California Governor Jerry Brown signed a “Rig
ht to Die” bill into law lastweek. Meanwhile, a state ballot initiative to impose price controls on medicines will insure that lots of people will take advantage of the law that otherwise would be alive.That’s because price controls create shortages of important medicines, especially for cancer. And price controls add months, if not years for the time it takes to get medicines to patients. And price controls are always combined with steps to coerce patients to take cheaper medicines.
1. There is a right to die using an off-label combination of lethal drugs if you have a fatal illness. There is no corresponding right to try an experimental treatment if you are dying. You can get an experimental drug if the company making it will cover the cost. Setting prices artificially low even as the cost of developing new medicines increases means that the right to die will trump the right to try.
2. Similarly, we force dying patients to wait years for new medicines to become available. In addition to Food and Drug Administration regulations, insurers and health systems demand evidence that a drug is worth it. That demand makes people wait for many new medicines. Price controls are based on such ‘evidence’. It is self evident that the unnecessary delays in access contribute to the desire to take one’s own life. Price controls will and do affect the decision to die.
3. Finally, we are developing cost control mechanisms that reinforce the desire for assisted suicide. Price controls are accompanied by so called treatment pathways limit the use of new medicines until people fail on older, often more toxic drugs with more side effects. In an age of personalized medicine, it is possible to customize treatments to patients to extend life. Yet most pathways use average response to one drug. In turn, that average response – which will be far below what many people with an illness would experience – is used to measure the “value” of treatment.
Most people choosing assisted suicide have cancer. And most of the cancer patients who make that decision have tumors or cancer types that have shown the least progress over the past 20 years. At the same time, the percentage of cancer patients choosing assisted suicide has declined since 1998 as new treatments emerge. Indeed, in 1997 sixty-three percent of HIV patient assisted suicide, and 55% acknowledged considering physician-assisted suicide as an option for themselves. In Oregon the number of HIV patients chose patients choosing assisted suicide went from from 10 in 1998 to 0 in 2014. The key variable is access to new drugs – many of which were shown to provide benefits deemed not worth it by treatment pathways put forth by physician groups and insurers – that extend and improve life. So by delaying access to new medicines that might be effective we are encouraging assisted suicide.
Finally, the Oregon survey shows that the reason for assisted suicide with the biggest increase since 1998 is financial implications of treatment. The percent citing this cause jumped 77 percent. By extension, eliminating financial burdens would eliminate assisted suicide.
However, our health system is moving in the opposite direction. It is shifting the cost of medicines that offer hope to patients. In many cases insurers are increase the effective price of medicines by more than the 5000 percent increase that has been a source of outrage. Under price controls, insurers and government health programs would not be obliged to cover anyt medicine it believes is too expensive. What’s more, rather than fighting to eliminate that burden with copay limits, the leading cancer doctor and provider trade groups have made the insurer-imposed cost to the patient a key reason dying patients should choose one treatment or another or no treatment at all.
A system that delays access to new treatments, underestimates survival and deliberately exposes the dying to the cost of the potential most effective treatments and then hits the patient over the head with the expense (instead of protecting them from it) essentially makes it easier for the the sick and disabled to die. As my colleague Peter Pitts has noted, in Oregon Medicaid denies coverage for certain cancer treatments for patients that have been deemed “too” sick, haven’t responded well to previous treatments, or can’t care for themselves.
Oregon state bureaucrats are severely restricting access to care and dooming potentially thousands of local patients to a premature death with medicines the state will gladly provide free of charge.
We have a health system that is turning the right to die into a duty to die. Price controls will make it virtual requirement to do so.
