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Notes -
Following up on the post about assisted suicide, here's more about that Swiss clinic which is the subject of allegations by an Irish family:
Now, I'm not going to argue over the right to die, when is suffering intolerable, religious objections, slippery slopes or the rest of it. What I'm going to do is say that this is a business (indeed, this is a claim made in the story by one of the families). And, just the same way that IVF has become a business, and embryonic selection (see the Herasight proceedings) will become a business, when we get into business territory, it's about profit. And to maximise profits, we reduce costs. If that means setting up a clinic that looks like a blocky industrial estate unit and skimping on postage, so be it.
There's some indication, at least from claims by these families, that procedures are not being followed through, or at the very least, merely rubber-stamped and not, in fact, keeping the promises they made about communication with and informing the families:
The same way that someone in the comments over on ACX described her experiences with IVF and why the clinic downplayed/ignored her problems, it's the same answer here: it's a business now, and profit (not the message about "we'll compassionately give you what you so emotionally desire") is the motivation. And the more it becomes just another business, the more slippage we'll see. No, I don't mean slippery slope, I mean this kind of thing: we don't email you, you have to track your mother's ashes "using a code, like she was a parcel in the post", and hey, verbal promises aren't worth the paper they're written on, we're legal in this country so too bad.
Standards only last as long as the brakes are on. When we take the brakes off, then it's a business and death (and life) is a commodity to be monetised.
A person who travels to another country in secret to end their life has, by their actions, expressed a powerful preference. That preference is not just for death, but for a death conducted on their own terms, which in these cases explicitly involves secrecy from their family. They tell their loved ones they are going on holiday. They, allegedly in one case, forge letters and create fake email accounts to maintain the deception. This those not strike me as ideal, but I can't really condemn someone who is clearly this desperate to die.
From the patient’s perspective, the ideal outcome is one where their autonomy is maximally respected. For the clinic, this presents a dilemma. Who is their client? The patient who is paying for a service and demanding confidentiality, or the family who is not their client but has a profound emotional and moral stake in the outcome?
If they were merely a profit-maxxing company, the answer becomes clear. They could, with ease, tell the family to fuck off, or something a tad bit more polite than that. After all, they followed the letter of the law.
When the clinic reportedly promised to “always contact a person’s family”, it may have been making a well-intentioned but practically impossible promise. What does a clinic do when a patient insists their family not be contacted, or provides false information for them? If Maureen Slough did indeed forge a letter from her daughter, the clinic was not simply "skimping on postage". It was being actively deceived by its own client in a way that pitted its promise to families against its duty to the patient. The failure to make a phone call seems like a clear error. But in a context of deliberate deception, we can see it not just as a cost-cutting measure, but as a failure to be sufficiently paranoid in the face of a determined client. And the paranoia would have been pointless, the family has no legal right to stop the process. At most, everyone feels better if they're on board.
I run into similar issues every week. Hospitals are forbidden from divulging patient details, even if the voice over the phone claims that they're a brother/wife/best friend. Especially if the person has capacity to make decisions, and this lady seems to fit the bill.
Second, the characterization of Pegasos as "a business" may be both trivially true and misleading. Of course it is a business in that it charges fees for a service. But reducing its motivation solely to profit maximization seems to be a category error. It appears to be a mission driven organization, an ideological entity that must also be a business to survive. The people running it are almost certainly true believers in the cause of bodily autonomy and the right to die. They charge money, like many an NGO does, to pay the bills and keep the lights on.
Their own site says:
And I believe them. The regulatory paperwork alone must be an awful nightmare. If Charles Schwab is handing out big bucks to save on the expenses of more longterm pods and chicken feed, they're not getting a cut.
Finally, we must be wary of the availability heuristic. We are reading these stories in the newspaper precisely because they represent catastrophic failures. The family who has a peaceful, well-communicated experience with an assisted dying clinic does not generate headlines. At least not after the first dozen times.
We have no access to the base rates. How many clients does Pegasos serve in a year? For what percentage do these communication breakdowns occur? It is possible that these tragic cases represent a small number of "glitches" in a system that, for the most part, functions as intended by its clients. Or it is possible that they represent a systemic failure. The point is that from this handful of terrible anecdotes, we cannot know. You can come up with lurid anecdotes for just about anything, and in medicine?
I've already presented a quantitative analysis. The slope doesn't seem very slippery to me and it certainly hasn't reached the point where fair and open-minded advocates feel beholden to shut the whole thing down.
The Swiss have had legal assisted dying since 1941. If the "businessification" of death inevitably leads to this kind of procedural slippage, we should have seen decades of this. We should have a mountain of data on Swiss citizens being bundled off to industrial parks by greedy doctors against their families' wishes. Instead, we have a few tragic stories, mostly involving "suicide tourism," where the informational and logistical challenges are exponentially greater.
The complaint about tracking the ashes "like she was a parcel in the post" is emotionally powerful. But what's the alternative? A private courier hand-delivering the ashes internationally? Who is paying for that?
A tired and overly generalized critique. Do the police run Burglary 101 classes when the crime rates get too low? Do cardiologists open McDonald's outside their hospital? Do the hospital admins squeeze tubes of trans-fats into the sandwiches served at their cafeterias?
In most professions, especially those with an ethical or ideological core, the profit motive coexists with, and is often constrained by, professional ethics, reputational incentives, and a genuine belief in the mission. A scandal like this is terrible for Pegasos, both for its "business" and its "crusade." It invites negative press, legal scrutiny, and tarnishes the very cause they champion.
A person who travels to another country to end their life has the agency that they can commit suicide the normal way.
I don’t advocate for putting cancer patients on a list of prohibited firearms possessors, even if I think them killing themselves is a bad thing.
There's a good deal of overlap between support for assisted suicide for everyone and support for nerfing the world so it's really difficult for anyone to kill themselves (e.g. bans on weapons, dangerous sports, etc)
Booooooo outgroup bad
Is it? Please explain.
He made a sweeping statement about people who's views he dislikes having other views he dislikes with 0 evidence or support
Is that not the definition of "booing the out-group"?
Well, fair enough. I suppose it didn't seem that way to me because
I actually suspect he's probably not wrong, but I'm unimpressed with the lack of rigour
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