President's Ethics Council Rejects Assisted Suicide

WASHINGTON — Assisted suicide and euthanasia should not be considered for terminally ill patients, the President's Council on Bioethics suggests in a soon to be released report.

“If you say assisted suicide and euthanasia are not the way to fix these problems, you have reaffirmed the principles we affirmed in the last chapters of this report,” said Gilbert C. Meilaender, Ph.D., council member and Phyllis and Richard Dusenberg Professor of Christian Ethics at Valparaiso (Ind.) University.

“We think that euthanasia and assisted suicide are out,” agreed council member Paul McHugh, M.D., the Henry Phipps Professor of Psychiatry at Johns Hopkins University, Baltimore. “This is just an old idea that crops up again and again in society, and various people tried it, and it always fails.”

The patients who are driven to consider assisted suicide “are the people who burn out in the process of care,” said Dr. McHugh, who is also professor of mental health at the university's school of public health. “They burn out simply because doctors have been extending things too far for them, asking more than they can deliver. … Never forget that inflicting extra care on people is to ultimately burn them [out].”

Dr. McHugh said he also favored giving family caregivers tax benefits to help them financially. He added that he wished there were more role models to persuade people to think of elder care as a career. “We don't have any Florence Nightingales, any Mother Teresas to tell people this is a wonderful life.”

Council member Alfonso Gómez-Lobo, D. Phil., lauded the report but said there was more work to do on the subject. “We have to think more about the way of making a distinction between ordinary and extraordinary means,” said the Ryan Professor of Metaphysics and Moral Philosophy at Georgetown University, Washington. “It is important to affirm, on the one hand, the goodness of life. On the other hand, it's not an absolute good. It's frail and fragile, and there are moments in which we just have to open ourselves to the fact that we have to let go.”

The council also recommended establishing a presidential commission on aging, dementia, and long-term care.

“Someone might say the last thing America needs is another commission, but this commission is really set up to be unique, understanding death not as a problem to be solved but an experience to be faced,” said council member Peter Lawler, Ph.D., chairman and the Dana Professor of Government at Berry College, Mount Berry, Ga. “We as a people aren't particularly equipped to think of death as an experience to be faced. But if a commission can accomplish that, it would be quite a commission. And I'm all for that.”

At the meeting, the commission heard from Robert Friedlander, Ph.D., director of the Center for an Aging Society at Georgetown. Dr. Friedlander told the council that although most of the caregiving for elderly patients is provided at home—often by family members—three-quarters of the money spent on caregiving is spent at institutions. This is partly because institutional long-term care is a mandated benefit under Medicaid, whereas home- and community-based care is not.

But “there have been tremendous efforts on the part of states to move care out of the nursing home,” especially since states think care is cheaper outside of institutions, he said. “This rebalancing has meant that in the period from 1991 to 2001, the expenditures in home and community-based care in Medicaid have more than tripled, from $6.2 billion to $22.2 billion.”

There also has been movement toward changing the financing of long-term care. “The past 6–8 years, most of the focus has been on tax credits for caregivers and more public incentives for the purchase of long-term care insurance,” Dr. Friedlander explained.

More fundamental changes need to be made to the long-term care financing system than are currently in place, Dr. Friedlander said. “I think without structural changes, it is likely to be harder for caregivers in the future.”

Further, things will only get worse as baby boomers live longer, and there are fewer children to support and care for them. “I would call these the best of times. I think when we get to the real crisis, these are going to look like the good old days.”

Greg Sachs, M.D., chief of the section of geriatrics at the University of Chicago, said that when it came to caring for dementia patients, he was “less worried about the advancing number of people and smaller numbers of caregivers … and much more worried about the propensity to overtreat, to not provide good end-of-life care, and in fact, to have a healthcare system that is particularly ill-suited for the ongoing care of people with dementia.”

Current financial incentives don't encourage the idea of letting dementia patients die peacefully at a nursing home, Dr. Sachs said. “When the [nursing home] patient has pneumonia and is getting close to dying, the nursing home has to provide more care … but they are not reimbursed more. Depending on where they are and if the patient is on Medicaid, if they send the patient to the hospital they can actually be paid a 'bed-hold,' and they are actually making money while the patient is in the hospital, rather than losing money from having to provide additional care.”

In addition, the physician, instead of being paid at a lower rate and doing less frequent visits, “hospitalizes the patient and makes more money by seeing the patient on a daily basis and gets reimbursed at a higher rate,” he continued.

“All the financial incentives are aligned for this patient to be transferred to the hospital rather than being cared for in the nursing home and being allowed to die peacefully,” he said.

The September meeting was the last one at which Leon Kass, M.D., a fellow at the American Enterprise Institute, would serve as council chairman. The new chairman is Edmund Pellegrino, M.D., professor emeritus of medicine and medical ethics at Georgetown.

WASHINGTON — Assisted suicide and euthanasia should not be considered for terminally ill patients, the President's Council on Bioethics suggests in a soon to be released report.

“If you say assisted suicide and euthanasia are not the way to fix these problems, you have reaffirmed the principles we affirmed in the last chapters of this report,” said Gilbert C. Meilaender, Ph.D., council member and Phyllis and Richard Dusenberg Professor of Christian Ethics at Valparaiso (Ind.) University.

“We think that euthanasia and assisted suicide are out,” agreed council member Paul McHugh, M.D., the Henry Phipps Professor of Psychiatry at Johns Hopkins University, Baltimore. “This is just an old idea that crops up again and again in society, and various people tried it, and it always fails.”

The patients who are driven to consider assisted suicide “are the people who burn out in the process of care,” said Dr. McHugh, who is also professor of mental health at the university's school of public health. “They burn out simply because doctors have been extending things too far for them, asking more than they can deliver. … Never forget that inflicting extra care on people is to ultimately burn them [out].”

Dr. McHugh said he also favored giving family caregivers tax benefits to help them financially. He added that he wished there were more role models to persuade people to think of elder care as a career. “We don't have any Florence Nightingales, any Mother Teresas to tell people this is a wonderful life.”

Council member Alfonso Gómez-Lobo, D. Phil., lauded the report but said there was more work to do on the subject. “We have to think more about the way of making a distinction between ordinary and extraordinary means,” said the Ryan Professor of Metaphysics and Moral Philosophy at Georgetown University, Washington. “It is important to affirm, on the one hand, the goodness of life. On the other hand, it's not an absolute good. It's frail and fragile, and there are moments in which we just have to open ourselves to the fact that we have to let go.”

The council also recommended establishing a presidential commission on aging, dementia, and long-term care.

“Someone might say the last thing America needs is another commission, but this commission is really set up to be unique, understanding death not as a problem to be solved but an experience to be faced,” said council member Peter Lawler, Ph.D., chairman and the Dana Professor of Government at Berry College, Mount Berry, Ga. “We as a people aren't particularly equipped to think of death as an experience to be faced. But if a commission can accomplish that, it would be quite a commission. And I'm all for that.”

At the meeting, the commission heard from Robert Friedlander, Ph.D., director of the Center for an Aging Society at Georgetown. Dr. Friedlander told the council that although most of the caregiving for elderly patients is provided at home—often by family members—three-quarters of the money spent on caregiving is spent at institutions. This is partly because institutional long-term care is a mandated benefit under Medicaid, whereas home- and community-based care is not.

But “there have been tremendous efforts on the part of states to move care out of the nursing home,” especially since states think care is cheaper outside of institutions, he said. “This rebalancing has meant that in the period from 1991 to 2001, the expenditures in home and community-based care in Medicaid have more than tripled, from $6.2 billion to $22.2 billion.”

There also has been movement toward changing the financing of long-term care. “The past 6–8 years, most of the focus has been on tax credits for caregivers and more public incentives for the purchase of long-term care insurance,” Dr. Friedlander explained.

More fundamental changes need to be made to the long-term care financing system than are currently in place, Dr. Friedlander said. “I think without structural changes, it is likely to be harder for caregivers in the future.”

Further, things will only get worse as baby boomers live longer, and there are fewer children to support and care for them. “I would call these the best of times. I think when we get to the real crisis, these are going to look like the good old days.”

Greg Sachs, M.D., chief of the section of geriatrics at the University of Chicago, said that when it came to caring for dementia patients, he was “less worried about the advancing number of people and smaller numbers of caregivers … and much more worried about the propensity to overtreat, to not provide good end-of-life care, and in fact, to have a healthcare system that is particularly ill-suited for the ongoing care of people with dementia.”

Current financial incentives don't encourage the idea of letting dementia patients die peacefully at a nursing home, Dr. Sachs said. “When the [nursing home] patient has pneumonia and is getting close to dying, the nursing home has to provide more care … but they are not reimbursed more. Depending on where they are and if the patient is on Medicaid, if they send the patient to the hospital they can actually be paid a 'bed-hold,' and they are actually making money while the patient is in the hospital, rather than losing money from having to provide additional care.”

In addition, the physician, instead of being paid at a lower rate and doing less frequent visits, “hospitalizes the patient and makes more money by seeing the patient on a daily basis and gets reimbursed at a higher rate,” he continued.

“All the financial incentives are aligned for this patient to be transferred to the hospital rather than being cared for in the nursing home and being allowed to die peacefully,” he said.

The September meeting was the last one at which Leon Kass, M.D., a fellow at the American Enterprise Institute, would serve as council chairman. The new chairman is Edmund Pellegrino, M.D., professor emeritus of medicine and medical ethics at Georgetown.

WASHINGTON — Assisted suicide and euthanasia should not be considered for terminally ill patients, the President's Council on Bioethics suggests in a soon to be released report.

“If you say assisted suicide and euthanasia are not the way to fix these problems, you have reaffirmed the principles we affirmed in the last chapters of this report,” said Gilbert C. Meilaender, Ph.D., council member and Phyllis and Richard Dusenberg Professor of Christian Ethics at Valparaiso (Ind.) University.

“We think that euthanasia and assisted suicide are out,” agreed council member Paul McHugh, M.D., the Henry Phipps Professor of Psychiatry at Johns Hopkins University, Baltimore. “This is just an old idea that crops up again and again in society, and various people tried it, and it always fails.”

The patients who are driven to consider assisted suicide “are the people who burn out in the process of care,” said Dr. McHugh, who is also professor of mental health at the university's school of public health. “They burn out simply because doctors have been extending things too far for them, asking more than they can deliver. … Never forget that inflicting extra care on people is to ultimately burn them [out].”

Dr. McHugh said he also favored giving family caregivers tax benefits to help them financially. He added that he wished there were more role models to persuade people to think of elder care as a career. “We don't have any Florence Nightingales, any Mother Teresas to tell people this is a wonderful life.”

Council member Alfonso Gómez-Lobo, D. Phil., lauded the report but said there was more work to do on the subject. “We have to think more about the way of making a distinction between ordinary and extraordinary means,” said the Ryan Professor of Metaphysics and Moral Philosophy at Georgetown University, Washington. “It is important to affirm, on the one hand, the goodness of life. On the other hand, it's not an absolute good. It's frail and fragile, and there are moments in which we just have to open ourselves to the fact that we have to let go.”

The council also recommended establishing a presidential commission on aging, dementia, and long-term care.

“Someone might say the last thing America needs is another commission, but this commission is really set up to be unique, understanding death not as a problem to be solved but an experience to be faced,” said council member Peter Lawler, Ph.D., chairman and the Dana Professor of Government at Berry College, Mount Berry, Ga. “We as a people aren't particularly equipped to think of death as an experience to be faced. But if a commission can accomplish that, it would be quite a commission. And I'm all for that.”

At the meeting, the commission heard from Robert Friedlander, Ph.D., director of the Center for an Aging Society at Georgetown. Dr. Friedlander told the council that although most of the caregiving for elderly patients is provided at home—often by family members—three-quarters of the money spent on caregiving is spent at institutions. This is partly because institutional long-term care is a mandated benefit under Medicaid, whereas home- and community-based care is not.

But “there have been tremendous efforts on the part of states to move care out of the nursing home,” especially since states think care is cheaper outside of institutions, he said. “This rebalancing has meant that in the period from 1991 to 2001, the expenditures in home and community-based care in Medicaid have more than tripled, from $6.2 billion to $22.2 billion.”

There also has been movement toward changing the financing of long-term care. “The past 6–8 years, most of the focus has been on tax credits for caregivers and more public incentives for the purchase of long-term care insurance,” Dr. Friedlander explained.

More fundamental changes need to be made to the long-term care financing system than are currently in place, Dr. Friedlander said. “I think without structural changes, it is likely to be harder for caregivers in the future.”

Further, things will only get worse as baby boomers live longer, and there are fewer children to support and care for them. “I would call these the best of times. I think when we get to the real crisis, these are going to look like the good old days.”

Greg Sachs, M.D., chief of the section of geriatrics at the University of Chicago, said that when it came to caring for dementia patients, he was “less worried about the advancing number of people and smaller numbers of caregivers … and much more worried about the propensity to overtreat, to not provide good end-of-life care, and in fact, to have a healthcare system that is particularly ill-suited for the ongoing care of people with dementia.”

Current financial incentives don't encourage the idea of letting dementia patients die peacefully at a nursing home, Dr. Sachs said. “When the [nursing home] patient has pneumonia and is getting close to dying, the nursing home has to provide more care … but they are not reimbursed more. Depending on where they are and if the patient is on Medicaid, if they send the patient to the hospital they can actually be paid a 'bed-hold,' and they are actually making money while the patient is in the hospital, rather than losing money from having to provide additional care.”

In addition, the physician, instead of being paid at a lower rate and doing less frequent visits, “hospitalizes the patient and makes more money by seeing the patient on a daily basis and gets reimbursed at a higher rate,” he continued.

“All the financial incentives are aligned for this patient to be transferred to the hospital rather than being cared for in the nursing home and being allowed to die peacefully,” he said.

The September meeting was the last one at which Leon Kass, M.D., a fellow at the American Enterprise Institute, would serve as council chairman. The new chairman is Edmund Pellegrino, M.D., professor emeritus of medicine and medical ethics at Georgetown.