by

Jane St Clair

Author of WALK ME TO MIDNIGHT

Fifteen years ago, Colorado’s governor Richard Lamm got himself in trouble by saying elderly people have “a duty to die and get out of the way.”

Lamm knew how much end-of-life care costs. About one-third of Medicare’s budget goes for costs incurred in the last one year of life, and 40% of that goes for expenses in the last one month of life.  It is so much cheaper if old people just do their duty and get out of the way rather than use hospitals, expensive tests and surgeries, and medications.

Congress knows this too, which is why they include Section 1233 in the proposed health care reform bill.

Under Section 1233, doctors get paid to sit down with all patients over 65 years old to talk about end-of-life issues.  The idea is to encourage people to sign living wills and enter hospices rather than getting expensive treatments. Since hospice provides only pain relief and palliative care, everyone else saves money. Under the new rules, you enter hospice when you have only 18 months to live, compared to today’s six months-- so this way you speed things along even faster for us.  In states where physician-assisted suicide is legal, end-of-life talks would no doubt include assisted suicide, the cheapest option of all.

The lawmakers  pushing cheap “end-of-life” healthcare call it the “complete lives system.” The idea is that old people have already led “complete lives,” so it’s time for them to do their duty, as Lamm put it.

The lawmakers behind these proposals are compassionate. They don’t like that dying people suffer, and they don’t like that a 90-year-old with cancer takes a government Handy Van to chemotherapy, while a baby in Africa dies because he can’t get clean water.  In fact, none of us like that, and we all agree something has to be done.

The problem is putting our compassionate ideas into practice. Even very smart compassionate people are not smart enough to make every decision for everyone else.  And what happens in practice is that most people want every treatment possible at the end of their lives.  Who gets to decide which people get which treatments?

Jane Strum spoke up at a presidential press conference in July 2009. Five years ago, her mother got a pacemaker at age 99 years, and is still alive today. Under the new government plan, Strum asked, would there just be cut-offs at certain ages, or would doctors be able to consider factors likes a “certain spirit? A certain joy of living?” Her mother’s doctors considered those things.

President Obama answered Jane Strum like this.

 “We can let doctors know, and we can let your mom know,” he said, “that maybe this is not going to help. Maybe you’re better off not having the surgery, but taking the painkiller.”

In this particular case, however, if you believe she would be better off not having the surgery but taking the painkiller, you believe she would be better off dead.

Let’s look at the particular cases of Randy Stroup and Barbara Wagner, who have cancer. They are sort-of old people: Stroup is 53 years old and Wagner is 64. They both got letters from the state of Oregon, which pays their medical expenses. The letters said that Oregon won’t pay their cancer treatments because each has only a slim chance of living more than five years.  However, the good news is that Oregon will pay for a painless, doctor-assisted suicide, defining it as “comfort care,” and including it as just another choice for them, like taking painkillers.  They could choose to be humanely put to sleep, the way you’d do for a beloved pet.

What this means is that some of the most caring people among us are willing to reduce each of us to a bunch of numbers, statistics, and risk factors because they think this will make things better for humanity as a whole.  It is medicine by accountancy. Accountancy has no philosophy or art in it. It lacks what Wordsworth called “the sweet sad music of humanity."

The New York Times reports that six Senators are sitting around a table making these decisions. There are no doctors, nurses, nursing home attendants, psychologists, medical ethicists, theologians, priests, rabbis, artists, shamans, and wise elders in these discussions. Congress alone decides who must do the noble thing and die for our country, the same way they make laws deciding who gets the criminal death penalty and who must go to war.

One of the first things they decided was to exempt themselves from healthcare reforms like Section 1322 and vote to keep their own healthcare plan just the way it is, thus avoiding end-of-life chats, issues of “complete lives,” duties to die, and assisted suicide.

Assisted suicide is like the line from the movie, “Young Frankenstein,” when Igor whispers, “Wait, Master, it might be dangerous. You go first.”

Since Congress is proposing this, and since the way is very dangerous, they should go first.