By Wesley J. Smith, J.D., Special Consultant to the CBC

Connect the dots: Legalized assisted suicide costs about $100 for the drugs, and perhaps $1,000 for the medical review. Assisted suicide is pushed unremittingly across the country, and is currently a big fight in Vermont.

Hospice, costs much more, because rather than discarding the patient to a drug overdose, hospice doctors, nurses, chaplains, home health care workers, social workers, and others care for the whole patient — providing palliative symptom management, spiritual and social services, suicide prevention, personal hygiene assistance, and the like. But pending cuts are threatening hospices, particularly in rural areas. From the National Hospice and Palliative Care Organization’s warning:

An independent study focusing on the projected margins of the hospice community found that, as a result of two recent cuts to Medicare reimbursement, the first regulatory and the second statutory, the overall median Medicare profit margin for the hospice community could decrease from 2 percent in 2008 to -14 percent by 2019. Further, analysis concludes that 88 percent of hospice programs could have negative margins by the same date.

Hospices caring for Americans in rural areas would be the most severely affected, with median profit margin decreases ranging from minus 2 percent in 2008 to minus 19 percent by 2019. The National Hospice and Palliative Care Organization today released the results of the study commissioned as part of its ongoing work to protect patient access to hospice in America. “This analysis confirms our worst fears,” said J. Donald Schumacher, president and CEO of NHPCO. “With the entire hospice community – rural and urban, large and small, community-based and multi-state – being hit by the same devastating slope downward, there is no way for patient access to not be negatively impacted.”

Hospice is about true caring and inclusion. Surely, we won’t condone cuts that will make it financially impractical to provide these crucial services to our dying loved ones. Will we?

But be warned: If we do — the dark alternative of doctor-prescribed death will become increasingly attractive to a society that will have indicated a pronounced willingness to abandon and isolate the most weak and vulnerable among us. As Barbara Wagner lamented when Oregon Medicaid refused life-extending chemotherapy but offered to pay for her assisted suicide: My state was willing to pay for me to die, but not to live.