By Mary Faulds, AFA Journal staff writer
August 2008 – Barbara Wagner is a 64-year-old mother, grandmother, and great-grandmother from Oregon. She struggles to make ends meet working as a waitress at a truck stop. Because of her low income, she qualifies for the Oregon Health Plan.
Two years ago, Wagner battled lung cancer into remission, but in May, a CT scan showed it had returned. Would she be able to fight it off again? According to the Oregon Health Plan, no. The state plan would not cover the cancer drug her oncologist prescribed. Instead, the rejection letter offered her the options of hospice, palliative care, or physician assisted suicide (PAS).
Wagner was insulted. “To say to someone, we’ll pay for you to die, but not pay for you to live, it’s cruel,” she told the Eugene, Oregon, Register-Guard. “Who do they think they are?”
Currently, Oregon is the only state in the United States that has legalized PAS. They say it’s about compassion and allowing the terminally ill a “death with dignity.” However, the country is actually split on the issue. A Harris Interactive poll from September 2007 found over one-third of the adults surveyed support PAS, while nearly that many opposed it.
Where is PAS headed in the rest of the country? Some recent events would suggest perhaps nowhere. Last year, the Vermont Legislature defeated attempts to legalize PAS, and earlier this year, a similar bill died in a Wisconsin Senate committee.
However, Dr. Paul J. Hoehner, an anesthesiologist from Richmond, Virginia, and a Harvey fellow of theology, ethics and culture at the University of Virginia says, despite the recent setbacks, trends in the United States favor the expansion and further acceptance of PAS.
Economic Woes
The main factor driving the U.S. toward approval of PAS is the increasing economic strain of the health care system. Hoehner believes that PAS will move away from its current “I’ll choose when I die” mentality to one of the terminally ill patient feeling “I need to die now” because his care is such a burden on the family, the state and the health care system. He says the elderly and the debilitated will be the first to feel the pressure, and the health care system will move farther and farther away from individual choice.
He feels Wagner’s situation in Oregon will soon become the norm rather than the exception. “I think that is an inevitable trend,” he said. “So much is driven by money and taxpayer systems. That’s a scary thing when insurance will, you know, they won’t pay for cures anymore, but they will pay for the easy way out.”
Aging Americans
Another impetus moving the U.S. toward acceptance of PAS is aging Baby Boomers. Hoehner believes this is still an issue of economics as well. “We’re spending so much money on that population [the elderly] at the end of life,” said Hoehner. “We’re searching for cheaper alternatives to paying for therapy.”
He expects that the U.S. will move toward defining the ethical treatment of the elderly as “doing away with the suffering by doing away with the patient.”
Oregon plus one
This November, Washington voters will decide on Initiative 1000, which would legalize PAS in that state. The initiative is almost identical in wording to Oregon’s Death with Dignity Act that was passed in 1994.
Dr. Shane Macaulay, spokesman for the Coalition Against Assisted Suicide in Washington, says the national campaign supporting PAS is being fought by proxy in his state. He said they call it “Oregon plus one, which is, you’ve got Oregon now, get another state, and then the dominoes will begin to fall.”
Macaulay says it’s vitally important for all Americans to get involved in stopping PAS from becoming legal in Washington. “Their [PAS supporters’] goal is to start with small and restricted scope of application, saying, ‘Oh, it’s only applying to people who are terminal, in their last six months of life, and such.’” Macaulay continued, “And then once they get it out with enough critical mass of states involved, then they can start to push the envelope and expand those so-called safeguards and criteria.”
Macaulay said the bottom line is this. “The amount of money being spent on health care in this country is going up exceedingly rapidly, in a way that we’re not going to be able to continue to pay. The Medicare hospital fund goes insolvent in just 11 years from now, in 2019. The fear is if you legitimize assisted suicide as a medical practice, then it’s going to be used as a cost-savings tool.”
Richard John Neuhaus, a Catholic priest and author, once wrote that bioethicists subtly “guide the unthinkable on its passage through the debatable on its way to becoming the justifiable, until it is finally established as the unexceptional.” Both Hoehner and Macaulay believe that theory is true regarding the debate of pro-life issues in the United States. Hoehner says the more that PAS, abortion, embryonic stem cell research, cloning and the like are in the forefront of the public eye, the more they do to erode the inherent value of life. 
