by Paul Russell:

A medical friend of mine told me once that in over many years of attending and taking aprt in medical conferences, whenever the 'E' word was mentioned there was always someone in the room that piped up about euthanasia creating savings in the public health purse.

I had previously always thought that cost-savings associated with euthanasia and assisted suicide were the 'elephant in the room'; always there, rarely acknowledged and rarely spoken about.

Not so in Canada. Canada is the most recent country to embrace state sanctioned killing and state sanctioned suicide for those whose deaths are "reasonably foreseeable" - whatever that means. Theirs is a hotch-potch system with different provinces taking very different approaches to precisely how they will make people dead.

Canadians will be pleased to note the headline of a recent article published on the University of Calgary website: Medical assistance in dying will not increase health-care costs in Canada.

The trouble is, that's not what the article is really about nor the Canadian Medical Journal article to which it refers. Concerned as Canadians might be about the cost of the so-called 'medical aid in dying' law on the public purse, the study conducted by Dr. Braden Manns and Dr. Aaron Trachtenberg of the Cumming School of Medicine uncovers potentially massive savings to Canada's health budget when killing and making patients dead is included.

Called quite directly, 'Cost analysis of medical assistance in dying in Canada' the study's results note that:

'Medical assistance in dying could reduce annual health care spending across Canada by between $34.7 million and $138.8 million, exceeding the $1.5–$14.8 million in direct costs associated with its implementation. In sensitivity analyses, we noted that even if the potential savings are overestimated and costs underestimated, the implementation of medical assistance in dying will likely remain at least cost neutral.'

No matter how you look at it, people deciding to die prematurely will be doing the nation a favour. Just how much of a favour is unclear. The authors note:

'the true effect on health care costs will not be certain until we determine who the typical Canadian patient requesting the intervention is and how its practice is implemented across the country. Our study highlights the need to prospectively collect certain data to accurately measure the effect of this new policy on health care spending, namely the total number of patients, in addition to demographics, underlying diagnosis and estimated effect on life expectancy.'

The authors of the study claim, somewhat in passing that, 'we are not suggesting medical assistance in dying as a measure to cut costs. At an individual level, neither patients nor physicians should consider costs when making the very personal decision to request, or provide, this intervention.'

Mmmm! Our elderly and frail already think they are burdens on their families and society. We've been subtly telling them that for years in one way or another. What do these researchers really think such people are hearing when professional people talk about cost savings by being made dead? Really! A glib and passing, 'By the way, we're not saying you should go early but...' is really stating the exact opposite.

Colleague of the authors Dr. Peter Tanuseputro, a physician at Bruyere Research Institute and the Ottawa Hospital Research Institute, commenting in the Ottawa University article makes a very poignant observation:

"These potential cost savings, which are not trivial, should be considered in the context of the largely inadequate and haphazard delivery of palliative care across Canada," he writes. "Despite some successful and exemplary palliative care programs, palliative care in Canada remains deficient; this is the reason that aggressive, institution-based and ultimately costly end-of-life care exists, and why such a large potential cost savings can be anticipated from medical assistance in dying in Canada."

"What matters most is that we address society's failure to provide adequate care for the dying," he concludes.

And a large failure it is as Dr Tanuseputro observes. Such a failure that many Canadians don't have a real option for the best of care. What kind of choice, what kind of autonomy does that endorse? Indeed, Canada desperately needs to address the failures in end-of-life care; only now it seems possible that any new or expanded palliative services will be funded by the very people it should have been serving - those who died under state approved killing and suicide.

Pressure? What pressure?

Adding to the ghoulish hand wringing consider also another published paper from December last year that discusses the new opportunities for organ harvesting the 'medical assistance in dying' offers in Canada. As Wesley Smith pointed out, the Journal of Medical Ethics article not only considers 'the potential to provide additional organs available for transplantation' it also posits the possibility that 'Living organ donation before MAID or death by procurement of organs would provide higher quality organs that would last longer and consequently reduce the organ shortage.' You got it, death caused by the removal of organs.

Imagine the Orwellian public interest promotion: 'Your decision to die may help others who are dying - thank you for your generousity!'

You couldn't make this stuff up.