Euthanasia may save $139M, study says

Argues savings dwarf costs of assisted death

Doctor-assisted suicide could save Canada tens of millions of dollars annually by avoiding costly “end-oflife” care, according to a provocative new analysis.

The savings — up to $139 million annually — will almost certainly dwarf the costs associated with helping dying patients kill themselves, University of Calgary researchers report.

The authors go to pains to state they aren’t suggesting people be voluntarily euthanized to save money. “Neither patients nor physicians should consider costs when making the very personal decision to request, or provide, this intervention,” they write in this week’s issue of the Canadian Medical Association Journal.

However, their attempt to cost out the controversial practice is an issue many have avoided touching.

According to the authors, “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.”

Their analysis is based on the number of Canadians expected to choose an assisted death, the amount of time a person’s life might be shortened by and the costs of care immediately preceding death in the final week or month of life, such as emergency visits, dialysis and hospital admissions.

They also calculated the cost of offering doctor-hastened death — including lifeending drugs that can run as little as $25, depending on the regimen.

If Canada follows the experience in the Netherlands and Belgium, the researchers estimate medical assistance in dying will eventually play a role in one to four per cent of all deaths in Canada.

At the high end, that would be 10,722 deaths a year, they calculate.

Eighty per cent of those people will have cancer; 50 per cent will be aged 50 to 80; 60 per cent will have their lives shortened by one month and 40 per cent by one week. Using Ontario physician fees, they calculate that the direct total cost for a “completed case” of doctorhastened death ranges from $269 to $756, depending on the doctors (family physician or internal medicine specialist) and drugs (oral versus intravenous) involved.

Overall, they estimate MAID — medical assistance in dying — could reduce annual health spending by $35 million to $139 million, exceeding the $1.5 million to $15 million in direct costs.

“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,” they conclude.

Canada was projected to spend a total of $228 billion on health care in 2016.

One Ontario study found the average person generates $14,000 in health-care costs during the last 30 days of his or her life, often receiving intensive treatment that may only make death more difficult.

However, “There was no agenda to this cost analysis,” stressed first author Dr. Aaron Trachtenberg, a resident in internal medicine. “We’re definitely not suggesting that medical assistance in dying be chosen over any other way of dying,” he said. “We’re just trying to describe the reality that may exist in Canada” under the new law.

In an accompanying commentary, Ottawa physician Dr. Peter Tanuseputro says it’s not clear which or how many Canadians will seek assisted dying, adding the difference between one and four per cent of all deaths “represents a grey zone of about 8,000 Canadians.”

According to Tanuseputro, “the very notion of costing end-of-life care and estimating savings with medical aid in dying is a bitter ethical quandary for some.”

However, he said pricey, end-of-life costs are often a symptom “of our failure to prevent undue suffering, the very thing that patients will seek to avoid by choosing medical aid in dying.”

While the potential savings aren’t trivial, “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,” Tanuseputro, of the Bruyere Research Institute, writes.