The graying of the Boomer generation begins and a new front in the intersection of morality and politics becomes evident - the end of life. Two current issues bear upon the human dignity at issue for aging Boomers: a Massachusetts ballot initiative for physician assisted suicide and a radical cut to Medicaid.
Physician Assisted Suicide
In Massachusetts this fall, voters are being pushed to approve a physician assisted suicide measure that would facilitate the deaths of the elderly. Specifically, the initiative would create a legal mechanism for those diagnosed with a terminal illness to obtain “medication” for the purpose of suicide. If passed by the voters in November, it would make assisted suicides legal with a physician’s diagnosis that a terminal illness will cause death within six months, with a declaration that the suicide is voluntary, with a physician’s determination that the person who wishes to commit suicide is of sound mind and making an informed decision, and with the proviso that the “medication” be self-administered.
In form, the proposed Massachusetts suicide policy would follow the worrisome precedents elsewhere, such as the systems in the Netherlands and in Oregon. Those precedents demonstrate real dangers to seniors, who even now are at times cross-pressured and counseled by family and even by medical professionals.
The elderly poor and middle class are especially at risk from such pressure. They are in a position where, faced with the diagnosis of terminal illness, the costs of end of life care pose an enormous challenge for themselves and their families. In the United States, end of life medical and care costs are very much dependent upon Medicaid. Medicaid does not cover frills. Even to qualify for Medicaid the elderly in many cases must intentionally exhaust their savings, property, and other assets -- a process that can generate anxiety if not actual resentment among family members. The elderly, faced with spending down their remaining wealth may well feel obligated to die now in order to save assets for heirs, especially in the context of family resentment. Moreover, the elderly poor often do not have the resources for legal and medical counsel to consider a full range of possible alternatives.
Such looming financial and family pressures however are only part of the frightening dynamic that the Massachusetts initiative would set for the elderly. Indeed, to what extent can such decisions ever be “informed” decisions? Advocates for assisted suicide seize naively upon an ideal of rational, informed, and autonomous choice as justification. Such transcendent choice is rarely found in end of life experiences. Frightening prognoses may generate both deep and subtle depressions. The psycho-social dynamics of friendships and relationships under these circumstances can have their own psychological implications. The medications of treating end of life conditions, including strong analgesics and sedatives as well as anti-depressants and powerful medications for underlying illnesses can play havoc on the elderly patient’s ability to make an informed choice. Serious illness itself creates a situation of great dependency -- dependency upon others in many capacities (doctors, nurses, family members), none of whom are in positions of objectivity, all of whom might, innocently or not, overly influence the thinking of the elderly.
Backers of assisted suicide always have two or three extraordinary cases as part of the rhetoric to advance their cause. The shameful reality revealed in the Netherlands and now Oregon, however, is far different from such extraordinary cases. Choices are seldom truly “informed.” The elderly poor and confused and depressed are the ones at risk. Pressures of many kinds are at play on the elderly in their last years. Don’t we all know of friends, relatives, or acquaintances who lived months and even years beyond their predicted death? Don’t we all also know from loved ones left behind just how meaningful and poignant the last months of life can be?
Radical Cut to Medicaid
According to analysis by the Center for Budget and Policy Priorities, if Congressman Paul Ryan has his way with the budget the 2016 Medicaid allocation would be cut by 29 percent and by 2022 the cut would be about 40 percent. The implications of a looming 40 percent Medicaid cut are enormous for graying Boomers.
Medicaid provides health care to the poorest Americas, of course, which is cause enough for our concern. It’s shameful to be cutting health care for poor kids and moms.
But the Medicaid cuts hit the middle class elderly equally as hard. Currently, about 60 percent of all nursing home care is paid for by Medicaid and for hospice care it’s even higher. Those percentages may be expected to rise in coming years. The number of people over the age of 65 will nearly double by 2030 to about 71 million. As the Boomer generation unfolds from early golden years of golf and travel to later years of assisted living, nursing homes, and hospices -- Medicaid will loom in importance.
Boomers are probably already well aware of how the move to Medicaid happens when one enters into nursing home care. Even today the average cost of nursing home care is more than $70,000 a year and tops $100,000 in some urban areas. After the elderly are admitted, these costs very quickly run through fixed incomes and accumulated savings until the elderly are poor enough to qualify for Medicaid. Indeed, on average it takes only about six months before savings are emptied and Medicaid is required. Medicaid is the last viable resource for care for the vast majority of the most elderly Americans.
So, what would the proposed 29 percent or ultimately 40 percent cut in Medicaid mean then for Boomers’ own last years? The picture is not pretty. More elderly Americans would need to rely on family or charity resources -- and, frankly, neither charities nor family resources are likely to be sufficient to cope with the need. Greater rationing pressures would be experienced in regard to nursing home housing, nursing care, and end of life medical care. Those pressures on families, on charities, and on the quality and availability of care will surely play out in worrisome dynamics for elder abuse and a host of other end of life moral issues.
The proposed Medicaid cuts make the Massachusetts’ ballot initiate for assisted suicide even more frightening. The teachings of our Church are clear about respecting and supporting the genuine dignity of living life as fully as possible until God calls. Our message as Catholic citizens is clear: Oppose the Medicaid cuts and defeat the Massachusetts physician assisted suicide referendum.
