Federal Legislation
EUTHANASIA BATTLES IN 2003 AND 2004
By Burke J. Balch, J.D., Director,
NRLC's Robert Powell Center for Medical Ethics
The year 2003 saw a massive victory on the euthanasia front against Medicare rationing and national attention to the averted - - for the present - - starvation of Terri Schindler-Schiavo. 2004 is likely to see battles at least two states over the legalization of assisting suicide in a continued fight for Terri Schiavo's life and the lives of others like her threatened with starvation and dehydration, and struggles over involuntary euthanasia.
MEDICARE
Since 1993-94, when the National Right to Life Committee played a key role in helping to defeat the Clinton Health Care Rationing Plan, the euthanasia battle has included working against government-imposed rationing of lifesaving medical treatment. Of particular importance has been the threat of rationing for older people under the government Medicare program.
Since Medicare's inception in the sixties, when retired people were first required to obtain their primary health insurance through the program, it has been financed by a combination of payroll and general taxes. Benefits for older people have been paid for by these taxes on the working population. The impending retirement of the large baby boom generation will mean such a shift in the demographic balance that it will be impossible to maintain per-person Medicare payments at current levels without massive tax increases, which are improbable. Consequently, NRLC has long realized that as a matter of practical reality, either older people will have to be permitted to use their own money to ensure unrationed care or the limitation of funds available from the government will impose increasing denials of treatments necessary to prevent death.
Until 1997, the Medicare law effectively prohibited senior citizens from spending enough of their own money for health insurance or health care to be able to be sure of avoiding rationing. A major effort by the pro-life movement that year established that they could do so if they selected private traditional indemnity "fee-for-service" insurance (under which a patient can choose any doctor or hospital, and tests and treatments are reimbursed whenever patient and doctor agree upon them) and paid the difference in the premium above the government's contribution using their own funds.
In 2003, amendments included in the Medicare prescription drug bill clarified that senior citizens may also voluntarily add their own money, on top of the government contribution, for "preferred provider organization (PPO)" plans and most forms of managed care plans as well as part of the private fee-for-service option. Under a PPO, one of the most common forms of contemporary health insurance, the insurance company negotiates rates with a selected group of providers. Beneficiaries of the plan can go to providers outside this group, but incur higher co-payments if they do so. The 2003 legislation also allows senior citizens who choose the private fee-for-service option and who wish to do so to add their own money on top of the government contribution to the new prescription drug benefit scheduled for 2006 in order to avoid drug rationing.
It will now be necessary to persuade health insurance companies that there is a market for more costly plans that are less likely to ration and to convince senior citizens to take advantage of such plans that are offered. However, there is now no government-imposed legal obstacle to obtaining unrationed health insurance for senior citizens - - a major breakthrough in the fight against rationing.
RIPPLES FROM THE SCHINDLER-SCHIAVO CASE
2003 also saw a public outcry over the denial of food and fluids to Terri Schindler-Schiavo. After the Florida courts consistently sided with her husband's position that the brain-damaged woman should be starved and dehydrated over the objections of her parents and siblings, popular pressure led to state legislation authorizing pro-life Gov. Jeb Bush to step in and direct provision of a feeding tube, according to the Associated Press.
However, the husband has challenged the constitutionality of the law in the state courts, and further legislation to protect Schinder-Schiavo and others like her is now necessary. The National Right to Life Committee developed and announced model state legislation to create a presumption for food and fluids when a patient is unable to speak for herself, which is likely to be considered in at least some states outside Florida this spring.
SUICIDE LEGALIZATION BATTLES
For some time, there have been two principal organizations of euthanasia advocates pushing to legalize assisting suicide. The older, more established, and generally more sophisticated group has gone through a bewildering series of renamings over the years, including the "Euthanasia Educational Council" and the "Society for the Right to Die." At present it is titled "Compassion in Dying."
The other group, founded by Derek Humphry, had since its inception been called the "Hemlock Society," named for the plant used to execute the ancient Greek philosopher Socrates. It had long been the more outspoken, candid, and "activist" group.
In 2003, however, in an effort to moderate its image, it too changed its name to "End of Life Choices." Evidently the recognition is now almost universal among savvy euthanasia advocates that if they hope to succeed, they must do their best to hide their aims in euphemism and ambiguity.
With both major groups now focused on pragmatism and a sophisticated approach, they have been successful in raising a good deal of money, which - - according to present indications - - is likely to be concentrated during the first months of 2004 in two targeted states: Hawaii and Vermont. Two years ago an assisted suicide bill passed the Hawaii House and was prevented from becoming law only by the switch of a couple of votes in the Senate. Critical struggles can be expected in the legislatures of both states in 2004. It is not yet clear whether there will also be referenda seeking to legalize assisting suicide by popular vote on the November ballots in any states.
INVOLUNTARY EUTHANASIA
Reports continue of increasing implementation of protocols and practices in hospitals across the country under which patients and their family members who want lifesaving medical treatment may be denied it against their will when an ethics committee considers the patient's quality of life to be too poor. In the face of polls showing widespread public opposition to doctors and hospitals assuming such power to kill patients against their will and that of their families, it is surprising that the practice has become so thoroughly accepted as part of mainstream medicine with so little public outcry.
Perhaps it will take a well-publicized case to awaken public opposition, as has occurred in the context of denial of food and fluids to Terri Schindler-Schiavo. National Right to Life and its affiliates will continue to press for legislation to protect patients from such involuntary euthanasia.