All Commentary
Tuesday, February 1, 2000

Saving Money by Taking Lives

Caring for Old People Is a Significant Burden on the Public Finances of the Welfare State

Two weeks ago, my 91-year-old mother-in-law died in a nursing home in Amsterdam. But although she had been suffering for nine months from a paralysis that prevented her from speaking and eventually from swallowing her food, she did not die a natural death from lack of nourishment. She died because the doctors decided that her time had come.

Even though she had never given any indication of wanting to die, the medical authorities at the Amstelhof home refused to perform a simple surgical procedure to put a nourishment tube in her stomach in order to prolong her life. They even refused to give her water intravenously. Without the benefit of widely available modern medical care, my mother-in-law expired within five days. Because she was unable to speak, the doctors at the government-financed nursing home made that decision for her.

While her case was not one of euthanasia, it clearly was a product of the “culture of euthanasia” that now abounds in Holland. Once the taboo against terminating patients dissolves, it is a short step to ending patients’ lives “for their own good” with neither the patient’s nor the family’s consent. The point, we were told, was to save her from further pain and misery. But until the day when she could no longer swallow, she had shown a voracious appetite and a zest for life.

The real motive for the Amstelhof doctors’ deadly actions, of course, was economic. Caring for old people is a significant burden on the public finances of the welfare state. Moreover, to extend life in fragile old people can be very costly. The medical authorities at the nursing home never informed us about the options for prolonging my mother-in-law’s life because it was in neither their personal interest nor their country’s economic interest to do so. A well-informed patient is an expensive one.

In the U.S., my dog got better treatment than this. The week before my mother-in-law died in Holland, my 13 1/2-year-old Irish setter was stricken with kidney disease and refused to eat. The vet said the dog would die without nourishment and that the only way we might extend her life was to place a tube in her stomach or esophagus. When I winced, the vet convinced me the procedure was simple and effective. We went ahead with the operation.

Free-market opponents might say the vet pushed the tube solution only to make a handsome fee on the operation. But if this is the case, it’s a blessing. The vet’s economic incentives encouraged her to let me know what my options were. With that knowledge, I was free to decide. In Holland the potential for profit gouging has been removed from the health-care system. As a result, the Dutch medical community cannot make money extending life; they can only lose it.

Sadly, both my dog and my mother-in-law died within a week. But my dog died despite the doctors; my mother-in-law died because of them.