On Medical Killing and “Capitalism”

There’s been an unusual and noteworthy alignment in recent political debates over medical killing between traditional conservatives and veteran socialists, whose shared skepticism of euthanasia has set them at odds with their—respectively—libertarian and progressive fellow travelers. This was most prominently reflected in the significant dissent among some Labour parliamentarians from the recent Leadbetter “assisted dying” bill in the United Kingdom. Though the small number of Conservative members of parliament were most consistent in opposing the measure overall, former Labour party leader Jeremy Corbyn publicly opposed it, while two recent Conservative Prime ministers, David Cameron and Rishi Sunak, both gave it their endorsement.

Contours of the Debate

Much of the opposition to the bill was couched in language about inadequate safeguards and concerns of potential coercion. There were also fears that already anemic support for existing palliative care would further buckle under the pressure that optional assisted suicide would bring to bear on vulnerable persons for whom continued care is exceptionally difficult, limited, and expensive to attend to. Some rightly pointed to the clear experiences that have been on display for several years in Canada, parts of continental Europe, and a few American states (e.g., Oregon): instances of people with major disabilities seeking to die as a response to acute financial distress, or of the criteria for eligibility expanding to include mental health conditions like severe depression. One opponent of the bill went as far as to juxtapose historic Nazi presentations illustrating the government savings afforded by their extensive euthanasia regime with a similar recent presentation by the Canadian Parliamentary Budget Officer, amid that country’s own debate over assisted suicide.

There was comparatively little discussion of the plain fact that what was being discussed was the direct killing of persons—perhaps the single primordial crime that legitimate authority exists to prevent and to punish. And not just killing, but killing by medical doctors, in contravention of the foundational ethical mandate of their vocation, namely, to “do no harm.” There was some discussion of what codifying eligibility requirements for assistance in death asserts about the value of some lives over others, and its inescapable implicit judgment about what sorts of lives are worth living. But by and large, contemporary political culture has siloed the raising of any of these objections into the impotent margin of a uniquely “religious” concern, greeted with a litany of suspicions and dismissals in a skeptical public square.

Cost and “Capitalism”

I found it a very welcome thing that many of my left-wing friends were acutely motivated by concern for the vulnerable, enough to ardently oppose medical killing. That being said, despite my great sympathy with their motivations, I found much of their accompanying rhetoric about “capitalism” to be decidedly off the mark, or at least in need of some disambiguation and reflection.

It is plainly very expensive to take care of the sick and dying, and some enormous share of total medical expenditures occurs in the last few months of life. This is true whether or not a society has single-payer medical care or for-profit private insurers. It’s true for charity hospitals and missions. In human life some costs are relative and conditioned, but others are thoroughly intractable, and the needs of the ill and dying are overwhelmingly of the latter sort. Each dying person is a red number somewhere for someone or some institution, insurer, or government that is responsible for them.

My father-in-law was on dialysis and oxygen for the last seven years of his life, as he wrestled with a rare and severe autoimmune disease. He had a good insurance plan from the railroad, and for the most part received good treatment from his many doctors and nurses. But in his final weeks at the hospital—while he weighed a decision to begin hospice care and to cease his dialysis—he rarely received more than the most muted and slim encouragement to continue his life. At best hospital staff would offer their empathy, like sober mirrors of his daily moods, ever mindful not to pressure him one way or another.

The notable exceptions to this were the handful of medical profiteers who would come to visit his hospital room. They came to pitch him on in-home dialysis and various other sorts of practical accommodations for men in his condition. They would list, with great confidence and charm, all the things that medicare and supplemental insurance would entirely cover, and regale him with stories of all the things other clients in similar shape were doing with their days.

It’s obvious that most of their enthusiasm came from the fact that for such people, his life was a potential green number on an income statement somewhere. Private profit gave some subset of actors and firms the external incentive that he live as long as possible.

This is all to say that it is misguided to try to rest one’s opposition to medical killing on a vague allergy to greed and to profit in general, when cost-pressures are a reality whether “profit” is relevant or not, and—in some cases at least—the profiteers are a countervailing force.

Caring for ill people is costly in every way. It demands the time and attention of others, and especially that of expensively trained specialists in narrow supply. It also demands much energy, and often scarce and expensive drugs. All of which means it’s costly to value the venerable and unambiguous precept that “Thou shalt not kill” as well as the plain moral injunction to visit and care for the sick.

Social systems, schemes of public and private ownership, and various means of organizing the world can be reasonably judged by the manner in which they generate wealth or apportion existing resources and labor. Their formal constitution in law and government will certainly have consequences for the shape of ordinary human life. But they cannot be the exhaustive medium by which we concretely love people, and they certainly cannot be a substitute for our mandate to do so. Even less can they serve as our excuse.

Image by picsmart and licensed via Adobe Stock.