I think an individual should be able to choose, and be assisted, to die peacefully and painlessly – provided he is of sound mind and is suffering from a terminal and painful illness.
But I am afraid that part of the building momentum for euthanasia in Europe is cost driven and not driven by a concern for the individual. Countries with aging populations and with well developed public health programs are facing increasing costs for the care of the elderly. In Sweden and the UK for example this care is often “out-sourced” or privatised. Many of these establishments are owned by risk capital companies – which is a little strange – but not fundamentally wrong. But the “quality” requirements they are required to meet are set by the public institutions doing the out-sourcing. Inevitably these “quality” requirements are specified in such a way that the out-sourcing succeds and contracts are let. To ensure this the requirements always allow the service provider sufficient room to make a profit. There is a clear incentive for the service provider to “increase the throughput” and reduce the cost per person they are tasked to care for. That – in turn – is leading to a deterioration in the care provided especially to the aged who are no longer competent or able to complain about the service received. It is clearly cheaper to allow a general reduction of service, and to only do more than the minimum if and when a complaint from a relative is received. Of course, relatives have only limited opportunities to notice any deterioration of service. The “out-sourcing” itself is driven by cost. There have been many “scandals” (such as this one) associated with the “quality” of service in “privatised” homes for the aged. But it is not by accident that the State and the municipalities and health authorities have pushed these scandals into the “privatised” sphere rather than to be found wanting themselves. Part of the reason for out-sourcing these services has clearly been to also out-source the scandals waiting to come as care of the elderly inexorably deteriorates. The more the care of the aged deteriorates the more attractive a voluntary euthanasia scheme becomes – for all parties involved.
I have a clear perception that in Sweden the quality of public medical and palliative care for the elderly is already driven by cost considerations. It is illegal in Sweden but age discrimination is endemic. We hear about procedures and expensive treatments being denied to the elderly for many ostensible reasons, but in reality because the patients are – in the judgement of the care-providers – just too old and too big a drain on costs. For public medical and palliative care, a form of unwritten age-discrimination is already in place. The aged patient has little recourse except to opt for private treatment and then euthanasia may be a much more cost effective solution..
The euthanasia debate is picking up steam in Europe but my fear is that though much of it is carried out under the guise of concern for an individual’s right to die, much of the debate is actually being driven by public health cost considerations. Many of the statements by politicians seem to me to be trial balloons or electoral posturing – but they have an underlying smell of preparing for curbing the costs of caring for the increasing number of the elderly.
It may be very cynical but I note that a healthy growth rate in voluntary euthanasia among the aged has many public and social and economic benefits. The cost of health care for the aged is both capped and reduced. The demographic of the ratio of elderly to working population is improved. Medical resources are freed for the more valuable, younger patients. And the aged patient gets what he or she wants.
A true win-win!
Euthanasia might be needed for poor people who cannot access palliative care, the new Lithuanian Health Minister has suggested. Rimantė Šalaševičiūtė was sworn earlier this month, but already she has made waves by backing an open discussion of the legalisation of euthanasia.
Without making any specific proposals, she told local media that Lithuania was not a welfare state with palliative care available for all and that euthanasia might be an option for people who did not want to torment relatives with the spectacle of their suffering.
The minister has also raised the idea of euthanasia for children. She noted that this option had been approved for Belgian children after a long public debate. It was an option which might be appropriate in Lithuania as well after public debate.
Ms Šalaševičiūtė will face an uphill battle in her campaign to introduce Lithuanians to euthanasia. Many doctors and the Catholic Church oppose it. Dr Andrius Narbekovas, who is both a priest and a doctor, and a member of the Health Ministry’s bioethics commission, told the media:
“The Ministry of Health should protect health and life, instead of looking for ways to take life away. It goes without saying that it is … profitable and cost effective … But a democratic society should very clearly understand that we have to take care of the sick, not kill them.”
Lithuania merely reflects the debate all over Europe which is probably most advanced in Belgium where even involuntary euthanasia (is that not murder?) has been proposed.
Politicians and many aged sufferers could find this irresistible: “Euthanasia is both profitable and cost effective”.
Two of my friends have utilised the services of Dignitas. So, for whatever reason it may come, I do hope that voluntary euthanasia is available to me when my time comes.