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PaperclipPerfector  4mo ago (text post)   25900 thread views

Culture War Roundup for the week of August 4, 2025

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Thank you for taking the time to write such a thoughtful reply. An AAQC report is the least I can do.

I agree that we disagree on some fundamental values. The policy I've envisioned is a compromised one, a version that is sanded down to increase its political palatability. I have more extreme views, I believe we should allow anyone who is of sane mind to opt for euthanasia (with massive caveats that they need to demonstrate their sanity and show that they aren't making that decision on a whim). However, I must hasten to point out that my policy recommendation isn't meant to be disingenuous, rather, it is a system I would genuinely be content with. If we had it in place, I wouldn't immediately switch to lobbying for suicide booths next to every bus stop.

but the one I like better is "if someone's going to die, you might as well grant them control over the method".

We're all going to die! I might be a transhumanist, one that considers living for a quadrillion years as software running on the carefully rationed Hawking radiation from a black hole in the post-stelliferous era to be a nice retirement, but even I don't think we can live for literally forever. Heat Death is likely to be a bitch.

Putting those aspirational stretch goals aside, we are really all going to die. The terminal stage of illness just makes that expiry date more... obvious. It becomes less of a hypothetical end to the story of your life, and more of a realization that the novel is about to end, there aren't many pages to flip.

Netherlands, Belgium, Switzerland, and Canada have all had assisted dying for 1-2 decades and do not "pressure vulnerable populations into premature death" and serve as good evidence.

As I've noted elsewhere, Switzerland has had assisted dying since 1941. All but nonagerians don't remember a time before some form of legal euthanasia. That is multiple generations, and they are a functional and wealthy society where the elderly seem quite content.

I consider this to be a very strong existence proof that a society can stably accept euthanasia without devolving in the directions many fear.

You bring up the Dutch report, and I'd say on the whole the Netherlands offers moderate evidence against a slippery slope. This study summation from 2009, though dated, states there is no slippery slope almost word for word, though in the decade and a half since rates have doubled again (the trend overall is definitely not exponential and has reversed itself at times).

I was recently challenged by iprayiam to prove that 5% of all deaths being MAID is an acceptable state of affairs. Interrogating it , I found out I was wrong, but wrong in the direction of underestimating the potential proportion of deaths that would likely be unproblematic candidates. And I mean going by your stricter definition, restricting ourselves to the terminally ill.

Humans have got a good thing going. Most of the usual causes of death in human history are largely irrelevant in the West. Heart attacks used to be nigh universally fatal, half the kids used to die in childhood. Now, we've dealt with that, but still have to deal with chronic disease which stubbornly resists our best efforts.

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.

Note those requirements. While technically more expansive than strictly terminal cases, in practice it seems pretty similar. Physicians are instructed not to encourage it, only to permit it, trust is high, and the requirement that it is "unbearable with no prospect of improvement" and "no reasonable alternative" is pretty strong. No prospect of improvement and unbearable! This is not the language of an elective suicide right. Also, "the general structure of the Dutch health care system is unique. The Dutch general practitioner is the pivot of primary care in the Netherlands

I will have to look into it, but this gives me the strong impression that their system is quite similar to the British one. I can only hope their GPs are paid better and work fewer hours.

Now, the report conflates assisted dying with terminal death care, but there is some cause of worry: institutions declaring it a right without distinction, that anyone disagreeing is against that right rather than a reasonable moral viewpoint, and explicitly stating that social change is happening. It's moral regulatory capture of a sort?

I disagree with this framing. All regulators tend to have some degree of moral consensus (or at least a majority vote). This fact only comes to conscious awareness when you face the fact that the regulators disagree with your own opinions, and then desire representation. I would expect that the final report is likely the outcome of internal deliberation, and usually internal dissent is squashed (bad) or consensus achieved. We don't know, there might be true euthanasia maximalist in there who are annoyed that they didn't get their way. I doubt most systems are like the US Supreme Court, in the sense that dissenting opinions are prominently featured in the final output, it not the verdict.

Belgium also displays something interesting: an increasingly large group with a "polypathology" justification: a combinations of conditions that are not sufficient on their own but combined are bad enough to qualify. That's something to keep an eye on.

I don't see a cause for concern? It seems quite clear to me that a person with, say, moderate dementia + moderate COPD + moderate arthritis can have a quality of life that's as awful as someone with a really bad case of any of the above. Multiple factors can work together to reduce QALY/DALY. When you get old enough, just about everything starts breaking down, it's a race to see which one kills you. Even the young can draw the short straw.

[I will pause here since I'm traveling right now, but I would ask that you hold off on replying since I intend to add a lot more to my reply. Unless you really want to, in which case don't let me stop you!]

@EverythingIsFine I'm getting hammered in a gay bar (no, not that way), so if you do wrote back, I'll check in when I'm sober

As I've noted elsewhere, Switzerland has had assisted dying since 1941. All but nonagerians don't remember a time before some form of legal euthanasia. That is multiple generations, and they are a functional and wealthy society where the elderly seem quite content.

On the other hand, Swiss clinics do have a reputation for dodginess around "if you can pay for it, we'll do it" plus the famous Swiss discretion regarding "it's none of our business where the money comes from: Nazi gold, drug money, African dictators robbing the treasury, we'll give you a bank account".

See the claim here about a Swiss clinic, Pegasos, that provides assisted dying. I don't know what the truth is here, but I wouldn't be surprised if there is "one law for the Swiss citizen, another for the foreign national coming over here to our discreet and legal clinic where what they do is none of our business (so long as they're not doing it to any Swiss)".

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