Many critics of the legalization of physician-assisted death oppose it in part because they fear it will further disadvantage those who are already economically disadvantaged. This argument points to a serious problem of how economic considerations can influence medical decisions, but in the context of PAD, the concern is not borne out. We will provide empirical evidence suggesting that concerns about money influence medical decisions throughout the full course of illness, but at the end of life, financial pressure is much more likely to influence a decision to pursue or reject aggressive life-extending care than it is to influence a request for PAD. We will also address the question of whether financial pressure as a result of being poor-particularly in the context of an inadequate social safety net-robs people of their autonomy, rendering their informed request and consent invalid. We argue that it does not. We will emphasize the impracticality and injustice of rejecting the role of poverty as a legitimate factor in decision-making, the irrational distinction between PAD and withdrawal of life-sustaining care, and the more appropriate focus on the great flaws in the American health care system.
© 2018 The Hastings Center.