Elusive Trope's picture

    Footing the Bill for Assisted Suicide

    One of issue that will become increasingly debated over coming ten years, in part due to the aging baby boomers, will be the legalization of assisted suicide

    It is already legal in places like Oregon and upheld (surprisingly) by the US Supreme Court.

    Under the law, a competent adult Oregon resident who has been diagnosed, by a physician, with a terminal illness that will kill the patient within six months may request in writing, from his or her physician, a prescription for a lethal dose of medication for the purpose of ending the patient's life. Exercise of the option under this law is voluntary and the patient must initiate the request. Any physician, pharmacist or healthcare provider who has moral objections may refuse to participate

    In Massachusetts, where a similar bill was defeated at the polls in 2012, one of the arguments

    A group of disability rights advocates called Second Thoughts came out in opposition to the measure. Disability activist John Kelly leads the group. According to Kelly, when commenting on the measure and Oregon, who administers "Death with Dignity": “Some people may ask why disabled people are speaking out about problems with a proposal that’s supposed to be about terminal illness, but when you look at the reasons Oregon reports for giving lethal prescriptions, it’s mainly about the social and emotional issues of becoming disabled, like depending on others and feeling like a burden.”

    The infamous slippery slope is, of course, what sums up a good deal of people's problem with the notion of assisted suicide becoming legal.  As with many of our most complicated and complex social problems, where one draws the line is where the debate gets heated. One may be "okay" with people having the right to carry concealed firearms, but then draw the line at certain places where they shouldn't be allowed to do so, while others want no limitations.

    In the coming decade, the debate is going to move away from just the  "terminally ill" that will die in six months (or thereabouts) to those who are merely a former shell of their past selves.  Even putting aside our culture's increasingly obsession with maintaining the appearance of youth, when the mind and body has become a vastly diminished remnant and, although we can keep on hanging in there for decade or two, some may decide it is time to check out.

    The insurance companies I imagine would love to push the line on such limitations, since most of us will be stay in there for those few decades with the help of this or that group of pills and medical procedures. 

    Now in the case with Oregon,

    An independent study published in the October 2007 issue of the Journal of Medical Ethics reports there was "no evidence of heightened risk for the elderly, women, the uninsured, people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations."

    But if the line starts to move, these "heightened risks" may start to show up.  As someone who has suffered from severe depression, having access to a physician who would put an end to the seemingly endless suffering has, even recently, seemed like a fine idea. 

    And with something like chronic and severe depression, again the insurance companies would be more than glad to foot the bill for a one time fix than continuing to cover costs for therapy and pills and hospital visits. 

    Which brings us to the Hobby Lobby world. While contraception is one thing, footing the bill for someone with depression or a severe disability with which others have come to find a way to live a "good life" is another thing.

     The measures pushing for the legalization of assisted suicide tend to have in one way or another "death with dignity" at the forefront. Which is another way of saying that the life one has to look forward towards is one without dignity.  And who really can say that they can claim their definition of what a life without dignity entails for another person. 

    Is it just not ethically wrong, but legally wrong, for you to say you aren't going to participate in some form of assisted suicide by denying your employees insurance that is more than happy to foot the bill?  Should you, if you find yourself  owner of a business, have that right to impose your spiritual, religious, or value judgment on your employees who faced with some impairment or distress that drives them to just put an end to the lack of dignity which they feel just not now, but unending til the end comes?

    I doubt the line will be pushed back much in the coming years, but once more and more states legalize it, which I do see happening, there will be the push to start moving that line.  And there will be those out there, maybe not physicians, who will be more than willing to assist those borderline cases, where someone finds themselves, whether a burden to others or not, just facing that life without dignity.  The only question is who is going to foot the bill.


    I was going to get into the ethics of suicide here but let's save that.  Whether it's birth control, suicide or my new annual right to a physical without a co-pay, my employer is not really the only paying for it, even if I buy my insurance through my employer.  What my employer is doing is selecting the insurance provider.  Even if my employer decides to pay 100% of the premiums and additional expenses of the plan, it is not really my employer who is buying the service.  The health insurance is, on whatever terms my employer sets, part of my compensation.  My employer should be no more concerned with how I use my health benefits than it is with how I invest my 401(k) money, including matching contributions.  Heck, it should be no more interested than it is in how I spend my cash wages.  It's all just compensation.  Whether it's used to buy birth control, tobacco stocks, euthanasia or a six pack of Coor's, it isn't the employer who is paying, it's the employee.

    I guess the point here is that it is compensation.  As someone who has worked on the budgets for organizations where the need to find line items to cut or reduce, I can say that compensation can be one of the biggest expenditures of the various line items on the budget. 

    I can also say that when compensation is reduced, one is usually greeted less than happy campers on the part of staff.  Unless it is somehow in writing, there is a implicit understanding that the compensation - esp. health care benefits - are as untouchable as salary.  Reduce the compensation by 10% can be even more enraging than reducing the salary by 10%.

    So even if the employer is paying, say 20% of the premium, that is resources that cannot be spent elsewhere.  Its sole role is to keep the employees happy so one doesn't have a problem with turn over.

    I haven't owned my own business, so can't speak from that experience, but even as just an employee I have certain sense of ownership (that is, I want to the organization to be successful) of those resources and how they are spent.  I work as the others do to basically put resource into the pot to be then spent however it is deemed to be spent.  So even from that perspective, if my efforts at doing my job create the financial resources which are in part used to cover the health insurance then I am directly involved in this.

    If there is an option between a cheap policy that covers a particular list of medical procedures that includes a very broad range of assisted suicide and a more expensive policy from another company that does not cover such a thing, if I go along with the cheaper policy than whether I want to face it or not, I am participating in the possibility that it will be used.  I basically saying "here's the bridge, jump if you want to."

    If I as owner, or the individual who has final say in which policy is chosen, then my responsibility is even greater.  I am making a decision to use the organization's resources to make it easier for the individual to leap from that bridge.  If I, as chief decision maker, or as part of some committee of decision maker, go along with it than I bear responsibility should the person use their policy in such a way such as assisted suicide.

    Of course, if it is legal, the person who chooses it (or for their severely disabled child if the line get pushed back that far) has not only the legal right to utilize those services, but bears the greatest part of the responsibility.  But the issue here is whether an employer (or say even a majority  of the staff) can step in say, "No. I (We) will not be a party to this."

    This is one of the reasons why I am against employer-based health insurance systems. It brings others into the mix when they really don't belong there.  [We should have in an ideal world a system where contraception, including the morning after pill, is accessible to anyone who wants it, regardless of their financial resources.]  But I don't see the employer-based system going away any time soon, definitely not as quickly as "death with dignity" starts to become more commonplace. 

    Personally I don't want to be part of someone's decision to utilize assisted suicide services.  There are lines where I think it is appropriate and where it is not.  These lines are as controversial as where along a pregnancy abortion is considered a legal option.  But the reality is that I might find myself involved, in a sense as responsible as a consumer in a way as if I decide to buy something at Walmart instead of a local place because it will save me a few bucks.

    "If there is an option between a cheap policy that covers a particular list of medical procedures that includes a very broad range of assisted suicide and a more expensive policy from another company that does not cover such a thing, if I go along with the cheaper policy than whether I want to face it or not, I am participating in the possibility that it will be used.  I basically saying "here's the bridge, jump if you want to."

    It's true.  But, say I work for you and you pay me all in cash -- no benefits whatsoever.  Now I can do anything that I can pay for with cash.  Would you attempt to limit my cash compensation to purposefully keep certain purchases out of my reach?

    No I wouldn't try to limit the ways in which you spend your cash, and the Hobby Lobby decision doesn't say that people who work for them can't use their cash compensation for access to the services they are against. 

    Of course the Supreme Court has made it so rich families, like those that own Hobby Lobby, can spend their money to support initiatives, politicians and such that would limit your access to those services, but that is another issue. 

    As a consumer, one can also choose not to give your cash to places like Hobby Lobby. 

    I suppose one point of the blog is that is easy to get all riled up about the Hobby Lobby decision because what is being denied is a medical service one believes to morally or ethically okay.  But one can see legitimate scenarios where, say a very liberal person, can find the decision to be a positive.  That is why I chose assisted suicide, because it is one which tends to cross over simple classifications of liberal/conservative.  It is also one which I think should be legal under certain circumstances, but also understand the slippery slope fears it generates in people.

    I see where you're going and I think it's interesting. My feeling, though, is that cash and non-cash compensation are not really all that different in terms of who owns the comp once the work has been done.

    For example: a good portion of my pay goes to rent my apartment every month.  It's a fixed expense and if I don't pay it, there's not much point in me doing the work.  If my employer offered me my current rent as a rental subsidy and took it out of my pay, it wouldn't make much difference to me.  I would also not say that my employer was paying my rent under such an arrangement.  I would say that if my employer wasn't the one transferring money to the landlord that I'd expect my employer to transfer that money to me so that I could fork it over.  I think that under either scenario, I am still the spender.  I see no difference, in terms of who is responsible for what, if I use my health insurance to finance my own euthanasia or, more preferably, youth in Asia.  My employer isn't paying for it.  I am.


    I see your point and in general agree with you. The issue at some level is at what point does the government have dictating to me how I choose to compensate you.  Say for instance I agree to subsidy your rent, but you are currently living in a place operated by a corporation that wiped out a community garden to build luxury condos. I should be able to say, look if you want the subsidy you're gonna have to find a new place to live because I can't in good conscience write a check to that corporation.  You can then choose to quit or move.  If you quit then I have to deal with finding a replacement for you and all the headaches that come from a turnover in staff.  The government shouldn't be able to tell me I have to subsidy your rent regardless of where you live, as long as there are comparable places for you to live that I am willing to subsidize.

    Of course, I should have to make this qualification upfront so you can choose to go along with my view of compensation or go elsewhere for a job. 

    So I would say that it is probably just best that compensation be just "cash" and the employees free to do what they want with it.

    If you're going to look at it that way its the government that is doing the subsidizing. Our current system of business supplied health care is due to the tax breaks companies get. I'd be fine with no employer mandate or regulation if corporations didn't get a tax break. You want the tax break, here's the health care you must provide to get it.

    My dog is like a child to me but I can't claim her as a dependent. Theoretically religions are not allowed to engage in politics to get all sorts of tax breaks. If they engage in politics they are supposed to lose those tax breaks. There are trade offs and corporations like Hobby Lobby want it to favor them both ways.

    The government in this country is technically a representative one. It makes the laws (including through referendums and initiatives pushed by citizen groups). The point would be I can choose to some degree where I work, but I can't choose my citizenship.  So if the government makes something legal as a medical procedure to be covered by insurance, than I should have access to that procedure through my insurance (which should be through sliding scale etc equal across the board). 

    If you want to be claim your pet as a dependent and there is enough of your fellow citizens who agree, then get the law changed.  That is the way is suppose to work.  And maybe some who agree with that do so out of some religious or spiritual belief, but that is not religion engaging in politics.  If a church or whatever, as organization, gets involved to push the measure through than that is engaging in politics that is against the tax code. 

    The Supreme Court made the distinction in their ruling that it only applies to closely held corporation - in other words, a corporation like GE or Boeing can't do the same thing.  When the corporation is basically owned by individuals or families, than they can act as individuals as their religion dictates them to act.  It doesn't mean I agree with their beliefs and won't be supporting Hobby Lobby knowingly.

    This is in part of the Supreme Court viewing corporation as individuals, of course, which I also disagree with, and it is likely that this will start to expand to other corporations.  But large corporations do want to attract the best of their fields for their top jobs, so it is also likely they will stay away from following Hobby Lobby lead on something like this for fear that they will lose some of their best to other corporations that don't insult their sensibility.

    So if we meld the Hobby Lobby decision with assisted suicide we get a legal opinion where an employer and/or health insurer decides when an employee as serious mental and/or health issues that can't be cured, they should be retired from the human race so as not to be a burden to the rest of society.

    That's not true.  If we meld the Hobby Lobby decision with assisted suicide, it merely says that closely-held corporations can "be exempt from a law its owners religiously object to if there is a less restrictive means of furthering the law's interest."  So if on "religious" grounds, one objects to suicide, assisted or not, than that entity has the right to find a way to meet the demands of the law that allows them to avoid participating in the law if they can find a way that still furthers the law's interest (e.g. providing insurance).

    A denial of medical service or product through withholding of financial resources is vastly different than using the organization's financial resources to compel someone to use a particular medical service or product.

    You're avoiding the financial incentive the Hobby Barn decision and assisted suicide offers both a corporation and health care insurers to make the move. It is possible the legal decision and the financial incentive of assisted suicide will merge in oh so subtle ways that corporations and health care insurers are all too well at playing on an unsuspecting public.

    In my original blog, I state that the insurance companies would most likely embrace assisted suicide (as they probably secretly embrace those who do it unassisted now, saving them all those costs of trying to prolong someone's life through expensive medical costs).  And if a corporation sees a financial incentive to push what is legal onto their employees than that is their right whatever the incentive (which is one reason why we should get them out of the mix in our health care system).

    If it the public is unsuspecting - then whose fault is that really. At some point we have to put the responsibility on the individual. I doubt there are those who chose to go the route of suicide because of terminal illness who don't give it much thought. And in this day and age of info overload there are plenty of people and groups out there on all sides willing to put their two cents into it. 

    But so far in places like Oregon, the evidence seems to indicate that this "subtle merging" isn't happening in any significant way yet.  With emphasis on the "yet."

    There is news on the Alzheimer's front this week: simple assessment tools that test smell recognition and other easily tested parameters to provide early diagnosis. Since there is no parallel treatment (simple or no) that accompanies this news, I am left wondering why this is is welcomed as good news. There is no effective treatment, and so what does one do with the information?

    My fantasy about suicide (if one can call it that) is this:  if I found out that I had a degenerative mental disease, and had x years to live productively, I would like to take a poison pill that would not activate for x years. That way I could enjoy my life knowing that once I lost my ability to make rational decisions I would die at a certain time and not waste away in a home. Of course, in the event of a cure there would be an antidote that people on the "registry" would give me if I was too far gone at the time. REMEMBER, this is a fantasy!

    The cost of assisted suicide seems negligible to me compared to the palliative care that people who would desire to end their lives would otherwise require. I don't understand the concern about the cost aspect, really. Don't get me started on what one's employer might say. As to the moral argument, see my fantasy above. 

    There are those who see suicide as a "sin" - however one wants to define it. In this culture of America we have a general weirdness, if that's the word I'm looking for, about death.  Mainly because we really don't want to face the whole mortality thing (see our quest for perpetual youth). Throw some "religion" into the mix and assisted suicide freaks a lot of people out even when it has nothing to do with them. 

    The cost is more about keeping people alive when they would otherwise die quickly 99% of the time. So they go through all the procedures and use the machines that go "bing" (to use Monty Python) in some hope for a cure or at best prolong the person's life for another month or two.  What right does society, or even family members, have to tell the person they can't be assisted in bringing the end that is obvious to the here and now, and have to go through this awful stage until modern medicine can no longer prolong it.

    Regarding your fantasy, in real life we can a lot of times see this moment coming in the near future.  I should be able to dictate when I reach what ever point, I can go down to my physician and say, "that's it for me Doc." Andset an appointment for a month or whatever down the road, and postpone as I see fit. 


    Thank you for a thought-provoking post, Elusive Trope, as well as for eliciting interesting commentary.

    I found this article regarding financial motivation for insurance companies, etc. to be useful.

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