EPC-USA responds to Massachusetts assisted suicide bill - The cost of suicide/assisted suicide.

May 29, 2022

Senator Cindy Friedman, Co-Chair
Representative John J. Lawn, Jr., Co-Chair
Joint Committee on Health Care Financing
24 Beacon Street, Room 313
Boston, MA 02133

RE: S.1384 An Act Relative to End of Life Options, creating an exception to involuntary manslaughter for physician assisted suicide

Dear Chairpersons Friedman and Lawn:

The Euthanasia Prevention Coalition USA opposes euthanasia and assisted suicide, supporting positive measures instead to improve the quality of life of people and their families. We are aging and disability advocates, lawyers, doctors, nurses and politicians.

We are asking you to let S.1384 (also H.2381) die in your committee. Enactment will likely increase your Medicaid budget by an estimated $14 million, with another $12.2 million for the uninsured (using publicly available data) as this letter explains.

Assisted Suicide Laws lead to More Suicides

Overall, Massachusetts has avoided the upward trend in suicide seen in other states, but that could change if S.1384 is enacted due to publicity, increased knowledge of methods, and normalization. Publicity or knowledge about suicide leads to more suicides, attempts and ideation. In 2017 when Netflix released 13 Reasons Why, the story of a 17 year old girl’s suicide and its aftermath, teen female suicides went up by 21.7% (95% CI, 7.3%-36.2). For every person who dies by suicide, another 30 attempt suicide. Legalizing Assisted Suicide sends a message that it is a normal way to solve problems which leads to more suicides, attempts and ideation.

Research about fatal suicides in Oregon, Washington, Vermont and Montana, the first four states to do so, found legalizing Assisted Suicide was associated with at least a 6.3% increase in the annual suicide rate. The study reported:

PAS [Physician Assisted Suicide] is associated with an 8.9% increase in total suicide rates (including assisted suicides), an effect that is strongly statistically significant (95% confidence interval [CI] 6.6%--11.2%). Once we control for a range of demographic and socioeconomic factors, PAS is estimated to increase rates by 11.79% (95% CI 9.3%--14.1%). When we include state-specific time trends, the estimated increase is 6.3% (95% CI 2.7%--9.9%).

Massachusetts Experience

According to the latest Massachusetts Public Health Data Brief, 615 people died by suicide in 2020, down from 642 in 2019. There were 591 monthly Emergency Department visits for attempted suicide (7,092 per year) and 4,882 visits per month for suicidal ideation (58,584 per year) during 2019 to early 2020.

As detailed below, a 6.3% increase would result in the following annual medical costs.

Fatal Suicides                 $3.47 million
Attempted Suicides     $29.84 million
Suicidal Ideation          $15.94 million
Total Added Costs        $49.25 million

The Medicaid share of these costs would be 28.4% or $14 million. When it comes to medical costs for suicide, 28.4% are paid by Medicaid and 24.8% are incurred by the uninsured. The uninsured costs of $12.2 would mostly be absorbed by hospitals.

Medical Cost Calculations

Total 2019 medical costs for fatal and attempted suicides in Massachusetts are estimated to be $33.3 million ($3.47 million for fatal suicides and $29.84 million for attempted suicides). Medical costs for fatal suicides are collected and reported by the CDC WISQARS Cost of Injury system. During 2019, WISQARS shows fatal Massachusetts suicides had medical costs of $3.47 million. The medical costs for attempted suicides ran about 8.6 times that for fatal suicides in the latest national study of 2013 data. So, the estimated cost of attempted suicides for Massachusetts would run about 8.6 times the $3.47 million estimated above for fatal suicides or $ 29.84 million.

The medical costs for suicidal ideation are also significant. According to a study of 2013 data by the federal Agency for Healthcare Research and Quality, 72% of those visiting an Emergency Department for suicidal ideation are hospitalized or institutionalized. On average, the length of stay was 5.6 days for a cost of $6,000. Recall, Massachusetts had 58,584 suicidal ideation visits in 2019. A 6.3% increase would be 3,690 visits with 72% incurring inpatient costs or 2,657 at $6,000 each for $15.94 million per year. (Note this ignores the Emergency Department costs for the other 28% of ideation visits.)

Cost Shifting to Medicaid due to Availability of Assisted Suicide

An additional cost to Medicaid could come from people whose insurance stops covering treatments due to the availability of Assisted Suicide. Dr. Brian Callister of Nevada says he was stunned when insurance would not cover life saving treatment for his patients who were transferring to states where Assisted Suicide is legal. Some of those people could turn to Medicaid to get their treatments paid for.

In closing, I urge you to consider the financial impact on your state’s budget and hospitals; and then, let this bill die in your committee.

Sincerely,

Sara Buscher, Chair
Euthanasia Prevention Coalition USA