In jurisdictions where it is legal, the option of ending one’s life through lethal drugs will always be the cheapest option available to any patient with a serious illness.
Data compiled by the Oregon health department has shown a steady increase in patients choosing to end their lives via the Oregon Death With Dignity Act due to financial concern about the cost of medical treatment. According to its annual report, 9.3% of patients ending their lives through the act in 2024 reported financial concern with treatment as a reason for doing so. This is an increase from 8.3% in 2023 and 5.1% in data combining years 1998 to 2022.
While I find the idea of even 5% of patients choosing to end their lives because of financial concern unacceptable, as a Delaware physician, I have no doubt that, if The Ron Silverio/Heather Block End of Life Options Law (House Bill 140) is enacted, a higher percentage of Delaware patients using it to end their lives would be trying to spare their families financial hardship.
In arguing for legalization of medical aid in dying/assisted suicide, advocates repeatedly mention the principle of autonomy. While this is an important principle in medical ethics, it is not the only principle. For example, when a patient with a viral infection asks for an antibiotic, the principle of autonomy would indicate that they should receive an antibiotic. However, other principles — such as beneficence/nonmaleficence (antibiotics will not help the viral infection and could cause harm) and justice (the antibiotic may increase community antimicrobial resistance and harm others) — argue against providing antibiotics for viral infections.
In making laws, justice is a particularly important principle. The disparate harm to vulnerable patients by medical-aid-in-dying laws (documented by the National Council on Disability’s “The Danger of Assisted Suicide Laws”) violates the principle of justice. There are many examples in the regulation of medicine in which we limit autonomy to protect justice. For example, it is illegal for a patient to receive payment for “donating” a kidney for transplantation (even though some people have tried to sell one kidney). Laws requiring compulsory vaccinations and treatment for highly communicable diseases, such as tuberculosis, also deliberately restrict autonomy in the service of justice. Similarly, speed limits on public roads restrict drivers’ autonomy, not only to protect others but to protect the drivers themselves. For patients without adequate resources faced with a disabling serious illness, being offered a choice between inadequate care and lethal drugs is not offering a truly autonomous decision — it is simply another injustice. For the sake of those vulnerable patients, please oppose HB 140.
Dr. Michael T. Vest is a resident of Hockessin. This article first appeared at BaytoBayNews.com
