Reports show some Canada euthanasia deaths driven by social reasons
apnews.com
apnews.com
It definitely has shortcomings, but I genuinely hope the fixes will not result in rolling back the program completely.
A society that encourages people to off themselves because they are a burden doesn't sound nice to me. I think anyone should have the choice (legally) to end their life, but it would be gross if people actually started talking about how that would be good for everyone else.
How much productivity can one expect to transfer from young people to old people if the total fertility rate is too low? Surely the cracks start to appear when there are 2 old people for every 1 young person? Absent sufficient automation, of course.
Typically, this causes asset price inflation, where the government tries to keep the most active voters (old people) happy, and to do that, they try to keep old people’s purchasing power from diminishing too much. And since older people have more assets than younger people, it effectively results in a transfer of the fruits of the country’s productivity from young to old.
I don’t know how accurate a picture the media and the rhetoric on the internet paints, but this seems to be a growing issue in Canada, at least from changes in their real estate prices relative to income.
At the end of the day, people who don’t work need people who work. But people who work don’t need people who don’t work. Presumably, if people who work never received anything in exchange, then they would not be incentivized to works.
And so the implied contract is people work now and give to people who don’t work, and in exchange, in the future, they will be the people who don’t work and receive from people who work.
But if there will be fewer people who work in the future, and not sufficient automation, and people who work now see perhaps their parents getting less than they expect, and they see TFR trends, and put two and two together and realize they are not going to get what they put in, then they may choose to opt out of this contract.
The way Canada operates me reminds me of people I know who have poverty mindset. Spending money on longterm investments seems unthinkable here
I think it's a side effect of politicians only really caring about the next election cycle. Any investment that won't pay off before the next election is sidelined
That people with terrible quality of life have the option is a good thing. It should be available for full autonomy.
I just don't want a case of any pressures to get euthanised, whether from family or society.
Much preferred to, say, ættestup: https://youtu.be/DwD7f5ZWhAk?si=WjwnN7cZC1h7TcJU
My IBD is relatively well-managed, but on bad enough days even I'll gravitate towards some not-so-sunny thoughts.
Offering MAID is not a solution to societal ills. But it’s just straight up evil to say that people can’t kill themselves to escape a bad life because it would make you sad to think about.
https://www.theatlantic.com/magazine/archive/2023/06/canada-...
https://apnews.com/article/covid-science-health-toronto-7c63...
One case (can't find it now, I think it may have been Alan Nichols') had someone claiming the doctor basically pressured them into it, implying they were taking up resources from other patients in Canada's health care system who could use it more.
Bodily autonomy should be a universal right. No one should be able to control what adults do with their bodies, IMO. It may lead to some dark places, but that's freedom I guess.
People on welfare shouldn't be afraid that they're going to end up homeless because the government is implementing wildly out of control immigration policies and piss poor zoning and permitting that is wildly driving up the cost of living beyond what their non indexed to inflation welfare covers.
Conservative people were calling this abhorrent, that people will be euthanized by their aptly named health care system due to lack of aptly named welfare, killed to maintain cost efficiency, and were dismissed as religious loons who want to restrict the right to bodily autonomy because suicide is a sin by scaremongering. Hence fever dream. Well now, that fever dream is proven to be a reality and we risk losing the principle of bodily autonomy in the public consciousness as the public learns that doctors are offing people because they're homeless.
[0] https://www.cbc.ca/news/politics/immigration-housing-crisis-...
Focusing on immigration is convenient (riles up nativists and doesn't threaten entrenched interests), but it is not what is causing the housing crisis or inflation
Marc Miller is the current immigration Minister and you can see his comment on immigration in the video on that link.
I agree with you, but this is one of those things where you need a whole lot of the rest of society built to avoid the kinds of abuses this opens up. Think about things like labor laws - why do we restrict the conditions under which a competent adult can consent to work? Because the power imbalance in the labor market and the broader economy led to working conditions we considered abhorrent and a great many people were forced to work in them on fear of starvation. The posted article points to a similar dynamic - "fears of homelessness led people to euthanasia" is not a problem with euthanasia, it's a problem with homelessness. A doctor pressuring a patient to commit suicide so they don't stress the medical system isn't a problem with euthanasia, it's a problem with resourcing of the medical system.
Again, I'm strongly in favor of bodily autonomy, and I do think that people will do things with that we wish they wouldn't and that's none of our business, but we can't ignore the power and resource dynamics that affect people's lives. We need to also build a society in which we can be sure that people who are exercising that autonomy are doing so freely and without coercion.
In the usual case, the doctor is working on behalf of the patient and is optimizing for the best outcome for them.
In this case, the doctor is is potentially attempting to optimize for the system as a whole. Why should the doctor I'm paying for have the incentive to not care about the outcome for me?
Ofc the above discussion is about asymmetry of information and the structure of incentives. Let's also try another idea. What if professionals don't try to push you in any particular direction and instead just dump information on you?
Oh, you're getting sued? Here's some case law. But what should I do with this case law? Should I countersue? How should I defend? Well, maybe you want to do this, in the past some clients have done this, but some clients have also done something else. Whatever choice you make I'll support you all the way.
People pay for strong persuasion. In other words, people pay for the professional to take over decision making. If that's the case, then professional trust and the structure of incentives are the only factors left in play. If the professional tries to play with a light hand and just throws facts at people without putting their thumb on the scale, in some sense they're dumping some of their responsibility back onto the client.
And the condition can be poverty, loneliness, and other things for which solutions could be provided.
I had run into this: https://www.youtube.com/watch?v=cxqVaaBx3gg
That is a really, really poor justification. Your boss asking you for sexual favors, is also the "individuals decision". Pressuring people is a no-go.
For instance: 18 year old woman decides life is too hard and wants out, 30 year old person committing suicide because they lost their job, .. etc?
"Death on demand: has euthanasia gone too far?" - https://www.theguardian.com/news/2019/jan/18/death-on-demand...
"...In the past few years a small but influential group of academics and jurists have raised the alarm over what is generally referred to, a little archly, as the “slippery slope” – the idea that a measure introduced to provide relief to late-stage cancer patients has expanded to include people who might otherwise live for many years, from sufferers of diseases such as muscular dystrophy to sexagenarians with dementia and even mentally ill young people.."
Also was this common? What cultures endorsed and regularly practiced this?
> "Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. . . But I will keep pure and holy both my life and my art. . .
> Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I transgress it and forswear myself, may the opposite befall me."
What's more, euthanasia leads to all sorts of perverse incentives in the administration of medicine, as Canada's MAID experiment demonstrates. It simply isn’t the job of doctors to end lives. It is, in fact, the precise opposite of their jobs -- and I believe you'll find that most doctors are opposed to legalizing euthanasia.
Suffering can be alleviated, and it should be society's job to help patients -- the very word means "sufferers" -- seek care. Many drugs can be spectacularly effective. But today drug-seeking means that you'll be treated like a criminal, whereas there's no hurdle to MAID-seeking in Canada. A grim omen, that.
Lol. What world are you living in?
Sure, I suppose if you give someone enough downers and obliterate their mind, suffering becomes a non-issue.
Don't pretend this world can alleviate 'all suffering'. It's simply false.
Most of them, like nitrogen and helium gas, are not regulated. Besides, there are a hundred other ways that require no poisons at all.
> trying to give the state control over others bodies
Yet it's only proponents of euthanasia who demand state sanction. There's something extremely infantile and undignified about this.
> most doctors these days take severely modified oaths mostly to uphold current profesional practices and ethics.
So much the worse, it seems.
A machine that fed the drugs in sequence wouldn't be complex but the IV line takes some skill.
So, I'm supposed to take you seriously? Some words in an oath mean one of my family members has to go insane and claw at himself until he bleeds because his brain has been destroyed by alzheimers? That's "pure and holy" to you?
The Hippocratic Oath is from between the fifth and third centuries BC, and its relevance has long since been superseded by modern ethical guidelines.
> Suffering can be alleviated, and it should be society's job to help patients
There is a lot of horrible suffering that can not be alleviated unless the doctor induces a coma and keeps the patient in a state of more or less total unconsciousness for weeks or months until death inevitably occurs. I agree we should help patients as much as possible, but there's a line where perhaps the only help we can give, and the only help the patient asks for, is a painless exit. Perhaps future drugs and treatments will eliminate the need for euthanasia, but we are not there yet.
As an idea, it has the same starting point, not a privileged one, IMO.
Sometimes.
I somewhat knew someone who committed suicide by dehydration. She understood the situation: broken hip, she wasn't going to live long enough to ever do anything more than lay in bed. She chose not to. Sure, the broken hip could have been treated but it wasn't even hurting her. The immobility was too much.
And I watched my father die of cancer. There was a period where he could be lucid and in pain, or comfortable but out of it. And then there was a period where he had no ability to make memories--if it wasn't in front of him it didn't happen. And in the end it took his remaining kidney function. We know there was a problem but he was too out of it to explain his distress.
And note that suffering can take forms other than pain.
Fundamentally, most slow forms of dying that don't take your mind will make life quite unpleasant before they kill you.
Isn't this just chemotherapy? It seems like we already break the Hippocratic Oath quite regularly and many people are glad we do!
In truth, "the dose makes the poison," as has been known since even before Paracelsus' time. In chemotherapy, strong and destructive drugs are indeed administered, but the aim is never to kill the patient, but instead to buy that patient -- otherwise facing an incurable and invariably fatal disease -- more time. In some cases, to cure that patient or send them into a long-lasting remission. This is not "poisoning" the patient. It is just the opposite; it is therapy with an eye towards lengthening the life of that patient.
Strychnine can be a poison or it can be a tonic. If you take 1mg, it'll improve your athletic performance. If you take 100mg, you'll probably die.
Acetaminophen is totally harmless in very small doses -- it's given to infants every day. Take too much, however, and it'll kill you. In adults, it's responsible for nearly half of all cases of acute liver failure in the US, and hundreds of deaths annually. Is it a poison?
I could go on all day. Almost every drug can be a "poison," and, at the same time, only very strong toxins with zero therapeutic window are inherently poisons. In the context of medicine, whether or not something is a poison hinges on the drug, the dose of that drug, its expected therapeutic effect (which is basically statistical), and the condition of the patient.
In cancer, where the condition of the patient is very unfortunate indeed, sometimes only very strong drugs with powerful side effects can provide any hope of eventual relief. Surely you see...
> What is the intent of the oath, if it's literal meaning is different from the intent?
...That the intent is to hopefully provide that relief.
> What does it mean to not poison people?
...That offering something that might cure or abate the patient's underlying condition is the very opposite of poisoning them.
Plus, how does that answer my other question? You say the Hippocratic oath's true meaning is that a doctor must provide relief, right? What is a greater relief then death? Or less flippantly, who gets to decide what relief is, if not the patient? And if they do, can't they decide death is a relief? I'm just unclear on how your quote from the oath makes it clear that euthanasia violates it.
Medicine has a therapeutic window that's context-dependent. Part of the doctor's job, which is why they make real money and have relatively high social status, is determining the right course of treatment from that context. To cure -- not to harm, not to kill. If a cure is impossible, to comfort.
> What is a greater relief then death? Or less flippantly, who gets to decide what relief is, if not the patient?
Patients have every right to refuse treatment. They can also end their own lives; nothing could be simpler. What's perverse is forcing the medical establishment -- in view of its other responsibilities, duties, and oaths -- to act as executioner. It disgraces everybody involved. The doctor ends up dishonored, the state itself is shamed, the human dignity of the patient is, frankly, severely reduced.
You believe incorrectly. Polls consistently show that a majority of physicians support physician assisted suicide.
See: https://compassionandchoices.org/resource/polling-medical-ai...
Canada is a country that is rich in every single resource from wood to metals, to hydrocarbons, wheat, meat, fruit... the list goes on and on and on.
It is a disgrace and a fundamental failure of our society if people feel forced to take MAID to avoid dying on the street from exposure or starvation.
I have a taxi driver cousin back in South America, wife but no kids. Want to take him in? He wants to emigrate. You could help him set up and such. You can dm me vyour phone number if necessary.
Why is anyone surprised? Did the people who planned out this program never visit a psych ward? They're chock full of homeless people in varying degrees of "I'd rather die than go back to the streets/shelter". Sad but it's how it is.
Hospitals occasionally have angel of death doctors and nurses. Should we get rid of hospitals? There’s consistently a lack of any hard quantitative data about the harm the program causes but there are for the benefits. So for critics what’s left are anecdotal stories some of which are true some of which aren’t.
> In another case, the family of Alan Nichols said he died by euthanasia, with hearing loss listed as the sole criterion. The family reported it to police and health authorities- but neither saw cause to investigate further. The RCMP told the family that Nichols “met the criteria” for assisted death.
> But physicians who provide Maid caution that anecdotes of Canadians slipping through the cracks often ignore other critical details of their respective cases, which must include a “grievous and irremediable medical condition” and do not necessarily suggest a failure in the system.
It’s important to remember that the families of people who die will still look for someone to blame. It’s a very human reaction. I know someone who blames the doctor for causing or accelerating her husband’s terminal cancer diagnosis as well as blaming him for telling the husband he had a terminal diagnosis in the first place (i.e. sapped his energy and strength).
That’s not to say that there shouldn’t be adjustments to the program. But driving it through anecdotes instead of expertise and data is the wrong balance to strike.
https://www.theguardian.com/world/2024/feb/25/canada-assiste...
You really want anecdotes in this case because they point to a system that is just getting rid of people for the wrong reasons. That's called insights.
But OK. So let’s presume we have anecdotes that show mistakes made in the program. Do we get rid of it? Hospitals and doctors and insurance companies make deadly mistakes too. Get rid of those as well? And what about the anecdotes of people who were greatly positively helped by euthanasia. Do we ignore their anecdotes? How do we weigh their anecdotes against the anecdotes of problems?
I may be thick but I’m failing to find the insights you’re claiming are there.
I must admit that people here tend to be against the death penalty but when it comes to killing people in difficult situations suddenly we need to be super flexible and innocents be damned
It’s worrying that you’re equating the death penalty and suicide when they’re very different things. Assisted suicide involves action by the person to end their life while the death penalty is the government taking that action. Very very very different things.
Even more worryingly that you’re outright discounting people killed by the death penalty as not innocent. Ignoring the obvious racial problems with black people being more likely to be sentenced that way since I don’t want to argue about sentencing disparity, the innocence project lets us estimate a lower bound on the amount of innocent people that had been killed before the invention of DNA (and even today after it’s part of the normal course of things). That number by the way I believe (but could be wrong) is higher by volume and percentage than the number of problematic deaths in assisted suicide. Care to rethink your priors about death penalty vs assisted suicide?
This is akin to "think of the children" excuse used to censor the web. But this time it actually kills people.
As for incentives, the estimate is that MAID reduces annual spending by ~100 million. The government spends 300B a year on healthcare. You’re not going to get out of this by killing your patients, not to mention that you need productive members in your economy to create a tax base in the first place. I think you have an incorrect analysis of the incentives at play here.
Without assisted suicide being requested, those people will just be overlooked & ignored.
Instead of removing assisted suicide programs, we should consider them to be a societal feedback system regarding society's greatest failures.
I knew that this obviously came with risks, old people being pressured into it to ease the burden on, or speed inheritance for their children, people being pressured to take pressure off the medical system, etc. But I believed that trying to manage these risks was well worth the outcome that people might be able to die with a shred of dignity intact.
I have to say that the Canadian experience has made me wonder whether I was wrong. Not in a strong rhetorical sense, but it has given me more doubt than I've ever entertained before. Are we socially or systemically incapable of managing those risks given a certain institutional configuration? I don't know. Happy for people to provide counter evidence for me if they like. I really don't know what to think about this anymore.
Empirically, Canada says "yes".
There are other reasons (philosophical, moral, religious) that will also speak to the folly of what Canada and Belgium are leading the way towards, but we are not to speak of those things any more - so we're left with the "what if we try it and don't like it - can't we just roll it back?" of the early years of another "forward-looking" society from the recent past.
I had always dismissed the "slippery slope" argument as being made in bad faith, but Canada seems to have given us an existence proof that a seemingly well-intentioned system can quickly start producing very bad outcomes.
All through my life, I've been milked by way of taxes--and I'm OK with it. I've had a decent life; I've tried to actively minimize the damage I cause thanks to my existence. So, when the time comes (and I decide when it is), I don't want to be left begging for relief. I want to go in peace and with some dignity. I absolutely don't want to resort to violent methods or leave a mess for others to clean up.
So, my ask is that a method is made available. If I need to sign up in advance--when I'm deemed to be of sound mind and body--so be it. But I need a way. I deserve it. This is not negotiable.
Some related links:
* https://www.imdb.com/title/tt1132623/
* https://en.wikipedia.org/wiki/Jack_Kevorkian (I know he's a controversial figure)
I think that this gene therapy should be given to patients instead!
"A few" is doing some serious heavy lifting here
Most deaths aren't pleasant nor peaceful. And modern medicine can keep your body alive for a long, long while as you survive in pain even when there's no chance of things ever getting better
Does not bode well for a generation of people hunched over their desks leading sedentary lifestyles.
To just focus on avoiding suffering instead of striving to live is not consistent with the attitude that is conducive to the flourishing of life and the advancement of civilization. It is precisely humanity raging against the light — the endless quest for survival and flourishing — that has driven humanity thus far and that will always drive life in general. The assisted suicide philosophy, if you want to call it that, is fundamentally a deviation from the civilizational and biological imperative.
All of this being said, a free society is one where people own their own body, meaning have a right to destroy themselves, with any drug or dangerous behavior, and to even commit suicide. So I cannot see an argument for prohibiting suicide or the provision of assistance in committing it. What's peculiar about countries that have legalized assisted suicide is the bevy of laws they impose to protect people from much milder forms of self-harm, like consumer protection laws that protect people from their own bad consumer decisions. You're not allowed to buy raw milk, but you can get a doctor's assistance in ending your life due to depression!
As I see it suicide should only be considered when the expected average future quality of life is negative. For the sake of argument let's consider a healthy person to have a quality of life of 100. A dead person inherently has a quality of life of zero.
Health problems and disabilities lower quality of life. The fact that anyone chooses suicide implicitly is saying that their perception of quality of life (and it has to be their perception, everyone has their own yardstick) has gone negative.
It's not just whether it's *currently* negative, but what is the sum of future expected quality of life?
Let's take a patient who considers their quality of life to be -10, with an expected lifespan of a year. I'll take the unit as days, so they have a total expected quality of -3650. I'll be generous and figure a miraculous save occurs 1 in every 100,000 cases and that a save returns them to full health (very unlikely) and gives them another 20 years (again, unlikely--people typically have other processes at work that would in time kill them.) Total expected quality is 730,000.
100,000 people. One is +730,000, for a total gain of 730,000 99,999 are -3650, for a total loss of 364,996,350
Clearly, hoping for the miraculous save increases suffering.