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The Youth in Asia Aren't Sliding: An Empirical Look at Slippery Slopes
In the thread fathered by Cjet, @EverythingIsFine raised the classic concern about assisted suicide: sure, it sounds compassionate in principle, but won't we inevitably slide from "dignified death for the terminally ill" to "economic pressure on grandma to stop being a burden"? This is the kind of argument that is very hard to adjudicate one way or the other without, in the end, appealing to observed reality.
After all, some slopes are slippery. Some slopes are sticky. Some are icy for five feet then turn into sand. The real question isn’t “is there a slope?” but “what kind of slope is this, and can we put friction on it?”
Fortunately, in 2025, which is well past its best-by, we can look at said reality in the many countries where a form of euthanasia is legal, and see how that's panned out. I think that settles the question far better than arguing over philosophy (I started the argument by arguing about philosophy). The best way to overcome Xeno’s paradox is to show that yet, things move.
The Welfare State Reality Check
Let's start with a basic empirical observation: the countries that have legalized assisted dying are not, generally speaking, ruthless capitalist hellscapes where human life is valued purely in economic terms.
The UK, where I currently work in healthcare, is hemorrhaging money on welfare policies that would make American progressives weep with joy. I can personally attest that a substantial number of people drawing unemployment or disability benefits aren't, if we're being honest, actually incapable of productive work. We have an influx of immigrants who aren't economically productive but receive extensive support anyway. As the public (or at least British Twitter) has realized, we spend gobs of money on Motability cars for people who look suspiciously able to jog for the bus (I can't make a strong claim on how widespread said fraud is, but several instances seemed highly questionable to me).
This is not a society poised to start pressuring vulnerable people into death chambers to save a few pounds. Our doctors are, if anything, a meek and bullied bunch who err on the side of aggressive treatment even when it's clearly futile. I regularly see resources poured into advanced dementia patients who have no quality of life and no prospect of improvement. The NHS is many things, but “relentlessly utilitarian” is not one of them.
If I had a dollar for every dementia patient who has straight up asked me to kill the, well, I wouldn't quite retire (and I'd ask why I'm being given dollars), but it would be enough for a decent meal. Enough for a fancy French dinner, were I to include family pleading on their behalf. And I think those people have a point. Most of these claims arise in the rare periods of lucidity that bless/curse the severely demented. You get a few good minutes or hours to realize how your brain is rotting, often before your body has, and you realize how awful things have become. Then you slide back into the vague half-life of semi-consciousness, and I hope your mind is choosing to devote its last dregs of cognition to happier memories, instead of the living hell you currently dwell in. Meanwhile, your loved ones have no such recourse. All the memories of good times are unavoidably tarnished by seeing the people you love shit themselves and not even care.
Even the supposedly heartless United States has far more social safety nets than people give it credit for. Reddit memes about medical bankruptcy notwithstanding, it still spends around 6-8% of GDP on public healthcare and another roughly 5% on Social Security. I'm not sure how to tease apart Medicare, Medicaid, Social Security Disability, food stamps, housing assistance. That doesn't exactly look like a Darwinian free-for-all.
In other words, both countries already have welfare states that leak money in every direction except the one we’re worried about. So the empirical track record is: we’re bad at saying no. If we legalised assisted suicide tomorrow, I expect the dominant failure mode would still be “keep Grandma alive at enormous cost,” not “shove Grandma off the cliff.”
The Empirical Record
But let's not rely on anecdotes or gut feelings. We have actual data from places that have implemented assisted dying:
The Netherlands legalized euthanasia in 2002. Belgium in 2002. Switzerland has allowed assisted suicide since 1941. Canada introduced Medical Assistance in Dying (MAiD) in 2016. If the slippery slope argument were correct, we should see clear evidence of these societies pressuring vulnerable populations into premature death.
Instead, what we see is:
In the Netherlands, for example, support for euthanasia remains at ~90% in both 1997 and 2017 in the general populace. I lifted said figure from this study
I would consider it rather suspicious if it was 95% in a country where 5% of people get offed annually by MAID. Fortunately, that's not the case.
(Yes, I know that it's 5% of all deaths, not 5% of the total population. I couldn't resist the joke, sue me)
The most common criticisms of these systems aren't "too many people are being pressured to die" but rather "the bureaucratic requirements are too onerous" and "some people who clearly qualify are being denied."
Designing Better Incentives
That said, EverythingIsFine's concerns aren't completely unfounded. Any system can be corrupted by perverse incentives. The question is whether we can design safeguards that are robust enough to prevent abuse while still allowing genuinely autonomous choice. I spend an ungodly amount of time juggling hypotheticals, so I have Opinions™.
Here are some mechanisms that could work:
Competing Advocates System
Structure the tribunals with explicitly competing incentive structures. Pay psychiatrists or social workers bonuses for every person they successfully talk out of euthanasia after demonstrating that their suffering can be meaningfully ameliorated. Simultaneously, have patient advocates who are rewarded for ensuring that people with genuinely hopeless situations aren't forced to endure unnecessary suffering.
This creates a natural tension where both sides have skin in the game, but in opposite directions. The "life preservation" team has incentives to find creative solutions, provide better pain management, connect people with resources they didn't know existed. The "autonomy" team ensures that paternalistic gatekeeping doesn't trap people in unbearable situations.
Red Team Testing
Implement systematic "penetration testing" for the oversight system. Create fictional cases of people who clearly should not qualify for assisted dying - someone with treatable depression, a person under subtle family pressure, an elderly individual who just needs better social support. Have trained actors present these cases to euthanasia panels. (E.g., 25-year-old grieving a break-up, fully treatable depression, no physical illness)
A modest proposal for the composition of such a panel:
7 people, randomly selected for each case):
2 psychiatrists, paid only if the panel declines the request.
2 social-workers/advocates, paid only if the group approves the request.
1 “neutral” physician (salary fixed).
2 lay jurors, paid a flat fee.
The psychiatrists and advocates must publish a short written justification (≤500 words). The neutral physician and lay jurors read both sides and vote. Majority rules. The adversarial structure means the psychiatrists have skin in the game if they rubber-stamp a case that later looks fishy, and the advocates have skin in the game if they brow-beat a clearly salvageable patient. The lay jurors are there to keep the professionals honest.
(Alternative models might be splitting the psychiatrists and advocates across both teams)
Any panel that approves inappropriate cases faces serious consequences. This creates strong incentives for rigorous evaluation while identifying systemic weaknesses before they cause real harm.
We already use similar approaches in other domains. Government agencies test whether stores are properly checking ID for alcohol sales. Tax authorities use mystery shoppers to verify compliance. Financial regulators use stress tests to identify institutional weaknesses.
Temporal Safeguards
Build in meaningful waiting periods with multiple check-ins. Not the perfunctory "wait two weeks" that can be gamed, but structured reassessment over months. Require people to demonstrate that their decision remains stable across different contexts - good days and bad days, when surrounded by family and when alone, after various treatment interventions have been attempted. At any time the patient can unilaterally revoke the request (one phone call suffices), at which point the whole timeline resets. Finally, lethal medication is dispensed only on the day of the procedure, and only if the patient re-asserts consent on camera, without the advocate or psychiatrist in the room.
This serves multiple purposes: it prevents impulsive decisions, allows time for circumstances to change, and creates multiple opportunities to identify and address external pressures.
More Watching of the Watchers
All decisions (with names redacted) are published in a searchable database. Independent academics can run regressions on approval rates vs. patient age, diagnosis, postcode, etc. Outlier panels get flagged automatically. (If Panel #7 approves 90% of 25-year-olds with psoriasis, maybe look into that). The tribunal system becomes a public good: researchers learn what actually predicts irrevocable suffering, and policy can adjust.
Economic Firewalls
Perhaps most importantly, create strong institutional barriers between economic interests and euthanasia decisions. Healthcare systems, insurance companies, and family members should have no financial incentive for someone to choose death over continued treatment.
This might mean that euthanasia decisions are handled by completely separate institutions from those bearing the costs of care. Or it might mean generous death benefits that make someone more economically valuable alive than dead. Or mandatory cooling-off periods after any discussion of treatment costs.
EverythingIsFine’s deepest worry is emotional pressure: Grandma feels like a burden even if no one explicitly says so. The adversarial tribunal can’t eliminate that feeling, but it can reduce the plausibility of the belief. If Grandma knows that two professionals will lose money unless they are convinced she is beyond help, the thought “my family would be better off without me” loses some of its sting. The process itself becomes a costly signal that society is not eager to see her go.
The Comparative Harm Analysis
But here's what I think clinches the argument: we need to compare the risks of legalized assisted dying against the status quo.
Right now, people who want to end unbearable suffering have several options, all of them worse:
Each of these approaches involves more suffering, more uncertainty, and more potential for things to go wrong than a well-designed assisted dying system.
Meanwhile, the people we're supposedly protecting by prohibiting euthanasia - those who might be pressured into unwanted death - are already vulnerable to abuse in countless other ways. Family members can pressure elderly relatives to sign over property, refuse beneficial medical treatment, or accept substandard care. Healthcare systems already make implicit rationing decisions based on cost considerations (but this is a necessary tradeoff for any system that doesn't have literally infinite amounts of money. The Pope doesn't spend all of the Church’s budget on a single drowning orphan)
Creating a transparent, regulated system for end-of-life decisions doesn't create these pressures - it makes them visible and addressable.
The Autonomy Principle
Ultimately, this comes back to the fundamental question of autonomy that cjet79 raised in the original post. If we don't trust competent adults to make informed decisions about their own deaths, even with appropriate safeguards and cooling-off periods, then we don't really trust them to be autonomous agents at all.
We let people make all sorts of life-altering decisions with far less oversight: whom to marry, whether to have children, what career to pursue, whether to undergo risky medical procedures, whether to engage in dangerous recreational activities. Many of these decisions are statistically more likely to cause regret than a carefully considered choice to end unbearable suffering.
The paternalistic argument essentially says: "We know better than you do whether your life is worth living." That's a pretty extraordinary claim that requires extraordinary justification.
Conclusion
Legalising assisted suicide beyond the “imminent death” cases does open a channel for pressure and abuse. But the same could be said of every other high-stakes civil right: police shootings, child custody, involuntary commitment, even driving licences. The solution has never been “ban the activity”; it has been “create adversarial oversight with transparent metrics and random audits.”
If we can audit restaurants for rat droppings and banks for money-laundering, we can audit tribunals for premature death. The price of liberty is eternal paperwork (woe is me, I do more than my fair share already) but at least the paperwork can be designed by people who actually want the patient to live if there’s any reasonable chance of recovery.
I'm not arguing for euthanasia-on-demand or a system with minimal safeguards. I'm arguing for thoughtfully designed institutions that balance individual autonomy against the genuine risks of coercion and abuse.
(To put an unavoidable personal spin on it, I've been severely depressed, I've had suicidal ideation. I would have a very easy time indulging in that feeling, and I refrained not just from thanatophobia, but from a genuine understanding that my brain is/was broken. My advocacy for the right for people to make this choice is informed by a deeply personal understanding of what being there is like. Don't worry, I'm mostly better.)
The slippery slope argument assumes that any movement toward assisted dying will inevitably lead to systematic devaluation of vulnerable lives. But this treats policy design as if it's governed by some inexorable natural law rather than conscious human choices about how to structure institutions.
We can choose to create robust safeguards. We can choose to separate economic interests from end-of-life decisions. We can choose to err on the side of caution while still respecting individual autonomy.
The question isn't whether a poorly designed system could be abused - of course it could. The question is whether we're capable of designing better systems than the brutal status quo of forcing people to suffer without recourse or resort to violent, traumatic methods of ending their lives.
I think we are. And I think the evidence from jurisdictions that have tried suggests that the slippery slope, while worth watching for, isn't nearly as slippery as critics claim.
I'm not sure about the Netherlands.
E.g. they killed a 29 year old woman even though she was perfectly healthy. Did they try any of the bleeding edge treatments of depression? E.g. a week long sleep deprivation fixes treatment resistant depression ?
You could actually find out how much of depression is genetic, and how much is learned. We are reasonably sure memory can be erased, so why dispose of valuable, healthy human resources through euthanasia? Maybe it could be a way of rehabilitating criminal sociopaths..
How is that surprising? The world's most enlightened and civilized people, Europeans, are against free expression because they correctly recognized the famous, reviled but unquestionably true in principle american dictum:
If they did not believe that people are sheep, easily led astray, they'd not be restricting the internet, free expression, suppressing holocaust denial, banning Russian TV and so on.
I am getting deja vu, and not just because of sleep deprivation.
As a matter of fact, I have previously addressed the exact same case. In short, I think the doctors did the right thing.
https://www.themotte.org/post/1701/culture-war-roundup-for-the-week/302719?context=8#context
...
"The doctors did the right thing in helping a 29 year old woman with depression kill herself" is quite literally the slippery slope. That's what we're talking about when we call something a slippery slope, that social norms will change so radically, and people will just be all "actually, that's a good thing we changed that!"
Hang on, please explain to me, ideally without referencing slippery slopes at all, what is the precise issue with this 29 year old woman with depression being offered euthanasia?
I try not to brow-beat people with my credentials any more than I can help, but I have experience in both psychiatry and being severely depressed. It would take far worse to make me seek euthanasia, but my depression wasn't as bad as it can truly get. Some forms of dysfunction and agony can truly be hard to discern from a distance. You see a pretty young woman in the prime of her life being consigned to death by uncaring doctors.
I see a tortured soul, who has consented to her doctors trying everything they can feasibly try. If you don't believe me, you can look at the article. Her every day is utter misery, we have no idea how to fix her, at present. And we've tried, tried oh so hard, with no results. I had reasons to cling to life even when my brain screamed it was pointless to get out of bed, I do not care to dictate beyond a very limited extent, how much others should really tolerate.
She is an exception. 99.9% or more of depressed people are not recommended euthanasia. She went through all the loops and hoops, she didn't change her mind. Her very right to do so was challenged, and when I initially engaged with the article, being adjudicated in a court of law. The rules are being followed.
This is a very critical point. By saying "MAID is in principle on the table for depression", you create some incentive to engage with the medical system.
If instead you take the firm stand that suicide is bad and that you will gladly lock up patients who talk about suicidal ideation until they learn to credibly deny having such thoughts, that is sending a very different signal.
As others have pointed out here, anyone who is not bedbound has a BATNA, which is to kill themselves against the wishes of broader society. Unilateral suicides impose great costs on broader society. You can not let your loved ones know lest they call the cops on you -- unless you trust them to approve your defection. While medically, killing a person in a way which is both painless and also not highly disturbing to onlookers is a solved problem, the situation for the average person is very different, and they may well prefer an option which is good at delivering a quick death but traumatizing for the onlookers. Jumping in front of trains has massive externalities, for example.
Knowing that your loved one is opting for MAID for depression is terrible, but what is worse is coming home and finding them dangling from a rope -- without you ever having had a chance to talk to them about it or say goodbye to them. If offering MAID for depression turns 10 suicides into 7 suicides (who do not want to jump through the hoops) plus 1 medically assisted death and two patients who can be treated to a level where their life is positive-sum for them, that seems like a clear win.
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If she wants to kill herself that's one thing. She didn't need assistance. She was young and healthy and could've just hung herself, or jumped off a tall building, or
in front of a trainin some other way that doesn't involve someone else, please. The fact that she couldn't muster up the will to do this, honestly makes me question how suicidal she really was in the first place. After all, thousands of people in the Netherlands do this every year. But unlike the bedridden elderly people that are usually taken as an example in these cases, she certainly always had the option.What I really think we shouldn't be doing as a society is validating or normalizing such a decision. That is not about the details her specific case, but about the example that's set for others. It doesn't even matter if her mental suffering truly were unbearable in some manner. Ultimately only she knows her inner mental state. To an outside observer, she was young and healthy, and she had people who cared about her. (We should all be so lucky!) And we're going to just kill her on request? That shouldn't be normal. It's what's observed from the outside that sets the norm.
Are you seriously suggesting that society prefer depressed people commit suicide by train?
That feels like the most outlandish thing I have read on the internet all week.
Suicides by train are only topped by intentionally driving on a highway in the wrong direction as far as damage to broader society goes.
Suppose you are a train conductor without psychopathy. You go through your routine job of driving the train, listening to music perhaps when suddenly a person steps on the track 50m ahead of you. You sound the whistle and slam the brakes. You have more than a second to contemplate what is about to happen, but no way to stop it. You hear the impact over the sound of the brakes. After the trains comes to a halt, you grab a first aid kit and run back the person you have just hit. If you are lucky you only need a glance to confirm that they are dead, cut apart by your vehicle. Or you might spent the next ten minutes giving CPR to a corpse until the ambulance arrives, hoping for a miracle which is unlikely to happen.
Intellectually, you know that you did not kill the person, they killed themselves. Still, it was your train. You know that it is not feasible to slow trains down to speeds where they will no longer be used as a method of suicide. If you had reacted a tenth of a second faster, it would not have made any difference. But still, you wonder while you lay sleepless in bed, held awake by the images and sounds which have burned themselves into your memory.
Driving trains is your job, a profession you spent years to learn. It is high responsibility, but also very routine. Before you had hit that person, it was not very stressful, most of the time. But now your brain anticipates that any second, another person might step on the track in front of you, and you would be just as helpless to do anything about it as the first time.
Personally, I would take the life of a physician who assists a suicide of a depression patient after all the process is done a ten times over the life of that train driver.
Okay, not a train. That's an asshole thing to do. If you're going to commit suicide, don't involve other people.
I included it because it's the stereotypical thing to do (at least around here), but thinking a bit further, it's probably that way because when someone does it, everyone in the train knows. Probably most people have been on a train that's been delayed because of a train suicide. Other methods of suicide don't get that attention.
I do absolutely think we shouldn't be offering assisted suicide to people who are physically capable of unassisted suicide.
This is surprisingly hard to do. Someone needs to find the body and unless you plan carefully this can easily be a random bystander or group of random bystanders (and planning carefully is hard when you are suicidal).
Usually EMS and healthcare get involved and seeing someone who has committed suicide can be deeply harmful (especially if it's gruesome like a gunshot to the head). Often they'll have to run a code on the body even if it's clearly dead which is....awful.
Then you have to think about the family and friends of the deceased. Having a close contact or family commit suicide is a risk factor for suicide it hurts people around you in a way that just dying doesn't.
Yes, suicide is bad. Ideally there would be no suicide at all. This is part of my point.
When we do something in an official manner, we thereby give it a stamp of approval. We should not approve bad things if we can avoid it. Because by doing so, we are saying that the bad thing shouldn't be considered as all that bad. We are shifting the norms and encouraging more of it. We can't always avoid this, but we should at least always try.
If someone's dying anyway, say with terminal cancer, and we artificially keep him alive at that point (which we've gotten quite good at), we are merely prolonging his suffering. At that point, sure, just end it humanely.
But this person (and see my other comment, there are more) was not actually dying. She was in fact physically healthy. There is no argument to be made that we are prolonging her suffering. We are not actively doing anything. There is no argument to be made about freedom either. If you are physically capable of killing yourself, you always have this option.
She could've ended her own life herself at any time. And that would still be bad, even if it truly is the least bad option it's still bad, but we would at least have avoided giving the act an official stamp of approval. And maybe she never would've killed herself, and then there would've been one less suicide. This is the point that I was trying to make.
And it does seem to be accelerating. I looked up the statistics (see my other comment for the sources). There were 14 euthanizations for purely psychiatric reasons in 2014. By 2024, this had grown to 219. In the same year, there were 1819 traditional suicides. So by now, for every ten suicides we're adding an eleventh.
Sorry I don't really have a dog in this fight I just wanted to make that point specifically.
In truth I remain somewhat undetermined about how to handle this specific issue which is awkward given the possibility of it appearing in my clinical practice, however my plan is to just follow legal, regulatory, and hospital frameworks and stay out of the ethical side of this thing.
That said it is worth dialing in just how miserable certain classes of patients are. Again I'm not convinced we should assist them in dying but certain patients have a lived experience that is comparable or worse than the more typical examples (dying of chronic disease, intractably bad life experiences, significant chronic pain*).
For instance someone with severe borderline personality disorder may find themselves zigzagging from being too happy to wanting to kill themselves to burning down their relationships to getting fired to whatever on a regular basis. With associated involuntary suicidal ideation it can approach a point where the life experience is almost abhuman, miserable, and devoid of the traditional pleasures of existence.
That's a reasonably good case, especially since some people like this may struggle to successfully kill themselves because the system does a good job of preventing it and because the problem isn't pure depressive misery, therefore it becomes challenging to overcome the routine desire to live.
Again not necessarily advocating here just pointing out if you had chance to interact with one of these people you might go....oh yeah, I get it, holy shit (or might not).
*Although best we can tell this is somewhat linked to psychic distress.
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The pilot of Germanwings flight 9525 would like to have a word with you.
I knew when I wrote this that someone would come up with another exotic counterexample. I will not try to argue that flying a plane into a mountain is a special case of going the wrong way on a highway either.
Fine. I retract my claim and say that they are the second most harmful commonly occurring suicides, and patiently wait for someone to explain to me why that is still wrong.
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Severely depressed people are famously known for being well motivated and agentic.
You might have heard, most likely as a semi-serious observation, that the side effect profile of most antidepressants includes increased risk of suicide.
Ever wonder why? It is because depression affects multiple part of the brain, and antidepressants can start fixing some parts before the other. In other words, you accidentally fix someone's motivation and agency before restoring their mood, and you suddenly have someone who is very energetically motivated to kill themselves.
People often do not know their inner mental state. If you care to criticize this, then just about nothing in psychiatry remains standing. There is nothing, in principle, stopping a sane person from talking into thin air, and gibbering about the CIA watching him. Yet this is a reliable metric for psychotic illness. In a similar manner, what do you think the usual stereotypes are of how a depressed person looks and behaves?
The reason that psychiatry is not purely stamp-collecting is because said stamps allow us to mail cheque's we can often cash. A diagnosis of depression usually leads to a treatment of depression. It's not perfect, in very rare circumstances, such as hers, literally nothing worked. If she wants to lie after all of that (and there is a lot of "all of that"), then she's earned the right to kill herself.
She's always had it, and never lost it. This was part of my point. It's the official approval that I disapprove of.
This is not the way in which I meant it. By outsiders I meant the general public, society as a whole, not her psychiatrists, who I'm sure knew what they were doing and tried their best. Because even if I grant that this was the right decision in this particular individual case, I still oppose it because of the example that it sets.
The picture that is shown is of a (physically at least) healthy 29-year-old, who has people who care about her. When someone like that commits suicide, it should not get a societal stamp of approval. Let alone that we should do it for her. This will cause the societal norm around suicide to shift.
I think that we shouldn't be giving the general public the idea that society approves of just stepping out of life if you're not feeling it. I grant you that that's not actually what happened in this case. But that is what it looks like. You know what the fancy words mean, but remember that to a layman, "depression" means "not feeling it".
And in fact, I've just found another depressed 29 year old woman who was euthanized. I forgot the name of the first one, googled "euthanized depressed 29 year old" and immediately found another. This made me go and look up the statistics. Here they are, in Dutch, but summarizing: in 2014 there were 14 cases of euthanasia for purely psychiatric reasons. This is the first year for which there is data, so presumably the first year this was even done. By 2024 this had grown to 219. Line go up fairly quickly.
Meanwhile, there were 1819 "traditional" suicides in 2024. So by now, for every ten suicides we're adding an eleventh. More than that.
This really looks to me like official approval causing the social norms to shift, in turn causing the psychiatrists too (who are after all also part of society) to be more free in granting approvals, causing the norm to shift further.
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I'm not necessarily pro suicide, but I think the idea that pursuing bureaucratic rather than kinetic means to suicide indicates a lack of seriousness is backwards.
One can jump off a bridge instantly on a whim, and of the people who have done it and survived many said they regretted it instantly.
Where euthanasia has a 100% success rate, and requires serious intent over an extended period of time.
Interesting idea for an RCT: Some portion of euthanasia subjects are head faked, put under anesthesia, then when they wake up you ask them if they regretted their decision. If they still want to die you kill them on the second try.
Probably because jumping off a bridge is awesome; it's the largest adrenaline rush I've had bar none including skydiving. Seems likely to (at least temporarily) break a suicidal mindset right there. I doubt the APA would approve bungi jumping even as an experimental therapy though.
Is it inexcusably awful that I think we should be utilizing the "wants to and is approved to die" demographic for experiments like that?
Fuck it, harness them up and toss them off a bridge. Let them drive dangerous car races, or play airsoft with live ammunition. See if it alters their feelings about death.
Russian Roulette as therapy? Mind you, I think that was the original purpose.
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So life sucked for her. Life sucks for a lot of people. Giving people who see no point in living (a surprising amount of people, most of whom are too anaesthetised to realise it) a societally sanctioned way of killing herself (this is clearly what she was after) is a pretty slippery slope. We'll see how slippery pretty soon after AGI, I think.
The manner of someone's death matters not as much as the fact of the premature death. One could theorize some nightmarish ways to go that could traumatize the bereaved but generally, it doesn't matter.
I stubbed my toe this morning. That puts me in the same category as people screaming from the agony of testicular torsion, childbirth, or a subarachnoid hemorrhage. It is helpful to deny them painkillers because I've walked it off.
I do not understand how you fail to see that the degree of sucking matters. If your mother complains of a mild headache, you pop down to the chemist for some Tylenol. If she is screaming with an arrow in her guts in the middle of the Amazon, you would be very kind to give her the opportunity to extend her life for a few minutes or hours, at least an opportunity to let her demonstrate moral character in the face of adversity.
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