Journey of the End of a Lifetime: It’s Always Financial

by Joanna Smith on Jul 20, 2016

I am working alongside a compassionate End of Life Care Options Physician: together we are a team helping P.S. navigate these last days of her life.
Poignant conversations these last few days with P.S. She is firm in her resolve to use Aid in Dying. To be clear, I ask if she feels under any financial pressures to use it: while she has a diagnosis that qualifies her to use the Aid in Dying Medication (and a life expectancy of less than six months, also another requirement under the law), ideally financial concerns should not drive a person’s decision to use Aid in Dying.
Really? Dream on.
Finances play a significant part in people’s decisions about their end of life care. We don’t have, in the U.S., a “wrap around” system that can provide the kind of end of life care that is affordable AND in the location that most people prefer for their death: home.
So, people look at the kind of care they would need–in this case, total care–and where they would like to receive it–in this case, at home. But economics tell a different story, and that is the one that partially drove P.S.’s decision. She felt the care would take all of her finances, and she wanted to leave something to her family. We delude ourselves when we think that finances don’t play a part….
So. P.S. is clear she wants to proceed, and we have talked openly about the medical, social, emotional and financial aspects of her decision. How else do finances play a part?

In California, the drug that was intended to be used is Seconal, an old, old drug which was very inexpensive previously. But with the advent of the Aid in Dying or (EOLOA as we are calling it in California), the price of Seconal has risen to between $3,500 and $4,000 for the prescription to end one’s life. There is a back-up prescription, but P.S. had a dilemma: she wanted the Seconal because there is more experience with it in Washington and Oregon, and it felt like a “safer choice” to her because of that. But she did not want to pay Valeant, the manufacturer of Seconal, a price that seemed outrageous to her.
“I want to end my life”, she said, with a great deal of effort because talking was becoming more difficult as her condition progressed, “and its legal to do it now here.
But even though I think Medicaid will pay for the drug, no pharmacy will accept any insurance payments because there is such chaos currently about who pays and who doesn’t. I don’t want to support a company that is making such a profit on my death.” What should she do?

Best Practices for Advocates in End of Life Options: A good assessment considers, medical, psychological, social, legal, ethical, diversity, environmental, spiritual and financial concerns. Integrate them all.

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