I understand this is a hot-topic, and definitely an extremely nuanced issue, but as a person who knows people who took the MAID (Canadian euthanasia process) way out for a terminal illness, I will be forever grateful for it. It’s not uncommon to meet people whose elder relatives went through it as well, after years of constant pain up here.
It definitely has shortcomings, but I genuinely hope the fixes will not result in rolling back the program completely.
And just because a problem isn't terminal doesn't mean it doesn't bring suffering. I do think Canada has some problems with it but even with the problems I think it's better than not offering it.
I was thinking about that in the case of "Mr. A" mentioned in TFA. They noted (but kinda glossed over) the fact that he had some sort of bowel disease, and obviously I don't know how much that informed his decision, but chronic health problems can bring immense physical, emotional, and social suffering.
My IBD is relatively well-managed, but on bad enough days even I'll gravitate towards some not-so-sunny thoughts.
He was also a mentally ill drug addict by the sound of it. People are so quick to defensively yell “just because this guy is an unemployed (homeless?) mentally ill drug addict with chronic health conditions doesn’t mean he should be killed”. And yeah, it doesn’t mean that. But let’s not pretend we don’t see that this guy probably has a miserable life.
Offering MAID is not a solution to societal ills. But it’s just straight up evil to say that people can’t kill themselves to escape a bad life because it would make you sad to think about.
I honestly think society would be very well served if people that were 85+ and in expensive hospice care with no quality of life decided they wanted to be euthanized instead to take the load off the medical system.
A society that encourages people to off themselves because they are a burden doesn't sound nice to me. I think anyone should have the choice (legally) to end their life, but it would be gross if people actually started talking about how that would be good for everyone else.
Nice or not, the numbers are the numbers. A society that dedicates too many of its resources to servicing old people who cannot provide anything back to society will not fare well on the global scene.
How much productivity can one expect to transfer from young people to old people if the total fertility rate is too low? Surely the cracks start to appear when there are 2 old people for every 1 young person? Absent sufficient automation, of course.
I don't think Canada behaves like a rich and prosperous nation, honestly
The way Canada operates me reminds me of people I know who have poverty mindset. Spending money on longterm investments seems unthinkable here
I think it's a side effect of politicians only really caring about the next election cycle. Any investment that won't pay off before the next election is sidelined
That is up to Canadians to decide. A common effect is decreasing purchasing power of currency, which typically causes political turmoil because young workers want to be able to buy things they want if they are going to be incentivized to work.
Typically, this causes asset price inflation, where the government tries to keep the most active voters (old people) happy, and to do that, they try to keep old people’s purchasing power from diminishing too much. And since older people have more assets than younger people, it effectively results in a transfer of the fruits of the country’s productivity from young to old.
I don’t know how accurate a picture the media and the rhetoric on the internet paints, but this seems to be a growing issue in Canada, at least from changes in their real estate prices relative to income.
At the end of the day, people who don’t work need people who work. But people who work don’t need people who don’t work. Presumably, if people who work never received anything in exchange, then they would not be incentivized to works.
And so the implied contract is people work now and give to people who don’t work, and in exchange, in the future, they will be the people who don’t work and receive from people who work.
But if there will be fewer people who work in the future, and not sufficient automation, and people who work now see perhaps their parents getting less than they expect, and they see TFR trends, and put two and two together and realize they are not going to get what they put in, then they may choose to opt out of this contract.
But that mindset is pervasive. If we don't have the resources for old people, then what about chronically ill? Everything gets optimalized away, then we end up with inadequate care for children...and if society is not even capable to provide that, why have it at all?
That’s just stupid. Even at its most evil, a policy optimized for cold economic efficiency with no ethics would have more resources for children because children are a valuable investment.
I’m grateful to have the option if and when the time comes. Even before that age, QoL needs to be of a certain level or possible to improve, else I’m unsubscribing.
One case (can't find it now, I think it may have been Alan Nichols') had someone claiming the doctor basically pressured them into it, implying they were taking up resources from other patients in Canada's health care system who could use it more.
At the end of the day in Canada, it's the individuals decision. And you can find tons of examples of folks making poor decisions for all kinds of situations, possibly due to the influence of others.
Bodily autonomy should be a universal right. No one should be able to control what adults do with their bodies, IMO. It may lead to some dark places, but that's freedom I guess.
> Bodily autonomy should be a universal right. No one should be able to control what adults do with their bodies, IMO. It may lead to some dark places, but that's freedom I guess.
I agree with you, but this is one of those things where you need a whole lot of the rest of society built to avoid the kinds of abuses this opens up. Think about things like labor laws - why do we restrict the conditions under which a competent adult can consent to work? Because the power imbalance in the labor market and the broader economy led to working conditions we considered abhorrent and a great many people were forced to work in them on fear of starvation. The posted article points to a similar dynamic - "fears of homelessness led people to euthanasia" is not a problem with euthanasia, it's a problem with homelessness. A doctor pressuring a patient to commit suicide so they don't stress the medical system isn't a problem with euthanasia, it's a problem with resourcing of the medical system.
Again, I'm strongly in favor of bodily autonomy, and I do think that people will do things with that we wish they wouldn't and that's none of our business, but we can't ignore the power and resource dynamics that affect people's lives. We need to also build a society in which we can be sure that people who are exercising that autonomy are doing so freely and without coercion.
If it's a universal right then having it gate kept by doctors isn't a good idea because of the gatekeeper influence. We need age verified/breathalyzer tested suicide booths like in futurama.
I'm curious, do you think there should there be certain requirements before someone can be Euthanized/receive assisted suicide? If so, what are they? Or are you arguing for removing any restrictions on suicide?
For instance: 18 year old woman decides life is too hard and wants out, 30 year old person committing suicide because they lost their job, .. etc?
The issue in question regarding the above comment is not about autonomy its about being persuaded by someone in authority to do something that they are not keen on originally. That something being terminating their life. And its not purely voluntary if someone in authority is trying to steer you into it.
I'd say it is quite different than the usual doctor patient relationship. Wildly different in fact.
In the usual case, the doctor is working on behalf of the patient and is optimizing for the best outcome for them.
In this case, the doctor is is potentially attempting to optimize for the system as a whole. Why should the doctor I'm paying for have the incentive to not care about the outcome for me?
It's not wildly different. You have this assumption of doctors that is not secured by the structure of incentives, so where does your confidence in this assumption come from? We just had a discussion¹ on HN a few days ago about routine unnecessary dental procedures. When a professional recommends that you get a root canal, how is that not coercion under this perspective? Whether we're talking about euthanasia or organ transplants or plastic surgery, to what degree is the doctor on your side? How do you know?
Ofc the above discussion is about asymmetry of information and the structure of incentives. Let's also try another idea. What if professionals don't try to push you in any particular direction and instead just dump information on you?
Oh, you're getting sued? Here's some case law. But what should I do with this case law? Should I countersue? How should I defend? Well, maybe you want to do this, in the past some clients have done this, but some clients have also done something else. Whatever choice you make I'll support you all the way.
People pay for strong persuasion. In other words, people pay for the professional to take over decision making. If that's the case, then professional trust and the structure of incentives are the only factors left in play. If the professional tries to play with a light hand and just throws facts at people without putting their thumb on the scale, in some sense they're dumping some of their responsibility back onto the client.
It's not freedom if a government is coercing people into making this desperate 'choice' by failing to provide a reasonable level of social support for the disabled that would prevent them from wanting to end their lives.
People on welfare shouldn't be afraid that they're going to end up homeless because the government is implementing wildly out of control immigration policies and piss poor zoning and permitting that is wildly driving up the cost of living beyond what their non indexed to inflation welfare covers.
People can and will kill themselves regardless of whether there is legal euthanasia. Regardless of euthanasia there has never been a sufficient level of social support for people in certain situations, and i highly doubt there will ever be. Removing the possibility of euthanasia does literally nothing except force people to die without dignity, alone, in pain, by brutal methods
The issue here is that government is using murder to solve housing. This was a conservative fever dream 10 years ago. We now have credible claims it's happening.
How was this a “conservative fever dream”? The majority of advocacy for assisted suicide seems to originate from the left-wing, as does the majority of advocacy for restrictive zoning.
You're in agreement you just misunderstood. He's saying, to paraphrase, that the conspiracy theories keep eventually showing to be true, it's not a good look for the left that they keep demonstrating how the slippery slope is real, etc.
Conservative people were calling this abhorrent, that people will be euthanized by their aptly named health care system due to lack of aptly named welfare, killed to maintain cost efficiency, and were dismissed as religious loons who want to restrict the right to bodily autonomy because suicide is a sin by scaremongering. Hence fever dream. Well now, that fever dream is proven to be a reality and we risk losing the principle of bodily autonomy in the public consciousness as the public learns that doctors are offing people because they're homeless.
“Death panels” were a talking point from American conservatives in the late 2000’s referring to the eventual end point of a fully liberalized healthcare system. A panel of bureaucrats that would decide who does and doesn’t get medical care, effectively killing those who weren’t selected to get care. It was considered ridiculous and not grounded in reality at the time, i.e, a fever dream. https://en.m.wikipedia.org/wiki/Death_panel
corporate pricing is driving inflation. housing as an investment is driving the price of rent (in addition to collusion on pricing through RealPage, et al)
At the bottom of the article you linked: "Hulchanski said that focusing on immigration as a cause, and promising to reduce it in order to bring housing costs down, is 'just another way of avoiding the real discussion, that we need systemic change.'"
Focusing on immigration is convenient (riles up nativists and doesn't threaten entrenched interests), but it is not what is causing the housing crisis or inflation
you argument makes the typical mistake done by nerds here to conflate "realism" with "idealism". yes, freedom and individual decisions ... 100%! but ... the point here is not that but what society would we like to live in? i don't want to live in a society suggesting self-evacuation upon productivity falling below some threshold - empathy is what we need and want.
"...In the past few years a small but influential group of academics and jurists have raised the alarm over what is generally referred to, a little archly, as the “slippery slope” – the idea that a measure introduced to provide relief to late-stage cancer patients has expanded to include people who might otherwise live for many years, from sufferers of diseases such as muscular dystrophy to sexagenarians with dementia and even mentally ill young people.."
The reality of our society is that many will meet their end alone and in poverty. Is it so different from parts of our history, where the old chose to take a long walk into the wilderness before the indignity of what follows? I’m not sure. We like to pretend our society is much richer and more capable than it is—that we can take care of everyone. Maybe we can, but I have my doubts. In cases where we fail, I think we should at least allow people the dignity of choosing their own exit. I don’t think it makes much difference whether their suffering comes from a disease of their body or a disease of society. In the short term, both can be inevitable and excruciating.
It fundamentally contravenes the Hippocratic Oath:
> "Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. . . But I will keep pure and holy both my life and my art. . .
> Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I transgress it and forswear myself, may the opposite befall me."
What's more, euthanasia leads to all sorts of perverse incentives in the administration of medicine, as Canada's MAID experiment demonstrates. It simply isn’t the job of doctors to end lives. It is, in fact, the precise opposite of their jobs -- and I believe you'll find that most doctors are opposed to legalizing euthanasia.
Suffering can be alleviated, and it should be society's job to help patients -- the very word means "sufferers" -- seek care. Many drugs can be spectacularly effective. But today drug-seeking means that you'll be treated like a criminal, whereas there's no hurdle to MAID-seeking in Canada. A grim omen, that.
> It fundamentally contravenes the Hippocratic Oath
The Hippocratic Oath is from between the fifth and third centuries BC, and its relevance has long since been superseded by modern ethical guidelines.
> Suffering can be alleviated, and it should be society's job to help patients
There is a lot of horrible suffering that can not be alleviated unless the doctor induces a coma and keeps the patient in a state of more or less total unconsciousness for weeks or months until death inevitably occurs. I agree we should help patients as much as possible, but there's a line where perhaps the only help we can give, and the only help the patient asks for, is a painless exit. Perhaps future drugs and treatments will eliminate the need for euthanasia, but we are not there yet.
“It’s old” is really not sufficient justification for “we know better now”. That kind of thinking led to some very dark places in the late 19th and early 20th centuries.
I somewhat knew someone who committed suicide by dehydration. She understood the situation: broken hip, she wasn't going to live long enough to ever do anything more than lay in bed. She chose not to. Sure, the broken hip could have been treated but it wasn't even hurting her. The immobility was too much.
And I watched my father die of cancer. There was a period where he could be lucid and in pain, or comfortable but out of it. And then there was a period where he had no ability to make memories--if it wasn't in front of him it didn't happen. And in the end it took his remaining kidney function. We know there was a problem but he was too out of it to explain his distress.
And note that suffering can take forms other than pain.
Fundamentally, most slow forms of dying that don't take your mind will make life quite unpleasant before they kill you.
In truth, "the dose makes the poison," as has been known since even before Paracelsus' time. In chemotherapy, strong and destructive drugs are indeed administered, but the aim is never to kill the patient, but instead to buy that patient -- otherwise facing an incurable and invariably fatal disease -- more time. In some cases, to cure that patient or send them into a long-lasting remission. This is not "poisoning" the patient. It is just the opposite; it is therapy with an eye towards lengthening the life of that patient.
In that case then, what is a poison? What is the intent of the oath, if it's literal meaning is different from the intent? What does it mean to not poison people? It can't strictly be "you must never do anything that shortens people's lives" because then hospice care would be unethical.
Did you miss the point I made in my previous post?
Strychnine can be a poison or it can be a tonic. If you take 1mg, it'll improve your athletic performance. If you take 100mg, you'll probably die.
Acetaminophen is totally harmless in very small doses -- it's given to infants every day. Take too much, however, and it'll kill you. In adults, it's responsible for nearly half of all cases of acute liver failure in the US, and hundreds of deaths annually. Is it a poison?
I could go on all day. Almost every drug can be a "poison," and, at the same time, only very strong toxins with zero therapeutic window are inherently poisons. In the context of medicine, whether or not something is a poison hinges on the drug, the dose of that drug, its expected therapeutic effect (which is basically statistical), and the condition of the patient.
In cancer, where the condition of the patient is very unfortunate indeed, sometimes only very strong drugs with powerful side effects can provide any hope of eventual relief. Surely you see...
> What is the intent of the oath, if it's literal meaning is different from the intent?
...That the intent is to hopefully provide that relief.
> What does it mean to not poison people?
...That offering something that might cure or abate the patient's underlying condition is the very opposite of poisoning them.
I understand that, but you see how that "intending to provide relief" is very very different from the original statement of "Neither will I administer a poison to anybody when asked to do so", right? Sure, words and context and meaning can change, but this is a very significant change in meaning such that quoting the original statement without clarification is misleading.
Plus, how does that answer my other question? You say the Hippocratic oath's true meaning is that a doctor must provide relief, right? What is a greater relief then death? Or less flippantly, who gets to decide what relief is, if not the patient? And if they do, can't they decide death is a relief? I'm just unclear on how your quote from the oath makes it clear that euthanasia violates it.
"Neither will I administer a poison to anybody when asked to do so" = "neither will I administer a substance I know to be deleterious or harmful to life." The very first definition of "poison" in the OED is: "Material that causes illness or death when introduced into or absorbed by a living organism."
Medicine has a therapeutic window that's context-dependent. Part of the doctor's job, which is why they make real money and have relatively high social status, is determining the right course of treatment from that context. To cure -- not to harm, not to kill. If a cure is impossible, to comfort.
> What is a greater relief then death? Or less flippantly, who gets to decide what relief is, if not the patient?
Patients have every right to refuse treatment. They can also end their own lives; nothing could be simpler. What's perverse is forcing the medical establishment -- in view of its other responsibilities, duties, and oaths -- to act as executioner. It disgraces everybody involved. The doctor ends up dishonored, the state itself is shamed, the human dignity of the patient is, frankly, severely reduced.
So stop regulating the poisons and allow access via a non doctor path, create a framework around it, trying to give the state control over others bodies has just as many negative externalities. Also please try to keep in mind that the original oath was created during a certain eras morality and philosophical leanings, most doctors these days take severely modified oaths mostly to uphold current profesional practices and ethics.
The heart of the Canadian approach isn't a poison at all. Everything they use is perfectly ordinary stuff you'll find in the hospital. But if you paralyze somebody without taking over breathing for them they'll die. It also requires an IV line.
A machine that fed the drugs in sequence wouldn't be complex but the IV line takes some skill.
So, I'm supposed to take you seriously? Some words in an oath mean one of my family members has to go insane and claw at himself until he bleeds because his brain has been destroyed by alzheimers? That's "pure and holy" to you?
Dehydration, exposure, and animals will take you a lot faster than begging on the streets and trying to cling on to life or becoming a burden to your village.
As far as historical examples just study Inuit, Greek, Japanese, Norwegian, or Scythian practices on the matter.
True - we might also learn something from the Greek practice of exposure of infants and the Roman law regarding the rights of the pater familias. All three of them are examples of social failure to model the law of love in some manner.
Animals seem to sense when time has come. I imagine, hopefully, sometime in the future, I'm going to be able to walk out into that wilderness. I think the difference is, I would never ask or require someone else to accompany or assist me.
It is so very different from parts of our history because we live in a part of the world where there is no good reason why anyone should die of starvation or homelessness.
Canada is a country that is rich in every single resource from wood to metals, to hydrocarbons, wheat, meat, fruit... the list goes on and on and on.
It is a disgrace and a fundamental failure of our society if people feel forced to take MAID to avoid dying on the street from exposure or starvation.
> It is a disgrace and a fundamental failure of our society if people feel forced to take MAID to avoid dying on the street from exposure or starvation.
I have a taxi driver cousin back in South America, wife but no kids. Want to take him in? He wants to emigrate. You could help him set up and such. You can dm me vyour phone number if necessary.
> In one instance, a Canadian Forces veteran claimed she had been offered Maid in response to a request for a wheelchair lift or ramp at her house. While a subsequent investigation found no record that assisted death was offered, Veterans Affairs discovered four cases in which Maid had been inappropriately suggested. The case manager was suspended and the incident was referred to the Royal Canadian Mounted police.
Hospitals occasionally have angel of death doctors and nurses. Should we get rid of hospitals? There’s consistently a lack of any hard quantitative data about the harm the program causes but there are for the benefits. So for critics what’s left are anecdotal stories some of which are true some of which aren’t.
> In another case, the family of Alan Nichols said he died by euthanasia, with hearing loss listed as the sole criterion. The family reported it to police and health authorities- but neither saw cause to investigate further. The RCMP told the family that Nichols “met the criteria” for assisted death.
> But physicians who provide Maid caution that anecdotes of Canadians slipping through the cracks often ignore other critical details of their respective cases, which must include a “grievous and irremediable medical condition” and do not necessarily suggest a failure in the system.
It’s important to remember that the families of people who die will still look for someone to blame. It’s a very human reaction. I know someone who blames the doctor for causing or accelerating her husband’s terminal cancer diagnosis as well as blaming him for telling the husband he had a terminal diagnosis in the first place (i.e. sapped his energy and strength).
That’s not to say that there shouldn’t be adjustments to the program. But driving it through anecdotes instead of expertise and data is the wrong balance to strike.
You really want anecdotes in this case because they point to a system that is just getting rid of people for the wrong reasons. That's called insights.
Assuming the anecdotes are correct and capture the entire story - which they rarely actually do in general and especially when you’re talking about death - at best they help land the human story to convince people.
But OK. So let’s presume we have anecdotes that show mistakes made in the program. Do we get rid of it? Hospitals and doctors and insurance companies make deadly mistakes too. Get rid of those as well? And what about the anecdotes of people who were greatly positively helped by euthanasia. Do we ignore their anecdotes? How do we weigh their anecdotes against the anecdotes of problems?
I may be thick but I’m failing to find the insights you’re claiming are there.
Why are you jumping the gun? Even if you keep the program this shows that there is a serious lack of oversight. Once people are dead they are gone and nobody to defend them.
I must admit that people here tend to be against the death penalty but when it comes to killing people in difficult situations suddenly we need to be super flexible and innocents be damned
Am I jumping the gun? All I’m saying is that anecdotes are insufficient for making any changes and here you’re claiming that it’s sufficient evidence of a lack of oversight. Yet there are arguably quantifiably more problematic deaths in regular health care (angel of death, malpractice where the doctor shouldn’t be providing any kind of care, etc) but you’re not arguing that there’s clearly a lack of oversight there. My point is the scale of the problem isn’t indicated by anecdotes and thus you can’t presume that any action should be taken by their existence purely from the fact that at any meaningful scale any human activity will have issues because humans. And that’s ignoring that I pointed out the potential problems with the anecdotes presented.
It’s worrying that you’re equating the death penalty and suicide when they’re very different things. Assisted suicide involves action by the person to end their life while the death penalty is the government taking that action. Very very very different things.
Even more worryingly that you’re outright discounting people killed by the death penalty as not innocent. Ignoring the obvious racial problems with black people being more likely to be sentenced that way since I don’t want to argue about sentencing disparity, the innocence project lets us estimate a lower bound on the amount of innocent people that had been killed before the invention of DNA (and even today after it’s part of the normal course of things). That number by the way I believe (but could be wrong) is higher by volume and percentage than the number of problematic deaths in assisted suicide. Care to rethink your priors about death penalty vs assisted suicide?
Incentives are what matters. When a government has a healthcare system already in the red, there is a strong incentive to get rid of weak and ill people from a government standpoint under the pretext of helping terminally ill people to die. You can see that they have been expanding it to people who were not terminally ill. That says everything you need to know.
This is akin to "think of the children" excuse used to censor the web. But this time it actually kills people.
It’s one thing to be concerned about the problem, it’s another to try to weaponize anecdotes to achieve the aim instead of being intellectually honest and focusing on quantitative data. I’d argue that your position is the “think of the children” position which argues from a place of fear and anecdotes while infantilizing people and removing their autonomy over their own lives.
As for incentives, the estimate is that MAID reduces annual spending by ~100 million. The government spends 300B a year on healthcare. You’re not going to get out of this by killing your patients, not to mention that you need productive members in your economy to create a tax base in the first place. I think you have an incorrect analysis of the incentives at play here.
That is a "fun" fact to spice up the conversation but not really relevant. The government screwed up one case, big surprise. If they had sent 1000 such letters because the PM wants to cleanse the population of disabled people to save tax dollars, that would be relevant.
> patients asked to be killed in part for social reasons such as isolation and fears of homelessness,
Why is anyone surprised? Did the people who planned out this program never visit a psych ward? They're chock full of homeless people in varying degrees of "I'd rather die than go back to the streets/shelter". Sad but it's how it is.
Adults must be left to make their own choices. When the time comes, I want to go in peace, at a time of my choosing (or imposed by fate--for example, if I were to lose my agency or independence due to a medical condition or an incident), and not rot and suffer until I'm "terminal".
All through my life, I've been milked by way of taxes--and I'm OK with it. I've had a decent life; I've tried to actively minimize the damage I cause thanks to my existence. So, when the time comes (and I decide when it is), I don't want to be left begging for relief. I want to go in peace and with some dignity. I absolutely don't want to resort to violent methods or leave a mess for others to clean up.
So, my ask is that a method is made available. If I need to sign up in advance--when I'm deemed to be of sound mind and body--so be it. But I need a way. I deserve it. This is not negotiable.
This thing turned into exactly the horror its critics were worried it would. Their concerns were so confidently dismissed from all sides, it was so easy to paint them as naive idealists or hardhearted religious weirdos or anything. They were right and now canada is at the forefront of a modern eugenics movement.
Why is assisted suicide programs the horror rather than the systemic effects that lead people with no terminal conditions to prefer death to possible living conditions?
Without assisted suicide being requested, those people will just be overlooked & ignored.
Instead of removing assisted suicide programs, we should consider them to be a societal feedback system regarding society's greatest failures.
With the internet, even the disabled and really old and infirm people can find ways to connect with others, alleviating (somewhat) the social isolation aspect of wanting to take a "long walk in the woods". My gut tells me that newer generations who basically are raised with internet access from day one will have little problem with this.
The technology to remove pain from humans has been invented via CRISPR. It is possible to live with "congenital insensitivity to pain", so we know it can be done safely. It has been demonstrated in lab animals.
I think that this gene therapy should be given to patients instead!
MAID in Canada is like gun laws in the US. Most lawmakers and most citizens would prefer to have stricter gun laws and stricter MAID laws, but the supreme court interprets the constitution in a way to regularly strike down stricter laws.
I was always very much in favour of opening up people's right to have control over the manner of their death, philosophically it seems inexcusable to me that we routinely keep people alive well beyond the point where they are not only in unbearable agony, but where their condition and/or medical interventions necessary to sustain them have sapped every last ounce of meaning from their lives, leaving them no option but to starve themselves to death or use some other grisly means to end their own suffering in isolation from their loved ones, when they could have a relatively painless death at the time, manner, and in the presence of people of their own choosing.
I knew that this obviously came with risks, old people being pressured into it to ease the burden on, or speed inheritance for their children, people being pressured to take pressure off the medical system, etc. But I believed that trying to manage these risks was well worth the outcome that people might be able to die with a shred of dignity intact.
I have to say that the Canadian experience has made me wonder whether I was wrong. Not in a strong rhetorical sense, but it has given me more doubt than I've ever entertained before. Are we socially or systemically incapable of managing those risks given a certain institutional configuration? I don't know. Happy for people to provide counter evidence for me if they like. I really don't know what to think about this anymore.
> Are we socially or systemically incapable of managing those risks given a certain institutional configuration?
Empirically, Canada says "yes".
There are other reasons (philosophical, moral, religious) that will also speak to the folly of what Canada and Belgium are leading the way towards, but we are not to speak of those things any more - so we're left with the "what if we try it and don't like it - can't we just roll it back?" of the early years of another "forward-looking" society from the recent past.
The British parliament is currently debating legislation to permit assisted dying in some limited circumstances. Five years ago I would have said that their proposals don't go far enough, but the implementation of MAID has made me far more cautious.
I had always dismissed the "slippery slope" argument as being made in bad faith, but Canada seems to have given us an existence proof that a seemingly well-intentioned system can quickly start producing very bad outcomes.
I tend to believe institutional abuse stems from psychopathic tendencies of individuals empowered by/within those institutions. I think the institutions are OK/worthwhile in a vacuum, but struggle to figure out how you avoid having, for lack of a better term, "bad folks" working within them. Review boards always seem to become lazy/apathetic overtime, and the patients often lack agency/collateral to be assertive.
Here in Québec acces to MAID is tightly regulated. Initially I tought it was too regulated but the excess in some other provinces sporadically making the news have made me realize that Québec probably have the right level of regulation around euthanasia.
There was a time when I was in favor of this idea - helping the terminally ill die with dignity seemed like a compassionate idea. Perhaps it still is. My problem with assisted suicide is not that it's giving terminally ill people a way out, it's the unintended consequences. We've already seen the slippery slope argument proven true time and time again. Young people, poor people, people with mental illness, veterans and the critically injured being funneled into assisted suicide. We've seen authority figures talk of counseling people with the wrong political opinions toward suicide. We've seen the profession attract "doctors" who take such glee in the act that in any other context they'd be viewed as serial killers.
I'm sorry, but the number of unnecessary deaths that I'm okay with in order to alleviate the suffering of a few is zero.
>the number of unnecessary deaths that I'm okay with in order to alleviate the suffering of a few is zero.
"A few" is doing some serious heavy lifting here
Most deaths aren't pleasant nor peaceful. And modern medicine can keep your body alive for a long, long while as you survive in pain even when there's no chance of things ever getting better
When I was a kid I worked in a grocery store. Every week we had the same people, sometimes 2-3 times a week. They talked to everyone, generally elderly, and seemed very lonely. I can understand facing the end of days painfully alone would push someone to choose their exit.
For those not actively following the situation, we’re well past the point where they offer and insist that you take the route of euthanasia before prescribing pain medicine in chronic painful conditions.
Does not bode well for a generation of people hunched over their desks leading sedentary lifestyles.
The cavalier way MAID has been implemented in Canada is pretty much eugenics. Everyone knew this would happen. They are killing off the homeless, poor, mentally ill, and medically costly populations to save $$. Super-utilizers, or 5-10% of the population, can cost up to 50% of healthcare cost. Alot of these folks fall into that category; they need to go obviously. How else can Canada afford to import 3-5% of their population every year with immigrants who can't take care of themselves financially? The healthcare system is overloaded and cost of living is astronomically high (esp compared to weak wages). I'm not anti-immigrant but native Canadians are getting shafted hard. Its about to get alot worse folks.
First, we are about 41 million people and every year we welcome about half a million new people to freedom and safety. That's about 1.2%. About 300 000 of these come to us in the economic immigrant category who are decidedly able to take care of themselves or they wouldn't be to immigrate so. A bit more than 100 000 of them are coming as family, 70-75 000 come as refugee and about 10 000 come as Humanitarian / Compassionate other. I always thought a nation as rich as ours should welcome a lot more refugees.
> I always thought a nation as rich as ours should welcome a lot more refugees.
Well, I think your fellow citizens are not happy with the levels - "Nearly six in 10 people now agree “there’s too much immigration to Canada,” according to the country’s longest-running survey on the topic by the Environics Institute. It’s the first time since 1998 that this view is held by a clear majority, and a stark shift from favorable opinion over the past two decades."
Fascism is on the rise in the entire world and Canada is alas no exception. Why, after three years what happened to Lytton, BC they are ready to elect a party which refused to add climate change to its policy book. That doesn't mean your propaganda about 3-5% immigrants who leech on the country has any truth in it.
I think the widespread acceptance of the idea that assisted suicide is a legitimate option that people ought to consider is a society giving up on humanity. I think that there is never a case where there is no hope at all. Even in cases of the most severe illness, with all of the advancements in technology and innovation emerging seemingly every day, you cannot say there is no chance of a cure or a recovery. And even in a failed attempt at such a cure or recovery, there is much to be learned that can be shared with the rest of humanity.
To just focus on avoiding suffering instead of striving to live is not consistent with the attitude that is conducive to the flourishing of life and the advancement of civilization. It is precisely humanity raging against the light — the endless quest for survival and flourishing — that has driven humanity thus far and that will always drive life in general. The assisted suicide philosophy, if you want to call it that, is fundamentally a deviation from the civilizational and biological imperative.
All of this being said, a free society is one where people own their own body, meaning have a right to destroy themselves, with any drug or dangerous behavior, and to even commit suicide. So I cannot see an argument for prohibiting suicide or the provision of assistance in committing it. What's peculiar about countries that have legalized assisted suicide is the bevy of laws they impose to protect people from much milder forms of self-harm, like consumer protection laws that protect people from their own bad consumer decisions. You're not allowed to buy raw milk, but you can get a doctor's assistance in ending your life due to depression!
There's always hope because we don't know everything. And there are cases where there is a lot of hope, even if the person themselves doesn't believe it, yet people are not being discouraged from suicide.
You seem to be seeing only one side of the situation while there are actually costs to both sides.
As I see it suicide should only be considered when the expected average future quality of life is negative. For the sake of argument let's consider a healthy person to have a quality of life of 100. A dead person inherently has a quality of life of zero.
Health problems and disabilities lower quality of life. The fact that anyone chooses suicide implicitly is saying that their perception of quality of life (and it has to be their perception, everyone has their own yardstick) has gone negative.
It's not just whether it's *currently* negative, but what is the sum of future expected quality of life?
Let's take a patient who considers their quality of life to be -10, with an expected lifespan of a year. I'll take the unit as days, so they have a total expected quality of -3650. I'll be generous and figure a miraculous save occurs 1 in every 100,000 cases and that a save returns them to full health (very unlikely) and gives them another 20 years (again, unlikely--people typically have other processes at work that would in time kill them.) Total expected quality is 730,000.
100,000 people.
One is +730,000, for a total gain of 730,000
99,999 are -3650, for a total loss of 364,996,350
Clearly, hoping for the miraculous save increases suffering.
If that were the calculation that we had used throughout history, humanity would have gone extinct. Suffering was extremely common and widespread pre-modernity.
I understand this is a hot-topic, and definitely an extremely nuanced issue, but as a person who knows people who took the MAID (Canadian euthanasia process) way out for a terminal illness, I will be forever grateful for it. It’s not uncommon to meet people whose elder relatives went through it as well, after years of constant pain up here.
It definitely has shortcomings, but I genuinely hope the fixes will not result in rolling back the program completely.
And just because a problem isn't terminal doesn't mean it doesn't bring suffering. I do think Canada has some problems with it but even with the problems I think it's better than not offering it.
I was thinking about that in the case of "Mr. A" mentioned in TFA. They noted (but kinda glossed over) the fact that he had some sort of bowel disease, and obviously I don't know how much that informed his decision, but chronic health problems can bring immense physical, emotional, and social suffering.
My IBD is relatively well-managed, but on bad enough days even I'll gravitate towards some not-so-sunny thoughts.
He was also a mentally ill drug addict by the sound of it. People are so quick to defensively yell “just because this guy is an unemployed (homeless?) mentally ill drug addict with chronic health conditions doesn’t mean he should be killed”. And yeah, it doesn’t mean that. But let’s not pretend we don’t see that this guy probably has a miserable life.
Offering MAID is not a solution to societal ills. But it’s just straight up evil to say that people can’t kill themselves to escape a bad life because it would make you sad to think about.
I honestly think society would be very well served if people that were 85+ and in expensive hospice care with no quality of life decided they wanted to be euthanized instead to take the load off the medical system.
> society would be very well served
A society that encourages people to off themselves because they are a burden doesn't sound nice to me. I think anyone should have the choice (legally) to end their life, but it would be gross if people actually started talking about how that would be good for everyone else.
Nice or not, the numbers are the numbers. A society that dedicates too many of its resources to servicing old people who cannot provide anything back to society will not fare well on the global scene.
How much productivity can one expect to transfer from young people to old people if the total fertility rate is too low? Surely the cracks start to appear when there are 2 old people for every 1 young person? Absent sufficient automation, of course.
Canada is a rich and prosperous nation. How do you figure “too many of its resources” is being spent on elderly care??
I don't think Canada behaves like a rich and prosperous nation, honestly
The way Canada operates me reminds me of people I know who have poverty mindset. Spending money on longterm investments seems unthinkable here
I think it's a side effect of politicians only really caring about the next election cycle. Any investment that won't pay off before the next election is sidelined
That is up to Canadians to decide. A common effect is decreasing purchasing power of currency, which typically causes political turmoil because young workers want to be able to buy things they want if they are going to be incentivized to work.
Typically, this causes asset price inflation, where the government tries to keep the most active voters (old people) happy, and to do that, they try to keep old people’s purchasing power from diminishing too much. And since older people have more assets than younger people, it effectively results in a transfer of the fruits of the country’s productivity from young to old.
I don’t know how accurate a picture the media and the rhetoric on the internet paints, but this seems to be a growing issue in Canada, at least from changes in their real estate prices relative to income.
At the end of the day, people who don’t work need people who work. But people who work don’t need people who don’t work. Presumably, if people who work never received anything in exchange, then they would not be incentivized to works.
And so the implied contract is people work now and give to people who don’t work, and in exchange, in the future, they will be the people who don’t work and receive from people who work.
But if there will be fewer people who work in the future, and not sufficient automation, and people who work now see perhaps their parents getting less than they expect, and they see TFR trends, and put two and two together and realize they are not going to get what they put in, then they may choose to opt out of this contract.
I agree with your main points.
But that mindset is pervasive. If we don't have the resources for old people, then what about chronically ill? Everything gets optimalized away, then we end up with inadequate care for children...and if society is not even capable to provide that, why have it at all?
That’s just stupid. Even at its most evil, a policy optimized for cold economic efficiency with no ethics would have more resources for children because children are a valuable investment.
I agree except for any emphasis on taking a load off the medical system.
That people with terrible quality of life have the option is a good thing. It should be available for full autonomy.
I just don't want a case of any pressures to get euthanised, whether from family or society.
So long as they decided, I totally agree. The danger comes from the pressures for it to not always be the patient’s true desire.
I’m grateful to have the option if and when the time comes. Even before that age, QoL needs to be of a certain level or possible to improve, else I’m unsubscribing.
Much preferred to, say, ættestup: https://youtu.be/DwD7f5ZWhAk?si=WjwnN7cZC1h7TcJU
There is a lot of social, cultural and religious that prevents some people
Some people would prefer to live as long as (medically) possible.
Really? Like spending years 60 through 90 in an inescapable coma, for instance?
Yes.
I think doctor assisted suicide is something we should have, but I've read some really messed up stuff about Canada's program.
https://www.theatlantic.com/magazine/archive/2023/06/canada-...
https://apnews.com/article/covid-science-health-toronto-7c63...
One case (can't find it now, I think it may have been Alan Nichols') had someone claiming the doctor basically pressured them into it, implying they were taking up resources from other patients in Canada's health care system who could use it more.
At the end of the day in Canada, it's the individuals decision. And you can find tons of examples of folks making poor decisions for all kinds of situations, possibly due to the influence of others.
Bodily autonomy should be a universal right. No one should be able to control what adults do with their bodies, IMO. It may lead to some dark places, but that's freedom I guess.
> Bodily autonomy should be a universal right. No one should be able to control what adults do with their bodies, IMO. It may lead to some dark places, but that's freedom I guess.
I agree with you, but this is one of those things where you need a whole lot of the rest of society built to avoid the kinds of abuses this opens up. Think about things like labor laws - why do we restrict the conditions under which a competent adult can consent to work? Because the power imbalance in the labor market and the broader economy led to working conditions we considered abhorrent and a great many people were forced to work in them on fear of starvation. The posted article points to a similar dynamic - "fears of homelessness led people to euthanasia" is not a problem with euthanasia, it's a problem with homelessness. A doctor pressuring a patient to commit suicide so they don't stress the medical system isn't a problem with euthanasia, it's a problem with resourcing of the medical system.
Again, I'm strongly in favor of bodily autonomy, and I do think that people will do things with that we wish they wouldn't and that's none of our business, but we can't ignore the power and resource dynamics that affect people's lives. We need to also build a society in which we can be sure that people who are exercising that autonomy are doing so freely and without coercion.
> At the end of the day in Canada, it's the individuals decision
That is a really, really poor justification. Your boss asking you for sexual favors, is also the "individuals decision". Pressuring people is a no-go.
If it's a universal right then having it gate kept by doctors isn't a good idea because of the gatekeeper influence. We need age verified/breathalyzer tested suicide booths like in futurama.
I'm curious, do you think there should there be certain requirements before someone can be Euthanized/receive assisted suicide? If so, what are they? Or are you arguing for removing any restrictions on suicide?
For instance: 18 year old woman decides life is too hard and wants out, 30 year old person committing suicide because they lost their job, .. etc?
The issue in question regarding the above comment is not about autonomy its about being persuaded by someone in authority to do something that they are not keen on originally. That something being terminating their life. And its not purely voluntary if someone in authority is trying to steer you into it.
Doctors make strong suggestions all the time. Does that mean it’s all non consensual? I think strong opinion is part of what you’re paying for.
I'd say it is quite different than the usual doctor patient relationship. Wildly different in fact.
In the usual case, the doctor is working on behalf of the patient and is optimizing for the best outcome for them.
In this case, the doctor is is potentially attempting to optimize for the system as a whole. Why should the doctor I'm paying for have the incentive to not care about the outcome for me?
It's not wildly different. You have this assumption of doctors that is not secured by the structure of incentives, so where does your confidence in this assumption come from? We just had a discussion¹ on HN a few days ago about routine unnecessary dental procedures. When a professional recommends that you get a root canal, how is that not coercion under this perspective? Whether we're talking about euthanasia or organ transplants or plastic surgery, to what degree is the doctor on your side? How do you know?
Ofc the above discussion is about asymmetry of information and the structure of incentives. Let's also try another idea. What if professionals don't try to push you in any particular direction and instead just dump information on you?
Oh, you're getting sued? Here's some case law. But what should I do with this case law? Should I countersue? How should I defend? Well, maybe you want to do this, in the past some clients have done this, but some clients have also done something else. Whatever choice you make I'll support you all the way.
People pay for strong persuasion. In other words, people pay for the professional to take over decision making. If that's the case, then professional trust and the structure of incentives are the only factors left in play. If the professional tries to play with a light hand and just throws facts at people without putting their thumb on the scale, in some sense they're dumping some of their responsibility back onto the client.
[1]: https://news.ycombinator.com/item?id=41842294
It's not freedom if a government is coercing people into making this desperate 'choice' by failing to provide a reasonable level of social support for the disabled that would prevent them from wanting to end their lives.
People on welfare shouldn't be afraid that they're going to end up homeless because the government is implementing wildly out of control immigration policies and piss poor zoning and permitting that is wildly driving up the cost of living beyond what their non indexed to inflation welfare covers.
People can and will kill themselves regardless of whether there is legal euthanasia. Regardless of euthanasia there has never been a sufficient level of social support for people in certain situations, and i highly doubt there will ever be. Removing the possibility of euthanasia does literally nothing except force people to die without dignity, alone, in pain, by brutal methods
The issue here is that government is using murder to solve housing. This was a conservative fever dream 10 years ago. We now have credible claims it's happening.
How was this a “conservative fever dream”? The majority of advocacy for assisted suicide seems to originate from the left-wing, as does the majority of advocacy for restrictive zoning.
You're in agreement you just misunderstood. He's saying, to paraphrase, that the conspiracy theories keep eventually showing to be true, it's not a good look for the left that they keep demonstrating how the slippery slope is real, etc.
Conservative people were calling this abhorrent, that people will be euthanized by their aptly named health care system due to lack of aptly named welfare, killed to maintain cost efficiency, and were dismissed as religious loons who want to restrict the right to bodily autonomy because suicide is a sin by scaremongering. Hence fever dream. Well now, that fever dream is proven to be a reality and we risk losing the principle of bodily autonomy in the public consciousness as the public learns that doctors are offing people because they're homeless.
“Death panels” were a talking point from American conservatives in the late 2000’s referring to the eventual end point of a fully liberalized healthcare system. A panel of bureaucrats that would decide who does and doesn’t get medical care, effectively killing those who weren’t selected to get care. It was considered ridiculous and not grounded in reality at the time, i.e, a fever dream. https://en.m.wikipedia.org/wiki/Death_panel
minor knit-pick: immigration policies are not driving the cost of living crisis
What's your reasoning here?
corporate pricing is driving inflation. housing as an investment is driving the price of rent (in addition to collusion on pricing through RealPage, et al)
How is it conceivable that huge numbers of immigrants coming in every year don't drive up housing prices?
The current immigration minister of Canada disagrees with that assessment.[0]
[0] https://www.cbc.ca/news/politics/immigration-housing-crisis-...
At the bottom of the article you linked: "Hulchanski said that focusing on immigration as a cause, and promising to reduce it in order to bring housing costs down, is 'just another way of avoiding the real discussion, that we need systemic change.'"
Focusing on immigration is convenient (riles up nativists and doesn't threaten entrenched interests), but it is not what is causing the housing crisis or inflation
As others said, in many cases people would desperately want to live, just not in their condition anymore.
And the condition can be poverty, loneliness, and other things for which solutions could be provided.
I had run into this: https://www.youtube.com/watch?v=cxqVaaBx3gg
you argument makes the typical mistake done by nerds here to conflate "realism" with "idealism". yes, freedom and individual decisions ... 100%! but ... the point here is not that but what society would we like to live in? i don't want to live in a society suggesting self-evacuation upon productivity falling below some threshold - empathy is what we need and want.
Sounds like where it all started...efficent and clean...
"Death on demand: has euthanasia gone too far?" - https://www.theguardian.com/news/2019/jan/18/death-on-demand...
"...In the past few years a small but influential group of academics and jurists have raised the alarm over what is generally referred to, a little archly, as the “slippery slope” – the idea that a measure introduced to provide relief to late-stage cancer patients has expanded to include people who might otherwise live for many years, from sufferers of diseases such as muscular dystrophy to sexagenarians with dementia and even mentally ill young people.."
This. I know someone personally who had this exact experience.
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The reality of our society is that many will meet their end alone and in poverty. Is it so different from parts of our history, where the old chose to take a long walk into the wilderness before the indignity of what follows? I’m not sure. We like to pretend our society is much richer and more capable than it is—that we can take care of everyone. Maybe we can, but I have my doubts. In cases where we fail, I think we should at least allow people the dignity of choosing their own exit. I don’t think it makes much difference whether their suffering comes from a disease of their body or a disease of society. In the short term, both can be inevitable and excruciating.
It fundamentally contravenes the Hippocratic Oath:
> "Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. . . But I will keep pure and holy both my life and my art. . .
> Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I transgress it and forswear myself, may the opposite befall me."
What's more, euthanasia leads to all sorts of perverse incentives in the administration of medicine, as Canada's MAID experiment demonstrates. It simply isn’t the job of doctors to end lives. It is, in fact, the precise opposite of their jobs -- and I believe you'll find that most doctors are opposed to legalizing euthanasia.
Suffering can be alleviated, and it should be society's job to help patients -- the very word means "sufferers" -- seek care. Many drugs can be spectacularly effective. But today drug-seeking means that you'll be treated like a criminal, whereas there's no hurdle to MAID-seeking in Canada. A grim omen, that.
> It fundamentally contravenes the Hippocratic Oath
The Hippocratic Oath is from between the fifth and third centuries BC, and its relevance has long since been superseded by modern ethical guidelines.
> Suffering can be alleviated, and it should be society's job to help patients
There is a lot of horrible suffering that can not be alleviated unless the doctor induces a coma and keeps the patient in a state of more or less total unconsciousness for weeks or months until death inevitably occurs. I agree we should help patients as much as possible, but there's a line where perhaps the only help we can give, and the only help the patient asks for, is a painless exit. Perhaps future drugs and treatments will eliminate the need for euthanasia, but we are not there yet.
“It’s old” is really not sufficient justification for “we know better now”. That kind of thinking led to some very dark places in the late 19th and early 20th centuries.
Neither is tradition a reason that it should be elevated above current thinking.
As an idea, it has the same starting point, not a privileged one, IMO.
If that’s true, GP should justify it on its merits instead of on “actually that’s really old”.
They probably should have done that by saying something like "its relevance has long since been superseded by modern ethical guidelines."
> Suffering can be alleviated
Sometimes.
I somewhat knew someone who committed suicide by dehydration. She understood the situation: broken hip, she wasn't going to live long enough to ever do anything more than lay in bed. She chose not to. Sure, the broken hip could have been treated but it wasn't even hurting her. The immobility was too much.
And I watched my father die of cancer. There was a period where he could be lucid and in pain, or comfortable but out of it. And then there was a period where he had no ability to make memories--if it wasn't in front of him it didn't happen. And in the end it took his remaining kidney function. We know there was a problem but he was too out of it to explain his distress.
And note that suffering can take forms other than pain.
Fundamentally, most slow forms of dying that don't take your mind will make life quite unpleasant before they kill you.
> I believe you'll find that most doctors are opposed to legalizing euthanasia
You believe incorrectly. Polls consistently show that a majority of physicians support physician assisted suicide.
See: https://compassionandchoices.org/resource/polling-medical-ai...
"Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course"
Isn't this just chemotherapy? It seems like we already break the Hippocratic Oath quite regularly and many people are glad we do!
"Chemotherapy = Poison" is a meme.
In truth, "the dose makes the poison," as has been known since even before Paracelsus' time. In chemotherapy, strong and destructive drugs are indeed administered, but the aim is never to kill the patient, but instead to buy that patient -- otherwise facing an incurable and invariably fatal disease -- more time. In some cases, to cure that patient or send them into a long-lasting remission. This is not "poisoning" the patient. It is just the opposite; it is therapy with an eye towards lengthening the life of that patient.
In that case then, what is a poison? What is the intent of the oath, if it's literal meaning is different from the intent? What does it mean to not poison people? It can't strictly be "you must never do anything that shortens people's lives" because then hospice care would be unethical.
Did you miss the point I made in my previous post?
Strychnine can be a poison or it can be a tonic. If you take 1mg, it'll improve your athletic performance. If you take 100mg, you'll probably die.
Acetaminophen is totally harmless in very small doses -- it's given to infants every day. Take too much, however, and it'll kill you. In adults, it's responsible for nearly half of all cases of acute liver failure in the US, and hundreds of deaths annually. Is it a poison?
I could go on all day. Almost every drug can be a "poison," and, at the same time, only very strong toxins with zero therapeutic window are inherently poisons. In the context of medicine, whether or not something is a poison hinges on the drug, the dose of that drug, its expected therapeutic effect (which is basically statistical), and the condition of the patient.
In cancer, where the condition of the patient is very unfortunate indeed, sometimes only very strong drugs with powerful side effects can provide any hope of eventual relief. Surely you see...
> What is the intent of the oath, if it's literal meaning is different from the intent?
...That the intent is to hopefully provide that relief.
> What does it mean to not poison people?
...That offering something that might cure or abate the patient's underlying condition is the very opposite of poisoning them.
I understand that, but you see how that "intending to provide relief" is very very different from the original statement of "Neither will I administer a poison to anybody when asked to do so", right? Sure, words and context and meaning can change, but this is a very significant change in meaning such that quoting the original statement without clarification is misleading.
Plus, how does that answer my other question? You say the Hippocratic oath's true meaning is that a doctor must provide relief, right? What is a greater relief then death? Or less flippantly, who gets to decide what relief is, if not the patient? And if they do, can't they decide death is a relief? I'm just unclear on how your quote from the oath makes it clear that euthanasia violates it.
"Neither will I administer a poison to anybody when asked to do so" = "neither will I administer a substance I know to be deleterious or harmful to life." The very first definition of "poison" in the OED is: "Material that causes illness or death when introduced into or absorbed by a living organism."
Medicine has a therapeutic window that's context-dependent. Part of the doctor's job, which is why they make real money and have relatively high social status, is determining the right course of treatment from that context. To cure -- not to harm, not to kill. If a cure is impossible, to comfort.
> What is a greater relief then death? Or less flippantly, who gets to decide what relief is, if not the patient?
Patients have every right to refuse treatment. They can also end their own lives; nothing could be simpler. What's perverse is forcing the medical establishment -- in view of its other responsibilities, duties, and oaths -- to act as executioner. It disgraces everybody involved. The doctor ends up dishonored, the state itself is shamed, the human dignity of the patient is, frankly, severely reduced.
So stop regulating the poisons and allow access via a non doctor path, create a framework around it, trying to give the state control over others bodies has just as many negative externalities. Also please try to keep in mind that the original oath was created during a certain eras morality and philosophical leanings, most doctors these days take severely modified oaths mostly to uphold current profesional practices and ethics.
The heart of the Canadian approach isn't a poison at all. Everything they use is perfectly ordinary stuff you'll find in the hospital. But if you paralyze somebody without taking over breathing for them they'll die. It also requires an IV line.
A machine that fed the drugs in sequence wouldn't be complex but the IV line takes some skill.
> So stop regulating the poisons
Most of them, like nitrogen and helium gas, are not regulated. Besides, there are a hundred other ways that require no poisons at all.
> trying to give the state control over others bodies
Yet it's only proponents of euthanasia who demand state sanction. There's something extremely infantile and undignified about this.
> most doctors these days take severely modified oaths mostly to uphold current profesional practices and ethics.
So much the worse, it seems.
> Suffering can be alleviated
Lol. What world are you living in?
Sure, I suppose if you give someone enough downers and obliterate their mind, suffering becomes a non-issue.
Don't pretend this world can alleviate 'all suffering'. It's simply false.
"Pure and holy"
So, I'm supposed to take you seriously? Some words in an oath mean one of my family members has to go insane and claw at himself until he bleeds because his brain has been destroyed by alzheimers? That's "pure and holy" to you?
How is a long walk in the woods not exactly 'meet their end alone and in poverty', given the shame that must motivate that?
Also was this common? What cultures endorsed and regularly practiced this?
Dehydration, exposure, and animals will take you a lot faster than begging on the streets and trying to cling on to life or becoming a burden to your village. As far as historical examples just study Inuit, Greek, Japanese, Norwegian, or Scythian practices on the matter.
True - we might also learn something from the Greek practice of exposure of infants and the Roman law regarding the rights of the pater familias. All three of them are examples of social failure to model the law of love in some manner.
Maybe we just try take the good and leave the bad when we borrow from previous societies?
It might teach you that reality is harsh and to face it.
We have some control over that. That's the essence of being human, IMHO.
Be careful because there's a lot of folk mythology on the subject that is pretty much entirely modern (specifically Romantic Nationalist) invention.
Getting killed by animals is an idiotically painful way to die
Given how widespread funeral rites are, I kind of doubt this practice is common.
Animals seem to sense when time has come. I imagine, hopefully, sometime in the future, I'm going to be able to walk out into that wilderness. I think the difference is, I would never ask or require someone else to accompany or assist me.
It is so very different from parts of our history because we live in a part of the world where there is no good reason why anyone should die of starvation or homelessness.
Canada is a country that is rich in every single resource from wood to metals, to hydrocarbons, wheat, meat, fruit... the list goes on and on and on.
It is a disgrace and a fundamental failure of our society if people feel forced to take MAID to avoid dying on the street from exposure or starvation.
> It is a disgrace and a fundamental failure of our society if people feel forced to take MAID to avoid dying on the street from exposure or starvation.
I have a taxi driver cousin back in South America, wife but no kids. Want to take him in? He wants to emigrate. You could help him set up and such. You can dm me vyour phone number if necessary.
What does this have to do with homelessness and MAID in Canada?
The government of Canada, when asked for funds to install a wheelchair ramp in the home of a veteran and Paralympian, famously offered to euthanize her instead - https://www.cbc.ca/news/politics/christine-gauthier-assisted...
> In one instance, a Canadian Forces veteran claimed she had been offered Maid in response to a request for a wheelchair lift or ramp at her house. While a subsequent investigation found no record that assisted death was offered, Veterans Affairs discovered four cases in which Maid had been inappropriately suggested. The case manager was suspended and the incident was referred to the Royal Canadian Mounted police.
Hospitals occasionally have angel of death doctors and nurses. Should we get rid of hospitals? There’s consistently a lack of any hard quantitative data about the harm the program causes but there are for the benefits. So for critics what’s left are anecdotal stories some of which are true some of which aren’t.
> In another case, the family of Alan Nichols said he died by euthanasia, with hearing loss listed as the sole criterion. The family reported it to police and health authorities- but neither saw cause to investigate further. The RCMP told the family that Nichols “met the criteria” for assisted death.
> But physicians who provide Maid caution that anecdotes of Canadians slipping through the cracks often ignore other critical details of their respective cases, which must include a “grievous and irremediable medical condition” and do not necessarily suggest a failure in the system.
It’s important to remember that the families of people who die will still look for someone to blame. It’s a very human reaction. I know someone who blames the doctor for causing or accelerating her husband’s terminal cancer diagnosis as well as blaming him for telling the husband he had a terminal diagnosis in the first place (i.e. sapped his energy and strength).
That’s not to say that there shouldn’t be adjustments to the program. But driving it through anecdotes instead of expertise and data is the wrong balance to strike.
https://www.theguardian.com/world/2024/feb/25/canada-assiste...
> But driving it through anecdotes
You really want anecdotes in this case because they point to a system that is just getting rid of people for the wrong reasons. That's called insights.
Assuming the anecdotes are correct and capture the entire story - which they rarely actually do in general and especially when you’re talking about death - at best they help land the human story to convince people.
But OK. So let’s presume we have anecdotes that show mistakes made in the program. Do we get rid of it? Hospitals and doctors and insurance companies make deadly mistakes too. Get rid of those as well? And what about the anecdotes of people who were greatly positively helped by euthanasia. Do we ignore their anecdotes? How do we weigh their anecdotes against the anecdotes of problems?
I may be thick but I’m failing to find the insights you’re claiming are there.
Why are you jumping the gun? Even if you keep the program this shows that there is a serious lack of oversight. Once people are dead they are gone and nobody to defend them.
I must admit that people here tend to be against the death penalty but when it comes to killing people in difficult situations suddenly we need to be super flexible and innocents be damned
Am I jumping the gun? All I’m saying is that anecdotes are insufficient for making any changes and here you’re claiming that it’s sufficient evidence of a lack of oversight. Yet there are arguably quantifiably more problematic deaths in regular health care (angel of death, malpractice where the doctor shouldn’t be providing any kind of care, etc) but you’re not arguing that there’s clearly a lack of oversight there. My point is the scale of the problem isn’t indicated by anecdotes and thus you can’t presume that any action should be taken by their existence purely from the fact that at any meaningful scale any human activity will have issues because humans. And that’s ignoring that I pointed out the potential problems with the anecdotes presented.
It’s worrying that you’re equating the death penalty and suicide when they’re very different things. Assisted suicide involves action by the person to end their life while the death penalty is the government taking that action. Very very very different things.
Even more worryingly that you’re outright discounting people killed by the death penalty as not innocent. Ignoring the obvious racial problems with black people being more likely to be sentenced that way since I don’t want to argue about sentencing disparity, the innocence project lets us estimate a lower bound on the amount of innocent people that had been killed before the invention of DNA (and even today after it’s part of the normal course of things). That number by the way I believe (but could be wrong) is higher by volume and percentage than the number of problematic deaths in assisted suicide. Care to rethink your priors about death penalty vs assisted suicide?
Incentives are what matters. When a government has a healthcare system already in the red, there is a strong incentive to get rid of weak and ill people from a government standpoint under the pretext of helping terminally ill people to die. You can see that they have been expanding it to people who were not terminally ill. That says everything you need to know.
This is akin to "think of the children" excuse used to censor the web. But this time it actually kills people.
It’s one thing to be concerned about the problem, it’s another to try to weaponize anecdotes to achieve the aim instead of being intellectually honest and focusing on quantitative data. I’d argue that your position is the “think of the children” position which argues from a place of fear and anecdotes while infantilizing people and removing their autonomy over their own lives.
As for incentives, the estimate is that MAID reduces annual spending by ~100 million. The government spends 300B a year on healthcare. You’re not going to get out of this by killing your patients, not to mention that you need productive members in your economy to create a tax base in the first place. I think you have an incorrect analysis of the incentives at play here.
Any policy is going to have instances of people who are harmed that otherwise would not have been. Focusing on those cases is not insightful.
A single employee made that offer, was fired, and the case was referred to the police. Not exactly a matter of government policy.
But people will bring it up every time, as it's the only bullet in their gun.
Wrong kind of analogy to use here.
That is a "fun" fact to spice up the conversation but not really relevant. The government screwed up one case, big surprise. If they had sent 1000 such letters because the PM wants to cleanse the population of disabled people to save tax dollars, that would be relevant.
While striking, that one seems like anecdata.
Quite devious
> patients asked to be killed in part for social reasons such as isolation and fears of homelessness,
Why is anyone surprised? Did the people who planned out this program never visit a psych ward? They're chock full of homeless people in varying degrees of "I'd rather die than go back to the streets/shelter". Sad but it's how it is.
Adults must be left to make their own choices. When the time comes, I want to go in peace, at a time of my choosing (or imposed by fate--for example, if I were to lose my agency or independence due to a medical condition or an incident), and not rot and suffer until I'm "terminal".
All through my life, I've been milked by way of taxes--and I'm OK with it. I've had a decent life; I've tried to actively minimize the damage I cause thanks to my existence. So, when the time comes (and I decide when it is), I don't want to be left begging for relief. I want to go in peace and with some dignity. I absolutely don't want to resort to violent methods or leave a mess for others to clean up.
So, my ask is that a method is made available. If I need to sign up in advance--when I'm deemed to be of sound mind and body--so be it. But I need a way. I deserve it. This is not negotiable.
Some related links:
* https://www.imdb.com/title/tt1132623/
* https://en.wikipedia.org/wiki/Jack_Kevorkian (I know he's a controversial figure)
This thing turned into exactly the horror its critics were worried it would. Their concerns were so confidently dismissed from all sides, it was so easy to paint them as naive idealists or hardhearted religious weirdos or anything. They were right and now canada is at the forefront of a modern eugenics movement.
Why is assisted suicide programs the horror rather than the systemic effects that lead people with no terminal conditions to prefer death to possible living conditions?
Without assisted suicide being requested, those people will just be overlooked & ignored.
Instead of removing assisted suicide programs, we should consider them to be a societal feedback system regarding society's greatest failures.
It's not "rather than" and there are plenty of signals other than the deaths of disabled people.
Like I said, those signals seem to be a lot easier to ignore.
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You know you live in a "Brave New World" dystopia when...
With the internet, even the disabled and really old and infirm people can find ways to connect with others, alleviating (somewhat) the social isolation aspect of wanting to take a "long walk in the woods". My gut tells me that newer generations who basically are raised with internet access from day one will have little problem with this.
There's an enormous range of disabilities and infirmity that make one unable to use the internet.
The technology to remove pain from humans has been invented via CRISPR. It is possible to live with "congenital insensitivity to pain", so we know it can be done safely. It has been demonstrated in lab animals.
I think that this gene therapy should be given to patients instead!
MAID in Canada is like gun laws in the US. Most lawmakers and most citizens would prefer to have stricter gun laws and stricter MAID laws, but the supreme court interprets the constitution in a way to regularly strike down stricter laws.
I was always very much in favour of opening up people's right to have control over the manner of their death, philosophically it seems inexcusable to me that we routinely keep people alive well beyond the point where they are not only in unbearable agony, but where their condition and/or medical interventions necessary to sustain them have sapped every last ounce of meaning from their lives, leaving them no option but to starve themselves to death or use some other grisly means to end their own suffering in isolation from their loved ones, when they could have a relatively painless death at the time, manner, and in the presence of people of their own choosing.
I knew that this obviously came with risks, old people being pressured into it to ease the burden on, or speed inheritance for their children, people being pressured to take pressure off the medical system, etc. But I believed that trying to manage these risks was well worth the outcome that people might be able to die with a shred of dignity intact.
I have to say that the Canadian experience has made me wonder whether I was wrong. Not in a strong rhetorical sense, but it has given me more doubt than I've ever entertained before. Are we socially or systemically incapable of managing those risks given a certain institutional configuration? I don't know. Happy for people to provide counter evidence for me if they like. I really don't know what to think about this anymore.
> Are we socially or systemically incapable of managing those risks given a certain institutional configuration?
Empirically, Canada says "yes".
There are other reasons (philosophical, moral, religious) that will also speak to the folly of what Canada and Belgium are leading the way towards, but we are not to speak of those things any more - so we're left with the "what if we try it and don't like it - can't we just roll it back?" of the early years of another "forward-looking" society from the recent past.
The British parliament is currently debating legislation to permit assisted dying in some limited circumstances. Five years ago I would have said that their proposals don't go far enough, but the implementation of MAID has made me far more cautious.
I had always dismissed the "slippery slope" argument as being made in bad faith, but Canada seems to have given us an existence proof that a seemingly well-intentioned system can quickly start producing very bad outcomes.
I tend to believe institutional abuse stems from psychopathic tendencies of individuals empowered by/within those institutions. I think the institutions are OK/worthwhile in a vacuum, but struggle to figure out how you avoid having, for lack of a better term, "bad folks" working within them. Review boards always seem to become lazy/apathetic overtime, and the patients often lack agency/collateral to be assertive.
Here in Québec acces to MAID is tightly regulated. Initially I tought it was too regulated but the excess in some other provinces sporadically making the news have made me realize that Québec probably have the right level of regulation around euthanasia.
There was a time when I was in favor of this idea - helping the terminally ill die with dignity seemed like a compassionate idea. Perhaps it still is. My problem with assisted suicide is not that it's giving terminally ill people a way out, it's the unintended consequences. We've already seen the slippery slope argument proven true time and time again. Young people, poor people, people with mental illness, veterans and the critically injured being funneled into assisted suicide. We've seen authority figures talk of counseling people with the wrong political opinions toward suicide. We've seen the profession attract "doctors" who take such glee in the act that in any other context they'd be viewed as serial killers. I'm sorry, but the number of unnecessary deaths that I'm okay with in order to alleviate the suffering of a few is zero.
>the number of unnecessary deaths that I'm okay with in order to alleviate the suffering of a few is zero.
"A few" is doing some serious heavy lifting here
Most deaths aren't pleasant nor peaceful. And modern medicine can keep your body alive for a long, long while as you survive in pain even when there's no chance of things ever getting better
When I was a kid I worked in a grocery store. Every week we had the same people, sometimes 2-3 times a week. They talked to everyone, generally elderly, and seemed very lonely. I can understand facing the end of days painfully alone would push someone to choose their exit.
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For those not actively following the situation, we’re well past the point where they offer and insist that you take the route of euthanasia before prescribing pain medicine in chronic painful conditions.
Does not bode well for a generation of people hunched over their desks leading sedentary lifestyles.
The cavalier way MAID has been implemented in Canada is pretty much eugenics. Everyone knew this would happen. They are killing off the homeless, poor, mentally ill, and medically costly populations to save $$. Super-utilizers, or 5-10% of the population, can cost up to 50% of healthcare cost. Alot of these folks fall into that category; they need to go obviously. How else can Canada afford to import 3-5% of their population every year with immigrants who can't take care of themselves financially? The healthcare system is overloaded and cost of living is astronomically high (esp compared to weak wages). I'm not anti-immigrant but native Canadians are getting shafted hard. Its about to get alot worse folks.
First, we are about 41 million people and every year we welcome about half a million new people to freedom and safety. That's about 1.2%. About 300 000 of these come to us in the economic immigrant category who are decidedly able to take care of themselves or they wouldn't be to immigrate so. A bit more than 100 000 of them are coming as family, 70-75 000 come as refugee and about 10 000 come as Humanitarian / Compassionate other. I always thought a nation as rich as ours should welcome a lot more refugees.
Source: https://www.canada.ca/en/immigration-refugees-citizenship/ne...
Cheers from a not-so-recent Canadian immigrant: I landed on September 1, 2008 and became a citizen in 2016.
> I always thought a nation as rich as ours should welcome a lot more...
You're ruining the country. Stop.
1 million is about 2.5% of 39 million, not 1.3%
That was a typo, I fixed it, you were too quick. It's 500 000. Check the source linked.
> I always thought a nation as rich as ours should welcome a lot more refugees.
Well, I think your fellow citizens are not happy with the levels - "Nearly six in 10 people now agree “there’s too much immigration to Canada,” according to the country’s longest-running survey on the topic by the Environics Institute. It’s the first time since 1998 that this view is held by a clear majority, and a stark shift from favorable opinion over the past two decades."
https://www.bnnbloomberg.ca/business/2024/10/17/support-for-...
Fascism is on the rise in the entire world and Canada is alas no exception. Why, after three years what happened to Lytton, BC they are ready to elect a party which refused to add climate change to its policy book. That doesn't mean your propaganda about 3-5% immigrants who leech on the country has any truth in it.
Fascism is when a countries population is bothered by record levels of unsustainable immigration?
Is Trudeau a Fascist for heeding the calls to reduce immigration? https://jacobin.com/2024/10/canada-trudeau-right-immigration...
No, the majority of the population is now leaning towards fascism as per https://newsinteractives.cbc.ca/elections/poll-tracker/canad... and of course Trudeau bows to them because after all he wants to stay prime minister
you forgot to apologize for spreading lies btw
I think the widespread acceptance of the idea that assisted suicide is a legitimate option that people ought to consider is a society giving up on humanity. I think that there is never a case where there is no hope at all. Even in cases of the most severe illness, with all of the advancements in technology and innovation emerging seemingly every day, you cannot say there is no chance of a cure or a recovery. And even in a failed attempt at such a cure or recovery, there is much to be learned that can be shared with the rest of humanity.
To just focus on avoiding suffering instead of striving to live is not consistent with the attitude that is conducive to the flourishing of life and the advancement of civilization. It is precisely humanity raging against the light — the endless quest for survival and flourishing — that has driven humanity thus far and that will always drive life in general. The assisted suicide philosophy, if you want to call it that, is fundamentally a deviation from the civilizational and biological imperative.
All of this being said, a free society is one where people own their own body, meaning have a right to destroy themselves, with any drug or dangerous behavior, and to even commit suicide. So I cannot see an argument for prohibiting suicide or the provision of assistance in committing it. What's peculiar about countries that have legalized assisted suicide is the bevy of laws they impose to protect people from much milder forms of self-harm, like consumer protection laws that protect people from their own bad consumer decisions. You're not allowed to buy raw milk, but you can get a doctor's assistance in ending your life due to depression!
You thinking there's never a case with no hope doesn't make it so.
There's always hope because we don't know everything. And there are cases where there is a lot of hope, even if the person themselves doesn't believe it, yet people are not being discouraged from suicide.
You seem to be seeing only one side of the situation while there are actually costs to both sides.
As I see it suicide should only be considered when the expected average future quality of life is negative. For the sake of argument let's consider a healthy person to have a quality of life of 100. A dead person inherently has a quality of life of zero.
Health problems and disabilities lower quality of life. The fact that anyone chooses suicide implicitly is saying that their perception of quality of life (and it has to be their perception, everyone has their own yardstick) has gone negative.
It's not just whether it's *currently* negative, but what is the sum of future expected quality of life?
Let's take a patient who considers their quality of life to be -10, with an expected lifespan of a year. I'll take the unit as days, so they have a total expected quality of -3650. I'll be generous and figure a miraculous save occurs 1 in every 100,000 cases and that a save returns them to full health (very unlikely) and gives them another 20 years (again, unlikely--people typically have other processes at work that would in time kill them.) Total expected quality is 730,000.
100,000 people. One is +730,000, for a total gain of 730,000 99,999 are -3650, for a total loss of 364,996,350
Clearly, hoping for the miraculous save increases suffering.
If that were the calculation that we had used throughout history, humanity would have gone extinct. Suffering was extremely common and widespread pre-modernity.
Isn’t MAID something out of Soylent Green?
@dang can I make a generalized comment on the state of Canada in this case?