Daniel Kahneman opted for assisted suicide in Switzerland

During his final days, he became unresponsive, only sleeping. The doctors gave us the option of feeding him through a tube. We made the hard decision of not doing it. Gave him all the medicine to help his body heal, but no invasive procedures.

We stayed by his side for the next 5 days. Playing songs that he enjoyed. Audiobooks that he loved. And just taking care of him.

Finally, his breath became slower and slower until it stopped and he passed away. I had the opportunity of being beside him during his last breath.

The passing of loved ones is always difficult, but I am grateful for how he went. He lived a full life and was incredibly healthy until the end.

Without knowing, we decided on a sallekhana-like process for him. It was the right thing to do.

Thank you for showing me this.

[0] https://en.wikipedia.org/wiki/Thalaikoothal

> Pegasos, a non-profit based in Basel, Switzerland, believes that it is the human right of every rational adult of sound mind, regardless of state of health, to choose the manner and timing of their death.

I found this bit "regardless of state" really interesting.

I wonder what their views would be for someone who wouldn't have a family and nothing much to do or explore after a certain age? Does it matter what nationality they are from? What if someone's reason is - they had savings and now they have run out of it and area already 55-60 or more and have no intention or plan to work anymore and don't want to go through the struggle of life? (Of course they would have had paid the euthanasia fees)

How does it all happen?

I don't think this is fair. I know several people who died with Alzheimer's and although their final years were very difficult for them nobody has a bad opinion of them. It's certainly a strain on the family but intimating that if you have dementia you better kill yourself or your legacy will be ruined is not ok.

  As Barbara Tversky, who is an emerita professor of psychology at Stanford University, wrote in an online essay shortly after [Kahneman's] death, their last days in Paris had been magical...

  One afternoon, according to her online essay, she asked what [Kahneman] would like to do. "I want to learn something," he said.

  Kahneman knew the psychological importance of happy endings. In repeated experiments, he had demonstrated what he called the peak-end rule: Whether we remember an experience as pleasurable or painful doesn't depend on how long it felt good or bad, but rather on the peak and ending intensity of those emotions. "It was a matter of some consternation to Danny's friends and family that he seemed."

But my personal anecdata puts that man in a minority. None of my older relatives with Alzheimer’s have become aggressive or troublesome. Worry, anxiety and confusion seem to be much more common states of mind, which admittedly also doesn’t seem like such a fun way to spend your days.

As we're currently seeing happen: whatever is left unsaid in the body of the law can and will be abused by evil people to concentrate more power (even if the spirit of the law advocates for something kind).

So, we have to normalize some sort of stress tests for laws... because you sure don't want to be dragged against your will because you're poor.

This seems like such an absurd conclusion to this, as though the opinions of other people of you are what matter when you functionally lose your personhood and then die.

Maybe a better focus would be that there often isn't a good way for a community to manage a person who suddenly becomes irrational because of an illness.

I completely agree that the disease is horrible, but your conclusion is bizarre. When you are in that condition, how anyone views you is the least of your worries.

Folks I know who have passed on also wanted to be remembered when they were strong, not when they were ill.

You even literally show that he isn't solely remembered for those last 3 years of his life. We owe people like that care and understanding, not murder framed as mercy.

It's always so painful to see old people around who are clearly living alone, forced to do everything themselves, having to ask strangers for help because they're afraid of being a burden, and their actual children can't find time for them. Only to now see people actually supporting murder because old people become a burden for a couple of years near the end of their life.

If you apply at scale the same logic with more sensibility you will also be able to rationalize a genocide because someone felt bad about something.

What defines demonic inspiration?

And here I don't say "demonic" metaphysically but philosophically.

I find the people who remember him as this guy somewhat contemptible though, so I guess my theory would be he wasn't remembered badly by anyone whose opinion mattered.

But on the other hand I guess that's the way the world works.

I disagree it’s up to you to conclude it would have been better if he had been killed 3 years earlier (which you imply).

In general you don’t have the right to such a statement.

Now, if you were discussing _your own_ condition this would be a totally valid consideration IMHO. But you (almost) _never_ have the right to conclude from someone elses part when it’s their time to go.

Assisted suicide is a humane option but ”I hope he had died with some dignity years ago instead of pissing everyone off” tarnishes the entire concept and is exactly the type of argument which stops assisted suecide becoming a more widely accepted option.

That's just as much failure of everybody as it is of him. This was dementia speaking and society needs to learn that.

You wouldn't tell somebody with a broken leg to get it together and it's just their personality that they can't walk. Nor should you treat dementia like that. Yes, people seem to shift personalities and anger others. But those others need to understand that it's a medical condition, an untreatable and fatal one, so should have even more sympathy than with somebody who broke a leg (cause that will likely just be temporary). Not alienate the person and speak ill of them.

I’ve never been close to anyone who had dementia. My grandparents on both sides died with their mental facilities in tact and my parents who are 83 and 81 are independent and just as of 6 months ago passed a cognitive test. I can imagine if they started acting out of character and being mean to me or forgot who I was that I would be hurt, overwhelmed etc. But not pissed.

The real issue is our broken systems for handling dementia and underfunded homes, overworked staff, no real community nets. Fixing that honors the full life someone led, instead of saying their value drops when they need help. Assisted suicide opens doors to abuse, like pressuring people who feel like burdens.

We owe better to people like your teacher.

I've really thought about this a lot after seeing a number of family members and friend's family members go through dementia, and it seems like it can go two ways: like this, which is how it went with my grandmother (whose hoarding behavior increased aggressively, and she started slapping people), or how it went with my grandfather on the other side (he became quieter and quieter, watched tv every day while understanding less and less of it, and when you caught his eye would repeat how much he loved you and how much seeing you "made an old man feel good.")

It has something to do with how you feel about the nature of people in general, and whether you feel they are all suspicious and possibly conspiring against you, or that you think they are basically good and want the best for you. When you have all of your mind, you can beat the demons or the angels back with your reasoning enough to have the personality that you want. My grandmother was very loving, and my grandfather was very shrewd and practical. But when that higher function can't regulate you, what shows is if you were someone who taught yourself how to see the good in people, or someone who taught yourself how to see the bad in people.

I suspect I'll end up like my grandfather, as much as I think of myself as like my grandmother. Deep down, I've always been crippled by the feeling that everyone is a wonderful person. My aggression and judgemental nature on a lot of things can really, embarrassingly, be interpreted as me looking for excuses for everyone's behavior.

At some point everything indirectly leads to euthanasia and society is not built for that at all. Everything you do might or might not lead to someone's euthanasia, which means you are liable for their death.

Let's say we can predict school shooters before they shoot and give them an euthanasia to save lives. If bullying or encouragement causes someone to start shooting up a school, then the latent shooter will die before they do their shooting, but it also means that the instigator is a murderer themselves, because in the absence of instigation, no crime would be committed and no euthanasia would be necessary.

Since it is probably not possible to assign liability of a euthanasia to a single individual, because multiple people contributed to the outcome, the liability will be shared. Ten people being involved means each has committed 10% of a murder, meaning that they should receive 10% of a life sentence. Are you ready to serve a cumulative year in prison spread throughout your life to account for indirectly causing euthanasia?

Note that this problem isn't necessarily unique to euthanasia. The problem applies to any cure all solution. (Think of series like "Common Side Effects")

If you punch someone's face in, but cure it with a blue mushroom, was it really a crime, since their face is intact? And yet, more punching happens as a result of the existence of the panacea, which is why there needs to be a punishment for making someone dependent on the panacea.

I am pro assisted suicide. Not sure about Switzerland but some countries allows it for young people with mental health problems. That I can't accept that.

That's the part that doesn't matter at all. Your life isn't contingent on others having a specific view of you - the rest of the world can, for lack of better words, go fuck themselves.

What matters is if you want to live a life where you can't drive a car, you might poison yourself with your cooking, you lose your mental facilities, etc. That is the relevant choice here.

It sucks. It's so easy to forget who they were before the disease. This is them now and it's hard as hell.

Simple things that take 1-step for us take 50+ steps for her. She doesn't readily communicate that she's hungry or thirsty or needs to use the bathroom, we have to constantly ask. She's always exhausted and walking around in circles but reacts aggressively to most suggestions to go to bed or take a nap (no matter how we word it). She can't focus for more than a few seconds, so she has no hobbies to occupy her time, and even the TV loses her interest after a minute at most. Her speech is one unbroken babble, and she gets annoyed if someone starts a conversation near her but doesn't let her interject.

Not sure how much more my dad and I have left in us. The disease stripped everything from her and it's stripping everything from us. In-home care is the likely course but she hates all strangers and is always paranoid about anyone other than us being in the house. There's no good solution.

Tell your parents you love them.

Think about what is happening from his point of view. The condition has fundamentally changed his perception of reality. You are trying to tell him that this perfectly cooked chicken is pink all-over when it clearly isn't. Everyone else has gone mad and he doesn't know why.

Yes, the sixty-fifth worst thing about degenerative brain disease. Good observation.

*no data though, just observing my village

I just could not digest it. I understood the words but I couldn't make whatever message he was trying to convey... it felt too "dense" for me. Maybe im just stupid, but I could not get past I think the first two chapters.

A later analysis[55] made a bolder claim that, despite Kahneman's previous contributions to the field of decision making, most of the book's ideas are based on 'scientific literature with shaky foundations'. A general lack of replication in the empirical studies cited in the book was given as a justification.

Where? This is a thing which always pops up in these debates because it is a deep-rooted fear, but are there countries where this is a thing?

That’s my biggest concern about assisted suicide for an otherwise healthy person who just wants to avoid the inevitable decline (as in this case). There is a direct financial incentive for families to push people into this.

The only way I can see to remove that would be to require that your estate can’t go to anyone who potentially has influence over you in the case of assisted suicide for with no terminal illness.

I had a friend that decided to stop treatment (dialysis), when he realized that he'd never get off it (he couldn't get a transplant). He was in his late 60s.

It was both a sad, and joyous experience. He took about a month to pass (renal failure). He was Catholic, and wouldn't do assisted suicide.

During that month, a bunch of us would go over to his house, almost on a daily basis, and we'd just hang out. It was actually a great experience.

I don’t do it, but I’m not sure how that solves the problem of other people doing it.

Imagine you're poor, your family is poor, and your friends are poor too. You spend 2 years in and out of inpatient care, and then die. Your family is now saddled with a debt they will never be able to pay. Your medical bills could make them homeless. Now imagine choosing between that, and MAID. MAID is obviously a cheaper "out."

Now remember the demographics of poor people in this country. If poor people end up being more likely to choose MAID, that necessarily means MAID would be used disproportionately on ethnic minorities and disabled people. So you end up with eugenics again, just because of the sorry state of our medical system and class demographics.

Not all assisted suicide is eugenics, to be clear. There's a discussion of Jain practices elsewhere in this comment tree.

But man did I lose sleep at the thought that we could have people volunteering to kill themselves solely because they're poor. You could argue that it's wrong not to give someone the choice to die sooner, given that dying later could cause so much strife for their family. But I hold that the right solution isn't making people die sooner, it's building a medical system where people never have to grapple with this choice in the first place.

And did you just go to eating more fibre from euthanasia in the same few sentences? :D

In Germany, it was illegal for doctors to recommend or advertise abortion, and that worked pretty well. You could do the same for assisted suicide.

^ Yes, it's "illegal" but it's effectively nulled if the means to it are made legal.

1. Administer the medication yourself

2. Be of "sane" mind at the time you do it.

3. Have a doctor certify that at the time you choose to do it, you are in unbearable pain/suffering, and there is no realistic relief from it.

This rules out dementia (especially item 2). So people here who are in early stages of Alzheimers go to Switzerland as well.

> It is difficult to reconcile that citizens may have the right to do almost anything to and with their own bodies– from participating in extreme sports to having elective plastic surgery– yet a terminal patient cannot choose to avoid experiencing additional months of discomfort or loss of dignity in their final months of life.

Counter-anecdote, my partners Granddad is 93. Age 90, we said the same as you. Now he's an old, rude, obnoxious liability - he's still great, and I don't hold it against him, he's earned the right. But I've never known anyone naturally age and die without losing their ability to be civil in some way towards the end.

From the article:

> Kahneman knew that many would see his decision as premature. But that was exactly what he intended, he wrote: If you wait until a life is "obviously no longer worth living", it is already too late.

I personally wish my partners final memories of her Granddad were him at 90, and not at 93. I've known for a good 5 - 10 years I will take the same route as Kahneman. I feel the desire to stay alive long enough to be a liability for yourself and those around you is a decision motivated by ego and fear, rather than compassion or logic.

> It’s relatively common for families to push people into nursing homes,

So you are rejected by your family and punished even more by taking away a dignified exit strategy?

She couldn't look after herself was was forced into care by the courts. Since going into a home she's physically never been fitter, but mentally she's not the person she was 10 years ago -- it's not that she's changed personality, it's as if her memory of the last 80 years was wiped.

There is no financial incentive. No-one is making any money from assisted suicide in Switzerland.

The instinct for self preservation is strong. Knowing what will come requires foresight and clarity. You may lose the capacity for informed decision making before the point where it's clear that there's not much to live for.

Many of us lack the insight that Kahneman perhaps had that in order to take control of the end you may need to leave some good days on the table.

You can get into a state of living death where the brain is mush and who you were is completely destroyed. That's hell for the family.

I saw my grandmother forget her daughter (my mother) it was heartbreaking. Seeing my mom realize her mom forgot everything about their life together was just painful.

It was just a sad existence to observe as well. Grandma lived for quiet a while with dementia and spent years trying to return to her childhood home. We'd constantly have to trick her into accepting help from us "strangers". Re-convincing her to come inside that these "strangers" wouldn't mind having her for a bit. Watching her read over the same page of a book for hours on end.

That's not an existence I want for myself or my family.

Of course, even if you lack legal permission, suicide doesn't strictly _require_ legal or medical assistance. An autonomous exit is always an option, though generally less painless than assisted.

And mentioning the cost of end-of-life care is risible when your alternative is paying paying indefinite rent to a company for freezer space to keep a corpse frozen.

Euthanasia has some strict rules in Belgium, especially for cases involving psychological suffering. In 2014, the age restriction was dropped (except for psychological suffering). Since then, 6 minors have received euthanasia.

> If you wait until a life is "obviously no longer worth living", it is already too late —- Kahneman

Live your life in a way that it is worth living until you no longer can, I suppose. To exist is hard, do your best.

I “retired my wife” at 46 in 2020, eight years into our marriage so she could enjoy her passion projects and I have turned down more lucrative jobs that would have required me to work harder and be in an office so I could work remotely from anywhere - but realistically in US time zones.

Everyone who knows me, knows that I would die with no regrets. As far as my wife who loves me and my grown (step)kids who I know also love me, I don’t owe physical suffering to anyone. Assisted suicide because of Alzheimer’s is more tricky than something like cancer though. What can you do? Sign something in advance where once you can’t pass a cognitive test three months in a row - kill you?

He kept to himself, so I didn't know him well. I did know that he was an independent and thoughtful man who hated that his tremor got so bad he couldn't feed himself. I remember talking with his family about if those self-balancing Google spoons might help.

There are two kinds of people for whom suicide sounds appealing: those in poor health who don't want to experience it getting poorer, and those for whom the difficulty of being alive outweighs the joy of it. If you're in the former camp, that pain is coming for them anyway. If you're in the latter camp and still make the decision, maybe you don't have those close bonds that make you want to persevere.

Many/most of the nursing staff are Filipino and strongly Roman Catholic.

As she lay dying and unable to speak, one of the nurses undertook to convert her at this last minute to their religion. At night, alone, after all visitors had left, she would come into mum's room and press mum, a very committed atheist, to pray for her salvation.

It's hard to describe how vulnerable someone is who is stuck in their bed and dependant on the nursing team for everything, even sips of water.

I will say this was not representative of her care, but it opened my eyes to the lengths religious believers will go to to push their views on others.

For physical illnesses.

It's less likely to be "a certain age" and more surrounding factors: if most of your friends have passed and you don't have much chance to do things that interest you because you could pass at any moment yourself there comes a point where life has limited worth.

Essentially, hope runs out, and when it's run out entirely you either wait for death, or ... don't wait.

> It's fascinating that even for very ill or injured people the will to survive is so strong

Sometimes. Chronic illnesses are a massive contributing factor to suicide rates for instance: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7...

I want every second. Even if it’s painful.

I am still alive.

You didn't mention Belgium so I'm pleased to hear that Belgium is doing well according to you (4000 cases of euthanasia per year of which 80 are for psychological suffering, 1 child per year).

Ironic is the opposite of what you mean, don't you think? By your explanation, Kahneman acted according to his life's work.

> The guy who spent his life researching how to live rationally chooses suicide at age 90, upon seeing “increasing metal lapses”, presumably in order to not ever live irrationally.

That was possibly part of his motivation. But also the pain, suffering (goes broader than physical pain), confusion, and cost -- to him and his family.