Ethicist Thaddeus Mason Pope Predicts Assisted Suicide Will Expand into Legalized Euthanasia Covered by Medicare

By Lisa Blumberg

Currently the several states that have legalized assisted suicide adhere to the Oregon model, the two most significant aspects of which are that assisted suicide is restricted to those presumed to have less than six months to live and the lethal drugs, once obtained, must be self-administered. Opponents of assisted suicide see the evolution of assisted suicide in other countries into euthanasia for broad based groups as a cautionary tale. Some supporters though see it as a goal, and they are becoming bolder in expressing their views.

Ethicist Thaddeus Mason Pope in an article published in the ABA Experience Magazine and reprinted in the Good Death Society Blog enthusiastically predicts that there will be major expansions to assisted suicide laws, with the end result being euthanasia available to anyone who can be seen to have a “grievous and irremediable medical condition” and provided free of charge to Medicare recipients with lethal injection as an option. He does not say why this would be a positive social development nor does he discuss the ethics of garnering public support for the passage of assisted suicide laws by touting minimal restrictive criteria as safeguards and then a few years later removing them. Pope refers to loosening the criteria as reforms.

Pope begins by discussing the expansions that are occurring now. Barriers to “medical tourism” (his term) have been dropping. The states where the residency requirement has been eliminated can now become like Switzerland, offering death to anyone from wherever who is thought to meet the criteria.

A few states now allow nurse practitioners and physician assistants to prescribe the drug cocktail, as if assisted suicide is a routine medical matter and that determining the prognosis for life expectancy does not require advanced skill. As one California legislator who urged a radical expansion of the already expanded California assisted suicide law has noted, a six month prognosis can be a “faulty metric” anyway.

Third, some states have reduced the waiting time between the two requests for a deadly prescription from fifteen days to 48 hours and in some circumstances, have waived it altogether, a period of reflection before making such a profound and irreversible decision being considered no longer necessary.

Pope then lists other expansions that may be on the way:

Six Month Prognosis – Pope sees the requirement that a person have a six-month life expectancy as “unusual” compared to a country like Canada which uses a “grievous and irremediable medical condition” as the threshold eligibility requirement. The term tends to be tied to some notion of physical or psychological suffering and decreasing loss of function or capability. Open-ended and ambiguous, it could sweep in a wide range of people with significant permanent disabilities.

Since disability “quality of life” biases are endemic in medical settings, it would be rather easy for a noticeably disabled person to find providers that they could convince of their suffering. Indeed, some doctors take the initiative of suggesting to such a person that they do suffer. Moreover, when combined with the impairments of aging, the functional limitations of virtually any disability will increase. We are all declining. (Given the disability bulge among the baby boomers, the intersection of aging with lifelong disability is a ticking time bomb that society has no will to deal with.) It is not too much of a stretch to say that the proposed change would open up eligibility to anyone whose ongoing disability causes them to be devalued.

Advance directives – Pope notes efforts in Canada which he seems to view as the gold standard, to allow people who fear dementia to arrange for “aid in dying” ahead of time. It’s not exactly clear how he thinks this would work. What if when the advance directives are triggered, the person exhibits no interest in death? Setting aside philosophical discourse on which personality should have the final say, this might be entering the realm of active, involuntary euthanasia. 

Assisted Self-Administration – Pope mentions the federal lawsuit challenging the self-administration requirement as violating the Americans with Disabilities Act. He refers to the concept of “assisted self-administration” but assisted suicide laws are already interpreted to allow for that. For example, someone else can mix up the potion, put a straw in it and give it to the person who drinks. What is being considered here is presumably voluntary euthanasia. The person speaks or makes a sign of assent and then the provider essentially causes the death (as opposed to providing the means for death).

Intravenous Administration – Pope predicts that intravenous infusion of the deadly drugs and lethal injection will soon to be allowed as a reliable, safe and effective way to cause death. Perhaps, Pope is unfamiliar with botched executionsespecially when lethal injection is involved. The idea of euthanasia by this means though really is not so new in America. It harkens back to the days of Jack Kevorkian except that it would be legal.

Medicare Coverage – Medicare doesn’t cover dental cleanings or hearing aids but there are efforts to have Medicare cover so-called “aid in dying”. This would presumably be coverage for whatever form of assisted suicide or euthanasia that a state enacted but Pope isn’t clear on this point. Coverage by Medicare would give death-making the status of full-fledged medical care with all which that implies. And if Medicare can provide coverage, why not Medicaid?

The proposed expansions are interrelated, each “logically” leading to the next one. If eligibility is expanded to include people who “suffer” from ongoing functional limitations or if people are allowed to pre-arrange for their deaths should they develop dementia, the question becomes practical access. This can be solved by permitting another to cause the death. If euthanasia or “assisted self-administration” is allowed, IV or lethal injection is the most expedient way to do it. Finally, coverage by Medicare normalizes the whole process. It reminds one of Jonathan Swift’s essay “A Modest Proposal” in which he sets forth a set of propositions which, when taken one right after another, justify Englishmen eating Irish  children. Swift was being satirical. Pope is deadly serious.

Pope’s piece is supposed to be a summary of the scope of current assisted suicide laws and the trends in expansion. His review omits one key thing though and that is the resistance!