[dathos]

My grandma always told me when she couldn’t go on her walks anymore she didn’t consider life worth living. When she got dementia she was placed in a closed hospice, to “protect her”. Now she only walks when I visit, and I only see a shell of the woman she was.

Anecdotal of course, but why do people think it’s an ethics question when society is individualistic as can be? There is no choice in being born, why don’t we get a choice in when we leave?

[rich_sasha]

To my mind the main obstacle is kind of orthogonal: how do you protect the people who don't want to go, being pressured or manipulated. I agree that if someone is really, independently and committedly deciding to go, you shouldn't stop them. But how do you express that test in a bureaucratic, legalistic framework?

In a friend's family, there was a big rift as one family member in direct line of inheritance was accused of (successfully!) pressuring his mother to refuse medical care. She died sooner and more unpleasantly than she likely would have otherwise, leaving more money sooner to her children. And that wasn't even with euthanasia being legal.

I have lots of sympathy for people so desperate they would rather kill themselves, but I don't know how you square that circle.

[The_Colonel]

> how do you protect the people who don't want to go, being pressured or manipulated. I agree that if someone is really, independently and committedly deciding to go, you shouldn't stop them. But how do you express that test in a bureaucratic, legalistic framework?

I would look into countries where euthanasia has been already implemented. It doesn't seem like it's a widespread problem, so apparently they made it work somehow.

Does it mean it's absolutely bulletproof and no-one will ever be pressured to undergo euthanasia? No, but you can't ever achieve such certainty, and it's better to look at it from the utilitarianism view - allowing euthanasia will prevent much more suffering than it will cause.

[sramsay64]

> I would look into countries where euthanasia has been already implemented.

That's what puts me off of the idea in the first place. Cases like Christine Gauthier (a former army corporal and paralympian) who was offered euthanasia when trying to seek government disability benefits to install a wheelchair ramp. If it takes someone with existing fame to speak out about this, how many more people has this been pushed on?

> from the utilitarianism view - allowing euthanasia will prevent much more suffering than it will cause.

I'm not totally convinced. I haven't run the numbers, and this also certainly takes into account my personal views on valuing life and family, but I do fear more pain and suffering will come with legal euthanasia than it will solve.

Just look at the end of the article. It gives several examples of the kind of thing that allows me as a utilitarian to say that the suffering of a few terminally ill is not as bad as the harassment of countless vulnerable people.

[philistine]

Should we keep medical assistance in dying illegal because bad eggs offer it outside the legal framework of their job in bad faith?

The Christine Gauthier case is used to justify the idea that the government will use it to reduce spending, when what happened to her is appalling, but was absolutely not something the government employee that offered it to her had the legal permission to do so.

What the Quebec law regarding medical assistance in dying does is guarantee its existence as a medical act. It does not allow any low-level government employee to offer it wily-nily to anyone. It is a medical act, reserved to doctors, to discuss assistance in dying.

[dghlsakjg]

> Just look at the end of the article. It gives several examples of the kind of thing that allows me as a utilitarian to say that the suffering of a few terminally ill is not as bad as the harassment of countless vulnerable people.

Countless vulnerable people haven't been harassed. There are 12 documented cases in the history of MAID in Canada where someone was allegedly offered MAID innapropriately. There have been inquests and reports that have counted them. Not one resulted in a death. Christine Gauthier's experience couldn't be substantiated when they reviewed her records, but they did find in that investigation that a single case worker had offered MAID to 4 veterans.

On the other hand there have been over 50k successful petitions for MAID most of which were for people with Cancer.

As a utilitarian, you should presumably look at the actual numbers, and balance the tens of thousands of people who chose not to suffer agonizing deaths against the 12 documented cases of people who were offered MAID as an option when they think they shouldn't have been.

[nickff]

To be fair to the grandparent, you can’t fully audit whether the cases of the people who successfully petitioned, because they’re now dead.

[dghlsakjg]

You can petition for MAID, and get approval, and then choose not go through with it.

[Martinussen]

I think these are valid concerns, but I would also say that there is an underlying issue with medical malpractice and disregard for the suffering and needs of certain groups of society which we tend to brush under the rug. I'm going to assume the concerns you have probably don't stop at just euthanasia - mine definitely don't, and I worry that a ban just makes the issue more... abstract, and PR-friendly.

If an individual in a difficult life situation comes to the state for help as a last resort, and there is a chance the representative they are assigned would recommend they should consider just dying as their last resort, the state has already failed to protect someone vulnerable, and obviously won't be giving them the help they deserve/need/should be entitled to as a human.

Any wrongful death is horrible, but I sincerely believe a "representative" like this and the harm they inflict is going to have an almost identical death toll, even if it's by way of consigning people to sub-human lives of physical or mental torment instead of pushing them towards a tool that "everyone" understands we need to keep a close eye on. My utilitarian take would be that many would happily extend the torment of the terminally ill and suffering, as long as they don't have to deal with the suffering their neglect inflicts on countless vulnerable people and the terminally ill already. (For e-clarity, I don't mean to imply that's your motivation here!)

[philistine]

> If an individual in a difficult life situation comes to the state for help as a last resort, and there is a chance the representative they are assigned would recommend they should consider just dying as their last resort, the state has already failed

Medical assistance in dying is a medical act, reserved to doctors. Just like a car salesman can't legally recommend you an abortion. No one in the government has the legal right to discuss it, even less offer it.

[Martinussen]

Yes, my point was that that person having a position where they are able to do that is already wrong. If a car salesman was telling every woman that came in they should get an abortion, there are places that person should be, and none of them are a car dealer's.

[okaram]

The way most countries who have it (including Canada) have solved it is to add waiting periods, and layers of reviews. In Canada, you need two different doctors to sign off on it. If you're not actively dying, you also have a 90-day period of reflection. And you have to be of sound mind.

This seems to me like good enough safeguards, don't you think?

[rich_sasha]

My ultimate point is that old people, especially those not very well, are very vulnerable to being forced to do this, and I saw ~first hand how easy and undetectable it was. You can add bureaucratic constraints but it's fundamentally a human problem. While expressing utmost sympathy to critically ill and unwell people, I don't know how you make this without endangering many more people than those would benefit from such changes.

How do you even measure if it's working "well" in Canada? They have a process. There is no way to question the people who went through with it whether, on reflection, it was their own free will.

But of course looking at how others do it is a good starting place for further analysis and I'll go now and educate myself.

[paulcole]

> This seems to me like good enough safeguards, don't you think?

No. I think it’s too much.

Nobody else should be deciding that my mind is unsound.

And if my body being “unsound” is a reason that makes it OK to want to die, why should an “unsound” mind be different?

[lucubratory]

The system in Canada results in the state killing homeless and disabled people rather than offering them support.

[deanCommie]

Does it? Or is this what anti-euthanasia advocates are spreading as misinformation around to acquire the support of progressives to their cause (which is driven not out of a care for homeless and disabled people, but out of religious/conservative mindsets)

Keep mind: I'm not asking "Do those cases ever happen"? Of course they do. There's already been stories. The question is what are the statistics. Every policy, every procedure, every decision can have mistakes and negative outcomes. Some homeless and disabled people have been offered euthanasia. Those cases should be investigated and the policies should be updated. But nothing will be perfect.

You can say "if you can't have a perfect system then you shouldn't have it at all." and while that may be philosophically justifiable in the same way that "I'd rather let 10,000 guilty people go free than convict 1 innocent person" is, but it's important to remember that despite that we still convict innocent people.

Some trans people regret their transition. They're a tiny minority. Some people abuse welfare. They're a tiny minority. Some people are pushed towards euthanasia when they shouldn't be. They're a tiny minority.

[LorenPechtel]

And note that the stories aren't always accurate portrayals of what happened.

I remember reading about one where someone drugged their mother to bring her in for euthanasia. What the naysayers didn't report was that that was by her own wishes--she knew her mind was going and set it up for when it was too far gone. I have no problem with that.

[lucubratory]

Comparing the act of people transitioning or people being given financial assistance to the act of people being killed by the state is genuinely sickening. Total inversion of reality and conflation of reversible benefits with literal death.

The government has no incentive to provide better housing or disability benefits to the working class when they can instead withhold those things and watch legions of poor & desperate people die. Do you know they actually calculate how much money killing all of these marginalised people saves them? That Canadian media advertises these figures to sell the state killing program?

[deanCommie]

I can't negotiate with people who have such a deep distrust of Government that they belie that the Government will kill it's citizens if given incentives to do so, or from pure $-based miscare.

This to me feels like a very dystopian way to have a relationship with it's government, and is a uniquely american perspective amongst the developed world.

The government is a proxy for society leadership. I expect human society to protect it's humans, and most of the world with functioning government does too.

The biggest threat to Canadian prosperity today is these american ideas percolating above the border and infecting the mind of Canadians who previously believed and trusted their government and no longer does.

[raydev]

> The government has no incentive to provide better housing or disability benefits to the working class when they can instead withhold those things and watch legions of poor & desperate people die.

What was Canada's excuse for poor healthcare before MAID existed then?

[jacobgkau]

It seems like somewhat reasonable safeguards for most circumstances, except that other guy replied to you saying he thinks there should be zero safeguards and he may well continue espousing and voting for that viewpoint for the rest of his life now that the basic system's in place.

Even if you think the current safeguards are the "sweet spot," continued pressure to make it more difficult will be necessary to prevent it from being made less difficult. (And if you don't think it would be a problem for it to be made less difficult, then citing those safeguards as part of your argument would be disingenuous.)

[ljsprague]

Bureaucracy for the win.

[marcosdumay]

Bureaucracy is usually added for the win. But people only notice when it's not.

[AlexandrB]

> To my mind the main obstacle is kind of orthogonal: how do you protect the people who don't want to go, being pressured or manipulated.

This is why it's important to have a pretty detailed living will[1]. Especially is you're already chronically ill and have a pretty good idea of how that road ends.

[1] https://en.wikipedia.org/wiki/Advance_healthcare_directive

[twoodfin]

What you’re hitting on is the inescapable truth that there are problems government institutions can’t solve.

[JohnBooty]

Surely you can see that we could apply that principle to either pro- or anti-euthanasia arguments?

Either way, the government is profoundly involved.

Either the government is in the business of telling us we cannot end our own lives in humane and medically-assisted ways, and that medically assisted deaths are equivalent to murder with all of the attendant legal issues.

Or they are in the business of enforcing rules about how those medically-assisted deaths can happen.

[twoodfin]

It’s the government’s choice whether they allocate resources to investigate and prosecute “suspicious” deaths of terminal patients.

Deciding as a matter of policy, not law, “No, we don’t do that outside of extraordinary circumstances” is something a government institution can do.

[thinkingemote]

Manipulation and coercion can oppose the suicide too. There's some cases where family members don't want their loved one to kill themselves.

I'm not sure how these were resolved but it's very messy and hugely traumatic for all involved.

[14]

Well I am sure no system is perfect but the people that choose to end their life have to meet several criteria. They first need to be of sound mind when they make this decision (and this is one of the current issues being sorted out). So they talk with their doctor and express interest. They then are seen by other health care providers like psychologist who discuss it more. They are spoken to privately without the family present. It is their decision in the end and only theirs. Once they choose a time they need to still be fully alert and aware and they have to personally push the button that ends their life. And that is one of the issues, some people do not want to live if they become paralyzed or brain dead. But we can not euthanize those people even if they expressed that wish before.

I have worked in hospice and they do MAID there all the time. It was a weird feeling to see a family and their loved one head into the downstairs where they would all sit around and tell them person how much they are loved and then that person would end their life. But I know it is the right thing.

[invalidname]

How do you prevent people from smoking? Eating processed food?

Is the fact that the process of suicide is slower/more conventional a difference?

People seeking this process go through a psychological evaluation to determine if they are under duress and of clear mind. Also there's liability to the ones applying undue pressure which can be criminal.

I think there's a point of personal responsibility. Potential abuse of the system should not be the reason to deny it to everyone. I want to have control over the way I live and die. Alzheimer's is unfortunately in both sides of my family, if it has no treatment and I start showing signs I would rather die than live. It would be torture for me to put my family through that.

[rich_sasha]

As I say, my concern isn't academic. I was close to a situation where someone was allegedly coerced into refusing medical help. It was in fact investigated, ended up as word against word, and nothing came of it. That was in a jurisdiction where euthanasia is not legal and anyway such coercion would be illegal, for both the coercer and the doctors. It didn't stop the alleged coercion, and no one was prosecuted. So how leaky would the system be where euthanasia is in facr legal?

But please don't get me wrong, I am absolutely full of sympathy to people so desperately ill they want to call it quits.

[invalidname]

Neither is my concern academic. My MIL struggled with cancer treatments for a decade of terrible pain. My father was catatonic with Alzheimer and my mother is in a pretty bad place health-wise.

I don't want to appear dismissive of your concerns because I'm not. Such abuse is horrible, criminal and tragic. No question. But looking at the morality issue and consistency I think the answer is pretty clear. We need to give people agency over their own lives. Safeguards are essential for sure, and abuse will happen even with the safeguards in place. But the current situation is just tragic. People are afraid to go to the hospital because they're afraid they will be kept alive and in-effect tortured to a slow death.

[wat10000]

Would you support laws that force people to get medical treatment whether they want it or not? It would avoid the sort of problem you witnessed.

[nitwit005]

The much more common case seems to be families forcing treatment, effectively just prolonging the pain. People don't exactly easily come to grips with their parents dying. Some people never do.

[jncfhnb]

Sounds to me like your family friend’s mother would have died more pleasantly if euthanasia were legal.

There are plenty of ways to pressure people into death, as you have already demonstrated. That’s not going away.

Emotional burdens to encourage people to live as long as possible even if you think they’re suffering are likely a far bigger problem. People know it’s unethical not to euthanize animals that are suffering. Lacking the social apparatus to suggest euthanizing humans is almost certainly a huge moral weakness.

[kerkeslager]

> To my mind the main obstacle is kind of orthogonal: how do you protect the people who don't want to go, being pressured or manipulated.

How often does this actually happen?

EDIT: To be clear, I'm not saying this doesn't happen, I'm really asking.

[bleakenthusiasm]

One reason is religion. That aside, people are afraid that this could be abused. People could choose this purelyto avoid additional cost to their relatives.

It could be used as an excuse why more costly options to avoid pain and suffering in old people might not be covered by insurance anymore.

People could be talked into it for various reasons.

Canada is a good example of a country where I think the base to make it work in a positive way is given. Their insurance covers a lot of treatments for basically everyone. The country cares about its citizens in a way that makes you believe they won't use euthanasia as a cop out to avoid paying for medical care.

If these circumstances are not given, euthanasia can easily be seen as an easy way to get rid of people who are too expensive for society or too cumbersome to take care of.

[Analemma_]

> People could choose this purelyto avoid additional cost to their relatives.

Why is this a bad thing? If there's a choice between giving $100,000 to my descendants and using it to keep me intubated in a hospital bed for an extra 6 months, I find the former preferable by far. If someone else doesn't, that's fine, but I find comments like this both annoying and creepily authoritarian in saying that the correct choice is obvious and so they're going to make the decision for me.

[karencarits]

Not the op but I guess the idea is that questions of life and death should not primarily be economical questions. You are free to disagree, of course, and there is, at some level, economical considerations for all medical treatments. But at least I'm my country is there a sharp divide; an individual should receive the best available treatment without economical considerations. What treatments that are available for various conditions (not individuals!), however, are decided by comparing cost and utility.

There is also an argument that can be made about the meaning of economy is to make lives better, but the opposite is not true

[quasse]

> Not the op but I guess the idea is that questions of life and death should not primarily be economical questions.

Sure, but as an American life and death is already an economical question *above all else*. The quality of medical care that I receive is already directly linked to how much money is in my bank account and how much my employer is willing to pay for a medical plan.

End of life care in the US is designed with the primary goal of vacuuming every asset out of you and then letting you die once it's gone. It seems unethical to say "sorry, you don't get to opt out of this. Everyone's got to go through the whole process."

[Analemma_]

That's mostly tangential to my argument though. In many people's lives, there comes a point where you can spend arbitrarily large sums of money to postpone death, but only in a form that I, for myself, don't consider all that valuable: I would be willing to be bedridden, intubated, and barely-conscious as a temporary condition if it meant a full recovery for more life later. But as a holding pattern before death, which is what it usually is, I'd rather not, and I personally would like to spend that money in other ways.

Note that this applies even in cases where all the costs are paid by taxpayers. If the state is making me an offer saying, "we'd like to spend $100,000 to keep you barely-conscious for a few months", that might be more generous in some sense than offing me, but I'd still rather they just give that $100,000 to my kids.

[amatecha]

Yeah, I knew someone who opted to have their dementia-suffering parent live with them until the end. That was tough, but... surely better than being left alone in a hospice/etc. as you mention. Unfortunately, yeah, you'll see the person just erode and ... it's really brutal as hell, ultra sad. Eventually the person is not even capable of consenting to euthanasia (nor any other medical procedure). Definitely something to discuss with family or closest friends especially upon getting diagnosed with an illness like that.

[nradov]

Caring for dementia patients at home is seldom better unless the family has the resources for 24×7 care. I know from personal experience that dementia patients will wake up in the middle of the night to wander out into the street or accidentally start kitchen fires. And if the family tries to do it all themselves it takes an enormous unsustainable toll. At some point everyone is better off putting the patient in a professionally staffed facility. Of course the prices for those create other challenges.

[14]

I have worked in hospice and would say typically the people who end up there are not what I would say left alone. But they are there to die. They usually end up there because the family who was looking after them is really struggling to do so any longer for various reasons like personal care or medication management being too much and they are approaching death.

When there they get basically as much drugs to fight pain, anxiety and other symptoms as much as they need. The goal is to provide as much as possible a comfortable end to their life.

Dementia patients are not candidates for MAID program here in Canada. You need to be of sound mind at this time. Perhaps in the future one can make a living will for future illness but currently if you are confused or suffering from dementia and can not understand what it is all about you can not consent to it.

[InDubioProRubio]

Because half of society is a labour camp without guard towers- and if the slaves leave the camp it collapses in on itself.

[nashashmi]

> why do people think it’s an ethics question when society is individualistic as can be

Because we disagree that society is individualistic. We are social creatures, not individualist creatures. And we need people around us. Including you needing your grandma. And she needs people like you.

turn the question around: why do people feel easy escapes are ok? We came in this world and were assisted in our upbringing and lived to old age, so why is it ok that we can feel like we can just get up and leave?

[wiseowise]

> why do people feel easy escapes are ok?

Because they are ok. Why wouldn’t they be? You don’t get bonus points after life for suffering on “hardcore”.

> We came in this world

I don’t remember anyone asking me whether I wanted to come in here or not and I sure as hell won’t let anyone dictate how I want to die.

> and were assisted in our upbringing and lived to old age, so why is it ok that we can feel like we can just get up and leave?

Because you’ll die anyway.

[jncfhnb]

What do you need from grandma, who is in constant pain and desires to die?

[nashashmi]

The touch, the voice, the eyes of love, the concern, the stories, the heart, the smile, ... shall I go on?

[jncfhnb]

Grandma doesn’t want to share those stories because it hurts to talk and she can’t see well and just generally she’s in a constant bad mood because her life sucks.

[nashashmi]

That would be the fault of those who are responsible for her happiness

[int_19h]

There are quite a few medical conditions in which it is impossible to make it not hurt.

[jncfhnb]

Ok. Even if we hold that ridiculous assumption true… so what? Let’s say grandma is explicitly suffering because others are failing her?

Your proposed thesis still suggests she does not have justification for choosing death. What does she still owe us.

[steve_adams_86]

All of this is beautiful stuff, but I think it no longer applies when suffering has removed a person's humanity such that they can't offer these things anymore. At that point they're only capable of putting their energy into suffering. Even your attempts to alleviate their suffering are probably useless, or offer little to no relief.

I don't see why you would think about or hope for these things when they're effectively gone; especially not if wanting these things for yourself is at a loved one's expense.

[wiseowise]

Grandma is long gone, you’re prolonging suffering of her husk for selfish reasons.

[buttercraft]

So you want grandma to suffer for you. How very selfish.

[int_19h]

Because nobody has the moral right to demand that other people suffer for their own sake.

[coffeefirst]

Because I’ve seen the slow end and I wouldn’t wish that degree of suffering on anyone.

[stronglikedan]

> why don’t we get a choice in when we leave?

Because dead folks don't pay taxes.

[bawolff]

Terminally ill people generally aren't paying taxes either. You have to make money somehow to owe taxes.

[Sohcahtoa82]

There are so many people that really have no idea how taxes work.

[barbazoo]

So which one is it, the government assisting in deaths too often or not enough, it can't be both at the same time.

[eru]

Alas, actually, it can be.

You can make both errors with false positives and false negatives at the same time.