Dollars-and-cents calculations have become part of the debate over assisted suicide and euthanasia, argues a British doctor in the journal Bioethics. Dr Miran Epstein says that bioethicists esteem autonomy so highly that any decision which patients make with full knowledge and full consent must be respected. By virtue of the fact that something has been freely chosen, it must be a legitimate decision, regardless of the reasoning behind it.

Bioethics "has been largely silent about [economic] pressures, when in fact it has been willing to legitimize individual and social end- of-life decisions even if they reflected such pressures," he says. Two reasons which are often cited in cases of assisted suicide, fear of becoming a burden on others and fear of loss of control and independence, may often be, fundamentally, economic considerations. Contemporary families are so busy and pressured by the "rat race" that they cannot afford the quality of care that the elderly deserve. And in fact, he says, 63% of the people who died in Oregon in 2000 under its assisted suicide law feared being a burden on their families.

Although Dr Epstein describes himself as a supporter of voluntary euthanasia, he admits that it is possible that "the meaning and the social role of a right to die with dignity depend foremost on the absence or presence of a positive right to live with dignity." Dame Mary Warnock, the UK’s doyenne of bioethics, illustrates his point. She argued in 1994 that "if a patient herself argued that keeping her alive was also too expensive for society… and that this was at least part of what caused her to wish to die, then that reasoning must be accepted… Cost-benefit must be the criterion here; and we should not be ashamed to use it."

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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