MSM Finally Discovers Compassionlessness of Oregon Assisted Suicide
I think the stories of patients being refused life-extending chemotherapy by Oregon's Medicaid--but offered assisted suicide instead--will materially impact the I-1000 legalization effort in Washington. First, this kind of heartlessness was predicted by opponents. Second, the old myth that Oregon has operated without abuses is now shattered. Third, unlike other Oregon abuses, the MSM is actually reporting the story--like an extended report on ABC News. From the story: The health plan takes "no position" on the physician-assisted suicide law, according to spokesman Jim Sellers. The terminally ill who qualify can receive pain medication, comfort and hospice care, "no matter what the cost," he said. But Sellers acknowledged the letter to Wagner was a public relations blunder and something the state is "working on."
I've been in a debate (in Lisbon at a Fulbright bioethics conference) with a top bureaucrat from the OHS and I can tell you that the "no position" may be technically true, but the (figurative) scratches on my face from the fury directed at my opposition showed me clearly that this is neutrality in name only. Moreover, to look at this as merely a PR blunder is to wilfully miss the point that assisted suicide represents the most profound form of abandonment.
"Now we have to review to ensure sensitivity and clarity," Sellers told ABCNews.com "Not only is the patient receiving had news, but insensitivity on top of that. This is something that requires the human touch."
Good grief! Even Geoffrey Fieger, who I have debated several times on television over his representation of Jack Kevorkian gets that:
"Her case is hardly unique," said Michigan lawyer Geoffrey Fieger, who defended Dr. Jack Kevorkian's crusade to legalize physician-assisted deaths. "In the rest of the country insurance companies are making these decisions and are not paying for suicide," Fieger told ABCNews.com. "Involuntary choices are foisted on people all the time by virtue of denials."Look for opponents to let as many people learn about this "blunder" as we can. Remember, if it can happen in a government health care plan, it can also happen with HMOs.
Assisted suicide is bad medicine and even worse public policy.
Labels: Oregon Assisted Suicide. Paying for Assisted Suicide but not Medical Treatment.
posted by Wesley J. Smith @ 4:51 PM
13 Comments
13 Comments:
If the gentleman's cancer is remotely treatable, Medicaid or a state-sponsored Medicaid waiver program should cover this expense. I have never heard of a Medicare or Medicaid program that rationed cancer treatment on grounds of medical futility or any other grounds; quite the opposite usually, if one is aware of the massive Medicare expenditures in the last 24 months of life. Private insurers, however, are often a different story. There must be more to this story than meets the eye. Will do some research and see if I can find the rest of the story....
If Wesley's version of the facts is essentially accurate (regardless of the inevitable editorial slant), it is an egregious act and would certainly be condemned by every Oreogian provider I know who is involved with the state's DWD act.
The Death With Dignity Act was never intended to be a bridge to encourage terminally ill folks to prematurely hasten death or to ration health care resources and to state otherwise is to intentionally perpetuate a falsehood. As it stands, precious few Oregonians have actually taken advantage of this option (roughly 35 per year on average) and none of them because of financial hardship. These records are all public and mandated to remain so.
Indiscriminately lumping the many responsible supportive providers and researchers of DWD in Oregon with far-left pro-euthanasia propaganda is incredibly disingenuous. And the "fury" that your position receives is not reflective of its accuracy but rather because of its sustained & unapologetic inaccuracy for these many years.
And in your characterization of PAS as ultimate abandonment, I guess that means that you also consider Tim Quill's treatment of his patient, Diane, to also epitomize medical abandonment?
Assisting suicide isn't "treatment," nor is euthanasia. As I recall, it's been a long time, Herbert Hendin also did as well.
I predicted this would happen in Oregon years ago. And I was right about that. And if PAS becomes a "treatment," Wall Street investors in HMOs will be dancing in the streets. Because, O, your presumptions and intellectual assumptions about what assisted suicide is supposed to do doesn't play out in real life==as the Netherlands, Belgium, Switzerland, and yes, Oregon demonstrate clearly.
From the ABC article... The prescribed drug - Tarceva - did not meet the insurer's "five-year, 5 percent rule" (a 5 percent survival rate after five years). A 2005 New England Journal of Medicine study found that Tarceva, does marginally improve survival for patients with advanced non-small cell lung cancer who had completed standard chemotherapy. The median survival among patients who took Tarceva was 6.7 months compared to 4.7 months for those on placebo. At one year, 31 percent of the patients taking Tarceva were still alive compared to 22 percent of those taking the placebo.
That the OHP's (or any other insurer's) drug formularies are coming under regular scrutiny is a good thing. That OHP would couple their denial with a 'pre-approval' for PAS is completely inappropriate and borderline coercive.
What I don't agree with is that this debacle is somehow part of a larger and hidden hastened death platform; that they intended for this to happen to patients in these situations. In fact, the DWD Act is specifically designed to screen for and remedy financially based reasons for requesting PAS. This has been a matter of public record since the very beginning. As the saying goes, "you could look it up."
Expanding health care and regulating the pharmaceutical industry is the appropriate response to this injustice; not blaming an EOL option that has nothing to do with an overly restrictive and inconsistent formulary criterion -- something which no doubt occurs in every other state where PAS is ILLEGAL. The two issues are unconnected except for those who believe in conspiracy theories.
"Assisting suicide isn't "treatment," nor is euthanasia."
No, they're not.. They're murder.
"And if PAS becomes a "treatment," Wall Street investors in HMOs will be dancing in the streets."
Yeah.. Goodness help the Soul who sneezes in their presence..
Re other....
Where PAS is legal, why bother expanding, translation: pouring $$$ into more services, when the opportunity to eternally eliminate the perceived "problem at hand" is instead so much easier to do, as in the now multiple cases of people with cancer given no Choice but be murdered..
End of problem. NEXT..!
Cindy Sue Causey said...
"Assisting suicide isn't "treatment," nor is euthanasia."
No, they're not.. They're murder.
Thanks for ignoring my posts and simply defining away any & all complexities. They're all "murder," plain & simple. No need to explain why; it's just that simple.
Sounds dangerously similar to the knuckleheads on the far Left who similarly define PAS and VAE as personal rights that impact no one else but themselves.
C'mon Cindy - is that the best you can do on this topic?
"In fact, the DWD Act is specifically designed to screen for and remedy financially based reasons for requesting PAS."
Hmmm. So if the chap in the story decided to take them up on the offer of assisted suicide, he'd actually be refused (even though they told him it would be paid for), because all of that wonderful screening would discover the fact that this sequence of events had taken place and no provider would give him the drugs, given that there was this financial spin to the whole thing?
Why am I in doubt?
What happened to this gentleman was a bad (and I believe rare) breakdown in the system that should be remedied. In fact, this case was probably newsworthy because it constituted such an egregious detour from the norm.
As to your first question, this individual obviously has no reason to request hastened death since he is pursuing curative therapy. In lieu of curative therapy, he could also pursue conventional hospice care which is what the vast majority of terminally ill Oregonians already do.
But, yes, if he did actually apply for a lethal prescription under the DWD act and explained in his request that he was doing this only because he was denied (desired) curative therapy for financial reasons, a conscientious provider would delay because this case would not evidence an "informed decision" as defined by statute - which mandates among other things that: (1)The physician informs the patient of her diagnosis and prognosis. If this is contested by either party, the process would stop then and there. (2)The feasible alternatives, including, BUT NOT LIMITED TO, comfort care, hospice care and pain control. Curative care is NOT precluded.(3)The diagnosis & prognosis of the attending physician is confirmed by a consulting physician who has examined the patient and the patient's relevant medical records.
The fact that you and your side still continue to ignore is that only an average of ~35 Oregonians annually avail themselves of this intervention. If massive numbers of uninsured or underinsured Oregonians were being denied appropriate curative care and instead offered PAS, why hasn't this number shot up significantly or this kind of story not occur years ago? DWD has been in play for over a decade now.
As to your rhetorical question, "why am I in doubt?" - I'll hazard a guess. It's probably because you let people like Wesley do your research for you and provide ready-made opinions for you to adopt before you've even considered whether there is another cogent side to the issue. Instead, you cherry-pick cases & stories that appear to confirm your suspicions and fears and willfully ignore any subsequet factual information that conflicts with your views. You "doubt" because you are either intellectually lazy or else you are unable to tolerate moral ambiguity.
Assisted suicide advocates such as C and C claim there are no abuses in Oregon. And you accuse opponents of "cherry picking" the abuses that do exist. Hmmm. Not consistent.
Here's the point, Okakura: Once the mindset accepts assisted suicide as a legitimate medical service--as you apparently do--the mind is turned over 180 degrees and the unthinkable becomes merely an anomaly to be excused away.
There are indeed relatively few assisted suicides reported in Oregon. Even the bureaucrats who put together the annual sham reports acknowledge that all they know is what doctors self report.
But the relatively low numbers are irrelevant. First, all of the millions in advocacy dollars and energy isn't being put in for a handful of people to commit assisted suicide each year. More to the point, suicide has been accepted as legitimate for a subset of the population and something the state should not only countenance, but allow to be facilitated.
Hundreds have died, people who had they received proper suicide prevention or been told that self killing was not an avenue their doctors could accept, might have found a way to go on and transcend the difficulties they feared, such as being a burden, losing the ability to do enjoyed activities, or losing dignity--the reasons almost all committed asssited suicide. Some might have even lived, but we will never know.
Case in Point: My first hospice patient was supposed to die (obviously). The first time I was with him I had to help him pee. He was so humiliated, he fell into my arms saying, "I want to die! I want to die! I want to die!"
"Why do you want to die?"
"I'm a burden! I'm a burden!"
Had he lived in Oregon, he would have qualified for PAS. Had he asked for the poison on that day and taken it two weeks later, after the waiting period (which has been violated according to the O statistics--another picked cherry I guess), he would have died and never lived to unexpectedly improve and be kicked out of hospice because he stopped dying.
Hmmm. Cherry picking. Or my last hospice patient who was suicidal with ALS but eventually came out of it and was so glad to be alive, who eventually died naturally and peacefully in his sleep. He too would have missed things that he was so overjoyed to have seen.
Cherry picking.
Or Art Buchwald, put into hospice and off dialysis with six months or less to live. Had he taken the pills, he would never have lived to write his last book after he too was kicked out of hospice.
Cherry picking.
Or Michael Freeland who was given a lethal prescription nearly 2 years before dying naturally and the prescribing doctor called to renew the prescription! He became psychotic and was forced into hospital and court oversight. But the psychiatrist said his suicide stash was "safely at home." No safeguards once the prescription is written! Cherry picking.
Or Kate Cheney who was demented and had cancer. A psychiatrist said her daughter was the one with the real assisted suicide ideation. The daughter just convinced Cheney's HMO to get another mental health opinion, who also saw pressure from the family as a factor, but approved the assisted suicide anyway. An HMO executive decided that the prescription should be written even though the second psychologist admitted Cheney couldn't remember how long she had had cancer. Cherry picking.
Or Patrick Matheny who got his poison via Federal Express, which is like telling him to go off into a corner and die like a dog. Cherry picking.
Or Patient A, the first legal assisted suicide whose own doctor refuse to write the prescription. So she went to a second. He said she was depressed. So she contacted Compassion in Dying whose doctor said she was merely frustrated. A quick consult with a mental health professional--no treatment, no attempt at suicide prevention--and she was dead two weeks from having met the prescribing doctor--Kevorkianism if there ever was one. Cherry picking.
Or the study showing that doctors in Oregon write prescriptions for patients who are not experiencing seroius symptoms. Cherry picking.
Or the two patients told they couldn't have chemo but could have assisted suicide under Medicaid. Cherry picking.
Or the memo from Kaiser Northwest soliciting plan doctors to assist the suicides of Kaiser members who weren't their own patients. Cherry picking.
Two more points: People here think for themselves, just like you do. They come here as one source of information because I have the ability to obtain it and I assume--agree or disagree--they are interested in my analysis. It is presumptuous to charge someone on this blog as being a lazy thinker without some facts to back it up.
Finally, as for moral ambiguity, gray is the color of fog and sometimes people get lost in fogs and fall off cliffs. "Moral ambiguity" is too often an enabling term that permits one to countenance that which should be rejected out of hand. To me, that is not a sign of superior thinking.
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Something in your post, Wesley, triggered remembering one of my own first comments to you..
Had been just a very quick, personal observation about the eugenics of this movement effectively weeding out people like me during any given moment of (mental health) weakness.. Very much like "Patient A"..
Instead, the search for my old comment found another better, this short blurb from another of your visitors:
"The sad fact is that all too often, an inordinate distaste for the suffering of others is mistaken for compassion, when, in fact, it is precisely compassion's opposite. We would rather they die than have to suffer compassion with them."
I like that.. Have seen it in one form or another with respect to PAS but really like his.. Seemed appropos to revisit with it crossing these Fingertips just now..
PAS is, plain and simple, some portion of Society's hard-sought easy out.. It was far, far easier for that "some portion" to take five minutes to write a prescription for Patient A than it would have been for them to have spent the untold number of hours it likely may have taken to help her help herself through this, our one and only shot at Life..
Going out now to see if Mother Nature's Perseid Shower has started early, something I wouldn't be doing in a few had there any number of hundreds of times been the likes of a PAS-enabled doctor anywhere within driving distance over the last fifteen years, give or take..
In Unity..
I'll just comment here that I don't really think numbers are the point. One is one too many.
The numbers in Oregon ARE the point when folks continue to maintain that Wesley's list of exceptions ("cherries") somehow does NOT prove the rule -- that the overwhelming majority of Oregonians (including those with terminal illnesses) have been adequately protected by the existing safeguards.
That said, should they be improved? Absolutely. Should hastened death/PAS ever be proactively promoted by providers or insurers as an economical alternative to other forms of treatment, including hospice? Absolutely not, and if this practice were ever to become accepted and officially utilized by the medical community, count me among the tens of thousands of supporters who would withdraw our support and work to repeal the Act by referendum. However, the existing average of 35 deaths a year suggests that this isn't yet the case.
WS: IMO, the DWD statute is still lacking substantive safeguards addressing the potential for 'doctor-shopping' and the current and insufficient psychological screening process. Won't bore you with my suggested changes because I know you categorically reject PAS in any form. Just mentioning it to demonstrate that some of us do actually listen to the other side and do not dismiss out of hand your reasoned analysis and criticism of our positions. In fact, it's usually very helpful, and this forum adds to that dialogue. I appreciate your continued participation in these discussions, however contentious they may get. I may disagree many of your views, but I have read a lot of your work and I respect your intelligence and the sincerity of your beliefs.
If I ever get the unlikely opportunity to meet you at a future bioethics forum, I'll 'out' myself and gladly buy you a beer. It's the very least I can do for unloading on you so many times in this forum. Actually, I probably owe you more along the lines of an entire lunch, with the concomitant promise not to ruin it with any leftist bioethical diatribes :)
Oka
I have to say, Oka, that you have been a real benefit to SHS. Your comments, challenges, and perspectives are deeply appreciated.
I'll take that beer.
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