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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.
If it is not possible to do what they advertise, they shouldn't be advertising it. False advertising doesn't cease to be false because the thing you advertised was impossible, but you really wanted to do it.
And if truthfully advertising what they actually do leads to bad publicity, so be it.
This is an isolated demand for rigor. Even the KYC protocols for banks don't have a 100% success rate at stopping identity fraud or impersonation. Out of N Pegasos clients, it hardly strikes me as worthy of damnation that one of them went to such lengths to throw them off. What if she'd hired an actor to come along with her? What if she brought forged legal documents? How easy is that to check from Switzerland?
Your argument also included "What does a clinic do when a patient insists their family not be contacted" which is a much easier case. They should have a policy of dealing with such requests, and they should be able to describe this policy in advance of it actually happening.
If she brought forged legal documents that can't be checked, they can have a policy that treats patients who show up with uncheckable documents as patients who have no documents. If legal documents are even an issue, the whole point of having them instead of taking someone at their word is so that they can be checked; if they cannot, they are useless.
If she hires an actor, you're probably stuck, but then, she didn't.
I hate to break it to you, but most legal documents are basically uncheckable. Even a notarized document can likely be faked without too much trouble. Government-issued documents (id cards, passports, banknotes) are certainly harder to forge, but also require someone who is familiar with the safety features.
That is not at all the point. The point is that verbal statements reported by third parties are notoriously unreliable. If Susan says: "Bob said I can sell his car", that is bound to create a he-said-she-said situation. Nobody will ever untangle if it was a honest misunderstanding or if one of them was lying.
This is why Susan needs a signed document to sell Bob's car. Can she easily forge Bob's signature? Sure. But that is now a serious criminal offense! If it is found that Bob never signed the paperwork, she is looking at jail time, and can not claim that she just misunderstood Bob's intention.
With assisted suicides, the difference is that nobody is going to put Susan's urn into jail.
I am sure that for every such sob story, there is also a sob story where someone could not get their next-of-kin to sign a paper stating that they were aware of the patient's intention to opt for MAID. A patient in Ireland would be hard-pressed to compel a relative to sign such a document through the court system. Likely, they would get themselves committed.
So I can totally understand that Swiss law does not require patients to provide a notarized genealogy with all the relevant death certificates to prove that whom they say is their next of kin is that.
That reasoning proves a little too much--it's basically saying that because Susan can't be put in jail, legal documents aren't useful at all. In that case there's no point in even asking "what if she brought forged legal documents". And this also amounts to admitting that the whole system has a fundamental, unfixable, flaw in it--there's no way to verify that Susan is telling the truth.
The proper response to this is not to say "well, they can't verify the documents so that doesn't matter", it's to say "well, they can't verify the documents, so the system is unworkable". Making sure that they're not killing more people than the assisted suicide law allows is actually important; if they have no way to make sure, they shouldn't be doing it at all.
The answer to this is "only take patients from places where they can legally get documents", not "stop asking for documents".
Suppose that you are a Swiss marriage registrar, and that Switzerland does not want to facilitate marriages where one or both partners a coerced into marrying. There are approaches with very different costs to filter these out. You could just keep a lookout for people who look unhappy or nervous. You could have a separate private chats with both the groom and the bride and mention that there are ways out for people who are coerced. You could require both of them to separately talk to a psychologist for an hour. You could require both to undergo psychotherapy for a year. You could just declare defeat and refuse to marry anyone, because it is not possible to know what motivations people have for sure.
In reality, you will probably not do that last thing generally -- even if you are fine with not having marriages, the same argument would also extend to employment contracts, loans, purchases, sex, etc. Or few people would argue that as you are quite likely to be able to smuggle a few grams of cocaine in a truck without it getting detected by customs, we either should abolish customs or stop international trade.
The assisted suicide case here was not even a matter of consent. But I will be sure that sooner or later, a case where consent is violated will appear. The chance that the evil family of some rich guy will kidnap their beloved pet and threaten to torture it horribly unless they opt for MAID is low, but not zero.
There is a conversion factor for violating the autonomy of those who would really want to live to violating the autonomy of those who really want to die. We probably disagree about the magnitude. From a utilitarian standpoint, I think that we should not minimize the suffering of those denied MAID.
Suppose a djinn offered you to prolong your life by a decade. If you accept, they will flip a coin. Heads, you get to live in the 98th percentile of happiness. Tails, you get to live in the second percentile of happiness (for your age cohort), with no way out. They also reveal that you will be 70 at the time your extra decade starts.
Personally, my answer would be fuck no. Sure, that decade in the 98th percentile would be sweet -- travelling, having sex with a great partner, enjoying life without being trapped in the rat race, playing with your grandkids. But the horror of the 2nd percentile would be much greater. You body failing, your mind fogging -- but not to the point where you do not notice any more, without social contacts, getting bedsores in some retirement home, in constant pain, waiting for a death which will not come for a decade.
In reality, we are not subject to the veil of ignorance imposed by the djinn. We can just ask the 70yo's what their quality of life is and if they want to die or not, and we will mostly get accurate answers. Nobody suggests randomly murdering elderly in the hope that they might welcome death.
So the next djinn offers their deal, which is the same as before, only you have a way to die before the decade is over -- say by stating your wish to die on seven subsequent days. They warn you that it is possible that someone will pressure you into taking that option even if you are in the happy branch.
This seems like a great deal to me. Sure, I lose some utility in the happy branch, but I also reduce the suffering in the pain branch by a factor of 5000.
Luckily, this is not how liberal governments deal with foreigners whose governments are uncooperative. If you are a refugee from Iran, and the regime hates you and will not give you any ID documents, then a reasonable country would recognize your plight and try to work around it, not just ship you back to Iran because without ID you can not stay legally.
The Swiss people (or their representatives) have decided that humans in Switzerland should have a right to assisted suicide. Why should they deny this to foreigners just because their backwards government is uncooperative?
This is the same problem as I have with open borders proponents: If you want to have open borders, then make your case for it and get laws passed which say that we have open borders. But don't have laws which say that we don't have open borders, but then work to make it easy as possible to not follow the laws.
If you really want there to be no conditions for assisted suicide, then have policies (and laws if necessary) saying "there are no conditions for assisted suicide". But if you can't or won't do that, don't have policies that say that there are conditions, but then set things up so that they are trivial to work around.
Arguments like "what if we compare various possibilities a djinn might give you and what if we ask the 70 year old", etc. are arguments that there shouldn't be conditions, or at least not the conditions we have now. They are not good arguments for "we should have conditions but since conditions are bad let's make sure they don't work".
If you are a refugee from Iran, and Iran won't let you have documents, the other country should try to determine that you actually are a refugee and from Iran, even if it is not as easy to determine this as it would be if you had an ID. If the other country says "Iran doesn't give out IDs, so we'll just accept everyone who claims to be an Iranian refugee", that's a bad policy which is forseeably going to be abused. (In fact, similar policies are abused in real life by "refugees" that aren't really refugees.)
Also, it's a lot easier to revoke a bad refugee status (or a marriage, or your other examples) than to revoke a suicide.
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