author:self_made_human euthanasia
self_made_human
Grippy socks, grippy box
12hr ago
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.
Hang on, please explain to me, ideally without referencing slippery slopes at all, what is the precise issue with this 29 year old woman with depression being offered euthanasia?
I try not to brow-beat people with my credentials any more than I can help, but I have experience in both psychiatry and being severely depressed. It would take far worse to make me seek euthanasia, but my depression wasn't as bad as it can truly get. Some forms of dysfunction and agony can truly be hard to discern from a distance. You see a pretty young woman in the prime of her life being consigned to death by uncaring doctors.
I see a tortured soul, who has consented to her doctors trying everything they can feasibly try. If you don't believe me, you can look at the article. Her every day is utter misery, we have no idea how to fix her, at present. And we've tried, tried oh so hard, with no results. I had reasons to cling to life even when my brain screamed it was pointless to get out of bed, I do not care to dictate beyond a very limited extent, how much others should really tolerate.
She is an exception. 99.9% or more of depressed people are not recommended euthanasia. She went through all the loops and hoops, she didn't change her mind. Her very right to do so was challenged, and when I initially engaged with the article, being adjudicated in a court of law. The rules are being followed.
self_made_human
Grippy socks, grippy box
14hr ago
Did you take that seriously? I would hope not, because the joke was that it's hard to get responses from participants in euthanasia because they're dead. If it's meant to be an educational aside, I appreciate it.
self_made_human
Grippy socks, grippy box
16hr ago
I will note that this is a concern I have intentionally and prominently addressed. I am personally okay with euthanasia as a cost-saving measure, keeping someone on the verge of brain death in the ICU is both expensive and futile. Doubly so if the savings are used to extend more lives on net.
As it stands, I am willing to compromise on my fantasy of euthanasia booths next to children's parks if that's the cost of making it available in more jurisdictions. What I proposed is a version specifically designed to appease the squeamish, while still being something I am content with myself. This involves removing or minimizing financial incentive to individuals or even most parts of the system.
To the extent that this calls for amendments in places with legal euthanasia, well, it does do that. It's just not as pressing as elsewhere.
self_made_human
Grippy socks, grippy box
19hr ago
It has been a generation! In some cases, multiple:
The Netherlands legalized euthanasia in 2002. Belgium in 2002. Switzerland has allowed assisted suicide since 1941.
If this a slippery slope, then at the current rate of progress we might have Dyson Swarms before the Netherlands breaks double digits for proportion of deaths conducted by MAID.
Switzerland has octogenarians running hobbling around who don't remember a regime before euthanasia. It also has a rather high proportion of the elderly, which suggests they're not being culled when inconvenient.
Can I make guarantees that societal norms won't change, and in a direction either you or I will disapprove of? Who can? The legalization of gay marriage hasn't, as far as I'm aware, causally produced a legalization of pedophilia or beastiality as some feared. I consider my claims very strong evidence, it's harder to get stronger.
You can't launch many rockets if your standard for rocketry is that we must perfect the design before putting a single nozzle on the pad. You will not enact any social change at all, out of an overabundance of caution. I consider this regrettable.
It wasn't seen as a failure, if there was no punishment
I can only address this if you link to the specific instance(s) of this happening.
The governments don't run on Open Source. If euthanasia was legalized with the intention of lowering healthcare costs, even if based completely on the own initiative of the patient, it's still meets the criteria for a systemic failure. However, without access to all communications and private conversations of all public officials involved in the decision, proving it will be impossible, and so your request is unreasonable.
This is, as far as I can tell, a fully generalized counter-argument against having a government at all. Or at least an argument for inventing mind reading devices and strapping them to every politician and bureaucrat. Once they're invented, we can re-examine this, and with my mild approval.
Why is cost-cutting inherently a bad thing? If drug X comes out that roughly does the same thing as drug Y, why would it be bad for a healthcare system to preference one over the other? Money matters (citation not needed), money saved somewhere can, at least theoretically, be spent elsewhere. If we're not spending tens of thousands of $currency on keeping someone who is going to die in a few days or months alive for the sake of it, then that money is available for other tasks.
For the sake of pragmatism, I don't care very nearly as much about why things are done, as I do about how they're done or their outcomes.
You should at least provide a plausible explanation of how these doctors came up with the idea to offer euthanasia in these cases, that doesn't condemn the system. My most mundane one is that they got a pamphlet telling them to shill it, so they shilled it. That's still a systemic failure.
What. I think it's a tad-bit much to expect me to do that. You can Google that yourself, I fail to see what I can add since I live and work in jurisdictions where euthanasia is yet to be legalized.
But, in short:
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Is patient sad/in pain? And not just a stubbed toe, to the point they're asking for the release of death. Or don't have the cognition left to ask.
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Can we do something about that?
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Have we tried? Anything left to try?
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Consider euthanasia based on previous points.
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Talk to them, their family, and a few lawyers before proceeding.
self_made_human
Grippy socks, grippy box
1d ago
If you have any evidence of systematic failures of the Canadian system, as opposed to anecdotes, then I would be happy to see them. Any large system would have failures, and eye-catching, condemnation worthy failures to boot.
(and just because you filtered out the em-dashes doesn't mean I don't see what you did there)
Is this a claim that this essay was mostly, or even substantially AI generated? If so, that would be false.
I have no qualms about stating that I use AI, but for the purposes of proof-reading, stylistic suggestions/polish, critique, or research. In fact, I've been an open advocate for doing so. What do you think this post suggests?
I'm happy to provide affirmative evidence. I've uploaded an album of screenshots. You can see the embryo of my original draft, further refinements and conversations with o3 where I did my due diligence. As a matter of fact, I spent at least an hour tracking down sources, and groaning as I realized that the model was hallucinating. If this essay is LLM-slop, then please, explain.
In fact, I can go further:
https://www.themotte.org/post/1701/culture-war-roundup-for-the-week/302888?context=8#context
https://www.themotte.org/post/1701/culture-war-roundup-for-the-week/302842?context=8#context
https://www.themotte.org/post/1701/culture-war-roundup-for-the-week/302567?context=8#context
Or one can simply look up everything I've ever said about euthanasia on this forum:
https://www.themotte.org/search/comments/?sort=new&q=author%3Aself_made_human%20euthanasia&t=all
You will find what I hope is extremely strong evidence of me formulating and discussing similar views months/years back, often with identical wording. Short of video-taping myself while writing each and every comment, there can be no stronger proof.
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:
- Rigorous oversight systems
- Multiple safeguards and waiting periods
- Low absolute numbers (typically 1.5% to 5% of total deaths, the Netherlands, after 23 years, finally broke through to 5.4% in 2024 and to 5.8% in 2025. That is less than the proportion of Americans who die as a consequence of smoking)
- Decent evidence of better outcomes for the family of the deceased (I've heard they tried to interview MAID participants post-procedure, but had truly abysmal response rates for reasons I can't quite fathom). For example, a statistically significant reduction in grief reactions or PTSD in the family of cancer patients who had opted for euthanasia as opposed to dying the old-fashioned way. In Canada: “The majority of family interview participants expressed high satisfaction with the quality of MAiD care their loved one received”. However, explicit single-item “approval rate” percentages among bereaved relatives are scarce.
- Very low rates of non-compliance with oversight or protocol. An example is this Dutch report, which found only six cases that the physician had not fulfilled the due care criteria in performing euthanasia.
- No significant evidence of systematic coercion. Every system has its failures, with anecdotes and horror stories to match, and the question is how often it fails.
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):
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2 psychiatrists, paid only if the panel declines the request.
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2 social-workers/advocates, paid only if the group approves the request.
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1 “neutral” physician (salary fixed).
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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:
- Violent suicide methods that traumatize families and first responders. Even ODing on pills usually isn't easy, and some, like paracetamol overdoses are a terrible way to go. I saw a doctor do that once, and it worked (they died of liver failure in the ICU) but it wasn't any fun. Wouldn't recommend. As a physician, I can certainly think of better ways, but Google or most chatbots aren't nearly as obliging for lay users.
- Traveling to jurisdictions where assisted dying is legal (expensive, logistically complex, forcing people to die far from home)
- Gradually reducing food and water intake (slow, uncertain, medically problematic)
- Overdosing on accumulated medications (uncertain success rate, potential for brain damage if unsuccessful)
- Convincing doctors to provide unofficially lethal doses of pain medication (creates legal liability for physicians, inconsistent availability)
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.
self_made_human
Grippy socks, grippy box
14d ago
(And here I thought I was a doomer)
This is a plausible scenario. It isn't necessarily the only way this could play out (did I ever mention we could all die?).
Most industrial societies today are willing to spend resources for the upkeep and care of the economically unproductive, or even those who are outright deadweights. The disabled, the very elderly, the mentally ill. We expect just about nothing back from them. (There are political concerns, but even so, the majority opinion is definitely not mandatory euthanasia, it certainly wouldn't poll well).
I have, in the past, explained at length that the expense of keeping every single human alive today in absolute luxury is negligible to a post-scarcity society like the ones full industrial automation and ASI can produce. A Kardashev 1 has about a thousand times our present energy budget, all 8 billion humans could live like kings.
If there is any altruistic impulse in those that hold the reins, then it really isn't a meaningful fraction of the light cone to keep at least us chumps happy. Doesn't mean they have to make us peers, or true equals, in the same manner the Saudi King doesn't hand out his own allowance to goat-herds. Such a life, well, I'd take it any day over what we have going right now, even if it's not optimal.
Maybe Bezos, Musk and Altman are bickering over galaxies or super-clusters. I'd be content enough with one of the hundred billion star systems in the Milky Way. I'd settle for a planet. That really isn't much.
Besides, a future of utter disempowerment or death isn't set in stone. We're literally building the machines today, it's not too late to make sure that they're programmed in a way that beats this very low bar.
self_made_human
Grippy socks, grippy box
5mo ago
Look, you're being too harsh on me.
When I say I had active suicidal ideation, I meant it. The barrier between suicidal ideation and an attempt is tenuous at best.
I wasn't very far at some points. I never actively planned things, but at certain points, if someone had come up and put a gun in my hand, I can't say for sure what would have happened.
Public attitude prior to about the 90s was suicide is wrong. Flat out wrong. Then euthanasia become a cause for terminal patients suffering from incurable cancers and the like, people in constant suffering. But it would never go past that the medical establishment insisted, and it would certainly never be trivialised by being offered to the depressed. 25 years later and the depressed can get assisted suicide. It is an example of the concept creep pusher_robot mentioned.
Norms change over time, and we're talking 30 years. The people who might have made the original claims could easily be dead or retired.
Governments have changed multiple times since. Culture would have changed even without strong pushes. It's not the same set of people making promises and breaking them the moment backs are turned.
I strongly disagree that there's any "trivialization" involved in offering it to the incurably and severely depressed. They're living miserable lives, even if we can't clearly and legibly figure out what's gone wrong with them. That's just the state of psychiatry today.
I would strongly push back against it being offered to people who hadn't exhausted the treatment options for their depression. What else can I say?
This pretty much sums it up for me. Yeah bud, I know it's unavoidable, that's been my point from the beginning. The fact that you would level it back at me as if that somehow excuses it is the core problem with the modern world. It's the death of a thousand cuts, responsibility is diffused so nobody has to own the psychological consequences of their actions and we say 'hey they have the freedom right? You aren't opposed to freedom are you? I didn't hand them a gun!' Sure you knew you were taking actions that would result in their deaths, but they could have just spent 700 pounds to ask a doctor to promise to never kill them during one of the infrequent periods when they could even see something resembling a future for themselves! How is that on you?
I am a consequentialist. I seek to maximize my values, finding compromise where they conflict with each other.
I strongly value personal liberty and freedom, including control of one's life. I also value other people living on, preferably as happy and satisfied as they can be.
I'm not lying or denying that there are clear downsides and tradeoffs involved. I just think that they're worth it.
You offer me a bullet, and I'm biting it.
You might value things differently, and that's your prerogative.
I would be willing to perform the kinds of roles my envisioned system would require. It would be difficult and emotionally taxing work, but most doctors eventually understand, through bitter experience, that not all patients can be saved. Sometimes everything that can be done had been done, and you're keeping a corpse hooked up on life support. Sometimes it's not that clear cut, but they consistently report that their life is misery while being otherwise physically well. If I can't save them, then prolonging their life against their wishes is as bad as putting a confused elderly woman with dementia on the ventilator so she can spend another week in pain and terror before her inevitable death.
Well you're right, it's not. Congratulations on winning the argument.
I guess it's on me for expecting you to actually grapple with the issue because you claim to have suffered depression. I should have realised you wouldn't be able to empathise when you explained that you had never been suicidal.
I never came into this with the desire to win an argument. If this passes as a victory, I want it even less than you do.
I'm doing my best to explain why I hold the views I do. That I am aware of your values and concerns, and the downsides of my own desires. I still think the price worth paying, and not because I'm not empathetic. I wouldn't be a psychiatrist if I didn't want to help people. I some rare circumstances, that help would be for them to no longer live on.
My point was supposed to be that we had previously been assured that assisted suicide would never be used for anything except terminal illness and certainly never for depression, and yet here we are.
As I've said above, I consider an intractable case of severe depression to be a terminal illness. I have no personal involvement in matters of euthanasia (beyond deciding if a patient is palliative and needs comfort care).
I presume that you're not in the Netherlands either, so when you say that "we were assured", who's the we?
I didn't provide that assurance, and regardless of whether, in the Netherlands, it was in fact a statement made some kind of authoritative figure, I consider this particular case an outcome I endorse!
And the case seems to be entering litigation, so it's not like the government ignored objections and killed the woman right away. I presume a court will rule on whether the actual law allows this.
If you point to an example of a clearly inappropriate decision for euthanasia, say someone who went to their doctors and said they're feeling sad, and that was the first suggestion made, then I would certainly say that's against my views.
You live in a world where you see doctors all day every day so talking to one is nothing, hell you can do all that shit yourself if you like, but otherwise your buddy will bang it out for you as a favour after work.
I do see doctors every day. But I'm afraid that they're unable to help me in any way, in terms of medical problems that require a prescription and not just casual advice.
In the UK, the GMC strongly frowns on prescribing or treating colleagues, I have ADHD, there are several senior psychiatrists who could have written me a prescription for my meds. I even asked, but as expected, they declined, saying it was inappropriate.
I personally think this is bullshit, and I should personally have been allowed to write my own script if needed (though stimulants require a psychiatrist who has completed training). In India, it wouldn't have been an issue at all.
I had to wait three months to be seen by a psychiatrist for my depression. I took the opportunity to also get him to prescribe for my ADHD. But if it had been just my ADHD, then I would have had to wait 2 years to be seen!
Trust me, at least in the UK, getting a doctor to see you, even if you're a doctor yourself, isn't trivial at all. I won't deny that they take me more seriously as a fellow medical professional, if I were to tell a psychiatrist I'm clinically depressed and I calculated it to be moderate-severe, they'll take me at my word. But the typical doctor will not react to someone telling them they're suicidal and don't want to be in a dismissive manner.
You live in a world where you see doctors all day every day so talking to one is nothing, hell you can do all that shit yourself if you like, but otherwise your buddy will bang it out for you as a favour after work. I live in a world where every fifteen minutes I spend with a doctor costs me $90, I can address one issue and if I bring up another it will cost me another $90 even if the last one only took two minutes to address. I do not go to the doctor unless I have no choice and I am incapacitated. And in my working class social circles I am considered a hypochondriac. I am regularly told that I trust doctors too much. That is the world I live in about half the time, and those people are not going to the doctor to ask him or her to promise not to kill them if they ask. I don't think you or @Throwaway05 understand how shot trust in medicine is amongst the working class. It's kind of terrifying.
Look, if I had ended up giving up on waiting for the NHS and gone private, I'd be paying anywhere from 400 to 700 pounds for an appointment that could be anywhere from 15 minutes to an hour. You can see how the rates compare.
And it might surprise you, but it's entirely possible that you make more money than I do! As a resident, I make about $50k a year. That would be well within the range of what a working class individual makes in the States. It's entirely possible for a skilled tradesperson in the States to out earn a senior doctor in the UK. If they start a small business and stick to it, they can leave us in the dirt.
And the cost of living in the UK is probably quite comparable to the US, while we pay more in tax to boot. I'm much closer to you than @Throwaway05 is in financial terms. I have technically free access to healthcare courtesy of taxes paid to the NHS, but even that isn't much good for anything but an ER visit straight away, or an appointment with a GP in weeks/months.
In case this is the point of confusion, I'm not concerned about that, I'm not concerned about me at all, I have the perspective of age now. I am worried about the young adults out there like me when I was a young adult, the undiagnosed schizophrenics (and the undiagnosed bipolars and major depressives) who would never give strangers power of deciding their fate, believe suicide is a personal decision and only hold back because of a sense of wrongness. Those people are going to die in your world before a doctor even knows there is something wrong.
It is unavoidable that media coverage of suicide, or more permissive social norms, will likely increase the number of people opting to commit it both through (hypothetical) legal means as well as taking it on themselves.
I value free speech and personal autonomy strongly enough that I do not foresee the numbers rising to the point that I can't accept the cost, even if I wish it wasn't so.
Quite confident. If my heterodox views are any indication, I'm not someone particularly susceptible to conformity or peer pressure. How many people do you think were born and raised in my circumstances and turned out the way I did? I defy neat classification.
If society was unchanged in terms of medical technology and overall technological progress, but actively encouraged suicide, I still don't think I'd opt for it. I'd demand that every possible treatment be tried first, then possibly ask for a legal document put in place that debarred me from applying for a lengthy period of time, no matter the cause. I'd spend the rest of my life hoping for a cure, and wouldn't give up until I was dying of other causes. If I really wanted to die, I already have more opportunities than I can count (not that the average person doesn't, bridges and busses aren't rare objects).
Do note that I would prefer that even if euthanasia on demand was an option, that there were multiple safe-guards in place to minimize impulse decisions. That would include medical review for reversible causes, counseling with therapists paid a bonus for every patient they talk out of it (to align incentives), and a wait time of a few months. If at any point someone has second thoughts, the wait time gets pushed back another few months.
Hell, keep it a secret under NDA that the first time they put you in the suicide pod, it's actually a drill. If you start screaming and want to be let out, that's when they tell you and swear you to secrecy. Even during the real thing, leave a big red button that would stop the process, if it's a lethal drug, have a bottle of antidote by their side when they're given it.
There was an incredibly poignant video of an elderly francophone lady taking her euthanasia meds for a terminal illness. She was lucid and in absolute control, and speaking till she went to sleep and never woke up. That's what I want the average person who takes this route to look like.
At that point, I'd be content that we're looking at people with incurable illnesses who can't be talked out of their intent. My confidence in an eventual cure for almost all disease isn't so strong that I would demand people hold out for it, that's their choice to make. My choice, at every point in the 10+ years I've been depressed, is to live for a better future.
self_made_human
Grippy socks, grippy box
5mo ago
I think euthanasia should be legal. I think there should be quite a lot of oversight of the process, but I'm not against governments doing cost-benefit analyses of who gets care.
By revealed preferences, it's impossible to care infinitely about a given life. If that wasn't the case, then the entire global economic output would be spent on the first kid who showed up with terminal cancer. Not even those who claim that Life Is Priceless act like that's true. The Pope isn't selling his mobile to save one more starving child in Africa. Even the Dalai Lama has personal possessions, and expensive ones.
Once you accept that (and no population on earth could function without doing so) , all that remains is figuring out how much society implicitly or explicitly values life and making it legible. Yes, it sucks. But we're not gods with unlimited resources.
(If you wish to spend your own funds on your care, then I have no objection to you spending as much as you can afford, your money, your choice. But if you're spending my money, through taxes..)
I also think that anyone who can prove they possess capacity (in the medicolegal sense) should have the right to end their lives.
I'd be open to that being a difficult process, you'd need doctors to sign you off as sane and not suffering from a disease that impairs judgement (and can be cured).
No, I avoid tautology by not claiming that just wanting to die is sufficient grounds to be diagnosed with a mental illness and hence lack capacity. I think there are philosophical reasons that are consistent with wanting to die, for reasons other than depression.
(Severe depression that is resistant to all treatment is, IMO, a terminal illness)*
I hold this position despite being severely depressed, with occasional suicidal ideation. I recognize that I don't want to be depressed or suicidal, and want that part of me excised. I'm quite confident I would never act on that (and doctors know how to make it quick, painless, and irreversible), and if my disease somehow overwhelmed my true volition, I would want to be saved.
I think that unless someone has formally applied for a Suicide License, the default presumption should be that something is wrong with them, and they don't actually want it. This allows us to try and save people who jump off bridges or take paracetamol after a bad breakup. I differ from most people in that I would accept people wanting to die for more considered reasons.
Of course, in the Real World, my hands are tied by laws and code of conducts that physicians must agree to if they want to stay out of jail and in their job. But that's my stance on the matter.
*I haven't exhausted all options, far from it. I even expect that we'll have a generalized cure for depression in my lifetime. I still am not comfortable with telling someone with depression so bad life has lost meaning that they must hold out in hopes of a cure, suffering all the way.
self_made_human
Grippy socks, grippy box
11mo ago
I support euthanasia being an option for the elderly, or anyone really, but I'm not quite aboard with actively encouraging it as the default option for the elderly.
I'd much rather we explore ways of delaying or reversing aging, the degree of investment there is nowhere near enough. On a pragmatic note, I'm all for a fixed budget or ceiling of care for people not paying out of pocket or through their family.
The UK is relatively sane in that regard, while we don't outright euthanize people on request, DNACPRs are widely used, and doctors have the ability to say enough's enough and refuse to treat further. At that point it's a matter of making sure they're comfortable till the embrace of death, while not doing anything to hasten or slow it.
self_made_human
Grippy socks, grippy box
1yr ago
Unemployed agents could always move into veterinary euthanasia or find work in PETA.
I can certainly discriminate between different types of mental illness, and have no qualms about doing so.
A BPD art-hoe and a depressed incel are both self-destructive, for no "fault" of their own (as popularly conceived as ethereal metadata not grounded in material properties), but one is far more destructive towards others.
A depressed person often doesn't want to be depressed. Or they feel terrible about being a burden, most of them aren't overdosing on paracetamol to get on welfare when their liver fails (presuming that doesn't kill them). In the UK, they are lucky to have the NHS around to save their ass for free (and me, eventually, though I charge for my services), but they do not undergo dangerous, crippling procedures to indulge a fetish and expect other taxpayers to clean up after them. The closest are the people into self-harm, and razer cuts and burns are nowhere near as expensive to treat, presuming they don't grow out of it.
Many would prefer not to be saved. We insist on saving them. I have mixed feelings on the matter, including extending to euthanasia: suffice to say that if rules and regulations didn't tie my hands, I would let a lot more people who didn't want to live on philosophical grounds kill themselves (presuming it wasn't just pure depression, or at least a form of depression that can be cured/managed to provide an acceptable QOL). Alas, the law and my medical licensing bodies disagree, and I care more about my paycheck than my principles here.
On the other hand, our friend Nullius Maximus here? While I have no way to prove it, I think he was mentally competent to gauge the consequences of his actions, and would likely have not gone through with it if he was left with the burden of fending for himself. And if he had, he wouldn't be newsworthy, just another crazy who killed himself for dubious reasons. Here, his craziness can be presumed to be sly.
That is far worse, as far as I'm concerned. I endorse his ability to do as he pleases. I do not endorse shielding him from the consequences of his actions.
self_made_human
Grippy socks, grippy box
1yr ago
Funny you should say this, since about an hour back, I was woken from a much needed nap by a panicked nurse in order to attend to a cancer patient, and arrived to see her grossly decompensating, with particular issues that made most of the initial resuscitation measures I'm in a position to provide useless.
I lost a bit of hair over how I was supposed to treat her, but was incredibly relieved to discover that, despite the nurses losing their shit, she was a palliative patient who had just had her End of Life and DNR forms filled by her family after the consultant in charge had informed them that all hope was lost as the brain mets gradually ate away at whatever made her human.
No amount of medical care any ICU could provide would save her or make her whole, at most we could prolong the process by keeping a living corpse hooked up to a ventilator at ruinous cost and taking space better served with the living. That calmed me down, even if this was the first time I had to deal with a dying patient entirely alone with nobody to back me up, I've read the guidelines, I know the drugs, and after some faffing around because apparently the oncology ward of the fanciest hospital in my part of the country didn't have syringe drivers capable of providing subcutaneous meds (utterly ridiculous, but they almost certainly have them in the ICU, but she was categorically forbidden from being transferred there), I managed to figure out a protocol that would ease the pain, or at least any residual discomfort someone who hadn't been conscious for days and never would be again might feel till her lungs filled with fluid and her heart became fitful and her ribs were no longer a cage for her soul.
So there you have it, I'm complicit in killing someone today, and I think it was a good decision, or at least the least bad of the options at hand. That's euthanasia for you, the modal case, representative of the end of suffering for millions.
It still hurt, at least for me, you'd think that working in an Onco ward would dissipate delusions that you can make sure your patients always walk out hale and hearty, but I did enter the profession because I'm proud to heal people. If that's not possible, may they pass gently into the good night, rage is more appropriate for the living who must deal with the banal, apathetic cruelty of an unfeeling world.
The problem is that very, very many people are flaky and short-sighted. Death is a one way trip, with no ability to undo a mistake.
Speaking very broadly, since practised and legal norms vary so grossly, euthanasia for the atypical cases where they're "physically" healthy involve lengthy periods of consultation and various opportunities to back out, though I think Canada has a more streamlined process, for better or worse.
So it's typically the case that multiple earnest medical professionals and social workers will repeatedly inquire as to the continued choice of the person to continue on the course. Even then, in my opinion, if someone who doesn't have a lack of capacity earnestly tells me they want to die, I wish to do my best to accommodate them promptly, even if I won't literally pull out a gun the moment they say so. This decision is obviously dependent on factors like acute pain or a severe bout of acute depression, where I can reasonably expect that treating them or will reasonably make the patient desist from their demands, but there's nobody who just kills people who have acute pain that I'm aware of, usually it's chronic and refractory to treatment.
People make plenty of decisions that they might vacillate on before death, the act of dying isn't special in that regard even if I agree it's rather terminal. They might want to adjust their will as they succumb to dementia and lose capacity to do so, they might want to feel the arms of a lover estranged for decades, it's the very lucky few who get to leave with no regrets at all.
Should their be due process and a period of waitful watching? I would certainly endorse that, but if someone over a span of weeks, months or even years keeps asking to die, I'm going to live and let die. That's how I address:
Do we really want to kill people who are edge cases and who may just be going through a bad period?
As for-
Excessive worrying might be improved through mental health care or altering people's news diet.
I can only chuckle ruefully at the idea that the majority of people who opt for euthanasia haven't had "mental health care" and oodles of it. They're usually refractory to treatment in the form of drugs, therapy and even physical interventions like ECT. They've failed to work.
I doubt the average neurotic woman with Trump Derangement Syndrome or even those who become anti-natalists or anti-humanists are lining up to kill themselves.
Shouldn't we try to fix society instead of killing the people who are unhappy because of societal pathologies?
That's a false dichotomy in my eyes. We can do both, and should do both.
That the group with a desire to die is disproportionally poor, urban and single, suggests a strong societal component is at play.
All associated with severe unhappiness and poor life outcomes and for good reason. Being poor, "urban" and single against your wishes sucks.
If you have a means of turning such people into rich, rural and married individuals, then I'm willing to hear it, but I doubt anyone does short of waiting for the world to get much wealthier.
self_made_human
Grippy socks, grippy box
1yr ago
I just want to convince you and your fellow machine gods to spare the poor humans who want to stick to their physical bodies and worship some sort of God.
I'm not homicidal myself, as much as I pity the religious, I don't think the solution is euthanasia haha.
Can't vouch for the Machine Gods, you'll need to take that up with Altman!
self_made_human
Grippy socks, grippy box
2yr ago
It doesn't take a very inelegant patch to say that there's a qualitative difference between something that was sapient and will likely become so if either left alone or given minimal care, versus something that is not, never was, but may become sapient if a large amount of time and resources were to be poured into it.
If you leave a sleeping person alone they will soon become sapient, while if you leave a lump of biomass alone it will stay a lump of biomass forever. Fetuses fall more into the former category than the latter, and so are definitely people.
A baby has obviously less need for cultivation than a random pile of biomass to become sapient, yet it still needs a great deal more to attain its potential. A sleeping person doesn't. If I had to draw a line where in practice, it's clear to me where I'm putting it, several years after birth.
I draw a distinction between denying rights to something that never had any, versus respecting the rights of someone who is only temporarily and unavoidably unconscious, and will likely resume consciousness soon.
let me give you a hypothetical: let's say you were just hit by a car, and are now standing dazed in the middle of the road as another car barrels towards you. Why should anybody save you? What makes you a person in this instance besides your future potential to regain awareness?
I think the fact that I recently was a conscious intelligent entity with rights suffices, and will be again given a small intervention.
No, children have much greater economic and social potential, and babies still more. I get that you were talking more short-term, as in, "what could an adult accomplish tomorrow vs. a baby" but we're literally talking about potential so I don't see why we should restrict the discussion to that timeframe.
I'm sure you're familiar with the idea of temporal discounting, all else being equal, saving a grown adult versus a newborn will incur far lower opportunity costs, and $1000 now is better than $10,000 50 years later in most contexts. If I was confronted with a drowning baby versus an adult, I'd save the adult because they represent a great deal of investment and are already productive.
Maternity windows are relatively short, and children born to younger parents are genetically much better off than those born to older parents. So even if we're just talking about loss to potential etc., either we're talking about a mother losing a potential child (i.e. having 1 child instead of 2) or having her second child later than she would otherwise. The latter leads to worse outcomes for everyone due to genetic issues.
I can't disagree, and you won't find me arguing that my views don't have drawbacks and tradeoffs. Policy Debates Should Not Appear One-Sided, but in this case if it's the parent's doing the deed, I see no principled reason for society to intervene unless we're also rounding up mother's who smoke crack or treat themselves to red wine while pregnant. I still don't see it as major enough to override personal autonomy in such matters, unless society bites the bullet and also punishes the idiots engaging in such obviously dysgenic activities.
Same with geriatricide, or just straight-up murder.
You're mixing up my personal ethics with what I'm ok with for society at large. If someone is so geriatric and debilitated that they're at the level of cognitive function of a baby, then by all means I support euthanasia for them! If I was the dependent of someone who had to care for me in that state, I'd be fine with their decision. I don't condone murder of the modal person for what I hope are obvious reasons.
If you know a healthy person will die tomorrow is it moral to kill them today?
Killing them would be a net negative in my eyes, but also OOMs less bad a crime than killing someone who had their whole lives ahead of them. Before you gotcha me, this period is being counted after they gained sapience and thus rights, not before. I don't recommend that judicial systems weight that too much because of perverse incentives, but that's not the same as it not being true!
The proximity of the Singularity seems irrelevant.
Imagine that, as a doctor, I'm counseling a person with a terminal illness and terrible QOL in two different scenarios:
In one, medical science has stalled, and I can credibly claim that no treatment or cure will ever be found for the condition they're facing, they're doomed to having their remaining life be worse than death with no recourse. In that case, I'd earnestly suggest they opt for euthanasia instead of suffering till the end.
In the other scenario, I've received word that very promising clinical trials are underway, and that there's a greater than even chance that a cure is forthcoming before the patient expects to die. If they can stomach the pain of some period, they have a long and healthy life ahead of them. Why on earth would I encourage them to euthanize themselves? I'd tell them to grit their teeth and pull through, but only because of a credible hope, not because I fetishize extending a life of suffering.
Similarly, I genuinely believe that in the next 10 years we either solve nearly all of our technological and societal problems, or die in the process, with only small odds of a business-as-usual outcome.
The death of an 80 year old man in the 1950s is far less tragic than the death of one in 2028, when it's plausible that we have working senolytic drugs or other therapies.
self_made_human
Grippy socks, grippy box
2yr ago
Before I nitpick, I just want to state that I mostly agree with you, and certainly have little interest in Amy's moralizing claims on any given day.
That being said:
How well do you think opiates control the pain of having fluid building up in your lungs so that you can't breath? What exactly do you think a "natural" death looks like?
https://erj.ersjournals.com/content/50/5/1701153
Opioids, other than themselves causing respiratory depression, are also effective in reducing the unpleasantness of breathlessness. It's commonly used for that purpose in palliative/EOL care.
I've seen enough people die ignominiously in ICUs to share your views of euthanasia, but just wanted to correct an error!
You've given me the idea for a very good medical comedy about a critical care doctor who either disagrees with the concept of euthanasia, or bumbles around never quite being told which patients are involved.
He, or she, holds the record for most lives saved or resuscitations performed. In a very British manner, the actual doctors responsible for euthanasia are very vexed by his tendency to immediately save their patients, and they're in a cat and mouse game of taking turns murdering and unmurdering any given patient.
The hospital brass are desperate to figure out a way to not award him excellence awards, because it's just plain old embarrassing at this point.
I can foresee potential to change the plot to get more demographic appeal. The life saving male doctor versus the ice queen no-nonsense German euthanasia dom. Or getting Rowan Atkinson to play the male lead.
It might be delightfully British. We can fabricate end of season drama by having them come to blows, and then have them either start to fuck over a corpse that comes alive (because their thrusting counts as CPR), or when they realize that they can game both metrics if they cooperate to keep the bodies clinically dead for long enough to fool the coroner.
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