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Comment by smnrchrds | Hacker News Reader

> Indeed, in some Canadian provinces nearly 5 percent of deaths are MAiD deaths. In 2021, the province of Quebec reported that 4.7 percent of deaths in the province were due to MAiD; in British Columbia, the number was 4.8 percent.

That's about in line with the Netherlands, to put things in perspective.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

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Perhaps the title should be "15% of terminal patients choose assisted suicide".

Presuming 35% of people who die, do so in need of palliative care [1] -- it is only a further one in seven who seek assisted suicide? In this light, I'd expect the number of deaths to be higher than 5%. Also, isn't it silly to report cause of death as suicide, when it was cancer or some other condition that would soon take their life regardless?

[1] https://www.hindawi.com/journals/ijpc/2014/529681/

I’d like to see a breakdown for the rationale of people using these programs. The absolute and relative numbers are irrelevant (IMO) if they are largely occurring for the “right reasons” like avoiding increasing pain or similar.

see section 4 (and specifically chart 4.1A) here: https://www.canada.ca/en/health-canada/services/medical-assi...

62% cancer patients, 80% coming from palliative care.

section 4.5 discusses the new controversial new provision for 2021 which allowed patients to recieve MAiD even if their deaths are not "reasonably forseeable", which accounted for 2.2% of MAiD recipients, or 219 people.

Seems like the law is working exactly as intended then. 219 people, or 2.2% if participants, is an excellent outcome showing the program hasn’t been taken over by greedy children pushing their elderly loved ones toward an early demise.

I would love to know if, of the 219 people, how many of them are victims of systemic neglect (e.g. chronic condition patient whose meds aren't covered by insurance, suicidal patient who cannot get inpatient therapy, addiction patient who has been denied methodone or other drug-assisted sobriety). Even if it's only 219 people, I think if even half were victims of systemic neglect, I would want very far-sweeping policy changes to prevent these deaths.

While you have a point, I really do think the absolute numbers matter too. When 1 in 20 people die from MAiD, it’s no longer a rare edge case regardless of how good their reasons might be; the provision of lethal injections is now a routine component of the Canadian healthcare system. I don’t think that any routine procedure can be subject to the level of weightiness and caution required to end someone’s life.

Wouldn’t you expect that the use of this option would increase dramatically in a massively aging population like most western countries, particularly where people across the whole spectrum of ages are unhealthier than in past generations?

I suppose this doesn’t negate your comment but it does offer that there needs to be some adjustment for population aging and health overall, to give proper context.

It’s not about what you’d expect but about what the consequences of normalizing it are. If you’d never heard of MAiD before, you’d react with shock and horror to the mere suggestion that your family members should get a lethal injection like the USA gives to criminals. I think that reaction is the right one, and the “what’s the big deal?” attitude you see a lot of downthread is terribly wrong.

It is very dishonest to frame it as the suggestion that "your family members should get a lethal injection like the USA gives to criminals", as it strongly implies a lack of agency and consent on their part.

What's happening here, to put it in the same terms, is that "your family members should be allowed to choose to be administered a lethal injection, like the ones that are given to criminals in the USA, as a medical procedure, if and only if a doctor determines that this is a reasonable way to put an end to their physical or mental suffering".

Turns out it's not really that shocking and horrifying unless you choose to be dishonest about it.

Perhaps ask why the doctor shouldn’t react with horror at being asked to consider proactively ending someone’s life the way we kill criminals, if the family is a stumbling block.

(I realize by positioning “determines that this is a reasonable way to put an end to their physical or mental suffering” as the greatest and only consideration, you have a prior commitment to ending the lives of others when you like the sound of it. I will still try, though.)

The doctor should not react with horror in any case, because the doctor is a medical professional, not a paid actor in a pro-life advertisement, and I would certainly hope for him to behave as such.

I'm not sure what your fixation with how criminals die is about -- there is no "nice" way to die, just more painful and less painful ones, more prolonged and less prolonged ones. Euthanasia gives us a choice that, speaking purely of the physical experience, is on the often-preferred end of the spectrum.

The doctor should consider it to be an acceptable measure under a limited set of circumstances, and should consider it not to be acceptable in almost all other circumstances. In all cases, the decision is only to be taken by the person whose life is going to end. All the doctor can do is authorize or deny that decision, never to make it on their behalf.

Family should often be consulted by the doctor in order to make that decision in an informed manner, but family doesn't get a vote. Your family does not own you or your body.

I don't have any prior commitment to "ending the lives of others", and to say so is to willfully misinterpret what I have said to an absurd extreme. My only commitment is to others, and myself, being able to decide how to end our own lives, and no one else's lives but our own, in a dignified manner, when our very existence entails suffering.

It does not matter whether I "like the sound of it" or not. I am not currently seeking euthanasia, and I am not a doctor for someone who is, so rest assured that nobody is asking for my opinion. What matters is if the person whose life is going to end does, given that they are of sound mind to make such a judgement.

I'm glad you will still try. We should always try to make others' lives better, to provide better lives instead of easier deaths. But sometimes we won't be able to.

You need to look at this from multiple aspects: the ability to make the "right" choice in an individual's case, factoring in all ethical, medical, social and financial forces and beneficiaries involved. The policy from an aggregate level, factoring in the same at an aggregate level. To make these decisions, you do need to periodically step outside the decision-making process and see it with fresh eyes, which is what I and the other user were attempting to prompt by inviting you to think about the similarity to state-administered violence in a legal system.

You are definitely entrenched within an intentionally limited set of inputs similar to what the MAID process has devolved to in some circumstances, sorry. In your current position, you would not be in a position to fully and most beneficially evaluate the decision to end life, whether as an individual, family member, physician or policymaker.

Again, you can rest assured that nobody's asking me my opinion on whether other people's lives should be ended, and I'm not looking to end mine, either.

And fortunately, given how these processes are set up, nobody will ask you, either. You win some, you lose some.

> The doctor should not react with horror in any case, because the doctor is a medical professional, not a paid actor in a pro-life advertisement, and I would certainly hope for him to behave as such.

Indeed, and in 1910 progressives were saying similar things about sterilising the feeble minded. This is why the education system is so important. If you control the education system you get to decide what a professional should think. If there are professionals who disagree there’s always disbarment.

A key distinction, though, between euthanasia and forced sterilisation or eugenics, is consent. The latter are, almost always, decisions taken or considered based on the externalities -- they're not done for the benefit of the person that the procedure is applied to.

While a dystopian society could consider choosing to kill people based on their externalities (such as, for example, as we currently do by putting criminals in death row) advocates of assisted suicide put the wishes of the person undergoing the procedure first and foremost. Euthanasia should never be something that is done to you without your explicit, self-driven, sound-of-mind consent.

And indeed, morality judgements are always influenced by the context of their time. Eugenics was a somewhat popular idea around that time, but it's important to note that this does not mean that early 20th century people were less moral than we are.

Families required the labor of all of their members to survive, and an unproductive member of the family that required extensive care carried a very clear cost in opportunity and quality of life to the family, often one that permanently impacted the life of the mother. It was seen as a moral good to somehow use science to figure out a way to "spare" families, and especially women, from what was seen as an arbitrary misfortune, an "act of god".

One of the reasons why eugenics is not nearly as popular today is that society takes on a more collective approach to supporting and caring for disabled people. While there's still a long, long way to go, there are schools for children with special needs, there are disability payments, there are ways through which society organizes to help those who care for others, alternatives to what was often a very tough choice for mothers, between abandonment, murder or misery.

Eugenics didn't change. Morality didn't change. Society changed, and in doing so, it shifted the balance, and it is no longer seen as the moral choice to engineer humanity so that Jerry doesn't exist, because the alternative to that no longer is to make his mother's life untenable. By having better options, we are enabled to make better choices.

Suppose a young health person says they want to die, and stops eating or drinking. We'd label that a suicide attempt, and force them to get medical care.

If a terminally ill elderly person makes the same choice, we label it as "voluntary stopping eating or drinking", and consider it totally normal.

Which is to say, even with no assisted suicide program in place, frequent decisions about who we're allowing to kill themselves is happening.

> When 1 in 20 people die from MAiD...

The ideal situation is not 0% of people dying from MAid, it's 100%.

We are all going to die. The choice is not dying vs not dying, it's dying after a horrible and interminable agony while in the hands of hostile nurses vs dying fast and without suffering.

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