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Am I severely miscalibrated? Over 5% of total deaths sounds like a massive amount to me.
If anything, it seems low to me. From my understanding of the actuaries table here, it seems that the median age of death is around 79--84.
That is certainly what I would call old age. Assume that half of the people dying above that age have a terminal condition which qualifies for MAID, such as cancer, and that half of the ones who qualify actually opt for it. That would give us 1/8th of the deaths (12.5%).
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I would say that in my own life, 5% of deaths "could have been timed better" sounds about right. Not necessarily a case of some exotic terminal illness, but cascading old age concerns. There's a clear point of no return, I could see someone pulling the trigger on it.
Especially these days when the medical apparatus is increasingly good at keeping people alive when they probably shouldn't be
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It sound tiny to me. The median lifespan is like 83, presumably some percent of these people want help dying at the end.
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I thought the same FWIW.
It was sold as ‘if you have a terminal illness, you are going to die in a few weeks, you are in terrible agony and there is no way of alleviating your pain or saving you’ which I would expect to be 0.1% max. Hence calling it ‘assisted dying’.
I think that this was never the intended use case and that those politicians who advocated for it on these terms were being dishonest.
Far more illnesses become terminal when you're old and frail. A flu you might walk off becomes fatal pneumonia. A mild UTI or stomach upset in the young becomes the cause of septic shock. A scratch becomes cellulitis and gangrene, becoming too weak to toss and turn becomes suppurating bed sores.
Children are often nigh-unkillable. The elderly are the exact opposite, it's a goddamn miracle life expectancies are where they're at.
Maybe something around 0.1% is your intuition for how many people are in such a state right now. It is closer, in terms of magnitude. The issue is when you lack firm intuitions for how that stacks up over the longterm, at least over a year. I probably tend to overestimate the figure that dies miserable deaths, because the peaceful desths at home don't come to me. I am, however, aware of that bias and try to account for it. It remains to be seen how successful that is, but I see 5% as fine.
"...and believe me, folks, I've tried." :P
I take your point. My intuitions could be wrong. But I think also 'assisted dying' was marketed as being for much more specific freak cases where people have an absolutely certain and very short life expectancy, and were in horrible pain that could not be alleviated through even strong pain medication. I would be willing to bet that if you raised the figure of "5% of all deaths" before this stuff was legalised you would be dismissed as a scaremonger if anti- and if pro- you would be taken aside and given a stern talk about staying on-message.
Look dude, you're the one who said that whatever's disclosed while sobbing in that 'Spoons stays in the Spoons.
At any rate, I wasn't around when the PR push you're talking about for euthanize took off (which jurisdiction are we talking about?) It's not legal in the UK, and I am part, albeit only at a very junior level, of the bodies putting forth policy proposals and considering whether to make it legal. I can tell you that we use simultaneously more careful, and more broad, language. It is definitely not being sold as something for those who are in maximal agony and only at the very last minute.
Ha. In all seriousness, though, you're aware that a bill was put forward at the end of last year to legalise it in the UK, right? And that it was basically bounced through the Commons as a private, unscheduled bill with no preparation and is now waiting for approval from the House of Lords, after which it will become law?
And I do remember that the first few times 'assisted dying' was floated it was about really quite specific scenarios, and that even now a lot of the 'pro' polls about it are still quite specific. For example
https://www.theguardian.com/society/2024/oct/16/england-and-wales-assisted-dying-bill-formally-launched-in-house-of-commons
And yet when it comes to the actual law:
whereas if you look at actual public opinion you see support for a much narrower version, with:
https://www.ipsos.com/en-uk/two-thirds-uk-public-continue-think-assisted-dying-should-be-legal-provided-certain-conditions-are
and
https://www.salvationarmy.org.uk/news/survey-reveals-publics-fears-about-assisted-dying-bill (yes, biased, but the poll was carried out by YouGov)
I've thought a lot about this issue for the last ten years, as many have, and it's hard to escape the feeling that public consent has been laundered by keeping the spotlight firmly on rare, sympathetic cases while the intent of campaigners has always been significantly more far-reaching. Even the chosen term is very obviously a marketing gambit - 'assisted dying' where in reality they aren't dying in any sense other than the philosophical and the point is to legalise deliberately injecting them with something that will kill them. My memory is that these words were originally justified twenty years ago by limiting discussion to the near-death cases I describe, though I admit I can't back that up.
I'm not trying to lay this on you, you're honest about your opinions. But the way the whole thing has been handled leaves a nasty taste in my mouth.
My extreme scepticism around these kinds of bills comes from abortion legislation (elsewhere and here in Ireland). The activists pushing for it run the most extreme cases, swear up down and sideways only a very teeny-tiny few will ever need to avail of this if made legal, and then work their socks off behind the scenes to have the language in the legislation as vague as possible (so it can be challenged in court if necessary) and that a way of gaming the system (e.g. having two doctors sign off on abortion in the UK became 'this is only rote rubber stamping') can be introduced to get what they want.
"Intolerable suffering from incurable condition" means what, exactly? If I'm thirty years old and claim that my depression means I have no boyfriend or no career (instead of a dull job) and I see no change on the horizon, am I not intolerably suffering?
There's a lot of wiggle room between "let everyone assume we mean people dying in horrible pain from mortal cancer" and "in practice, just tell the doctor this script with this exact wording to get it".
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This...seems like a fully generalizable description of basically all political activism in WEIRD democracies??
Yeah, I guess. I hate it. But in particular I feel like I was around for most of this one and so I feel more jerked around by it.
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Yeah people massively underestimate how good modern medicine is at prolonging that last 6 months to a year now. My father who's in good shape for mid seventies now had successfully-treated skin cancer a few years ago and some of the people he and I saw clinging to life whilst visiting oncology were medical miracles.
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What do you think the intended use case was?
Broadly that described by @self_made_human. Total autonomy (as least for educated people) over their own life and death in all cases, Roman-style, which in practice means breaking the social/religious and legal taboo over suicide. The 'assisted dying for the terminally ill' case was introduced as the thin end of the wedge where those objections were not very sensible, with advocates knowing that they would be able to push the ball significantly down the slope once the Schelling fence was overcome.
I think that the 'we will euthanise the elderly to save NHS money' people aren't wrong at the edge but this happens to some extent anyway with Do Not Resuscitate; I expect some scandals but not widescale abuse. I am more worried about the elderly pressuring themselves into suicide, and about those with long-standing but irrational suicidal tendencies. I differ from @self_made_human in thinking that suicidal depression is an absolute indicator that a given person cannot be trusted with this particular form of autonomy as their judgement in this area is compromised.
Personally, I would rather have legalised voluntary assisted suicide specifically for dementia patients, requiring two time-spaced diagnoses of clinical dementia from two different doctors and a voluntary statement from the patient taken when compos mentis (to the extent that this is practical). I think this addresses the real, secret fear that is propelling normie support for these political movements and is limited enough to be stable. Alas I don't think that 'culling the mentally-feeble' would make it past the journalists and I don't think it would satisfy the campaigners, but I think it would take the wind out of the issue.
I think being depressed is very good reason not to agree to people's pleas to die right away! It is a mental illness which twists your cognition. It should be difficult to kill yourself on the grounds of depression.
I do not think it's an absolute indicator to ignore someone, if used in the literal sense. You have to keep in mind that the BATNA for these patients is jumping in front of a train. That makes absolutist stances less than actionable, in the pragmatic sense. If you want to achieve this in the real world, you need to lock some people up for the rest of their lives on those grounds alone, and I think letting them kill themselves might well kinder in some cases.
Holding out for a miracle cure is a gambit at the best of times, but still - I think "how likely is it that we'll have unprecedentedly effective antidepressants by, say, 2050" has to be considered. There is a difference between locking people up for life as the stated goal, and locking them up indefinitely until we help them better. If you think there's a decent chance of a cure being developed within the patient's lifespan, I think it's worth the chance.
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Who am I to tell you what's massive or not? When you see how the elderly, who make up a very large chunk of all deaths these days, actually go out, it really doesn't surprise me. I would start raising eyebrows past 20%, and be alarmed past 30. This is implying business as usual, not something like the Culture's post-scarcity, where people almost never die natural deaths, and euthanize themselves when they're bored. We'll figure that out if/when we get there.
The person using the number as part of an argument that there's no cause for concern?
That's pretty wild numbers, imo, and reduces my ability to take your general judgement of risk, safety, acceptibility, etc on this topic as particularly calibrated toward anything persuasive. I think burying your own calibration in a p.s. is kind of dishonest when you are trying to lay out a defense of something.
Yeah but the medical doctor who's likely spending significantly more time in the company of the hospiced and hospice-adjacent probably has a better bead on this than a layperson.
Can't remember the Scottpost but the stats on medical professionals opting out of end of life interventional care at a highly elevated rate are likely relevant here.
From 2011 (not Scott)
https://www.zocalopublicsquare.org/how-doctors-die/
Scott linked it in one of his golden era posts, who by very slow decay
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Yep that's the one I was thinking of, thank you. Afaik Scott linked it in one of his articles?
Realistically, that's probably where I found it lol
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Really? Okay? What if I say 5% is massive, or not massive? You can make the same fuss either way. There are people who are categorically against the euthanasia of even a single person, and people who think that every human should be euthanized. What do you have to say to them?
Do you have an intuitive or even an intellectual understanding of how miserable the average death is? Did you remind yourself that euthanasia is meant to replace that inevitable, often painful and undignified death, with one that doesn't draw out the inevitable and lets people go out on their own terms?
Please, if you accuse me of being miscalibrated, then produce your own ISO calibrated standards. I remain in earnest anticipation, and until then, this is probably the queerest objection in the thread.
Reading iprayiam's post, I was originally in agreement with him, but now, I am not sure. If euthanasia was legalized, I would expect a spike as all the olds with terminal illnesses and low quality of life euthanized themselves, and then a stabilizing as the rate of them would be the rate of people entering those low quality of life stages of their life for the first time. Are there really 5% of people right now with terminal illnesses and low quality of life? I hadn't really ever thought about it.
A major issue:
Terminal illness is not strictly defined, and neither is low quality of life. It's more of a know it when you see it kinda deal.
If you're willing to settle for proxies -
How many people will need palliative care in 2040? Past trends, future projections and implications for services
My quick trawl of the literature suggests that ~95% of all deaths in the Anglosphere are due to illness and not external factors. I mean, if a disease kills you, I'd certainly call it terminal at some point. Most of these patients have some combination of cardiovascular disease, respiratory disease, cancer and so on.
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregistrationsummarytables/2023#leading-causes-of-death
This is illustrative. I manually added all the leading causes:
4.2+4.8+5.1+5.5+10+11.6 (the big 6) add up to 41.2%. That leaves every other thing that kills people.
Note that is not exhaustive, and this kind of data is a pain to collate. I hope that even just going by the biggest causes makes it clear that a 5% MAID rate is nothing to write home about. @iprayiam3 is, to out it bluntly, terribly miscalibrated. People can just say things, and be wrong on the internet, while bringing no facts to the table themselves.
My own figures of 20-30% are hardly perfect, but they're certainly closer to plausible figures for people undergoing rather unseemly and painful deaths. They came from a strong hunch, and it's clear that working in medicine makes that gut feeling more accurate.
Now that I know more accurate values, I can see a plausible case for much higher rates.
Forgive the aside, but what is the meaning of the word 'disease' in medical parlance? I suppose in the back of my mind I was aware of 'heart disease' but I would normally think of 'disease' as synonymous with 'infection'.
Disease is defined somewhat tautologically, since we usually define health (or the WHO does) as:
Google tells me that they haven't bothered to define disease. Well, a disease is anything that impacts you negatively and isn't something like a car crash or a bullet to the head.
Wikipedia goes for:
This has plenty of room for arguments, even if I find some deeply stupid or misguided. Some deaf and autistic people claim that trying to cure their conditions, or that of their children, is medicalizing a "normal" or equally valid state of being, and tantamount to genocide.
I have no sympathy for such a position, sure, mild autism isn't that bad, but if they're non-verbal and low-functioning, almost everyone wants them cured. At best, I support individual autonomy enough that if a deaf person insisted that they wished to remain deaf, they have the right to refuse treatment. I begrudgingly concede that they should have the right to make that decision for their children, even if I think it's a really dumb one.
Fortunately, the sufferers of most diseases seek cures. There's no movement to redefine psoriasis, fungal feet infections or heart attacks as a manifestation of the human condition that shouldn't be eliminated. Doctors just nod at the dumb stuff, and keep doing what seems sensible. Or at least I do.
I see, thank you.
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