Saturday, October 17, 2009

Barbara Wagner and the Myth of State-Encouraged Euthanasia.

Conservatives have embraced the story surrounding Barbara Wagner because, as they tell it, they think it best demonstrates state-encouraged euthanasia.

As I wrote in a recent article for AlterNet, Wagner is considered an example of killing by rationing. Yet, the facts of the case point to another story:

Take, for instance the sad case of Barbara Wagner of Oregon, a 64-year-old lung-cancer patient whose death has become a cause celebre of opponents of health care reform.

Under headings like "Oregon Offers to Pay to Kill but not Treat Cancer Patient," and "This is What Government Rationed Health Care Looks Like," Wagner's story went viral in the conservative blogosphere. In 2008, Wagner petitioned her insurer, a public health plan offered by the state of Oregon for people ineligible for Medicare or Medicaid, for coverage of a $4,000-a-month experimental drug prescribed by her doctor.

The Oregon Health Program denied her request with an unsigned, indelicate letter that listed her treatment alternatives: palliative care (pain management), end-of-life care through a hospice, and/or use of the state's Death with Dignity law, which permits terminal patients to end their lives. There's no question that her request could have -- and should have -- been handled with more compassion.

But a recent study of Tarceva, the drug prescribed by her doctor, showed little difference in the extension of life experienced by patients who took the drug: the median survival rate of patients like Wagner who took the drug was one month longer than those who took a placebo. After a raft of publicity, the drug-maker, OSI Pharmaceuticals, offered Wagner the drug for free. She died less than three months later.

We will never know what conversation Wagner had -- or should have had -- with her doctor regarding the end of her life, or how long she could have lived without the drug. What we do know is that a woman who was close to death did not want to die, was not ready to die and was led to believe that the drug denied her was her last chance to live.

And thanks to the bureaucratic insensitivity of OHP administrators (who have since enacted a more compassionate policy for contacting patients who petition for exceptional care), Wagner thought the state of Oregon would rather kill her for $50, the cost of lethal drugs, than let her live for $4,000.

In truth, it appears the greatest indignity Wagner suffered at the hands of her state insurance program and her doctor was their apparent failure to prepare her for imminent death.

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