quetzlbazaar

Regarding 3., the reason it is being ignored is because it may dampen uptake of the vaccine by people who had already had and recovered from COVID. You probably were already aware this was a reason but just to clarify and in case. It's probable that being vaccinated can improve on your natural immunity[1], though since natural immunity can be comparable to or better than immunity from vaccination, it shouldn't be considered necessary in my opinion. At least in Israel, their Health Ministry is recommending people who have already had COVID need only get one dose, as a compromise.[2]

[1]: https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v...

[2]: https://www.haaretz.com/israel-news/israeli-study-recovered-...

I am not vaccinated either so playing Devil's advocate. I have not seen anything convincing regarding a risk of ADE for the vaccines as they are used in production. As far as I can tell, ADE could potentially happen for your natural antibodies as well.

Also, although the vaccine was "rushed to market" relative to the normal process, perhaps the normal process for approving vaccines was overly slow? Maybe as a society we are too conservative in general with things like vaccine approval, and in fact (if you take that these vaccines aren't particularly unsafe which you may not) we were wrong before and the process for how these new COVID vaccines were approved is closer to the "right" speed.

The widespread vaccination as is happening in the West specifically targeted against the spike protein will lead to an evolutionary pressure on the coronavirus to mutate its spike protein. I think all things considered though this is just something we can accept. As the mRNA vaccines were much more suited to quick, mass production it made sense to use them and they are effective at stopping people getting seriously ill.

I am not vaccinated. Firstly, I think it is great that effective vaccines have been able to get to market so quickly and in general lean towards the view that regulators and society in general is too conservative with this sort of thing. I support even things like businesses and other entities being able to require vaccine or health passports, if they really want to and think it's sensible. Necessarily, I believe I do not need it or that it wouldn't be all that beneficial to me, otherwise I would be getting the vaccine regardless of any other reason I don't want to be getting it. As someone under the age of 30 in relatively good health who has already been exposed to the virus, I believe I can selfishly get away with not getting it, even though getting vaccinated can improve your immunity somewhat even if you already have decent natural immunity to from a prior infection, as I understand it. I do strongly believe that the risk of COVID in general to my demographic (and to me as an individual) has been overstated by governments and scientific bodies, and deliberately so in some cases.

Primarily though, the reason is that I do not agree with the general politics around COVID in Western societies - lockdowns, performative hygiene theatre, a trend towards authoritarianism, some extremely severe dishonesty and politicking on the part of institutions I might have (mistakenly) respected before like the World Health Organization, and most of all the suppression of and hatred towards those who express any serious dissent from whatever the party line may be on COVID at any given time, which, of course, changes and even reverses. There is no real way to vote against all this, it is very hard to politically organize against it. Where I live all the major political parties support most if not all of the measures. Debate is only around degree and alternatives cannot be considered. It is a taboo and also a class marker to disagree strongly with any of it.

I think many people are aware that there are things that the government and other bodies have lied about and gotten away with, that we have had to go along with over the course of this pandemic, but accept that it is or was for a "greater good". There is a distinction in my mind between being passively complicit in something you don't agree with, and actively collaborating with it. If I go and get a vaccine, that I (perhaps mistakenly?) believe I don't need and don't want, because the government and the media whom I don't trust and everyone knows do lie from time to time, are propagandizing me and my peers to, using emotional manipulation, and even subtly and not so subtly threatening to restrict my freedoms if I do not get it, then - what am I doing? Personally I'm not much more scared of COVID than I am of a plane I take being hijacked. There is a bigger picture here in terms of how society is trending that needs to be slowed down at all costs, I am willing to put my money where my mouth is and take a small risk here. It should not in my opinion be acceptable at all for governments to act like how most have with regards to COVID. I want to be able to make my own choice and have the right to not go along with and submit to the theatre of this new, dark power structure which has swept over the world. On a level deep down, I believe people know getting this vaccine is not entirely a free choice, from a political perspective. There are political and social consequences to not getting it, orthogonal to how safe, effective or beneficial it might be.

The vaccines per se are not an issue. They could be 100% safe and 100% effective and I would still be reluctant to get them. I may get the vaccine at some point in the future, but the only reason would be something like if the nature of COVID changed such that I didn't think immunity from my prior infection was sufficient, or more likely out of a sense of political self-preservation if unvaccinated become scapegoats or targets, which they are now to an extent.

It means anything which violates the social norms and laws that undergird a society, one of which is suicide. Another might be illicit drug use, including psychedelics. Any solution or help a state-linked therapist provides must necessarily steer away, if necessary by force, from anything that involves these. This even may be if something like psychedelics could help the individual, although psychedelics are likely to become legal in the future for this purpose. Suicide in most jurisdictions is entirely illegal not excepting euthanasia and in such jurisdictions, a therapist engaging with a rational terminally ill person as you describe would not be allowed in an official capacity to have an honest discussion about euthanasia as an option for their situation.

> There is no strong evidence that suicidal people have a genuinely held belief that they wish to stop living, as opposed to a psychiatric episode that once passed does not reflect their actual world view.

I would argue that there is an overwhelming amount of evidence that suicidal people have a genuine held belief that they wish to stop living, in the form of genuine and sometimes successful suicide attempts. To redescribe it as a "psychiatric episode that once passed does not reflect their actual world view" is to simply negate the validity of the belief by viewing it through a medical rubric which affirms suicidality as something pathological. This is a value judgement. Compound with the complication that, as described through the comments on this post, any discussion of intent towards suicide can have severe consequences and therefore suicidal people will necessarily be coerced into denying their true beliefs of things, and must acknowledge the consensus view that their desire to kill themselves was in fact not "a genuine beliefe". That they may come at some point (possibly much later on) to have genuinely changed their mind not to kill themselves or to have kill themselves may be great but does not invalidate their previous belief at the time they were suicidal.

For comparison, imagine a society in which intent towards abortion was viewed as a pathological state of mind, and any talk towards such was met by extreme force from the state similar to that which it is for suicide, to wit: forced imprisonment, pharmaceutical intervention and koshing of a person until they no longer expressed (openly) a desire to have an abortion. A statement like "There is no strong evidence that these women have a genuinely held belief that they wish to not have their baby, as opposed to a psychiatric episode that once passed does not reflect their actual world view." may sound valid to people living under such a value system but we might recognise something more going on here.

I would agree, hence the offensiveness of suicide to society in the large.

One option might be to not require a medical cause for assisted suicide. Instead it could be something that people have an absolute right to do for any reason or none, though I do not think most societies would be comfortable with that. Perhaps heavy due process similar to that required in many jurisdictions for a woman wanting to carry out an abortion could be required.

The epithet of "chemical lobotomies" for antipsychotics is an appropriate analogy not just for the physical effects but also for the potential political uses.

It makes sense when you consider that the therapist is there to help you but only in a way that does not challenge society. You are right to not feel completely safe to discuss it, unfortunately. I'm not sure why this taboo has evolved to be so strong, though I would guess it runs very deep psychologically in peoples' fear of death and also has something to do with the potential societal implications to any culture which does not treat it as something to be dealt with with extreme prejudice.

People did not live as long and would die of some cause such as illness long before they got to the age where they would develop things like dementia. Our situation with many people living to an advanced old age, an exceeding number by historical standards, is more recent (past 100 years or so).

You're right, it is not really a solution specifically to this problem, 'alternative' would have been better a better choice of words. Certainly I think it would be a good thing if people had the option of dying, even if they also had the option of going to a good care home - if only on the basis that dementia in and of itself may not be something an individual wants to experience even in the case where they are receiving good care.

We can think of care homes as like suppliers in a captive market, and we are the consumers - but it is even worse that a captive market in the sense that at least in a captive market you have the option not to buy, whereas we will be forced to. The existence of assisted dying as an option may even economically incentivize the care industry to improve.

Yes, it's unfortunate. The taboos (cultural or otherwise) and personal hang ups that people have surrounding death and dying prevent people from acting before it's too late. Ideally very-old-age/death planning would become as normal and culturally acceptable as planning your retirement and pension. The former is absolutely certain to happen but people will give almost all their thought to the latter.

I would definitely expect to read such an exposé and certainly there would be cases of people pressured into assisted suicide who otherwise would not want it. There is no good solution to this issue, in my mind. Some measures could be taken to prevent undue coercion like criminalizing those who did it but I'm not sure how it would work exactly.

Personally I think I would prefer euthanasia if I knew I was developing dementia and likely to end up in a care home similar to the one described in the article, or even one much better than that, so perhaps selfishly I would prefer a society where such is legal even though there would end up being abuses like you describe.

Suicide is offensive to society and many individuals on a deep level, especially of people who do not have a "good reason" (such as a terminal illness). While it may have progressed beyond being a criminal act, it is still taboo enough for alternative and equally good avenues to exist for society to deal with it, in this case, police and physicians empowered by law with the "duty of care" concept. This is of course better than suicidal intentions being dealt with as criminal, but not as good (in my opinion) as it being dealt with as something that someone has a right to do and therefore cannot have force used against them, but perhaps should be dissuaded from, maybe similarly to abortion.

I'm not aware of any that do not have horrible side effects. That is a value judgement I perhaps arrogantly think most people who have taken or been forced to take them (including myself) would agree with, maybe some people would not regard the side effects as all that bad. Certainly they can serve a good purpose and are a good tradeoff for many people who could not function as they'd like without them.

The issue is as you note in this instance, their use for something otherwise, that is, to force submission to make others' lives easier. It is not just in care homes that they are used for this purpose. Psychiatry as is practised within institutions such as prisons, schools, or care homes, serves as a way to legitimize dealing with difficult people using forced or coerced drugging, something we would not otherwise accept on the face of it. I don't see any good solution to this issue, especially not in the case of a care home where many residents will be deemed by all to not have capacity. Oversight can only do so much and when there are loopholes like the three excepted diagnoses mentioned in the article being exempted from public tallies, incentives will do the rest to close it.

EDIT: I'd like to add I have considered a bit more about other people I know who have taken or are taking antipsychotics (voluntarily), and they have never expressed extreme distress at their side effects. So I should have said 'can have' rather than 'have', my initial wording being influenced by my own experience.

The solution in my opinion to this problem is to permit euthanasia and for assisted suicide to become culturally accepted as an alternative to a drawn out death of dementia in a care home. The quality of life for many (not all) care home residents who are on these sorts of drug regimens is dire and in reality not entirely for their benefit, as is apparent to everyone including those responsible for oversight like Medicare. This system exists (primarily in the West) due to a combination of taboos surrounding death and profit/political incentives on the part of pharmaceutical and care home companies.

Antipsychotics have horrific side effects but are useful in institutional settings to make residents/patients/inmates easier to manage - psychiatry is the tool used to legitimize drugging people without need for their consent in such settings, for the benefit of others and the institution. It makes me despondent to read an article like this as I believe there are too many perverse incentives and cultural taboos for this situation to change in any meaningful way.