The Long Run

End-of-life economics

Suffolk University survey asked whether, given soaring medical costs, seniors should be allowed to choose to die

By Kay Lazar
June 6, 2011

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Americans have a complicated relationship with death.

Most, when asked in surveys, say they favor allowing patients who are terminally ill to end their own lives. Over the past three decades, that sentiment has steadily risen, from 59 percent of those surveyed in 1977 to nearly 70 percent last year, according to the General Social Survey conducted by NORC at the University of Chicago.

Just last week, the death of Jack Kevorkian — an icon in the assisted-suicide movement who claimed to have helped more than 100 people end their lives — put the advocacy for personal choice over death in the news again.

Yet Americans spend a lot of money trying to stave off the inevitable.

One-quarter of the money for Medicare — the federal health insurance program for seniors — is spent caring for elders in their last year of life, according to the Dartmouth Institute for Health Policy & Clinical Practice.

Amid increasing anxieties over the rising cost of health care, and the contentious debates in particular surrounding a potential Medicare overhaul, a new nationwide poll from Suffolk University’s Political Research Center is believed to be the first to directly link health care spending for seniors with end-of-life choices.

The researchers were surprised at what they found.

Thirty-five percent of the 1,070 likely voters queried last month said they would favor allowing “mentally able seniors’’ to end their own lives in an effort to “help save health care costs.’’

“The wording of the question directly links the economic piece to end-of-life, so I thought there would be various slices of no’s that outweighed the yeses,’’ said David Paleologos, director of the Suffolk University Political Research Center.

“For me, it was an amazing finding that over a third said that this should be an option for mentally able seniors,’’ said Paleologos, who has been polling people for more than 25 years.

Men were much more likely than women to say yes, as were people under 65, and those with higher incomes and education levels. Among those least likely to favor allowing seniors to end their lives in order to save health care costs were Republicans, and those who live in the South and Midwest.

The Suffolk survey, which mainly focused on political issues, included questions that directly linked spending and care. Those questions immediately preceded the one on end-of-life, perhaps underscoring the relationship between money and mortality in respondents’ minds.

One question, for instance, asked whether health care is being rationed right now, and responses were mixed, with 39 percent saying yes, 36 percent saying no. The rest were undecided.

Other polls involving end-of-life choices have not singled out seniors, per se, and most clearly link questions about the right-to-die with a terminal illness, not costs.

The Suffolk survey, conducted as Americans continue to debate the future of health care for seniors, was too much of a third-rail for some asked by the Globe for their thoughts on the issue. Researchers at the Dartmouth Institute for Health Policy & Clinical Practice, the organization that found one-quarter of Medicare spending is in seniors’ last year of life, declined comment.

But George Annas, a medical ethicist at Boston University’s School of Public Health, said that while the poll question presented too “simple a solution to a complex problem,’’ it does cast an important spotlight on health care spending.

“Lots of things we do in medicine don’t have a payoff,’’ Annas said.

Stuart Altman, a health economist at Brandeis University’s Heller School, said the survey question speaks to the growing concern of “wasteful spending’’ at the end of life that he often hears from health care providers.

“Older people committing suicide, I don’t think would save much money,’’ Altman said. “But I do think phasing out the wasteful care for people is where the money is.’’

Altman said he asks physicians why they provide care that has a small chance of saving a patient’s life and they tell him that it is because the family requests it and it is not their job to deny care.

Others, such as Bryan Harter, a social worker with the American Cancer Society in Boston, said that in their experience, money is not a deciding factor in end-of-life conversations.

“People are worried about the financial piece and certainly they don’t want to leave their spouses with significant debt, especially for those who are uninsured,’’ said Harter, who has been counseling patients since 2004, including many who are facing terminal illnesses.

But he said he can’t remember one who mentioned costs as a motivating decision in wanting to end their lives.

In Oregon, one of only two states with a physician-assisted suicide law, physicians who help patients in ending their lives are required to fill out detailed forms. The material asks about seven possible concerns that may have contributed to a patient’s decision to request a prescription for lethal medication.

Most cited a loss of autonomy, dignity, and the ability to engage in activities that make life enjoyable. Just 13 people — 2.5 percent of the 525 registered patients who have chosen physician-assisted suicide since 1998 — reported worries about the financial implications of treatment.

Patients over 65 who chose suicide outnumbered younger ones by two to one. The median age was 71.

State Representative Louis Kafka, 65, a Stoughton Democrat, is sponsoring legislation modeled on Oregon’s right-to-die law that would legalize physician-assisted suicide in Massachusetts. He filed the bill, he said, on behalf of a constituent who had cancer and wanted the option, but died before the proposal had a legislative hearing.

Kafka said money was not a motivator for his filing the bill and that, given the relatively small numbers who have opted for suicide in Oregon, allowing terminally ill people to commit suicide likely wouldn’t save much anyway.

“When it comes down to it, people want to live,’’ Kafka said. “This just gives them another option.’’

Kay Lazar can be reached at


Suffolk poll results

Suffolk poll results

To help save health care costs, do you believe mentally able seniors should be able to end their own lives?

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