Compassion & Choices NY Weekly Why: This Isn’t About Money (April 4)

Apr 4, 2022 New York

Distributed to New York State Lawmakers via email April 4, 2022:

Good morning!

As you work to finalize the state budget and money is on your mind, I thought I’d take this opportunity to answer three of the most commonly asked questions I get about the financial implications of medical aid in dying.

  1. Does choosing medical aid in dying save money on end-of-life care?
  2. Will insurance companies deny coverage for life-saving treatment because medical aid in dying is available as an end-of-life option?
  3. Are families able to collect on life insurance policies held by people who use medical aid in dying?

The short answers: No, no, and yes.

Does choosing medical aid in dying save money on end-of-life care?

People are only choosing medical aid in dying to shorten the very worst, very last part of the dying process, when curative treatment -- the most expensive part of end-of-life care -- has ended. Medical aid in dying may shorten a person’s life by days, maybe weeks, but not months. Research published in the New England Journal of Medicine concludes insurers have no financial incentive to pressure patients to accelerate their deaths because there are no substantial cost savings. (E. Z. Emanuel & M.P. Battin, What Are the Potential Cost Savings from Legalizing Physician-Assisted Suicide? NEJM, Vol. 339 (1998), pp. 167-172, available from: https://www.nejm.org/doi/10.1056/NEJM199807163390306). The article was co-authored by an opponent of medical aid in dying more than 20 years ago, when relatively inexpensive hospice care was less available.

A 2018 study published in the Hastings Center Report noted, “Financial pressure is much more likely to influence a decision to pursue or reject aggressive life-extending care than it is to influence a request for physician assisted death.” (L.M. Freeman, S.L. Rose, and S.J. Youngner, Poverty: Not a Justification for Banning Physician-Assisted Death, Hastings Center Report (2018), available from: https://doi.org/10.1002/hast.937). No one wants to leave their family destitute trying to extend an inevitable and irreversible dying process, but both research and experience confirm that worry about finances is not one of the key motivating factors that lead someone to request medical aid in dying.

Healthcare providers have no incentive to pressure or coerce their patients into requesting or using medical aid in dying. Often, providers will continue to offer treatment, even when the likelihood of a change in the individual’s disease is extremely unlikely. Medical providers do not make more money from prescribing medical aid in dying for their eligible patients.

And as for “greedy relatives” that some people have expressed concerns about? The terminally ill individual who qualifies for medical aid in dying only has six months or less to live. It strains credulity to believe that a greedy relative would risk criminal prosecution and felony charges (and risk losing everything rather than inheriting a bit less quickly) when the person is already expected to die soon. In fact, there have been no reports of such an occurrence in any of the jurisdictions that have authorized medical aid in dying. The reality is, if someone who stood to inherit anything of value from a terminally ill individual wanted to hasten death, there are many ways to do so that involve far fewer safeguards and less legal liability: overmedicating, undermedicating, failing to bring the terminally ill person to medical appointments, neglecting the person's needs. Access to this option does not heighten the risk of abuse; it dissuades it.

Furthermore, when faced with the prospect of losing a loved one, family members and caregivers are far more likely to cling to patients in late-stage illness and demand that all measures be taken to prolong life. (L. Blackler, LCSW-R, MBE, Compromised Autonomy: When Families Pressure Patients to Change Their Wishes, Journal of Hospice and Palliative Nursing (2016), available from: https://www.nursingcenter.com/cearticle?an=00129191-201608000-00003&Journal_ID=260877&Issue_ID=3584510#P30). In a large U.S. comprehensive cancer hospital study analyzing decision-making in lung cancer patients and caregivers reported that 65% of caregivers experienced treatment disagreements. The same study revealed that families and caregivers were less likely to agree with patient choices regarding decisions to discontinue therapeutic treatments or do not attempt resuscitation (DNAR) status. (A.Y. Zhang & L.A. Siminoff, The role of the family in treatment decision making by patients with cancer, Oncology Nursing Forum, Vol. 30(6) (2003) at pp. 1022-1028).

Will insurance companies deny coverage for life-saving treatment because medical aid in dying is available as an end-of-life option?

There is no connection between the denial of expensive or experimental treatments and the coverage of medical aid in dying as an end-of-life care option. Insurance providers cover treatments that are deemed effective and proven, and they deny coverage for those considered unnecessary, experimental or below the standard of care. Sometimes insurance companies wrongly deny coverage for life-saving treatment. This fact is a harsh reality of our healthcare payment system in every state, those that authorize medical aid in dying and those that do not.

Health insurers have no incentive to encourage medical aid in dying because the vast majority of people who choose medical aid in dying are enrolled in hospice care and no longer pursuing extensive or intensive treatment. Hospice enjoys nearly universal insurance coverage, and hospices have charitable funds to cover those who cannot pay. Medicare covers hospice services — as does Medicaid — with no lag or delay in payment, as with some other services.

Are families able to collect on life insurance policies held by people who use medical aid in dying?

Yes, and this protection is explicit in New York’s Medical Aid in Dying Act, which reads, in part: “A person and his or her beneficiaries shall not be denied benefits under a life insurance policy for actions taken in accordance with this article.” (See section 2899-n (3)(a)). In fact, no one has ever been denied payment from a life insurance policy held by a person who utilized medical aid in dying in a jurisdiction that authorizes it.

I hope these quick answers about money and medical aid in dying are helpful to you. Please reach out to me if you have further questions or you’d like to talk this through. As always, if you want to add your name as a co-sponsor of this bill, please reach out to Assemblymember Amy Paulin or Senator Diane Savino to add your name.

Thank you for your thoughtful consideration. I hope you have a great week and best wishes for a speedy resolution to the budget.

Corinne Carey

Compassion & Choices

 

Weekly Why Archive

Each week that New York State Lawmakers were in session in 2022, Compassion & Choices New York provided a deep dive into each of the issues surrounding New York's Medical Aid in Dying Act. You can find each of these weekly communications with lawmakers here: