide–as happened to cancer patients Barbara Wagner and Randy Stroup under Oregon’s oh, so “compassionate” law. And the editorial ludicrously talks about restricting heart transplants for 92-year olds–as if all those near-centurions are getting all the organs. What a joke.
Some are willing to dismantle Hippocratic medicine by tossing the sickest out of the lifeboat and legalizing doctor-prescribed death as a way of saving money and promoting “pragmatism.” I am not. VT opponents of assisted suicide, raise this editorial as a battle flag and defeat the threatened culture of death.
July 19th, 2011 | 2:16 pm
I heard someone is trying to remake Logan’s Run, perhaps it could not have come at a better time?
July 19th, 2011 | 2:38 pm
[...] Pig Is a Dog Is a Boy: The Human Cost of the Animal Rights Movement (Encounter, 2010). This column originally appeared at Smith’s blog Secondhand Smoke. Share this [...]
July 19th, 2011 | 4:43 pm
The fairy tale about the nonagenarian who supposedly received a heart transplant originally came from Hillary Clinton during the Clintoncare debates over 15 years ago. She was citing him as an example of how the medical system as we know it wastes money. (I believe she also claimed the old guy had Alzheimer’s and was in a nursing home, and Medicare and Medicaid paid the full cost of the transplant.)
Seems this urban legend still has legs!
July 19th, 2011 | 8:41 pm
Wesley:
This past Sunday, while railing against what you term “the solipsism of transhumanism,” you wrote: “Ah, the old transhumanist lament: We’re inadequate in every way, and we don’t live long enough. But just as a lake or pond needs the regular infusion of fresh water to remain healthy, society needs generational change to keep from becoming reactionary and stagnant.”
Here it is Tuesday and you’re arguing that the head of Vermont’s health care system used the dreaded “R” word — although he mentioned it in the context of a question (which you conveniently eliminated in your diatribe against him): ” [S]hould we, for example, provide extraordinary end of life measures in surgery, such as heart transfers, for 92-year-old patients?”
Hadn’t you better make up your mind? Or do you take some perverse pleasure in holding two fundamentally opposing opinions simultaneously?
HW
Wesley J. Smith Reply:
July 19th, 2011 at 8:55 pm
Really, HW? That’s a serious question or just your frequent trollism? They are not mutually exclusive. In fact, they deal with different issues altogether, e.g. keeping people from efficacious medical treatment and/or permitting them to be killed to save money and seeking vastly expanded life spans through various technologies and redesigning progeny.
HistoryWriter Reply:
July 20th, 2011 at 7:10 am
@Wesley J. Smith,
It’s a serious question. Do you consider giving a heart transplant to a 92 year-old man “efficacious medical treatment,” or an unnecessary allocation of resources to extend life? Your past postings on this subject indicate that you have no great love for solipsistic “life extension.” Let me ask you this: if Terri Schiavo had developed a cardiac problem do you believe it would have been appropriate to perform a heart transplant in order to keep her alive?
Oh, by the way, you can call me a troll any time you like. It does, however, seem a rather juvenile way to handle criticisms directed at your intellectual honesty.
HW.
HCM Reply:
July 20th, 2011 at 5:29 am
@HistoryWriter, And don’t forget, Wesley, that only a few decades ago, medical paternalism ran roughshod over any notion of “informed consent.”
July 20th, 2011 | 5:26 am
Assisted suicide is far more compassionate than terminal sedation, Wesley. And far harder to abuse, since informed consent is mandatory.
Les Reply:
August 3rd, 2011 at 8:43 pm
@HCM,
The difficulty in ascertaining if “informed consent” is indeed given is the degree to which depression plays a role in one’s desire for assisted suicide. I have known, and known of people, who celebrated live while dying and in pain. (Think Randy Pausch.) There are others who are as miserable as a Dickens character because a significant other dumped them. It is the height of hutzpah for someone else, even a “medical professional” to determine that someone’s life is “not worth living” and help them end it, something that they would be unlikely to do if the person seeking assistance in their suicide was “merely blue” from getting dumped or canned. Depression associated with either proximate cause is still depression. Effective and efficacious treatment of depression, a real and debilitating illness, should be pursued along with whatever other treatments are given a terminal patient.
July 20th, 2011 | 6:55 am
When life is no longer sacred, it won’t be just no longer sacred for that guy over there, but for all of us.
This is not a slippery slope. This is an either-or. That line either exists or it does not.
July 20th, 2011 | 9:52 am
History Writer,
Your accusation against Wesley for a lack of intellectual honesty here is invalid. You say he leaves out the editorial’s statement about the hypothetical heart transplant to a 92 year old when, in face, he refers to that statement in his second to last paragraph and offers his response there. He provided a link to the editorial for anyone who wants to read the whole thing and offer their opinion on his response.
As far as your accusation of hypocrisy in regards to rationing health care, Wesley uses the term “explicit” to refer to the type of government mandated rationing that he has written about on numerous other occasions. While I think he could have been more precise, he is hardly obligated to repeat his entire argument on that matter each time he writes about a related topic.
More to the point, Wesley has expressed on numerous occasions the philosophical, ethical and moral principles that guide his views on these matters. He is quite clear about the premises from which he makes his arguments. They form the foundation of this blog. You can, and, from all appearances, do, disagree with his premises, but if you want to accuse him of hypocrisy, you first need to do the work of explaining why his statements would be inconsistent within the context of the premises from which he operates.
Wesley’s reference to you as a “troll” is valid to the extent that you display a consistent pattern of employing ad hominem attacks against him. Asking him if he takes “perverse pleasure in holding two fundamentally opposing opinions” is an example of such an attack.
HistoryWriter Reply:
July 20th, 2011 at 3:43 pm
@Peter S,
Gee, Mrs. Smith, I’m impressed.
HW
July 20th, 2011 | 10:28 am
Now on to what I wanted to write about.
“Passing a law that allows physicians to help end a patient’s life under very controlled circumstances, known as “death with dignity,” is one such measure that could help . . .”
This sentence is a good example of what editorial writers of all (and I emphasize the “all”) stripes (ideological, political . . ., etc.) do, take someone else’s propaganda and repackage is as your own idea. That sentence could have come straight out of a Compassionate Choices brochure. The writer just dropped it into the middle of the paragraph as if none of its huge unstated premises merit discussion.
For anyone who cares, those premises are:
1. The administration of a lethal dose of a substance by a physician can be regulated and constrained such that it only occurs under “very controlled circumstances.”;
2. That a death induced by such means in these “very controlled circumstances” has some special quality of “dignity”.
This is another instance where I think Wesley is not obliged to restate his entire case against assisted suicide and the way it spreads to include ever more broad categories of human illness and suffering. For anyone who cares, he has provided links to other articles in which he addresses those issues. So, please, can the accusations of incompleteness or hypocrisy. It’s tiresome.
It is, however, hard to dispute that killing people is a cost effective way of solving their problems with suffering in this mortal coil, as well as the problems that others have with them. Almost sounds like a win-win.
(For anyone who is unsure, that last paragraph was indeed meant to be sarcastic.)
HistoryWriter Reply:
July 20th, 2011 at 3:51 pm
@Peter S,
“Killing people” (active euthanasia) is not the same as assisted suicide. But I think you already know that, as well as the fact that assisted suicide can, indeed, be both controlled and dignified. You are right about one thing, though: Wesley’s case against assisted suicide needn’t be restated time and time again. Repetition won’t make it any less silly than it already is.
HW
HCM Reply:
July 21st, 2011 at 3:21 am
@Peter S, Would you prefer they resort to more violent methods, and die alone? Because independence is something desired by everyone, not just by pro-choicers.
Choosing to die ‘naturally’ is still a choice.
July 21st, 2011 | 1:23 am
HW misses a great deal of what Wesley J Smith says and what he means to convey in what clearly are just ad hominem attacks.
Mr. Smith simply observed that his longstanding prediction based on his observations about human nature and the body politic have, once again, been proven accurate. I defy anyone to read the Vermont editorial and come to any other conclusion.
July 21st, 2011 | 7:12 am
It takes a morally-shriveled person to assert that assisted suicide is different from killing people. There’s a long-standing common-sense principle in moral philosophy that formal cooperation in evil is itself evil, in many cases equally as evil as the direct deed itself. This principle not only applies to strictly moral cases, but also to our jurisprudence. The obvious iconic example of this is that the getaway driver is equally guilty of robbing the bank, even if he never touched the loot before getting caught.
Back to the point of the article: this kind of rationing, to the point of assisted suicide, is the natural outcome (and very possibly the intent) of Obamacare. The latter is incapable of being repaired–it must be eradicated down to its roots, including the very idea that the federal government should be that deeply involved in health care, regardless of good intentions or attempts at good design. It can’t possibly work.
I have to hand it to the evil genius of Obama to have killed two birds with one stone. By stripping Medicare of a chunk of its funding, he ensures the early demise of many of us Medicare recipients, which in turn saves billions in Social Security payments! Don’t cry for this old bird–I’ll be OK. But I fear for the sake of my wife, and siblings, and friends.
Wesley J. Smith Reply:
July 21st, 2011 at 9:36 am
I defined “killing” in the post as “ending life.” It is entirely accurate. It is a proposal to use legalized killing, life-ending, as a means of saving money.
Joe DeVet Reply:
July 22nd, 2011 at 8:41 pm
@Wesley J. Smith, Wesley, I was not second-guessing your use of that or any word in this post.
July 21st, 2011 | 8:36 am
Also, Wesley, you too believe that the ends justify the means.
As long as we aren’t “killing” anyone, we can do anything we want to patients, correct? We can paint terminal sedation as “helping patients die” and place the blame on the disease rather than the doctor or nurse, right?
To me, that’s equivocation at its worst.
Wesley J. Smith Reply:
July 21st, 2011 at 9:34 am
No, we can’t. Palliative sedation, not terminal, is a legitimate pain controlling technique that should only be done with permission from patient or proper surrogate. You are a broken record (if you are old enough to understand that metaphor.) It is very unpersuasive.
HCM Reply:
July 21st, 2011 at 9:40 am
@Wesley J. Smith, But it’s also easy to abuse. Doctors who work within the system can easily abuse it.
And remember that Kevorkian was only convicted for active voluntary euthanasia, not assisted suicide (where drugs were provided to the patient).
Wesley J. Smith Reply:
July 21st, 2011 at 9:41 am
And that hurt the world, HCM.
HCM Reply:
July 21st, 2011 at 10:00 am
@Wesley J. Smith, No, it didn’t. It hurt the Religious Right, and other paternalistic busybodies.
The definition of paternalism I am using is this one:
the system, principle, or practice of managing or governing individuals, businesses, nations, etc., in the manner of a father dealing benevolently and often intrusively with his children: The employees objected to the paternalism of the old president.
There is nothing more inherently arrogant than saying “I know better than you.”
HCM Reply:
July 21st, 2011 at 3:41 pm
@HCM, And more importantly, my father’s own paternalism led to my suicide attempt. For me, boarding school really was nothing less than abandonment.
July 21st, 2011 | 3:22 pm
Certain leaders of the right-to-die movement have already made the connection between assisted suicide and health care rationing. Here’s Derek Humphry and co-author Mary Clement in their 2000 book Freedom to Die:
“Similar to other social issues, the right-to-die movement has not arisen separate and distinct from other concurrent developments of our time. In attempting to answer the question Why Now?, one must look at the realities of the increasing cost of health care in an aging society, because in the final analysis, economics, not the quest for broadened individual liberties or increased autonomy, will drive assisted suicide to the plateau of acceptable practice [emphasis mine]. As technology advances, as medical costs skyrocket out of control, as chronic diseases predominate, as the projected rate of the eighty-five-and-older population accelerates, as managed care seeks to cut costs and as Medicare is predicted to go bankrupt by 2007, the impetus of cost containment provide impetus, whether openly acknowledged or not, for the practicalities of an assisted death.”
This comes from a chapter in the book titled “The Unspoken Argument”; it’s apparently not unspoken anymore.
And HW and HCM should take note of this: If assisted suicide really does become a matter of cold government-controlled economics, it won’t be about personal autonomy anymore. Intrusive paternalism is just as bad when the government engages in it.
Wesley J. Smith Reply:
July 21st, 2011 at 3:29 pm
Yes, Kathleen. I am well aware of that book and chapter. They write about the billions that could be saved for people who can be cured and want to live.
HCM Reply:
July 21st, 2011 at 3:52 pm
@Kathleen Lundquist, Would you rather let millions commit suicide because of a lack of morphine?
Or lose out on kidney transplants (or bone marrow transplants for that matter)?
Kathleen Lundquist Reply:
July 21st, 2011 at 5:19 pm
@HCM,
With all due respect, what are you talking about? Where on the planet are “millions” committing suicide because they lack morphine? In what recent case has such a common pain reliever as morphine been refused by a physician to someone in need of it? (FYI, if you’re referring again to palliative sedation, with recent advances in pain management & pharmacology, it’s a much brighter line these days between true palliation and “pushing” morphine with the intent of hastening death.) If they can’t get morphine, can’t we give them Oxycontin? What do you mean?
And who is “los[ing] out” on a kidney transplant because assisted suicide is not legal (in your state, I assume)? Does someone’s continuing life prevent someone else from receiving a kidney or bone marrow transplant? A person can donate either of these without giving up their life to another – is there something I’m missing?
From your comment, I can barely imagine what caricature you have of my position (stated simply, I guess I’d say that euthanasia doesn’t make you free; it makes you dead). I’m interested in any answers you have to this question, though: What, in your view, is the best argument for our government to legalize euthanasia on demand (a la Belgium, the Netherlands, or Switzerland)? Would you say:
1) personal autonomy/individual choice,
2) the societal economic burden of caring for the ill,
3) to escape the presence or future prospect of suffering (from illness, disability, depression, poverty, abuse, whatever)
or some other reason? Do you support Derek Humphry’s view that personal choice issues notwithstanding, euthanasia for economic reasons is OK? What reasoning goes into your support of euthanasia?
HCM Reply:
July 22nd, 2011 at 3:36 am
@Kathleen Lundquist, The suicide rate is highest among the elderly. It’s not just due to a lack of morphine – it’s also due to a lack of personal choice.
http://www.suicide.org/suicide-statistics.html
Elderly (65+ yrs.) .5,393……….14.8………15.3……….0.3
If they could gain assistance, the rate of suicide among the elderly would fall.
And since I only advocate voluntary euthanasia, reason 1 (personal autonomy/individual choice) is the best argument to legalise it.
Don’t forget that doctors already know how to gain a peaceful death. Why should the rest of us be denied selfsame?
HistoryWriter Reply:
July 22nd, 2011 at 6:08 am
@Kathleen Lundquist,
I really wish you’d stop using the terms “euthanasia” and “assisted suicide” interchangeably. It only muddies the water.
There can be only one justification for suicide, assisted or unassisted, and that is personal autonomy. My life is mine, not yours and not the state’s. The moment I admit to some governmental or religious body’s having a superior claim to my life than my own, I become no better than a slave.
The “unalienable right to life” which we in America proclaim loudly and often to be one of the great benefits of our system of government, presupposes the unalienable right to end it on one’s own terms— just as freedom of religion presupposes the right *not* to worship.
HW
Wesley J. Smith Reply:
July 22nd, 2011 at 9:18 am
You are the one using a heterodox definition of euthanasia as involuntary. The only difference in debates is who takes the final act. I say that is ethically immaterial.
HCM Reply:
July 22nd, 2011 at 12:40 pm
@Wesley J. Smith, So you don’t care about a documented fact in Oregon, namely that 2/3 of patients who qualify don’t take the drugs?
HistoryWriter Reply:
July 24th, 2011 at 8:55 am
@Wesley J. Smith,
Not so. I think you’re attempting to broaden the definition of euthanasia to include assisted suicide, although the commonly understood definition of euthanasia is that it is involuntary.
Unless the act of suicide, whether by active or passive means, is unethical — and you have not established that it is — then it should not be unethical t assist it.
HW
July 22nd, 2011 | 2:04 pm
[...] Wesley J. Smith says “I told you so”: Vermont has passed a single payer healthcare plan with no means to pay for it – and the media is suggesting “death with dignity” and rationing as a means of meeting this obligation. [...]
July 23rd, 2011 | 3:46 am
Clearly, what constitutes a civilized, decent society, is never putting money above human lives.
As difficult as it may be, we have to find a way to ensure that everyone, regardless of income, age, or disability, has access to the same high quality health care.
These things are expensive, but it’s inconceivable that we could, morally, put a price on some one’s life.
thanks, Wesley for continuing to bring to our attention these issues, and for your continual courageous fight against the abuses, and potential abuses in our healthcare system.
HCM Reply:
July 23rd, 2011 at 2:53 pm
@Bret Lythgoe, The US could easily do so by reducing its military budget.
July 25th, 2011 | 8:57 am
Barbara Wagner and Randy Stroup were both on Medicaid. Had they not had state provided health care via that Medicaid, they wouldn’t have received the initial chemotherapy … so, of course, getting approval for subsequent chemotherapy for recurrences would be a moot point.
Medicaid provided the initial treatment for Barbara Wagner and Randy Stroup. This “single payer” health care extended their lives beyond what they would have had without it.
Clearly, we need more funding for (and less waste in) providing health care – and no one should ever be denied care – but I honestly don’t understand your views here. Would you have preferred that Ms. Wagner and Mr. Stroup not received any medical care at all?
And what do you propose for the millions of people in this country who go without medical care at all because of a lack of health care insurance? Should we just let them die when they get sick? And, if we do, aren’t we technically assisting them in involuntary suicide?
September 2nd, 2011 | 12:04 pm
[...] liberal advocates, such as the NYT editorial page, want explicit rationing. Along the same lines, rationing–and assisted suicide–are also being pushed in Vermont to help pay for its new … The Wisconsin Medical Association also pushes rationing for Medicaid. But why allow inconvenient [...]
September 9th, 2011 | 11:55 am
[...] in which the psychologist or psychiatrists are told not to be judgmental about suicide. A Vermont newspaper has promoted assisted suicide as a way to help pay for the state’s new sin…Family members support the suicides of their elderly loved ones’, and proudly proclaim their [...]
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