In Oregon, you have lots of options

Is this the best option for palliative care?Is this a case of bureaucratic thrift or bureaucratic madness?

Here is the case for bureaucratic thrift. The government health insurer in the American state of Oregon is denying patients funding for chemotherapy if their chances of survival for another five years are less than five percent. You can imagine how Barbara Wagner, a 64-year-old woman with lung cancer felt when she received an unsigned letter from the Oregon Health Plan.

It read: "Treatment of advanced cancer that is meant to prolong life, or change the course of this disease, is not a covered benefit." Her specialist had prescribed Tarceva, a US$4,000-a-month drug which would slow the spread of the cancer growth and extend her life, even though it wouldn’t cure her.

Heartless, huh? Needless to say, Ms Wagner felt devastated.

Now for the case for bureaucratic madness. The Oregon Health Plan did not leave Ms Wagner in the lurch. It offered her another option. Its letter went on to say that the Plan "would cover palliative, or comfort, care, including, if she chose, doctor-assisted suicide".

In other words, Oregon will pay you to die, but not to live. "I think it’s messed up," Ms Wagner told the Register-Guard newspaper. "To say to someone, we’ll pay for you to die, but not pay for you to live, it’s cruel."

The letter was not a hoax or a mistake. In fact, Ms Wagner was not the only one to receive it. Fifty-three-year-old Randy Stroup was denied medication for his prostate cancer, and was also told that suicide was a treatment option. "It dropped my chin to the floor," Mr Stroup said. "[How could they] not pay for medication that would help my life, and yet offer to pay to end my life?"

It is weird to read in black and white how suicide fits into Oregon’s health plan. Its "prioritized list of health services" gives five examples of "comfort/palliative care" for terminally-ill patients. The fifth option is assisted suicide:

5) Services under ORS 127.800-127.897 (Oregon Death with Dignity Act)... include but [are] not limited to the attending physician visits, consulting physician confirmation, mental health evaluation and counseling, and prescription medications.

"It's chilling when you think about it," Dr William Toffler, a lecturer at Oregon Health & Science University and the national director of Physicians for Compassionate Care, told Fox News. "It absolutely conveys to the patient that continued living isn't worthwhile... It corrupts the consistent medical ethic that has been in place for 2,000 years."

Even more chilling is the bewilderment of the Oregon health bureaucrats. They were jolted by the reactions of the two patients. "I understand the way it was interpreted," said Dr John Sattenspiel. "I’m not sure how we can lift that. The reality is, at some level [doctor-assisted suicide] could be considered as a palliative or comfort care measure. We had no intent to upset [Barbara Wagner] but we do need to point out the options available to her under the Oregon Health Plan."

Better than any harangue from the death-with-dignity crowd, this comment illustrates  the dangers of legalising voluntary euthanasia and assisted suicide. Oregon’s assisted suicide law was intended to allow people to exercise their autonomy, to choose the hour of their departure. But it will tempt mainly the poor, those without family, and those who fear burdening their family. By no stretch of the imagination can it be termed "comfort/palliative care". It is cold comfort to realise that the people regard you mainly as a financial and emotional burden. And it only palliates the conscience of bureaucrats and politicians who are running an increasingly heartless society. If they were honest with themselves, they would realise that it is effectively government-sponsored violence against the poor. 

Fortunately the manufacturer of Tarceva decided to provide Ms Wagner with the drug for free and Mr Stoup fought back and the bureaucrats reversed their decision. They will live a bit longer. According to official figures, Oregon doctors helped 341 people between 1997 and 2007. As the American population ages, as the economy edges into recession, and as state budgets get tighter, other people may not be so lucky.

Michael Cook is editor of MercatorNet.


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