Esmond Birnie: To justify euthanasia in terms of economic efficiency is a dangerous and facile argument

Medical Assistance in Dying (MAID) was introduced in Canada in 2015. Canada’s Parliamentary Budget Officer reported that one advantage of euthanasia was that it would save thousands of dollars as compared to paying for the long term care for the chronically or terminally ill.

This was actually a silly application of the concept of efficiency. One medical ethicist pointed out that the cheapest medical outcomes are often those where the patient dies but of course we don’t regard that as a good outcome.

In a polite sort of way the Canadian official was implying that the old and the sick should think about what their patriotic duty might be in terms of choosing MAID as a way to prevent further increase in healthcare costs.

In economic theory we think about a sort of mythical sovereign consumer who makes his or her best choice between Ford or Toyota or Coca Cola or Pepsi. In real life, of course, when we make choices we are all subject to all sorts of outside pressure.

In a world of legalised dying one can imagine some senior citizens thinking to themselves, “Well, I don’t want to be a burden on the rest of the family”.

A further sinister scenario is as follows, given the context of the relative affluence of the baby boom generation which was born after the Second World War as compared to the more recent Generation X, the Millennials and Generation Z.

Inheritance, especially of houses, is becoming a major driver of changes in family living standards. This may not happen very often but we could imagine some of the unscrupulous wishing to accelerate the coming nest egg by dropping heavy hints to the elder generation about euthanasia.

It is worth focusing on the Canadian experience of euthanasia (MAID) since 2015. Canada demonstrates, as does the experience of Belgium and Canada, that over time the legal safeguards defining when assisted dying can happen will be watered down.

From 2027 adults suffering from various mental illnesses will be eligible for MAID in Canada. Some of the many euthanasia related deaths in Belgium and the Netherlands related to eating disorders. During 2019-22 MAID deaths in Canada grew by 30% every year. In 2022 an incredible 4.1%, one in 25, of all deaths in Canada could be attributed to MAID. That proportion will almost certainly grow.

If Parliament does vote for assisted dying it will be one major unintended consequence of Labour’s massive majority in the July general election. That election produced a massive turnover in the House of the Commons and it probably also reduced the average age of MPs.

Arguably, the House of Commons is now being asked to undertake a complex exercise in deliberative judgement which will very much stretch the limited experience which most of the MPs have. This is not a party-political point, I suspect if there had been a Tory landslide many of the right-wing ideologues would also have been pro-euthanasia.

Ironically, one Labour MP has expressed doubts about euthanasia. This is none other than health secretary Wes Streeting. His point is a very logical one. The advocates of legalised assisted dying would claim all they want is to give people the option to make a reasonable choice between continuing in great pain or accelerating death.

Streeting’s point is that many people would choose to continue living if they could be certain they would get sufficient support in terms of palliative care to control and limit pain. The current problem is that given the existing state of the NHS, adequate palliative and end-of-life care is not always guaranteed and so, in the view of the health minister, there is a great danger people will be coerced into opting for euthanasia.

A further powerful argument against the law change is that assisted dying will in the long run fundamentally change and arguably corrupt the doctor-patient relationship. Up to now we have known that medics take seriously the imperative not to do harm but that will change in the world where some doctors actively end a life through, for example, preparing the drugs that produce that outcome (the terms of the bill insist that any treatment will still have to be self-administered by the patient - one wonders how long that safeguard will last).

Euthanasia raises some of the deepest philosophical and indeed theological questions about the nature and purpose of life but suffice to say I do not think economic efficiency arguments in favour of it are in any way sound.

Esmond Birnie is a senior economist at Ulster University Business School and also a member of the NI Fiscal Council