" The choice is, rather, "allow patients to die rather than taking heroic measures, and redeploy these scarce resources to improve overall healthcare, quality of life and lifespan." Nurses are required, as one of the 9 conditions of their oath, to triage and rationalize the giving of healthcare. If an ER nurse, for example, has a series of patients with whom she can only deal one at a time, he/she must make the 'triage' decision to focus on the patient who can benefit from his/her care the most.

That means that not all patients can receive the same level of care.

Lost in the debate about Oregon's "right to die" legislation is that the State of Oregon also embarked on a thoroughgoing analysis of healthcare rationing. The state disallowed a number of categories of medical treatment, and cut back on a number of other such methods, in order to free up resources to focus on the sicker patients. The overall goal was to support procedures and the use of resources in such a way that healthcare was enhanced. The right-to-die legislation was part and parcel of this overall effort. Those backing the legislation in the State understood that heroic expenditures at the end of life were not only futile, but they diverted scarce resources from other areas where the patients could be better-helped.

The better way to present the ethical dilemma is as follows: "Does it make more sense to invest in preventative healthcare, for everything from nosocomial infections and breast cancer to prostate cancer and diabetes, or does it make more sense to spend those resources on prolonging dying patients' lives in hospital beds for a few days or weeks, particularly if the patients would not choose to go on living?"

Americans are changing their attitudes towards death and dying, which may augur well in other states for right-to-die legislation (Journal, 1981). What is less likely to change in the short-term is our medical system's attitude towards intervention. American physicians are much more likely to perform hysterectomies, cardiac catheterization, cardiac bypass operations, hip replacements and many other procedures than their European,...

But another part of the rationale comes from the American attitude towards "doing something" as opposed to doing nothing, watchful waiting, or acceptance of the inevitable course for the patient.
How much of the push towards expensive intervention comes from the healthcare institution and the physician? While many more patients are making their own healthcare decisions, preparing Living Wills, and taking a more active role in understanding their options, many patients and their families nonetheless rely on the physicians for the opinion on what to do. "If it were your mother, Doctor, what would you do?" Asked of a surgeon, it is doubtful that the answer would be "watchful waiting," at least in the United States.

To a degree, cultural inclinations in other countries are conditioned by, and tailored to, the reimbursement systems in those countries. In addition, less restrictive court systems make it easier for physicians not to "take every measure" to prolong life when such measures would not be helpful to the patient.

Bibliography

Crisci, M. (2001). Attitudes towards death and dying in a representative sample of the Italian population. Palliative Medicine, 372-378.

EIU. (2007). World Economic Glossary 2008. London: Economist.

Journal. (1981). Our Changing Attitude towards Death. The Journal of Popular Culture, 741-743.

Klein, E. (2007). The Health of Nations: How Europe, Canada, and our own VA do health care better. The American Prospect, n.p.

NEJM Editorial. (1994). Rationing Medical Care -- a Comparative Perspective. NEJM, 1089-1091.

PBS. (n.d.). How Much Do We Spend on End-of-Life Care? New York, New York, USA: PBS Channel 13.

One can make the case that Native Americans, Hispanics and African-Americans have lower life expectancy, partly due to genetic and partly socioeconomic factors. These populations may be less in the other named countries.

Oregon Death with Dignity Act