Thursday, October 22, 2015

California's Slippery Slope

Since this topic came up in class, I wanted to get a bit deeper into the PAS conflict that will be testing our home state in the coming years as this law takes action. Many of us have heard the term slippery slope when regarding PAS due to its nature, but wether it is or is not something to worry about is almost as controversial as the topic itself.

If insurance companies are faced with prescribing patients with a prescription to help prolong their life, but that medication was more costly, would they choose to cover it? Or is it just as likely that they would offer to cover the prescription to end a patients life instead of that which would prolong it due to cost? Supporters of the law say that just because it may be covered by insurance will not push people to make the choice to end their lives. They add that the cost that would be saved would be insignificant enough to incentivise and pressure PAS to patients that did not want it.

Taking a life goes against the code of a doctor, taking a life is a federal offense, but PAS gets close to that line, and this is why people have such strong opinions about it. "The barbiturates prescribed to patients to end their lives cost about $1,500. Average healthcare spending in a patient's last year of life is $33,486, according to federal data." What is a persons life worth to you? What is is worth to keep a person happy in their final days? To remember them with family instead of with suffering? What are these lives worth to the insurance companies? To the hospitals? Is this a flaw in bureaucracy? Big business? Or just the way the world works?


Scott Chow said...

I think there is another facet often associated with the 'slippery slope' argument, which is the expansion of PAS to the likes seen in Belgium and some states in the EU. On the other side of the pond in Belgium, PAS has been extended to children as of last year ( Many people also worry that PAS is the beginning of a slippery slope to euthanasia, and I'll take this moment to make the distinction (just in case). Euthanasia is when the doctor administers the lethal drug (he plunges the syringe and pushes the plunger) and PAS is when the doctor writes a prescription for a lethal dose of barbiturates and the patient SELF-ADMINISTERS it (he swallows the pills of his own volition and doing). I do believe, however, that the pressure that insurance exerts on an individual in that situation isn't so formal in terms of coverage. Thanks to the ACA, insurance companies are not allowed to discriminate in terms of coverage, but the looming medical bill of palliative care (treatment of symptoms over the disease) does generate potential informal pressures. This quickly leads to the question of whether or not these individuals are even qualified to accept PAS due to the infinite possibilities for outside influences to be affecting their decision: the idea that there is no truly independent decision. That being said, I don't think the bureaucracy is at fault here, but our society's taboo on death is. The bureaucracy does what it can to manage the procedural exploitation, but at some point we as a people will have to confront the skeletons in the closet.

Huayu Ouyang said...

I agree that laws legalizing PAS often do not do enough to regulate the practice to ensure that the decision to end one's life is completely independent and not influenced by anyone else. For example, in Oregon, where PAS was first legalized in the US, a cancer patient, Barbara Wagner, found out that she could receive life prolonging treatment for her cancer, but that her insurance plan wouldn't cover this treatment. However, her insurance would actually cover physician assisted suicide. In addition, the Oregon law has been criticized for not having adequate safeguards to protect mentally ill people or the elderly from either themselves or coercive family members.

I agree with Scott that the controversy surrounding PAS isn't necessarily a flaw in bureaucracy or insurance companies, but rather has to do with how people see life, death, and personal autonomy. For example, people are generally more willing to accept someone choosing to take themselves off of life support, but people are less willing to accept this concept a step further in PAS, or to an extreme extent, euthanasia, which is why people either don't want to legalize PAS or want the law to give more safeguards and prevent any slippery slope.