Ruminations

End-of-Life Health Costs

"Neither patients nor physicians should consider costs when making the very personal decision to request, or provide, this intervention."
"As death approaches, health care costs increase dramatically in the final months. Patients who choose medical assistance in dying may forgo this resource-intensive period."
"Providing medical assistance in dying in Canada should not result in any excess financial burden to the health care system and could result in substantial savings."
Report, University of Calgary research

"There was no agenda to this cost analysis. We're definitely not suggesting that medical assistance in dying be chosen over any other way of dying."
"We're just trying to describe the reality that may exist in Canada [under a new law]."
Dr. Aaron Trachtenberg, resident, internal medicine, study co-author

"[The difference between one and four percent of all deaths] represents a grey zone of about 8,000 Canadians. The very notion of costing end-of-life care and estimated savings with medical aid in dying is a bitter ethical quandary for some."
"We should quickly move past counting dollars saved from medical aid in dying, and count instead the days of unbearable suffering that result from missed opportunities to provide palliative care."
Dr. Peter Tanuseputro, Bruyere Research Institute

New research suggest medically assisted dying could result in substantial savings. But the study's author says costs should not be considered when individual patients consider the option. (Chris Kreussling)

Indeed, the conclusion reached by the research team out of the University of Calgary, published in the Canadian Medical Association Journal of the economic efficacy in savings up to $139-million annually in aiding dying patients to kill themselves before the natural process of dying completes its journey -- as a remedy to high health costs associated with the last living days of people moving toward the final days, weeks, months of their lives -- does leave an acrid taste in one's sensibilities.

The analysis, based on those Canadians expected by the system to choose an assisted death, and the amount of time a person's end-of-life might be quickened, the costs of care immediately preceding death based on emergency department trips, dialysis treatment and hospital admissions led to the calculation that the cost of offering doctor-hastened death would lead to a gross medical-health savings that would more than balance the cost of doctor-aided death as opposed to continued health care until death.

With the experience of the Netherlands and Belgium as a guide, the researchers were able to estimate medical assistance in dying would play a role in one to four percent of all deaths in Canada, resulting in approximately 10,722 deaths annually. Of those deaths, an estimated eighty percent would be struggling with cancer; fifty percent would be between 50 to 80 years of age, and sixty percent would have had their lives cut short by an average of one month. Based on physician fees in Ontario the calculation was that direct total cost of doctor-hastened death would range from $269 to $756.

Medical assistance in dying (MAID) in practise, has the potential to reduce annual health spending by $35-million to $139-million. For 2016, Canada was projected to spend $228-billion on health care. According to one Ontario study, the average person is responsible for generating $14,000 in health-care costs through the last thirty days of their life, inclusive of receiving intensive treatment which, in the end, serves frequently to temporarily delay otherwise-imminent death.

"Canadians die in hospitals more often than, say, our counterparts in America or Europe and … we have a lack of palliative care services even though we are trying to improve that. And therefore people end up spending their final days in the hospital", explained Dr. Trachtenberg further. "Hospital-based care costs the health care system more than a comprehensive palliative care system where we could help people achieve their goal of dying at home."