In 2008, when Oregonian cancer patients Barbara Wagner and Randy Stroup received letters from the state Medicaid program denying payment for prescribed and wanted chemotherapy and listing assisted suicide among the alternatives that would be covered, they were devastated at being condemned to premature deaths and angry at the infringement on their personal autonomy (http://abcnews.go.com/Health/story?id=5517492&page=1). Informed by the press of the huge cost savings of assisted suicide vs treatment, a significant portion of the public agreed with Wagner and Stroup, enough that, according to testimony given before the VT Senate Judiciary Committee in the spring of 2012, Oregon stopped offering to cover assisted suicide in its denial-of-treatment letters.
What was not stopped, however, was the rationing of health care that makes Oregon’s Medicaid program unique among the 50 states. Oregon is the only state with an overt, specific rationing program. The Oregon Health Evidence Review Commission (HERC) is a body charged with ranking health care services and deciding which will be covered and which will not, based on its perception of their benefits to the affected population.
In short, poor citizens of Oregon do not get to choose the type of end of life care they want. Experts choose for them. Of course insurance companies have always denied coverage. What is unique in Oregon is that assisted suicide is available as an alternative to treatment. It is cheap. It is always cheaper for a human being to cease to exist than to do anything else. Once legalized, assisted suicide is simply there, a pressuring presence in thought or conversation, especially at the end of life but not exclusively so, as is indicated by Oregon’s rising general suicide rate since legalization .
Below, in italics, is a post from the Medical Futility Blog (http://medicalfutility.blogspot.com/2013/08/oregon-starts-rationing-end-of-life.html) about HERC’s decision, at its August 2013 meeting, to change the criteria for restriction or denial of end of life chemotherapy from an expected two years’ life expectancy to the experts’ perception that a patient is too weak for chemotherapy or that he is not benefiting from it.
There is certainly a time to stop treatment aimed at achieving a cure for disease, when that treatment is futile. The problem in Oregon is that HERC makes the decision, a decision which in the end should be made by the patient after a frank conversation with a doctor who knows him well, a decision which should never be made under the cloud of legal assisted suicide.
Friday, August 9, 2013
Oregon Starts Rationing End-of-Life Treatment
Yesterday, at the monthly meeting of the Oregon Health Education (Sic) Review Commission, the HERC adopted restrictions on the type of treatment that cancer patients under Medicaid can receive. The new guidelines go into effect in October 2013.
An earlier revision said patients expected to live two years or less were to have restricted treatment. But that was revised to instead impose restrictions on terminally ill patients too weak to withstand chemotherapy or who have had multiple rounds of treatment and are not improving. So, if the patient’s organ systems are so fragile they are getting so close to the end of life, then they will not be eligible for treatment aimed at curing their cancer. But treatment for pain and nausea, including some surgeries and radiation, will still be covered.