Dying for Money?

Compensated physician-assisted death could reduce end-of-life health care expenditures and reduce pain and suffering.

When abortion was illegal before Roe vs Wade, people with means went abroad to have the operation done legally. Today, physician-assisted death is illegal (see update below), and the hopelessly ill who want to exit early have no foreign country to go to for the service.

Because physician-assisted death is illegal, the hopelessly ill who are unwilling to resort to desperate attempts to end their life must endure needless pain and suffering, undergo futile treatments, and drain the Social Security coffers.

There is no question that an earlier exit will help contain the seemingly uncontrollable health-care costs. It is estimated that 25 - 35% of Medicare expenditures in any given year go to only 5 - 6% of those enrollees who will die within that year, and that 46% of health-care costs in the last year of life are spent in the last 60 days. Long-term care costs range from an average of $15,000 a year for home care to $60,000 a year for high-quality nursing-home care. Government budget deficits, corporate balance sheets, and the welfare of the hopelessly ill would all be improved if physician-assisted death were legalized.

But those who choose physician-assisted death should be compensated because they are giving up a de facto property right¹ to entitlements. This compensation could be in the form of converted death benefits equal to, say, 60% of the projected entitlements the volunteers would have received if they choose to die a slow death instead.

Converting benefits for greater efficiency is based on a well-known economic principle. Namely, a consumer is better off, or at least no worse off, if a payment in kind can be converted into an equivalent amount of cash that can be used to buy anything the consumer chooses. One reason why this principle has not been widely used to reduce benefit over-commitment is because recipients are not trusted to exercise the freedom wisely.

Another important reason why benefit conversion has not been used is because of a failure for policy makers to recognize the de facto property right of the insured patient to the benefit. This de facto right exists because it is expensive for the insurer to determine whether a course of treatment demanded by the insured and the treatment provider is really necessary.

If dignified death with benefit conversion saves resources, wouldn't dignified death alone save even more? After all, the procedure of converting benefit itself would use up resources that could be directly redeployed in its absence. First, absent the benefit conversion, there may not be enough volunteers to form a critical mass needed to reduce the insurance premium of the average insured. In addition, unless the wishes of volunteers are taken into account, the saved resources might instead be devoted to more futile treatments for those who should have chosen but refuse to choose dignified death. Also, refusal of futile treatment does not even reduce the refuser's insurance premium.