Attorney Margaret Dore has reminded us of a very important side story to the widely publicized Barbara Wagner case, in which the Oregon Health Plan (Oregon Medicaid) declined coverage of life extending chemotherapy for Ms. Wagner’s lung cancer in a a letter listing, among other options it would cover, physician assisted suicide ((http://abcnews.go.com/Health/story?id=5517492). After an explosion of negative publicity, the Oregon Health Plan, according to testimony given to the VT legislature, quit sending letters offering such stark alternatives. It does, however continue the practices it no longer dares to state: rationing care, favoring preventive care over care for the sick, covering assisted suicide, and refusing to cover treatment that does not have at least a 5% chance of producing a 5 year survival rate.
At the time of the Wagner story, Barbara Coombs Lee, the national spokesperson for Compassion and Choices, the group that has lobbied for assisted suicide laws for many years, wrote an op-ed defending the Oregon Health Department (http://www.margaretdore.com/pdf/Coombs_Lee_against_Wagner.pdf). Here is a quote from her essay:
As a publicly funded service, Oregon Health Plan aims to do the greatest good it can. It assigns a high priority to preventive care, health maintenance, and treatments that ofter (sic) a near-certain cure. Elective, cosmetic or ineffective, “futile” care is not covered. Futile care is defined as any treatment without at least a 5 percent chance of 5 year survival. “We can’t cover everything for everyone,” said the medical director of OHP. “Taxpayer dollars are limited for publicly funded programs. We try to come up with policies that provide the most good for the most people. “
From a utilitarian viewpoint that reduces a person to dollars and cents, this practice seems rational and necessary. We are, however, dealing with human beings, and True Dignity believes the numbers must be secondary to human needs, among them the need for the very autonomy in decision-making that the proponents of assisted suicide demand in their mantra: “My life. My death. My choice.” What about Barbara Wagner’s life, death, and choice? While a person wanting assisted suicide is perfectly capable of committing suicide without assistance, Barbara Wagner’s only chance to get her wish was the chemotherapy. Barbara Coombs Lee does not seem to support Wagner’s right to any choice except the cheap one of suicide.
The biographical note at the end of the article tells us that Barbara Coombs Lee has been a managed care executive. The real question here is who is going to manage medical care: an insurance provider, tax-funded or not, or the patient who is affected? Do we really want to tell patients like Barbara Wagner that we will not pay the $8000 it would have cost to give her a couple of more months of life that she, well aware that it would likely be no more than that, said she wanted and needed? After the publicity, the drug maker stepped in and provided the medicine. Wagner’s death three weeks after starting it could have been hastened by the stress and delay involved in getting it. The death certainly does not prove that the state was right in its denial, as Ms. Coombs Lee asserts, or even that the three weeks were not the gift of the drugs.
A physician whose comment you can read at the end of the Coombs Lee article wrote that there are methods of reducing runaway medical costs without impinging on patient autonomy. His suggestions are:
- Figuring out a way to reduce very expensive emergency room visits for care that could be provided by a doctor at less cost. Unfortunately, emergency room visits have increased, not decreased, since the adoption of Obamacare
- Encouraging healthy lifestyles that could prevent or delay chronic illnesses that are expensive to treat
- Providing incentives for people to use their health insurance wisely, perhaps by making them pay a greater percentage of the cost of tests like MRIs and CAT scans
This doctor says the end of life is not the time for cost cutting. He says that accepting the utilitarian viewpoint that judges the worthiness of living in terms of dollars and cents would logically lead society to refuse to pay for any cancer care at all. By that logic why pay for any care of the sick, since a human being costs zero dollars if he or she is dead? The doctor says that the end of life is the very time when people should be able to get the care they want. True Dignity was going to add “and that their doctors want”, but we are hearing from patients that the corruption of medicine under the influence of people like Barbara Coombs Lee and of programs that incentivize doctors to deny care is so complete that the patient now has to fight for his own right to live without help from doctors. We speculate that fear of doctors may also be contributing to the explosion, not only in emergency room visits, but in visits to urgent care centers, which are growing in numbers and making lots of money in taxpayer subsidized insurance payments.
True Dignity agrees with the doctor/commenter. Pundits, doctors, and medical ethicists who complain about and want to reduce spending at the end of life are disrespectful of the contributions every person has made during his life, by his relationships, his work, and his simple existence, but also by his payment of taxes and insurance premiums through many healthy years, made under the presumed existence of a social contract in which he expected to pay for sick people’s health care then and have his own paid for when he became sick. In many cases, retired people and poor people dependent on Medicaid continue to pay premiums. The optional Medicare Part B is not free by any means, and required Medicare Part A premiums continue to be deducted from pension checks for those of us lucky enough to have them. Medicaid also has premiums and co-payments, set by each state.
Are we as a society so divorced from centuries of custom and ethics that valued caring, and so sold on the Barbara Coombs Lee “managed care” “ethic”, that we are willing to use our laws to push suicide in order to save money? True Dignity continues to hope not, and so we continue our fight against legalization of assisted suicide.