Opinion

Euthanasia can be an economic decision made early

Economists typically assume that individuals seek to maximize their lifetime satisfaction - yet, when it comes to voluntary euthanasia, the law prohibits such a decision. Moreover, many dying people are beyond the stage where they can act according to this calculation; younger people are much better equipped to make this rational choice in advance.

At the beginning and the end of a working life, individuals should be free to decide about such matters. At the beginning, there might be a choice between buying end-of-life insurance (maybe with pre-tax dollars) in return for a reduction in Medicare tax; or accepting that end-of-life costs will be charged to - and recouped from - their estate. And at the end of a working life: a choice between receiving end-of-life care, or allocating those funds to grant oneself a metaphorical "immortality."

For those opting out, such "immortality" could be provided through an annuity - an eternal income to a worthy cause of the individual's choosing (a "named" scholarship, an annual charitable contribution, etc.). The end-of-life privately insured could be offered a cash payout in return for surrendering their policy. (Or public and private insurance could offer both choices.)

Medical co-payments assist rational decision-making: the private, unarticulated conversation that mumbles on in one part of our brain is confronted by the external reality of incentives (costs). This external conversation leads to actions that more closely resemble reported desired outcomes (for example, many tobacco smokers report that they would like to quit, but remain trapped in their habit. Increasing tobacco taxes nudges short-run outcomes toward the desired long-run result.) Public policy should assist such outcomes; without such intervention, the individual will likely make no decision at all - to the detriment of all concerned.

A large proportion of health care resources are allocated to a system in which the dying have their bodies - but rarely their lives - prolonged: in the United States, about 27 percent of Medicare's annual budget is spent on final-year-of-life expenses. In advance, many would choose to forgo these last few months; but when death is close, there is no longer a legally available choice.

A prolonged death can drain more than societal resources; it can be traumatic for those who lose their parents and loved ones long before the funeral. Even if some final-year expenditures produce measurable benefits, these have to be weighed against alternative uses. There can be no objection to someone choosing to self-fund palliative care; neither can there be an objection to the taxpayer choosing to fund, for example, better infant mortality outcomes than end-of-life expenses.

The primary objections would be raised by those religious leaders who regard voluntary euthanasia as a sin. However, even the most devout recognize that religions are (at least in part) secular institutions. Religious doctrines change: Indulgences, for example, are no longer typically extracted in return for the promise of a reduction in the length of a sentence (purgatory). And some religions maintain that birth control is a sin - yet their followers practice the sin regardless. In a competitive market, religions that fail to adapt will lose their customers.

Moreover, most religions instruct that we are not just our bodies: We should behave with potential immortality in mind. Bodies can be kept alive long after life has any connection to conventional quality-of-life measures. While still free to choose, many would prefer secular "immortality" to a lingering, humiliating and incapacitated drift toward a rapidly approaching death.