Physician-Assisted Suicide in the Context of Managed Care

Abstract:     
Debate over whether to legalize physician-assisted suicide and its constitutional status has largely ignored the context for end-of-life care and this practice. For a large proportion of Americans, that context is some form of managed care. This compels consideration of how the cost-containment measures essential to managed care would affect the use of physician-assisted suicide in jurisdictions where the practice may be legalized. This article considers the organizational and incentive structure of managed care, together with available data on physician attitudes and practice in the context of managed care. Those data indicate that in the cost-containment environment of managed care, physicians may be more inclined to consider assisted suicide. Moreover, data indicate that treatment of factors known to lead patients to consider PAS (especially depression) may lag. The article thus argues that treatment and insurance context matters. The author suggests how context should bear on the constitutional status of bans on assisted suicide and the states’ policy determination of whether to legalize the practice.

Number of Pages in PDF File: 26

Keywords: Physician-assisted suicide, euthanasia, end-of-life care, death and dying, managed care, HMOs, health insurance, health care delivery, health law, bioethics, empirical studies

Accepted Paper Series