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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.
Definitely worth a larger discussion! Good post.
First I think it might be helpful to quote my full original comment:
I advocate for staying within a framework where we draw the line at imminent or near-certain death cases. I'm fine with assisted suicide there. I'm not fine with anything more flexible than that, and the direction I believe most societies that relax suicide legalization will end up going is a bad one. There are essentially two competing rationales here. If you draw your justification from the idea that "adult decision-making fundamentally should include suicide" that's one idea, but the one I like better is "if someone's going to die, you might as well grant them control over the method". Those are not interchangeable, and should not be conflated. Let's call the first a suicide right and the second a terminal death right for clarity.
My argument, to be clear, is that as a practical matter whatever the philosophical truth of the suicide right, not only is it controversial, implementing it is very vulnerable to abuse, to a degree that the terminal death right is not; therefore, we should not implement anything beyond a terminal death right. Some people still disagree with a terminal death right, but the scope of abuse is inherently limited. The major concern is that the diagnosis is wrong. If the suicide is done too early, frankly they were going to die anyways, so while there might still be harm to the family or others, they were going to have to cope with it at some point (and as we all know, the normal method of death is often worse for them). I think the evidence is clear enough on that point we can just all agree. So we're just left with the concern about misdiagnosis, and we can discuss that if someone objects, but structurally the incentives mostly run the other way: people don't like to be told their death is certain, the medical system both doctor and insurer prefers to keep them alive (and paying bills), etc. Of course, the government does not, they'd rather do whatever is least costly overall, and the individual doesn't have enough say on policy to matter, even if theoretically affected by the premium increase. Ironically despite 2010 opposition to an ACA addition for Medicare coverage of voluntary end-of-life consultations and decision-making (so-called "death panels"), we ended up with something slightly worse, where we ended up with coverage but the decisions are usually made ad-hoc, last minute, and influenced by hidden coverage decisions by bureaucratic panels. Still, despite the imperfection, I don't think people who could have lived longer but were misdiagnosed is a large group, and I am not worried about that group growing too big over time.
By contrast, a suicide right has a much larger scope of potential harm. The most notable one being that you might getter 'better' in some way. So a death cuts off that entire potential. After all, that's one of the main and more general moral objections to death, is that is robs an individual of potential. Because of this scope enlargement, some issues that were previously irrelevant suddenly become very relevant. Because of this scope enlargement, the potential pool of people expands by an order of magnitude at least. Some examples include the mentally ill, those in chronic pain, those with "bad quality of life", and also the elderly themselves as a whole category. Even, potentially, people who aren't mentally ill in a traditional sense but find low overall "meaning" in life. In addition to the possibility that you might exit one of these groups (get 'better' in the relevant way), there's also the possibility that one or more of these groups shouldn't philosophically deserve a death right at all. We might call that last opinion, where you like some but not all of those groups, a limited suicide right for clarity of language.
Now again I want to say that I'm agnostic or even slightly in favor of a broad suicide right (for example on the autonomy grounds you mentioned). I simply don't trust the incentives to align in a way where that right, insofar as it exists, is meaningfully and rigorously defined and enforced. In other words, I don't want to give it the full legal status as a "right" because of side effects. Does that mean I don't actually believe in a suicide right as an traditional right? I leave that to the philosophers, but I feel similarly about the death penalty, if it's relevant. I think a death penalty is highly natural, even desirable, but practically the legal fight and bills and guilt certainty and political controversy and all that isn't worth bothering over, so if the "right" goes unimplemented, I'm not too bothered.
So let's talk evidence. As you say, my argument can be disproved or disputed seemingly simply based on the evidence (is abuse so common as to become inevitable). I agree that it is sensible to do so, and hopefully we have enough data. However, I think it's telling that despite agreeing here you then spend most of your post in speculation mode despite the stated intention to spend it in evidentiary mode. I don't mean that as any kind of attack and enjoyed your post quite a bit as a thought experiment, but think you settled the evidence too quickly and glossed over the details of the system as it currently works abroad. Yes, that does mean we get plenty of good elucidation of your ideas on the subject more broadly, which is neat, but I don't find it a satisfying response to my actual original claim, and that's what I'm going to focus on in my response here. With that said, it's possible I'm wrong about this and you are admittedly in a slightly better spot to asses it (?) than I am. I also want to caveat this with the point where I notice that all the examples are by definition foreign examples. America has a unique health care system, very infamously set up differently than how almost everyone does it, and so it's probably true that the American risks take on a slightly different form than those abroad! I'm American and admittedly American-centric in most of my comments here (sorry).
You basically present the following pieces of evidence:
"The countries that have legalized assisted dying are not, generally speaking, ruthless capitalist hellscapes where human life is valued purely in economic terms"
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.
There are rigorous oversight systems and multiple safeguards, and furthermore these have neither decayed/weakened nor been peeled back in scope or rigor
The absolute numbers remain "low"
The families of those killed have "better outcomes"
There is "no significant evidence of systemic coercion"
People like the policy overall
(I find the last point irrelevant. Sometimes people like bad policies. That doesn't make them good policies, and doesn't make them good for society either. This is a common fallacy and I don't think it merits inclusion, my belief in the wisdom of the masses notwithstanding.)
Before I go further, let me clarify a few things. A suicide right, remember, can be applied to the mentally ill, those in chronic pain, those with "bad quality of life", and also the elderly, not just terminally ill people. Some of the common failure modes to a suicide right that I had in mind:
Government pressure to kill yourself early/without sufficient cause, saving money
Misdiagnosis risks for non-terminal categories
Family pressure to kill yourself early/without sufficient cause, saving them trouble or money
Self-pressure to kill yourself early/without sufficient cause. The reasons are myriad but might prominently include three: fearing being a burden, making a poorly reasoned/rushed decision, or finally a subjective claim that your life lacks sufficient function and/or meaning [implied: which might be inaccurate or morally objectionable].
Well meaning doctors pressure you to kill yourself early/without sufficient cause, but use poor judgement in doing so
Insurers pressure you indirectly to kill yourself early/without sufficient cause to save money
"Society" provides a background pressure to kill yourself early/without sufficient cause, and this distorts all of the above in more subtle ways
Safeguards become lax, toothless, ineffective, confusing, or counterproductive
To be clear, I will acknowledge as true that safeguards, waiting periods, and smart policy might potentially mitigate many of these worries simultaneously without needing to address root causes, and that might be fine. This admittedly makes evidentiary examination a little tricky to tease out, but also potentially easier, as in theory we can simply examine end-states instead of going point by point. However, examining end states is not an exhaustive reply to all of my concerns.
I have a few doubts about your evidentiary claims here more specifically.
A lot of the studies you cite (and performed) are about terminally ill patients. This completely misunderstands my original point, as I hope is clear above. Terminally ill patients don't give us near the same information about the slippery slope that I worry about, they aren't the problem. You cite a study about cancer patients who were terminally ill. Then you cite a study about Canada's first two years of MAID, which is a mixed-methods examination of medical end providers and families but seems to my eyes to be more an examination of how the implementation was rather than an examination of the process itself (e.g. the survey questions and methods all baked in an assumption of patient autonomy, i.e. a suicide right, as a good thing, and some moral objections as a bad thing, things like that). Furthermore, as I'll detail, the Canadian process in the first two years is much different than it is today.
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). A few more words about the Netherlands: The Dutch report refutes point 7, yes, finding that notable instances of protocol noncompliance are rare. In a sense, point 7 and point 2 are pretty similar, and maybe not justified. Maybe it bears on points 1, 5, 6, or 7, but what about the others? Anyways, it appears the Dutch protocol is designed to confirm that the to be due care, a request was "voluntary and well considered", suffering was "unbearable with no prospect of improvement", well-informed, with "no reasonable alternative", an independent physician's confirmatory opinion (including psychiatric expertise if relevant), and a well-executed death. It does seem like a legitimate system overall, with reasonable stability, and no significant evidence against, although I'm interested in what the next 10 years will have in store.
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", so we have the generalizability issue, and I'd furthermore call out of some language from the foreword: "As in previous years, 2024 saw a significant rise in the number of euthanasia cases" and "I am therefore pleased to see the public debate on euthanasia for young people with a psychiatric disorder... debate leads to reaffirmation or adaptation of social norms... [it] helps prevent euthanasia for being taken for granted". 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? Though yes, absolute numbers are in a certain sense downstream from the pressures, so if we aren't seeing supermassive increases maybe it's decent evidence against. That's however the extent of your evidence as presented.
Implied to be similar are the cases of Belgium and Switzerland. This basically also agrees against slippery slopes in Belgium despite modest increases year on year. However we should also note increasing references to a suicidal right in legislation proposed, which was on initial adoption (via decriminalization without mandatory reporting, notably, so there's reason to distrust their official numbers) explicitly said not to be a right at all. Belgium also expanded the law to cover minors, though I don't think this is a big deal by itself. 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. And yes, the numbers we have also continue to rise, albeit slowly, and in part due to demographic changes, and mostly as that link says due to more "complex" health conditions, not psychiatric stuff, and remains mostly terminal case stuff. Overall I'd consider Belgium moderate evidence in your favor.
Switzerland is weird. It's basically self-administration only, legally unbanned with the only requirement being that it's "nonselfish"... but in practice it's administered by nonprofits or by doctor discretion which do their own gatekeeping and there's a parallel medical system that takes care of it. Frankly I think this is fertile ground for investigation, especially socially, but my post is feeling too long so I'm going to ignore it for now because those effects seem pretty unique and difficult to tease apart to my satisfaction.
Finally, but more relevantly, the Canadian example could hardly be more different than the Netherlands. Notably the best comparison for the US in particular, we see a dramatic expansion of terminal suicide rights to outright suicide rights, in all sorts of areas which trigger nearly every one of my concerns. Initially the issue is forced due to a court case that I'm not qualified to explain. It's framed in 2016 as terminal care: adults, consent-capable, "end of life", "serious and incurable illness" (in legislation softened to add "or disability"), "advanced state of irreversible decline", and "constant or unbearable physical or psychological suffering with cannot be relieved in a manner the patient deems tolerable" (in legislation softened from tolerable to "acceptable"). Seems mostly in line already, but see some cracks? The patient deems what is a tolerable remedy, and the end of life assessment is if it's "reasonably foreseeable". It's implemented, but the next development is a 2019 court case strikes the end of life bit, though, citing the Canadian modern bill of rights equivalent (!) and requests some vague changes.
The new ensuing legislative response (after some delay, in 2021) is startling. We get almost a wholesale shift from terminal-right adjacent claims to suicide-right language. More specifically, there's an expansion from terminal to "grievous and irremediable" only (though non-terminal get their own set of different requirements), the patient's own judgement remains enshrined, they expand to "mature minors", they allow limited "advance" consent, they even allow an eventual automatic time-gated clause to expand to purely mental conditions (currently on pause, it was extended). Terminal patients are given their own track, but even the existing safeguards are notably weakened, with fewer witnesses required, a removal of the waiting period, etc. The non-terminal patients admittedly get a nominally more strict set of requirements, like a 90-day reflection period. But critically, the patient must be informed about other options, but is not even required to attempt such! The witnesses need only agree that the person "given serious consideration" to the alternatives presented.
It's my understanding that this was partly based on an assertion stemming from the court cases in the early 2010s outside Quebec that suicide is in many cases itself ethically valid, and thus the physician might as well participate. I will say overall "bioethicists" come off quite poorly: see for example this impassioned and personalized narrative of the situation dressed up as a formal paper, and with a clear and controversial agenda accompanied by a disdain for any who disagree (outright abuse of credentialism, false consensus, and laundering of opinions as fact, normally things I am skeptical of when accusations are made, are pretty notable and pervasive here).
Some reporting on this issue may lead to you think that Canada, even once it allows purely mental health cases, will only be up to par with the Netherland model. I can't emphasize enough how this seems not at all to be the case. The latter model basically requires all avenues to be exhausted or likely not to work; the former only makes vague gestures at such, and although to some extent all judgements about assisted suicide have an element of subjectivity to them, Canada's model takes this way too far and almost leapfrogs terminal death rights to arrive at something pretty close to full suicide rights almost cold turkey. The narrative and impetus is driven by court cases rather than a normal bottom-up democratic process.
Data is a little sparse especially for the newer non-terminal track patients, but the numbers are much more potentially exponential looking overall than we saw in either European nation we looked at, see here for an example. Although in those cases we saw increases in the earlier years of the program, Canada has seen continual tweaking and also what appears to me to be steeper increases. We've also started to see some abuse. Non-compliance is plainly very rarely reported, see here for an example, allegedly up to a quarter of all total MAID cases, and requiring legwork the government did not even attempt to do. This examination flatly concludes that "The Canadian MAiD regime is lacking the safeguards, data collection, and oversight necessary to protect Canadians against premature death." A Wikipedia page relates several examples of exactly the kinds of pressures I worried about: doctors telling patients not applying for MAID is selfish, considering homelessness an inherently valid reason for suicide, offering MAID as a suicide intake risk assessment tool, offering MAID as an alternative to installing a wheelchair ramp, etc. to name a few. There are MAID teams at pretty much every major hospital in Canada, and my understanding is that they sometimes advocate their services under the guise of awareness, rather than keep shop open for last-resort style care.
I speculate that the Canadian method of implementation makes it uniquely vulnerable to these pressures, and I further speculate that if implemented in the United States, it would be a disaster. Maybe there's a cultural element to it as well. And before you say it, Oregon and similar states are also terminal illness only models. The US system especially has already quite a problem and unique situation with insurers and other layers in the medical system that make the incentive structure go crazy.
So hopefully you see my point. Terminal suicide rights are fine. An independent individualized suicide right based purely on conceptions of autonomy is a different ball game. I furthermore think that when considering suicide rights as such, the European examples aren't actually of nearly the same utility as they first present themselves to be (they are mostly presented in the language of terminal rights despite technically being more broad). And yes, wording and systems matter. I ran out of steam here so apologies if this didn't fully address the points that you made, but as I see it the actual evidence that I see is pretty weak for a right to suicide rooted purely in principles of autonomy. The only nation to most closely attempt such has shown very worrying signs that should be red lights for all advocates, and I predict these issues will only worsen. It's quite possible that better-designed legislation can prevent or mitigate these issues sufficiently, but that's mostly untested.
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.
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.
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.
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.
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.
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.
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
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