Amory/Moody

Jack Amory & Drayton Moody

HLTH 361

Khoa Truong

9 December 2014

The Economics Behind Physician Assisted Suicide

Introduction/Background/Significance

In April 2014 Brittany Maynard, a 29 year old woman from California, was diagnosed

with grade 2 astrocytoma and told that she had 6 months to live. Maynard’s rapidly growing

brain tumor was putting her in excruciating pain and left her facing a debilitating, painful, and

certain death (Luscombe 2014). After hearing this devastating diagnosis, Brittany decided that

she did not want to spend the final weeks of her life suffering and made the move to Oregon to

employ the use of Oregon’s Death with Dignity Law. Maynard stated, “death with dignity is the

best option for me and my family” (Luscombe, 2014). Brittany Maynard took advantage of a

form of suicide known as physician assisted suicide (PAS). The Canadian Medical Association

defines physician assisted suicide as knowingly and intentionally providing a person with the

knowledge or means or both required to commit suicide, including counseling about lethal

doses of drugs, prescribing such lethal doses, or supplying the drugs (CMA 2007). Many times,

physician assisted suicide is confused with euthanasia, which is different in that euthanasia

involves performing an act that is intended to end another persons life. PAS usually takes place

with a lethal dose pill and is done on the patient’s own time, while euthanasia is an injection

usually performed by the physician. Physician assisted suicide is legal only in limited areas such

as Oregon, Washington State, Switzerland, and the Netherlands. The outlook on the continued

legality in these areas is uncertain, as many find the act unethical or not economically feasible.

With skyrocketing healthcare costs and with limited resources to pour into the system, the

implications behind a decision such as physician-assisted suicide could not be more relevant.

Society today places a focus on the moral consequences of medically ending an individual’s life

over the economics behind one’s choice. At the end of the day, the question ultimately boils

down to this: Is the moribund individual in charge of making his or her own rational decision at

the margin?

1

Amory/Moody

Specific Aims

This paper aims to analyze the benefits and costs associated with physician assisted

suicide. An analysis of how denying physician assisted suicide saps funds from the healthcare

system due to increasing costs will be covered. Furthermore, this essay addresses economic

choice, specifically focusing on the impact on the economy of the rich and the poor when faced

with whether or not to go through with PAS. Finally, the limited resources of our world are

discussed as we consider whose decision it is to deviate money from those who can be cured to

those on palliative care who wish to end their life. The focus of this paper is not on the morals

or opinions on whether it is ethical to offer physician-assisted suicide to the medically terminal;

it is about the economics behind allowing freedom of rational decision-making at the margin.

Conceptual Framework/Analytic Methods

In order to show the implications of legalizing physician assisted suicide, we will be

applying the economic concept of marginal benefit and marginal cost. Marginal benefit is

defined as the additional benefit from a one-unit increase in the activity, while marginal cost is

defined as the additional cost associated with a one-unit increase in the activity. As rational

consumers, we are expected to maximize our benefit by comparing benefit to cost at the

margin (Truong, 2014). The framework of this model is applicable to physician-assisted suicide

in that it allows society to see situations in which PAS would be necessary and economically

efficient. Another important concept used to show the side effects of legalizing or outlawing

PAS are externalities, defined as the side effects of production and consumptions that impacts

individuals not directly involved in the activity or transaction (Truong, 2014). Furthermore,

cost-benefit analysis is the most appropriate method to tackle PAS because it puts aside any

opinionated viewpoints and focuses on the economics of medically ending one’s life. While this

paper exemplifies the validity of legalizing PAS and the effect it may have on the economy, it

cannot change ingrained values and preconceived notions such as religious beliefs and moral

values. More specifically, the moral implications behind the procedure will continue to be

vague, as the economic advantages of legalizing PAS will not be able to override an individual’s

perceptions of right and wrong. Above all, the issue relies on society’s definition of suicide.

Many argue that physician assisted suicide may be the incorrect name entirely because it

2

Amory/Moody

includes the word “suicide,” which is a difficult argument to make when the individual is already

in excruciating pain from a terminal illness.

Results/Critiques

In the world of economics, resources are finite. There are a fixed quantity and quality of

resources along with a fixed level of technology. When care is given to one individual, another

loses the opportunity for that care. In the case of physician assisted suicide, forbidding those

with terminal illnesses to have access to physician-assisted suicide uses up valuable resources,

thus taking them away from other members of society. There are dramatic cost savings that go

along with legalizing PAS. When adjusted for inflation, the last month of end of life care costs

nearly sixteen thousand dollars (Emanuel and Battin, 1995). Because the majority of patients

who qualify for physician-assisted suicide require months of expensive medication and hospital

care to prolong their life, these savings are further intensified. According to a study done at The

University of Manitoba, 8.5% of terminally ill patients “acknowledged a serious and pervasive

desire to die” (Chochinov, Wilson, Enns, et al, 1995). Thus, adjusted for inflation, the

percentage of terminally ill patients who choose to medically end their life two months early

will save 7.28 billion dollars each year in medical expenses in the US (Emanuel and Battin,

1995). This drastic number exponentially increases the supply of available medical care in the

United States. According to the law of supply, as the supply of available healthcare increases,

the price of receiving that service decreases (Truong, 2014). Thus, physician assisted suicide not

only frees up medical resources such as medicine and hospital beds, but also increases access

into the system by lowering the monetary barriers of entry into the medical system.

Further economic motives can be brought to notice by considering a theoretical

example of an extremely wealthy, however terminally ill patient. In this situation, infer the

wealthy patient choosing physician-assisted suicide has the medical requirements necessary to

qualify. Part of the reasoning for this patient’s choice is their wish to leave money to his or her

family instead of spending it on healthcare. Adjusted for inflation and the steep rise in

healthcare costs, the average cost of end of life care is over fifty thousand dollars (Emanuel and

Battin, 1995). For this patient, the opportunity cost of the extra few weeks of life is not worth

the huge sum of capital it takes to sustain their life. In our world of limited assets, these

3

Amory/Moody

doctors, nurses, hospital beds, and other resources could be better put to use towards curing

an individual. Furthermore, It is important to note that even without this wish to bequeath

money to their family, the patient would not want to live any longer than absolutely necessary

due to extreme suffering caused by their condition. Society would likely not deny PAS to this

individual, even if the choice were made for solely economic reasons. Many may disagree with

the wealthy patient’s choice, but because the wealthy patient was competent and had

sufficient wealth to make the decision on their own, society would be less likely to object to his

actions.

Having examined how physician assisted suicide may impact society and the wealthy

individual, it is important to consider the same situation involving a terminally ill poor patient.

Unlike the wealthy patient, the poor patient’s family would not be left with enough money to

live decently unless the patient chooses PAS. This scenario is more unfortunate. Economic

motives may pressure the patient to take his life early, leaving many to believe that the poor

patient’s decision is not voluntary. Applying the economic marginal analysis model, however,

one can readily see that the patient is making a completely rational decision just as the wealthy

patient did. Denying an individual their freedom of choice does not fall in line with the

fundamentals of economics. Building on this, in many instances the taxpayer or medical center

is paying for the palliative care for poor patients. The exorbitant costs of end of life care now

have a twofold impact on the economy. The three factors of production, land, labor and capital,

are now not the only resources being consumed to keep a dying patient alive. The taxpayer

now bearing the economic burden in the form of an externality, meaning the individual’s choice

is impacting society. This economic externality further saps money that could have been used

elsewhere to stimulate the economy.

The first economic concern regarding PAS is that patients may feel pressured by their

healthcare providers to request physician-assisted suicide. These providers include their

physicians, hospitals, or any type of managed-care facility. Most plans that are managed care

receive their funding from employers that are self-insured (Mehlman, 2014). Managed care

plans are designed to reduce spending in two ways: either by keeping costs down for the

employer, or to save money by not using the full premiums. The organizations participating in

4

Amory/Moody

managed care plans use different methods to have physicians keep down spending on

members of the plan. These methods can be by sharing the risk or the profits, also known as

capitation, where a predetermined amount of money is kept from the physician’s fee and given

back to the physician at the end of the fiscal year if the desired fiscal efficiency is reached. This

may cause physicians to feel pressured to encourage their patients to participate in PAS due to

the massive saving implications.

A second concern is that patients will feel pressure from their own families to request

physician-assisted suicide. Families may pressure the patient into thinking that it would be best

for them to leave money behind instead of “wasting” the money on terminal care for

themselves. The patient may also feel that their families already spend too much or do not have

enough money because of unwise decisions. These fears may obligate the patient to help fix

those financial problems by ending their life with PAS. As mentioned before, it is estimated that

7.2 billion dollars could be saved each year by legalizing PAS, giving substance to the concern

that families may be able to pressure their family members into ending their life early (Emanuel

and Battin, 1995). If the patient does not have any form of life insurance, the pressures could be

even more prominent.

The final concern is that a patient may feel the need to request physician-assisted

suicide on their own without any type of push from their families and other relationships. For

many, this is not a concern as it comes down to individual beliefs about the issue. Is it unlawful

or unethical for the patient to decide to end their life early to avoid pain and save money? This

question is outside the realm of economics, and thus cannot be answered. From an economic

standpoint legalizing PAS is the correct direction to head in, as for many individuals the

marginal benefits outweigh the costs. Nevertheless, our world has many facets beyond the

economic realm so religious, cultural, and moral conflicts must be addressed as well.

5

Amory/Moody

Works Cited

Chochinov, Harvey, Keith G. Wilson, and Murray Enns. "Desire for Death in the Terminally Ill." American Journal of Psychiatry 152.8 (1005). Web. 3 Dec. 2014. <http://psycnet.apa.org/psycinfo/1996-92637-001>.

Emanuel, Ezekiel J., and Margaret P. Battin. "What Are the Potential Cost Savings from Legalizing Physician-Assisted Suicide?" New England Journal of Medicine (1998). Web. 3 Dec. 2014. <What Are the Potential Cost Savings from Legalizing Physician-Assisted Suicide?>.

"Euthanasia and Assisted Suicide (2007 Update)." Canadian Medical Association. CMA, 2007. Web. 3 Dec. 2014. <http://policybase.cma.ca/dbtw-wpd/Policypdf/PD07-01.pdf>.

Luscombe, Belinda. "The story behind Oregon's controversial Death With Dignity Act." Time. N.p., 8 Oct. 2014. Web. 3 Dec. 2014. <http://time.com/3481599/brittany-maynard-death-with-dignity-oregon-right-to-die-law/>.

Mehlmen, Maxwell J. "Economic Motives for Physician-Assisted Suicide." The Doctor Will See You Now. N.p., 2014. Web. 3 Dec. 2014. <http://www.thedoctorwillseeyounow.com/content/bioethics/art1976.html?getPage=4>.

Truong, Khoa. "Economics Lecture." Clemson University. 2014. Lecture.

6