Judy La Salle: Who decides who will live or die?

You probably saw it on the news, but a 53-year-old man in Oregon requested treatment from the state's health care since he had no insurance of his own. His prognosis was not the best and he was, because of that, denied treatment.

Evidently Oregon's State health care won't pay for life-prolonging treatment if the patient has less than a 5 percent chance of living for at least five more years. That is sad enough, but that isn't the worst of it. The worst part is that the man who requested treatment received a letter stating that, although the state would not pay for treatment, it would foot the bill if he wanted to pursue physician-assisted suicide. Some have referred to the practice as "a 'chilling' distortion of medical ethics." Well, no kidding.

I think it is generous to simply call it "chilling," because, to me, the idea is nothing short of abject malevolence. The letter didn't state the obvious, which is, "You're not worth trying to save," and it is exactly what I feared when the "right to die" movement began. A few people tucked away in the health care system make choices regarding who should live, and that should make us sit up and take notice. It's a pretty good bet it won't be the sick or the old who make those decisions, even though the decisions are about them.

But let's go from today, to tomorrow. Lots of people think physician-assisted suicide is a wonderful thing. I don't endorse the practice but I can't judge anyone who feels driven to it. The Oregon Legislature evidently defines the practice as "a means of providing comfort, no different from hospice care or pain medication." Not everyone in Oregon agrees.

Some medical experts say it is an idea that conveys the wrong thing to patients. Instead of hope it suggests they really should die, which is a corruption of the medical philosophy that has stood for saving lives for 2,000 years. State officials, however, defend the practice by saying their current emphasis is on preventive care and cost effectiveness. It sounds like they are saying, "If you are healthy we want to keep you that way, but if you are sick we don't want to spend money on you."

At least the Oregon Health Plan has reversed its decision where our 53-year-old patient is concerned, and is now providing chemotherapy which, he says, is offering him hope -- hope that he will be around for a while for his elderly mother and his grandchildren. Somehow he wasn't all that comforted by the offer of free suicide.

As I said, it is not my place to judge those who would opt to end their own suffering, but I think the practice presents a very real threat to future generations. The problem isn't so much with people having choice as it is that the choice will most likely not remain with the patient, and will eventually include patients who do not necessarily want to die. This incident with the 53-year-old man is only the beginning and we should take notice.

We have a way of making ideas sound ever so reasonable and ever so enlightened, even when we may not have really thought things through. New ideas rarely end where we think they will -- too often they get carried to the extreme.

If we think of how today's "enlightened" ideas might affect our children and their children, things get pretty scary. There will be more people in the world then, so space will be at a premium, and the expense of keeping people alive when the population needs the room could change our outlook on who "should" live and who "should" die. We may end up with some practices we now find abhorrent.

Plainly stated, as with so many things in history, what begins today as an option could very likely end up as a mandate.

Judy La Salle is a retired division director with the Merced County Probation Department. Her e-mail address is judy@justadvice.com or visit www.justolder.com