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Comment by cannonpr | Hacker News Reader

The reality of our society is that many will meet their end alone and in poverty. Is it so different from parts of our history, where the old chose to take a long walk into the wilderness before the indignity of what follows? I’m not sure. We like to pretend our society is much richer and more capable than it is—that we can take care of everyone. Maybe we can, but I have my doubts. In cases where we fail, I think we should at least allow people the dignity of choosing their own exit. I don’t think it makes much difference whether their suffering comes from a disease of their body or a disease of society. In the short term, both can be inevitable and excruciating.

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It fundamentally contravenes the Hippocratic Oath:

> "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.

> It fundamentally contravenes the Hippocratic Oath

The Hippocratic Oath is from between the fifth and third centuries BC, and its relevance has long since been superseded by modern ethical guidelines.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.

“It’s old” is really not sufficient justification for “we know better now”. That kind of thinking led to some very dark places in the late 19th and early 20th centuries.

Neither is tradition a reason that it should be elevated above current thinking.

As an idea, it has the same starting point, not a privileged one, IMO.

If that’s true, GP should justify it on its merits instead of on “actually that’s really old”.

They probably should have done that by saying something like "its relevance has long since been superseded by modern ethical guidelines."

> Suffering can be alleviated

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.

So stop regulating the poisons and allow access via a non doctor path, create a framework around it, trying to give the state control over others bodies has just as many negative externalities. Also please try to keep in mind that the original oath was created during a certain eras morality and philosophical leanings, most doctors these days take severely modified oaths mostly to uphold current profesional practices and ethics.

The heart of the Canadian approach isn't a poison at all. Everything they use is perfectly ordinary stuff you'll find in the hospital. But if you paralyze somebody without taking over breathing for them they'll die. It also requires an IV line.

A machine that fed the drugs in sequence wouldn't be complex but the IV line takes some skill.

> So stop regulating the poisons

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.

> I believe you'll find that most doctors are opposed to legalizing euthanasia

You believe incorrectly. Polls consistently show that a majority of physicians support physician assisted suicide.

See: https://compassionandchoices.org/resource/polling-medical-ai...

> Suffering can be alleviated

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.

"Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course"

Isn't this just chemotherapy? It seems like we already break the Hippocratic Oath quite regularly and many people are glad we do!

"Chemotherapy = Poison" is a meme.

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.

In that case then, what is a poison? What is the intent of the oath, if it's literal meaning is different from the intent? What does it mean to not poison people? It can't strictly be "you must never do anything that shortens people's lives" because then hospice care would be unethical.

Did you miss the point I made in my previous post?

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.

I understand that, but you see how that "intending to provide relief" is very very different from the original statement of "Neither will I administer a poison to anybody when asked to do so", right? Sure, words and context and meaning can change, but this is a very significant change in meaning such that quoting the original statement without clarification is misleading.

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.

"Neither will I administer a poison to anybody when asked to do so" = "neither will I administer a substance I know to be deleterious or harmful to life." The very first definition of "poison" in the OED is: "Material that causes illness or death when introduced into or absorbed by a living organism."

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.

"Pure and holy"

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?

It is so very different from parts of our history because we live in a part of the world where there is no good reason why anyone should die of starvation or homelessness.

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.

> 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.

What does this have to do with homelessness and MAID in Canada?

How is a long walk in the woods not exactly 'meet their end alone and in poverty', given the shame that must motivate that?

Also was this common? What cultures endorsed and regularly practiced this?

Dehydration, exposure, and animals will take you a lot faster than begging on the streets and trying to cling on to life or becoming a burden to your village. As far as historical examples just study Inuit, Greek, Japanese, Norwegian, or Scythian practices on the matter.

True - we might also learn something from the Greek practice of exposure of infants and the Roman law regarding the rights of the pater familias. All three of them are examples of social failure to model the law of love in some manner.

Maybe we just try take the good and leave the bad when we borrow from previous societies?

It might teach you that reality is harsh and to face it.

We have some control over that. That's the essence of being human, IMHO.

Be careful because there's a lot of folk mythology on the subject that is pretty much entirely modern (specifically Romantic Nationalist) invention.

Getting killed by animals is an idiotically painful way to die

Given how widespread funeral rites are, I kind of doubt this practice is common.

Animals seem to sense when time has come. I imagine, hopefully, sometime in the future, I'm going to be able to walk out into that wilderness. I think the difference is, I would never ask or require someone else to accompany or assist me.

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