License to Kill

On a recent visit to a West Coast hospital, I received a glimpse of the face of medicine to come--and it was a fearful sight. I happened to arrive while a physician was examining my friend, an elderly gentleman. The doctor seemed rushed as he checked my friend's vital signs. He explained that his employer had instructed him to spend no more than 12 minutes with any given patient. What was going on in that hospital was an ominous example of social forces that could turn the so-called "right to die" into the duty to die. During the past two months, two federal appeals courts have ruled that terminally ill people have a constitutional right to physician-assisted suicide. These two decisions demonstrate that we've crossed a moral Rubicon: We've given physicians a license to kill. The only remaining question is how far will that license extend? According to Washington Post columnist E. J. Dionne, the answer is: terrifyingly far. In a recent column Dionne described an all-too-likely nightmare scenario. Health care now consumes one-seventh of the gross domestic product, and it's growing at an unsustainable pace. For example, the cost of Medicare is doubling every seven years. The problem will only worsen as our population ages. Clearly, something has to be done. One possible solution is managed care, which involves tight controls over the use of medical resources, including a physician's time. This confluence of social forces is what scares Dionne. He writes that we're giving doctors a license to kill just as we're moving into "managed-care health plans in which all the incentives are to cut costs." "What easier way to cut costs," Dionne asks, "than to create subtle pressure on patients to kill themselves?" Despite the soothing assurances of right-to-die advocates, Dionne says "it is naive to pretend that such pressures will never arise." Dionne is right. It's estimated that about half of all medical costs are incurred during the last six months of life. Cash-strapped families may reason, "what's six months of Grandma's life versus the financial needs of my whole family?" Imagine the pressure on Grandma as she lies in her hospital bed, surrounded by family members with their pockets turned inside out. Bureaucrats may fall prey to the same twisted logic. After all, they may reason, what's six months of one anonymous citizen's life compared to the financial health of the whole country? Right-to-die proponents dismiss this scenario as alarmist nonsense. What they don't understand is something social scientists call "the law of unintended consequences." Our fallen natures guarantee that even the best intentions are subject to the human tendency to prey on the weak and defenseless. In the case of physician-assisted suicide, the impulse to relieve suffering becomes the agent of unimaginable evil. And that's the message we've got to get across when our neighbors tell us that assisted suicide is compassionate. We need to explain that by legalizing assisted suicide, we're creating not a compassionate world, but one in which the old and the sick--like my elderly friend--are pressured to snuff out their lives.  

07/10/96