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Reported Economic Benefit of Medical Aid in Dying Gives New Meaning to 'Lives Not Worth Living'
Heidi Janz, Ph.D.
Adjunct Professor, John Dossetor Health Ethics Centre, University of Alberta
For decades, disability-rights advocates have warned that the legalization of assisted suicide would inevitably lead to the increasing social devaluation of people with disabilities by strengthening the already-common ableist belief that a life with disabilities is a life not worth living. In the same vein, disability-rights advocates foresaw that, once assisted suicide became an accepted practice in Canadian society, it would soon start being seen as a viable alternative to costly, and ultimately futile, medical treatment. A widely-publicized report that appeared in the Canadian Medical Journal last week reads like an Orwellian fulfillment of those dire predictions.
According to this report, Medically Assisted Death could reduce annual health-care spending across the country by between $34.7 million and $136.8 million. These estimated savings exceedingly outweigh the estimated $1.5 to $14.8 million in direct costs associated with implementing medically assisted dying. The authors of the report explicitly stressed that the demonstrated cost reduction should not factor in to the decision-making process of either doctors or patients when considering end-of-life treatment options. Reading this directive, I could not help but see it as an obligatory, if parenthetical, attempt by the authors of the study to close the Pandora’s box that they’ve just opened, or at least to absolve themselves of any responsibility for the moral or ethical dilemmas that will inevitably arise from their heralding of Medical Aid in Dying (MAID) as a fiscally responsible option for people facing end-of-life. Given the present reality that Canadians’ demand for medical resources regularly exceeds the supply, resulting in long waiting-lists—and even, in some cases, the rationing of medical services—for the authors of this study to, on one hand, tout the economic benefits of MAID, while on the other hand, admonish doctors and patients to exclude these economic factors from their decision-making process when it comes to end-of-life care, is, at best, naïve, or, at worst, irresponsible and even cynical.
Living with severe and multiple disabilities is expensive. Thousands of Canadians with disabilities and their families know this all too well. Even those receiving “full” medical benefits under income support programs for people with disabilities often find themselves spending thousands of dollars per year on disability-related medical expenses. Additionally, many Canadians with disabilities are without the level of homecare support that would enable them to live independently in the community, and thus find themselves warehoused in long-term care facilities. It seems to me highly unlikely that either a person with disabilities facing end-of-life in such circumstances, or their doctor, would heed the admonition of the report’s authors and exclude the purported economic benefits of MAID from their decision-making process. On the contrary, I think it is more than probable that freedom from financial burden on the one hand, and efficient use of limited healthcare resources on the other, would be top-of-mind and would likely tip the scale in favour of Medical Aid in Dying as the ‘solution’ to these quandaries.
Thus, as we approach the first anniversary of the Supreme Court of Canada’s decision legalizing assisted suicide, it’s becoming increasingly evident that the slippery slope that disability-rights advocates warned of does, indeed, exist. More and more, the lives of people with disabilities are viewed as ‘not worth living,” in both psychosocial and economic terms. We, as a country, are now well into our downhill descent.