By Zeya Qiu (Denis)
One The Economist article in September One door closes, another opens (Sep 19, 2015; Vol. 416, accessible on BU library page) touched the heated topic on physician-assisted suicide legislation. Recently, “by narrow margins, California’s state assembly and senate passed the bill on legalising such procedure. It will soon be legal if the governor, Jerry Brown, does not veto the bill within 30 days.” The article also made a contrast between the voting results of similar bills in California and in the UK and called for the same protection of patients’ liberty.
What potential impacts could this legislation have on the health care system? Short answer is that this could help reduce the huge amount of costs in some way.
Costs and coverage are the two main concerns in health care system. When talking about the high medical costs in the United States, the first things some people would complain about are the unnecessary tests, over-prescription and overuse of expensive drugs, and over-treatment in the hospital. It is not rational to blame this problem on the profit-seeking of the medical providers. Patients mentality also plays an important role in shaping this medical landscape. Patients as consumers, lacking the expertise on medical science, generally believe that more treatments equal better treatments.
Our focus here is how patient mentality shapes another scenario of over-utilisation, a less mentioned one. The costs of care for patients in the hospital near the end of their life usually soar in very short period. According to the documentary Money & Medicine, sometimes the patient and/or family would ask for highly risky and expensive surgery to give a relatively short time for the patients. Or they may require expensive medical care to sustain the extremely low-quality life of the dying person. The medical bills from this kind of care are usually unbearable for a non-wealthy family, even if they have health insurance.
What I found interesting is people’s attitude towards health care in this special time, or also related, towards death. For example, what is a good “last days’ health care”? What is a good death?
Patients themselves have diverse opinions on the demarcation of a “good death”. Or maybe, death is never good. Some would love to stay in this world as long as possible, despite the pain, suffering and possible financial distresses. Some would prefer to “let nature takes its course”. Some would ask for a death with dignity. We should understand that all these dying wishes derive from human nature and all of them should be respected. Many of the overwhelmed families would love to sustain their loved ones’ life or to fulfil their wishes at any cost. As a result, there come piles and piles of medical bills.
Cultural factors could also influence the family’s decisions. For example, in traditional Chinese culture, “filial piety (孝道 xiao dao)” is very important. The care for a dying family member is one good presentation of this moral. Nevertheless, sometimes in very extreme cases, some people ritually put more energy and money towards the “last days’ care” than in the daily care before their family member gets into severe medical situations. This phenomenon surely attracts moral criticisms. By providing premium or even excessive health care for the dying person, those families who are still alive feel better about them and their guiltiness is partly relieved because they have given a good death to him/her.
Although we mainly discuss the issues concerning financial costs here, a legislation like this apparently involves more dimensions such as bioethics and religion. In places where doctor-assisted dying is abandoned, many patients are not surviving with dignity because the pain and sufferings they have exceeded all the emotions of death, which is the main drive for the legalisation process.
This legislation might not only relieve the families who are currently bearing the financial burdens from last days’ care, but also gradually change people’s perception towards death and care for the dying by offering an alternative.