In grim accounting, Canadian report says assisted suicide saves health care money

CNA Staff, Oct 21, 2020 / 23:18 pm

A Canadian report has put a dollar figure on legal assisted suicide, claiming that legalization has saved millions of dollars in health care costs-and that a looming expansion of legal assisted suicide, known by backers as "aid in dying," would save millions more.

A new Parliamentary Budget Officer report, released Oct. 20, is intended to provide economic and financial analysis of legislation to improve parliamentary debate and promote "greater budget transparency and accountability."

While the report acknowledged cost savings of assisted suicide, it said "this report should in no way be interpreted as suggesting that (medical aid-in-dying) be used to reduce health care costs."

At the same time, the report acknowledged the "disproportionately high" health care costs to care for people in their last year of life, especially in their last month. Such patients represent 1% of the population and 10% to 20% of total health care costs.

Access to medically assisted suicide, the report said, reduces health care costs for Canada's provincial governments, the primary health care providers. Since the legalization of assisted suicide in June 2016, the report estimated some $66 million in U.S. dollars have been saved because individuals are helped to die rather than receive health care or palliative care.

A Quebec superior court last year ruled that it was unconstitutional to limit medically assisted suicide only to those whose natural death is "reasonably foreseeable," according to the Canadian news site Global News. Canada's Minister of Justice and Attorney General of Canada chose not to appeal the decision, a decision lamented by Canada's Catholic bishops.

This court ruling required the government to introduce legislation to comply. That legislation would no longer require natural death to be "reasonably foreseeable" for a patient to be eligible for assisted suicide.

Rather, the bill provides easier eligibility rules for people near death and stricter eligibility rules for people who are not near death. It removes a 10-day waiting period for those whose natural death is "reasonably foreseeable."

For persons whose natural death is not reasonably foreseeable, eligibility assessments must take at least 90 days unless loss of capacity to consent is imminent. According to a summary of the bill at the website of Canada's Department of Justice, two independent doctors or nurse practitioners must provide an assessment and confirm the requester is eligible. At least one doctor or practitioner assessing the person's eligibility must have expertise in the medical condition causing his or her suffering.

The bill allows the possibility to waive final consent for assisted suicide for patients whose death is reasonably foreseeable and who are at risk of losing the ability to consent. It would also reduce the number of required witnesses for patient consent from two to one.
 
Under the legislation, the patient must be informed of options to relieve suffering, including counseling, mental health and disability support, community services, and palliative care. Mental illness as a sole underlying condition would not be sufficient to access legal assisted suicide.

The report's financial analysis predicted an estimated 6,465 assisted suicide deaths in 2021 under the current law, with over $66.14 million in U.S. dollars saved in provincial health budgets due to these deaths. The number of dollars saved is reached by subtracting the costs of palliative care, about $55.4 million, from mean end-of-life costs of about $138.6 million, and then subtracting $17 million in costs to administer that number of assisted suicides.

The new legislation to expand access to assisted suicide will result in another 1,164 assisted suicide deaths in Canada in 2021, the report predicted, with an estimated $46.8 million in health care costs saved. This would increase total estimated savings to some $113.4 million, compared to a situation in which assisted suicide was illegal, the Parliamentary Budget Officer report said.

"While this amount may appear significant, it only represents 0.08% of total provincial health care," said the report. The cost reduction "represents a negligible portion of the health care budgets of provinces."

Justice Minister David Lametti introduced the latest assisted suicide bill in February but its progress was halted when the House of Commons adjourned in mid-March because of the coronavirus epidemic.

The bill, numbered C-7, is characterized as a "medical assistance in dying" bill. It would modify Bill C-14, passed by Canada's Parliament in 2016 to legalize and regulate doctor-assisted suicide.

In February the Catholic Bishops of Canada voiced "the greatest concern and dismay" about efforts to expand assisted suicide. They condemned "the lamentable legislative aim" of broadening access to assisted dying, and insisted "that every opportunity for due diligence be taken during the parliamentary process." They have said better palliative care is needed.

"We unequivocally affirm and maintain the fundamental belief in the sacredness of all human life, a value that we share with many others in our country, including persons of different faiths and no faith at all," Archbishop of Winnipeg Richard Gagnon, president of the Canadian Conference of Catholic Bishops, said in an October letter to Prime Minister Justin Trudeau.

"Despite the misleading euphemism, 'Medical Assistance in Dying' remains simply euthanasia and assisted suicide – that is, the direct taking of human life or the participation in his/her suicide, which can never be justified," Gagnon added, according to Grandin Media.

A report released by the Canadian government said that more than a third of those who opted for "medical assistance in dying" cited concerns of being a burden to family or carers.

Assisted suicide opponents have warned that legalizing such killings helps increase social or financial pressure on a person to kill him or herself, whether this pressure comes from insurance companies, private or government health care administrations, or relatives. They question how society can campaign against suicide for the healthy or in favor of better palliative care for the ill while justifying assisted suicide at the same time.

They say there is a danger that assisted suicide further marginalizes the disabled, the elderly and the terminally ill and undermines the duty to respect and care for them. People facing treatable conditions could be presented assisted suicide as a better option, they warn.