I am Dutch so this is a familiar topic for most of my life :-( A large part of my life when I was part of the what was then called left, I supported your line of reasoning enthusiastically. However, some cases in Holland changed my mind. The taboo on killing is imho a Chesterton fence, it is sacred for a reason. Once you remove this fence, I fail to see why your eloquence and logic reasoning skill could not take it further. Where is the next fence?
I strongly believe that our moral intuition evolved to develop successful offspring. It does not have logic, it is not scientific, it is just a tool of the evolution to let us do the heavy work for the next generation. It motivated us quite well for many eons and brought us in a time where we're extremely prosperous by historic standards.
Alas. In the last decades your kind of logic reasoning and eloquent style brought our prosperous societies on a glide slope; I blame the universities. Agree, I am often seduced and charmed but if we take a step back and see how well we do on the next generations, both quantitatively and qualitative then it is hard to deny that we seem to be failing in our most basic task. Many of our girls seem to have given up on having kids (and their mothers were already quite reluctant) and now you seem to want to give up on our old, sick and disabled because they are a nuisance.
I agree that I lack the eloquent reasoning that fatally destroys your argument; I stand here with only my moral conviction. A believe that some fences attacked by your arguments actually have a reason. Even if they are hard to articulate now.
I remember a comparable situation with Haidt's moral story about incest. If it is consensual, legal, surefire prophylactics, and safe, why not? Liberals tend to answer (reluctantly) that it should then be OK, conservatives reject it out of hand. However, feeling torn for some time on this topic I realized one day why we have this taboo. If it was a normal practice, there were bound to be cases where younger siblings mimicked it and then the prophylactics might be missing. In this case, my intuition just warned me for something that was not obvious in the problem description.
I believe there is a good reason why actively killing people feels so morally repulsive for humans; I could never ask a doctor to do this for me. I think we should tread very carefully in this area.
"I am Dutch so this is a familiar topic for most of my life :-( A large part of my life when I was part of the what was then called left, I supported your line of reasoning enthusiastically. However, some cases in Holland changed my mind. The taboo on killing is imho a Chesterton fence, it is sacred for a reason. Once you remove this fence, I fail to see why your eloquence and logic reasoning skill could not take it further. Where is the next fence?"
It's individual liberty and consent, that's what stops the nightmare scenario. I've never seen much evidence that any society has gone too far in defending that principle. Perhaps the West has taken it too far, but our problems pale in comparison to the problems of every other society that has ever existed.
"Consent" seems to have failed pretty spectacularly when it comes to "gender-affirming surgery." Lots and lots and lots of people have consented to this barbaric mutilation, including minors. Of course I would agree, as would anyone, that consent is usually a principle worth defending, but any single-variable view of the world is bound to have limits. Would you support, for instance, someone's "right" to have both of their arms amputated as part of their "trans-abled" identity, under this premise of "well, they consented, so it must be okay?"
As far as "individual liberty," you'll have to excuse me, but this concept has proven to be a poor joke that crumbles like sand in the face of government coercion.
Gender affirming surgery is extremely rare, and if that’s the literal worst thing you can think of when taking individual liberty too far it shows that it’s better than any other principle we have.
OPs point about taboo on killing being a Chesterton's fence is a strong point which you haven't really addressed. This practice of surgical mutilation of children based on pure consent enabled by a social contagion spread by people who hate individual liberty on matters everythign else except trans surgeries and abortions is less than 5-10 years old. This is purely a product of the Great Awokening & Transgenderism.
If something as brutal like this can be developed in 5-10 years doesn't this give you reasons to at least wonder what horrors a pure consent based system for killing will produce in the next 10, 50, 100 years? That's the Chesterton's fence we are worried about.
What the trans phenomenon and COVID have shown us beyond any remaining doubts is that "individual liberty" is simply no match for social pressure and state power. It's a nice thought to imagine that everyone is some kind of rational island who can make fully informed and well-reasoned choices, free from pressure or coercion.
A rare few people might be able to approximate that. In reality, most people outsource their decision-making to the herd and comply with social standards, whatever those standards might be. Even if the standards are evil and insane. Richard seems to acknowledge this when talking about the pesky low IQ right wingers and anti-vaxxers who are too stupid to deserve any respect, so it's a bit funny to see him try and fall back on "individual liberty" as if he's some kind of strong libertarian.
Rare by comparison to what? It sure is a hell of a lot more common now than it was 10 years ago. Either way, this is an implicit concession that yes, "well they consented so it must be a good idea" obviously does have a limit.
Small compared to the things that have been done in the name of every other principe people have defended as the basis for organizing society. It doesn’t affect 99% of people.
Neither does euthanasia, yet here you are. It is interesting that you simultaneously use "it doesn't happen very often" to both dismiss gender mutilation as unimportant and also to dismiss concerns about euthanasia as overblown fear-mongering. If "it doesn't affect 99% of people" renders a topic meaningless and not worthy for comment, why are we even sitting here reading this?
So who cares if something's small? So by that logic no one should care if a law gets passed that legalizes murder, but only people named Richard Hanania. No big deal right?
Surprisingly optimistic take after what we've just witnessed with the vaccine mandates. I am vaccinated but I've been horrified how the public opinion turned on anti-vaxxers with cruelty and glee.
I’m disgusted by the long winded arguments on assisted suicide in many variations, this one MAiD. The folks who have the luxury of time and health go on and on about the morality, politics and expense or damage to society. For those of us facing the reality of needing options these arguments are ludicrous.
Who among us would deny the justice of facilitating the euthanasia for a suffering animal? Yet it changes entirely for a human. I’ve got a severely disabled adult son with chronic pain. My goal is to relieve his intractable extreme suffering and thus honor his dignity. At some point I’ll have to make decisions as his guardian and I’ve always known there are limits to any options for him.
Quality of life is most important to him, daily. Just as important is a “good death”. It all is part of HIS existence. I fight for his “good life” and I’ll fight for his “good death” when inevitable and the only way for him to stop unbearable, severe and excruciating suffering.
Thanks for your message. Opponents of euthanasia act as if they have a monopoly on compassion, the implications of their views lead to some of the most extreme cruelty imaginable.
I almost wrote back about my own comment. Overall, my feeling is that these kind of discussions/conversations and even arguments will go better if one keeps in mind that your loved one who is nearing the end of life is listening in.
I realize I am up close and personal with these topics and sometimes have a very emotional reaction. Because the policies are so intensely affect our own lives, I have to listen in when I have the opportunity. Sometimes families like ours have the feeling all the most important discussions are made behind closed doors, and sometimes medical decisions are kept quiet too, out of our hearing. I do appreciate hearing what people think about these things and your article.
Your son's efforts and your own are heroic. I believe that the job of the living is to live, and that the rest of us must do our best to make life worthwhile for those who suffer.
Yes, desperate people will reach the end and let go, but the idea that medical personnel will help them do so to save healthcare costs is ghastly.
This highlights an important divide on the issue that perhaps needs to be addressed more clearly. I am quite sympathetic to the idea of euthanasia as a means to alleviate suffering for those who truly have no other option for relief, because they are suffering from chronic debilitating pain. However, when we move into the realm of advocating euthanasia simply because someone is a financial burden on the state, now we are talking about something else entirely.
In order for me to have any chance of supporting euthanasia overall, I need to be firmly convinced that we will only get the former without slippery-sliding into the latter. I would imagine this is also true for many who are wary of euthanasia, and we are certainly not reassured by Richard's perspective that it's fine to casually throw away human lives just because they are costing other people money. This is one step away from outright eugenics (and yes, it occurs to me that Richard may unironically support eugenics, but I wonder whether he'd have the balls to write an article like this one trying to articulate that position in detail).
You write about this often, yet you still haven't explained why do these people need doctors to kill them? Why don't they just kill themselves? Suicide is one of the most common causes of death, so a lot of people figured it out.
"Yes, for most people you can always kill yourself by jumping off a bridge, but I don’t think people should be tortured because they lack the courage to do that.“
What happened to revealed preferences? People who "don't have the courage" to kill themselves do not, in fact, want to end their lives. It's like saying "I really like to practice violin, but someone please force me".
"And many are of course disabled and unable to commit the physical act of suicide."
An overwhelming majority of euthanasia patients are not disabled to the point of not being able to commit suicide through multiple means. Even terminal neurological patients typically know months ahead what is in store and can act on their supposed preferences.
That's not what revealed preferences means. You seem to be using the term to mean something like "an action you would take no matter what even if we stack the deck against it and make it as difficult as possible."
Revealed preference is whatever is revealed by actual behavior, such as committing suicide, as opposed to mere words, e.g. "I want to die". Those who want to die don't need doctors to do it for them. They don't need a 'gentle push' or 'compassion'. In fact, they often kill themselves despite repeated and desperate attempts by their family to save them.
What euthanasia does is not help people carry out their decision to die, but rather, it helps them make that decision. Clearly, you think this is the right decision for them and all that, but that is every bit, if not more, patronizing than opposing euthanasia is.
You might as well say we should ban personal trainers because if people really want to lose weight they’ll do it themselves, because if you do anything that makes a decision easier or more convenient it’s not a real preference, which is not how people understand the concept of choice in any other context.
No, my point is not that there are some pure, absolute preferences. All preferences are, trivially, context-dependent. It was your argument that euthanasia is nothing more but compassionate assistance to people in accomplishing their true goals that every lover of liberty must embrace. And what I am telling you is that people's hesitance to kill themselves reveals underlying tradeoffs - they might want to die, but they also want to live.
A lot of people believe that when it comes to major irreversible decisions such as ending one's life, those should be hard. After all, nobody can stop those who really want it; the act itself works to filter only the most committed. You, want to tilt the scales so that the hesitant, the ambivalent, and the confused also go through. But you are doing that because you have a certain set of beliefs and values (that many lives are not worth living, that being dependent on others is undignified etc), not because you are some principled defender of liberty.
It's the same as your argument for freedom of speech. Very few care about the principle, only what gets to be banned. You want a more spartan society and this would help it go there. No need to dress it up as liberty and compassion.
This may be hard for you to understand, as lack of concern for liberty seems to be a common theme whenever I argue with Slavs, but a lot of people feel very strongly about the principal of freedom of speech, myself included. You should not assume that everyone else shares your own inclinations, let alone accuse them of disingenuity. And I hardly see how offering the suffering a humane and dignified end is more 'Spartan' than your own suggestion—that they instead be told to go jump off a bridge.
As long as I am fit enough and conscious enough to kill myself, I do not absolutely need MAID. True. Sorry for those who have to clean up the mess when I crush on the pavement. Or blow my brains with a gun (hard to get in Germany) on the couch - sorry for the kid finding me, too. Or the train-driver who ran me over. And gets some weeks+treatment for the trauma (on average a train driver runs over 1.7 in his career. Some less lucky.) - When I am 80, diabetic, somewhat senile, unable to read or to find my way around - it will be harder. And PLEASE put away then this vegetable that happens to have my finger-prints. How about a compromise: Hand everyone at 21 proper medication - heard there are some fine pills. And stop that ungodly medical assistance. Fine now?
Canada lets you either self administer fatal drugs or have a doctor do it for you. Only 1% of MAID patients choose the DIY option. People would clearly rather have an authority figure kill them than do it themselves. I find that strange, I’m much more of a DIY type, but I defer to the data.
Sorry for being gory, but have you ever witnessed a splattered brain on the carpet of the living room? I am very sadly speaking from familial experience from a case that would have been a no-brainer for MAID.
Going to a doctor is cleaner, won't traumatize for life the poor souls that will need clean up, and ensures you don't end up in a vegetative state/paralyzed because you missed.
In a perfect world there would be no need for this debate. We are not in one.
Assisted suicide solves all the supposed logistical problems of suicide. California introduced assisted suicide at the same time Canada introduced euthanasia. Yet, 20 times fewer people took advantage of it. As I said - euthanasia is not about carrying out the patients' wishes, but shaping them.
In California, a doctor will provide the drugs to commit assisted suicide, but will not administer the drugs. The patient must administer the drugs to themselves. On the other hand, in Canada, the physician will administer the drugs, in a procedure essentially identical to lethal injection in the US (with minor differences in drugs).
California
> The law requires that an individual must be over the age of 18 and possessing full capacity to make an independent decision to end their own life, as well as be able to administer the drugs themself. Participation in all aspects of the bill is voluntary for all involved and the application must be made to both an attending and consulting physician with a gap of no fewer than 15 days,[17] and should either physician request one, a mental health specialist such as psychiatrist or licensed psychologist.[1] The patient must also be certified by the physician as having a life limiting illness with estimated less than 6 months to live and other palliative care options must have been previously discussed and considered.[6] The law does not specify which drugs must be prescribed.[1]
Canada:
> The patient must give written consent to receiving euthanasia at the time of the procedure. The patient is also given the opportunity to rescind verbally their request for euthanasia immediately prior to the procedure taking place.[8]
> IV Drugs
> A lethal dose of propofol is used for euthanasia in Canada to quickly induce deep coma and death, but rocuronium is always given—even when patient dies as a result of Propofol injection. Delivery order of IV medication is as follows, with saline flushes between medications:[8]
> Step 1: Midazolam 10–20 mg 2-4ml of 5 mg/ml preparation (pre-anesthetic, induces sleep in 1–2 minutes).
> Step 2: Lidocaine 40 mg 4ml of 1% preparation; pause to allow effect. (reduces possible burning in a peripheral vein due to Propofol).
> Step 3: Propofol 1000 mg 100ml of 10 mg/ml preparation (loss of consciousness within 10 seconds, induces coma in 1–2 minutes; death may result from the Propofol but Rocuronium is always given.).
> Step 4: Rocuronium 200 mg 20ml of 10 mg/ml preparation (cardiac arrest after Rocuronium injection usually occurs within 5 minutes of respiratory arrest).
Interesting. I wonder if that 20-fold difference in use of these is due to this difference, or some other difference between Canada and California (or some combination of both). Requiring that those claiming a wish to die self-administer their own death, thus making it a true suicide, is..... reasonable, I suppose? It at least defeats Richard's complaint about "forcing grandma to blow her brains out."
"The patient must also be certified by the physician as having a life limiting illness with estimated less than 6 months to live" not sure how many in that group are physically able to kill themselves with medication - or fire a gun.
From having worked with patients in such situations, frankly, they don’t know how to - even with the books/advice out there. That is, it isn’t as easy as one thinks to kill oneself. Also there is the real risk of failing and ending up with brain damage or additional maladies.
Moreover it is common to see patients get medicine like in Oregon and not take it. Knowing that it is there for a backup, in case things become too rough, is often a solace itself.
I think you're getting the right-wing antipathy towards COVID restrictions completely wrong - they don't feel that way because they have less care for the value of life. They feel that way because they believe that people should be able to choose their own level of risk in living (on this issue - same cannot be said for drug use, premarital sex, etc.). Euthanasia is the opposite of that self chosen risk - it's an end to risk and suffering made in the belief that there is no more hope on this earth for a good life.
I'm ambivalent. Suicide has a social contagion effect, and I could easily see this becoming the next gender dysphoria, with autistic/mentally ill kids being told that the real road to the happiness is through the gas chamber rather than hormone treatments.
I work in a Catholic hospital. People here say the phrase “culture of life” a lot, as in “we need to cultivate a culture of life.” They say it almost as often as they say “patient-centered”. At my hospital orientation, a whole bunch of nuns and executives and people like that got up and told us how we had to do our part to “cultivate a culture of life.”
And now every time I hear that phrase I want to scream. 21st century American hospitals do not need to “cultivate a culture of life”. We have enough life. We have life up the wazoo. We have more life than we know what to do with. We have life far beyond the point where it becomes a sick caricature of itself. We prolong life until it becomes a sickness, an abomination, a miserable and pathetic flight from death that saps out and mocks everything that made life desirable in the first place. 21st century American hospitals need to cultivate a culture of life the same way that Newcastle needs to cultivate a culture of coal, the same way a man who is burning to death needs to cultivate a culture of fire.
Let start with two caveats: 1) I am generally a big fan of Richard's and 2) I am quite torn on the topic of MAID.
With those two notes out of the way, his philosophical arguments in favor of MAID are quite weak and actually might have pushed me further to the anti-MAID side. Let's review:
"A moment’s thought, however, reveals that “doctor shopping” is an inevitable part of any but the most totalitarian healthcare systems. When one doctor refuses to carry out euthanasia and another does, Raikin simply assumes that the one who chooses the outcome he likes is correct. Doctors disagree on treatments all the time. Dentists often can’t agree on whether the same tooth needs a root canal, and that doesn’t even involve the complex psychological judgments necessary to decide whether someone is “really” allowed to end their life. To demand complete consistency in the application of a euthanasia program is holding it to an impossible standard, one we do not apply anywhere else in medicine."
-Here Richard compares doctor shopping for state-sponsored suicide to <checks notes> if someone needs a root canal. I hope I don't need to explain to anyone why this comparison is ludicrous. Further, we don't apply this unanimity standard anywhere else in medicine because there is no other procedure in medicine with this degree of dire circumstances. Should the standard for this "care" be higher than any other... particularly a freaking root canal?
"If your standard for accepting euthanasia is “the healthcare system can never make mistakes and should have 100% consistency in its applications,” you will never be satisfied."
-So what should the standard be for this program? 90%? So if 10% of people are killed by the state's hand, who otherwise shouldn't have been, Richard chalks that up to an oopsie? Sorry, not good enough. Not even close.
"I’m not going to lie to you and say Canada, or any other country, never makes mistakes. But one has to also worry about cases where people are forced to live decades in miserable conditions. Yes, for most people you can always kill yourself by jumping off a bridge, but I don’t think people should be tortured because they lack the courage to do that. “Grandma doesn’t need state-sponsored euthanasia, she should have the balls to blow her brains out on the carpet” isn’t a humane approach."
-To Richard, since the above is inhumane, the 10% oopsies are the humane option?
"I don’t think we need many safeguards in a euthanasia program because the best safeguard is that people usually want to live, and despite what MAID opponents say, our culture generally discourages suicide."
-Culture can change, and it can change rapidly, especially in the days of social media. Has Richard seen the increase in LBGT kids in the last 5-10 years? The fact that in our culture today people "usually want to live" (his words not mine) should not be good enough justification for anyone especially since if the tide turns, stopping it will be a major lagging indicator that something as gone haywire.
"Those who don’t want to continue living are very rare, and since no one can truly understand the mental state of another person, I will defer to their own judgments about their condition."
-Remind me to never ask Richard for a recommendation to a physiatrist. I'll just say this, as someone with family members who have severe mental illness...deferring judgement to everyone about their own mental condition is so incomprehensibly stupid, it's hard to believe it was written. Using this logic, why should people even have to see a doctor before using MAID? Why can't they just walk into a clinic and be killed right there on the spot, since "no one can truly understand the mental state of another person." Simply nuts.
"One could just as easily say that people who want to kill themselves after becoming disabled are seeing things more objectively, and when they accept their condition they’re coping and living under a kind of false consciousness."
-Adapting to a difficult circumstance is "living under a false consciousness?" Please also remind me to never ask Richard for recommendations on a motivational coach.
"The data from the Netherlands and Belgium stresses something that really should be obvious and go without saying, which is that most people do not want to put children to death except to alleviate the most extreme and pointless suffering."
-Again, five years ago you'd say that "something that really should be obvious and go without saying, which is that most people do not want to cut the healthy breasts, testicles, and uteruses, off of and out of young boys and girls..." but yet, here we are.
"If you think that Canadian medicine is turning out psychos who want to start slaughtering children in their offices, and they’d be able to get away with it, we have much bigger problems then any deficiencies in MAID."
-One more time for the people in the back...they're turning out people who cut the various organs out of children, so is it so crazy to think this evolution could happen in the near future because it is the "humane" thing to do?
This was more I was planning to cover, but these are the highlights. Richard's logic on a wide array of his arguments is severely deficient and his hand waving away of people who have serious concerns about the program does nothing to help is cause. These are serious issues which need to be addressed and his weak thought process here actually dissuades me from his side.
"-So what should the standard be for this program? 90%? So if 10% of people are killed by the state's hand, who otherwise shouldn't have been, Richard chalks that up to an oopsie? Sorry, not good enough. Not even close."
The question of how you would even determine that someone was "wrongly killed" via MAID seems like a whole discussion unto itself. As long as the dead person signed on the dotted line, it seems impossible to prove, and trying to do so would surely get messy as you have family members with highly vested interests in portraying the situation one way or another. For example:
Here being a case of a young man who wants to off himself due to diabetes and depression, and being stopped from doing it by his mother. If his mother had failed to stop him, how would she even go about showing that he was "wrongly killed" via MAID?
"-Culture can change, and it can change rapidly, especially in the days of social media. Has Richard seen the increase in LBGT kids in the last 5-10 years? The fact that in our culture today people "usually want to live" (his words not mine) should not be good enough justification for anyone especially since if the tide turns, stopping it will be a major lagging indicator that something as gone haywire."
This is a blind spot he seems to have on this issue. People worry more about the future trajectory than the current situation, and if you look at history, they're often right to do so. If you told someone in the early 2000s that gay marriage would be legal nationwide within a decade, you could easily be accused of worrying too much about a slippery slope that shows no signs of manifesting yet. Likewise if you told someone in the early 2010s that in less than a decade their governments would begin to enforce mandatory deference to transgenderism in public spaces.
Richard isn't doing anything to alleviate such concerns by openly arguing that euthanasia should be expanded while simultaneously treating slippery-slope concerns as ridiculous. It's a dishonest inside-outside game typically played by the left, wherein they will typically claim that something doesn't exist or barely exists so why do you care about it, but also it's a Good Thing and we need more of it (i.e. "no one is coming for your guns don't be ridiculous, but also hell yes we're coming for your AR-15").
"The state’s interest in saving costs, as long as it’s going to pay for healthcare, is also legitimate, although I won’t dwell on that here."
I think this is the central issue that people are going to have a fundamental divide on, and which you should perhaps be talking about more instead of all this other stuff, although to be fair I doubt you could change many minds on it. You say that you are completely okay with the idea of the state encouraging suicide simply to save money on healthcare costs. But to many people, perhaps most, that is an abhorrent concept on a deep first-principles level, and you're just not going to reason and logic your way past it.
I guess, but in that case, why require that money be attached to suicide? That seems rather grim and unnecessary compared to simply letting the person give money to their descendants freely with no need for suicide as part of the process.
I can see what you're getting at, though I still don't see why suicide would be required as part of the deal. At most, one would just offer it as an option, if the end-of-life patient wanted it (as opposed to simply letting nature take its course).
Either way, the potential for moral hazard here is obvious. You would certainly have cases of children encouraging their parents to hurry up and die already so they can get more money via this mechanism. If your view that this form of suicide is an act of "bravery and love" were to be adopted as the social standard, we would have a situation where the elderly are expected to kill themselves at a certain point, and those who had the audacity to desire that they continue living for a while longer would be looked down upon as selfish and petty.
Maybe you end up deciding that this would be a Good Thing, but again, I don't think it's hard to see why it would make people uneasy, especially with its being administered by the state. Once state-administered suicide at a certain age becomes a societal expectation, it's only one step away from being made mandatory.
I suppose this comes down in large part to your confidence in our governments and in our culture more broadly to handle something like this responsibly. It probably goes without saying that I have no such trust, but obviously others might.
You made a quite good argument about euthanasia, but not about MAiD.
You almost got the point when you correctly state "If the state is going to provide healthcare, it should acknowledge that suicide is a legitimate choice for people to make." but in your first instance you openly state that "The state’s interest in saving costs, as long as it’s going to pay for healthcare, is also legitimate, although I won’t dwell on that here.".
In fact, under a truckload of rethoric, the true argument for Canandian MAiD is to cut the healthcare public spending: i frankly find nothing "free" in a poor guy that the government push to suicide not to pay for his healthcare bill.
Funnily enought, one of the strongest argument for lockdown and forced administration-of-a-serum-never-tested-for-immunization-so-not-labellable-vaccine-without-definition-manipulation is to cut healthcare pubblic spending: "save the NHS" is the most reknown.
So, i find your argument "“Dying of Poverty” as Emotional Manipulation" a strawman at best: i want you to argue how "The state’s interest in saving costs through euthanasia, as long as it’s going to pay for healthcare, is also legitimate".
P.s. to attack Raikin because "he’s against all euthanasia no matter what condition a patient is in [so] Complaints about shortcomings of MAID should be understood from this perspective" is an ad hominem fallacy: otherwise, i should dismiss your whole argument as anti-elderly bigotry, because you made clear you are against the gerontification of the modern world.
I find it notable that Richard will acknowledge how absurdly tyrannical, corrupt and irresponsible governments often are in some cases, then in a case like this one, completely brush aside any concerns that the state might ever possibly overreach or begin to act in an abusive manner.
He has a similar inconsistency when it comes to the COVID vaccine--despite claiming to hold to libertarian/choice principles, I have never once seen him condemn the insane coercion campaigns that were enacted WRT the COVID shots, because he is always too busy going on about how stupid and dangerous those gosh darn low IQ "anti-vaxxers" are.
Have you read Helen Dale's "Kingdom of the Wicked" series? She sets up an alt-hist technologically advanced Roman Empire in part to contrast its morality with Judeo-Christian morality, and show us that the Roman alternative, though flawed, had its attractions. I bet based on this and your other writing that you will sympathize more or less completely with the Roman worldview Dale portrays, more than the vast majority of people would and even more than I would-- and I view the book as making a pretty compelling pro-Roman case. In any case it'd make a fascinating review post for your newsletter.
Look you can delete comments and put “pressured” in scare quotes, but MAID is a moral disgrace, and getting the state to kill grandma is a proper nazi style slippery slope, no matter how many 1000 words you write
I think America has a unique capacity to make things dumber and more prevalent/normalized. E.g. it's easy to imagine #DeathTok where influencers discuss how amazing it's going to be to snuff out your life, and an army of hack doctors encouraging them and doing whatever the euthanasia version of "yeet the teats" is
It seems like the way he gets there is just by saying that all the ways Canada has expanded euthanasia are good, so it's not a slippery slope. He seems to take it on faith that the expansion will never pass a line into what he would consider bad.
First time reading a post on a substack and interrupting my reading to go and find the "subscribe" button. I've encountered your writing from time to time (most recently in the comment section at ACX) and liked it, but absolutely loved this. Higher agreement-per-word for me reading this than almost anything other than reading back over something I wrote myself. Back when the MAID fake news was heating up I irritated friends on both sides of the political aisle with my constant debunks. I wish I'd just had this link to send them.
Now, this comment comes too late for anyone ever to be likely to read it, but despite my complete agreement with it I have an additional angle on the motivations of those who oppose assisted suicide. I needn't duplicate any of Robin Hanson's talking points -- it is obvious that there is tremendous signalling value in proclaiming our willingness to support at any expense those who are too disabled to do so themselves (even if we have to force them to stay alive so that we can do so). No, rather I would like to comment on other, [post]Christian motivations. It will be offensive to objectors from the right and left that I lump them together, but I do so for good reason, likely nobody will ever read this, and my own authentic thoughts are apparently classified as 'trolling' so what the hell.
One lens (like all lenses it is imperfect and is best used in conjunction with other lenses) with which to understand what this looks like from the inside (for objectors) is to consider shifts in thinking in/with/around the rise of Christianity. Rather than one's life belonging to one's paterfamilias, one's polity, or one's (democratic) peers, it belongs solely to the Lord God, who alone can dispose of it justly (sometimes through [tacitly] divinely-approved kings). This coincides with and helps explain the preciousness of the individual: each person is like a coin that even if minted of base metal is stamped with the face of the one King of Kings. Thus when (according to legend) St. Lawrence (of the grid-iron) was told to hand over the ill-gotten gains he was presumed to have as chief deacon of Rome, he gathered up all the beggars (mostly crippled, blind, and lame) and proclaimed, "here are the treasures of the church". Islam, though obviously different, continued this new ownership-relation: one's life is not one's own, but belongs rather to Allah. Centuries later, Marxists were not facetitious in referring to the Acts of the Apostles in saying "from each according to his means, to each according to his needs". However changed might have been the frame, within even the worst times under communism we see a similar dynamic -- every person stands in relation not to God but the People, and if comrade Stalin has the power to dispose of a human life it is because he is merely a pawn of this People. "But this is a facile and obvious fraud!" one might respond. Sure, but so was the divine right of kings -- that doesn't mean neither expressed and augmented the underlying ideology. Consider the gulag practice of having prisoners send birthday well-wishes to comrade Stalin. Though literally dying of mistreatment yet even still they were (symbolically-only) regarded as part of the People and part of the political process.
Any descendant of this kind of thinking regards a human life as something outside ordinary disposal (however thirsty for exceptions or excuses any particular person who holds this view may be). The simple statement "your life is your own to dispose of as you will" at a stroke undercuts a primary value on either side. Thus freed, individuals might have premarital sex, get tattoos or abortions, publically blaspheme, kill themselves, or make decisions with economic consequences beyond the State's duty to ameloriate.
I am a cryonicist and the topic is of great importance to me. The success of cryonics, that is being able to return to life after a period of cryonic suspension in liquid nitrogen, crucially depends on the length of time between your last heartbeat and the beginning of the cryonic suspension procedure. Ideally you would want to stop your living functions at a time and place of your choice, with the cryonics team ready to start cooling your body and preserving your brain while your heart is still beating. Unfortunately this approach would under current laws in the US land the cryonics providers in prison and the cryonics patient autopsied and thoroughly dead.
I am angry at the world that curtails my right to extend my life through cryonics, while making incoherent noises about the sanctity of life. My life is my own, for me to dispose of as I see fit, not for others to play ideological games with. Hopefully, by the time I am old and decrepit enough that cryonic suspension is needed to avoid death from dementia and infirmity, laws will change and I will be able to make the right choice for myself, on my own terms.
You have definitely shifted my view on this topic. I’m still a little worried about some slippery slope scenarios, but overall I’m pro MAID now. Thanks.
While I had a vague sense of disagreement with you going into this article, I'm now open to being persuaded. Wondering if aesthetics is the main problem here again. Thanks for that.
I am VERY happy to see you bring up Nuclear Power & the Death Penalty--as I am very much in favor of both. However, I noticed you seemed more focused on what people on Twitter were saying as opposed to the article Kass wrote. I realize that responding to a philosopher like Kass would be a huge article in and of itself--but I think we might benefit from a critique of the other side's "best to offer." Or maybe a link to someone who has a good case against Kass?
One point I'm not seeing addressed by either side in this debate is this: Both California and Canada have similar-sized populations, and both are pretty "woke" and secular. Yet, I believe the per capita use of MAID is much higher in Canada than California. Not that it would affect the moral argument you put forward--but I really wonder if there's a good explanation for that? Is there any data point we can look at and say, "THIS is why Canadians are more comfortable with MAID than Americans?"
Related Topic: Forgive me as I meant to post this on a previous post of yours (congrats on having a wonderful daughter this year!) but I was wondering if this article might shift your stance on abortion somewhat:
As I say in the article, I think the difference between California and Canada is probably Canada makes it easier and therefore has the better policy.
I don't buy what the TAC article is selling. "A recent survey asserts that 1 in 5 single adults are more hesitant to engage in sex since the Dobbs ruling." Come on, of course many liberals will say something like that as a way to say they don't like Dobbs. People who are smart enough to be influenced the law are smart enough to use birth control already. We're not going back to the 1950s.
I'm Canadian, and I'm not interested in the general question of euthanasia for terminal conditions; I'm interested in my government expanding the criteria so it can kill people who have depression and "fibromyalgia," which is usually depression. The second-order question is how this national psychology affects everyone else. There are already multiple friends of friends who are considering it, despite having no terminal issues.
Negative psychology is a loop. It causes problems that cause problems. Whiplash doesn't exist in places where people don't know about whiplash. People don't kill themselves due to fibromyalgia in cultures where fibromyalgia isn't accepted as a thing or as a valid reason to kill yourself.
Killing yourself is like divorce: we make it difficult for a reason.
This is also occurring in an environment where the government is desperately flooding the country with immigrants to prop up housing values for Boomers, flushing out the poor and vulnerable (and making new people poor and helpless). Our housing costs have increased 500% in 20 years due to government policy. This country is becoming the epitome of despair. I'd be interested to hear someone from Toronto or Vancouver who doesn't own property roll in here holding the opinions expressed in this essay.
I'm sure you know that thing about survivors who jumped from the Golden Gate bridge mostly regretting the jump. I'm not going to break the bank trying to stop them, but I hate this government that will steal your life's work and then push you.
I didn't say anything in support of spending that money to stop them from jumping. I said that I don't support my government killing non-terminally-ill suicidal people, or creating an environment consistent with such a thing.
So people who survive regret jumping, but if they'd only died, it wouldn't matter because they can't have regrets? No harm? This is just like saying it doesn't matter if you die, since you're dead. How about I come find you and kill you since you can't be upset about it, since you'll be dead? If you're going to make some argument about your family and the people who care about you, I can just kill them all too.
Ultimately we'll all be dead and nothing will matter. Why don't we just get it over with?
It doesn’t matter if you’re dead, because you’re dead. The dying part and the leadup to it frequently involve additional suffering that makes them harmful. If one was able to painlessly kill someone in their sleep who had no idea it was happening, that person wouldn’t be harmed; they would be gone. And I would absolutely reject the idea that their loved ones have a meaningful claim here, because that just leads to enslavement at the hands of one’s family.
I honestly find it bizarre to think that it does matter to oneself if one is dead. I mean, it’s a nonsense concept if you don’t believe in an afterlife.
I'll get started on making plans to look you up and kill you in your sleep. Don't worry; it will be a surprise, so you won't have to worry about it coming. And I will leave your loved ones alive since it would be wrong to let their emotions get in the way; I might even put your head in one of their beds like that scene from The Godfather. That's what my utility function would enjoy.
In fact why do I even need to surprise you in your sleep? If I just kick the door in during the day, you'll experience 30 seconds of fear but so what? That's less total suffering than a few jump scares in a movie theatre. This will save a lot of planning. In fact I'm not even sure that it matters if you worry about it before I do it, since I could get going on this tonight and it would be less than 24 hours between me and... wherever you are. 24 hours of worrying; I'm sure you've experienced a lot more than that at work.
In FACT, all that worry of yours is irrational too, since you're worrying about something that has no harm associated with it. It's an evolutionary instinct, sure, but it's irrational, and if you can't learn to suppress it I don't even know why I should take it into account.
I'm sorry, you believe that depriving someone of their life does them no harm? I guess Epictetus would agree with that, but as a society we have very good reasons to make it illegal.
"Negative psychology is a loop. It causes problems that cause problems. Whiplash doesn't exist in places where people don't know about whiplash. People don't kill themselves due to fibromyalgia in cultures where fibromyalgia isn't accepted as a thing or as a valid reason to kill yourself."
You should read "Crazy Like Us" or Scott Alexander's review at least.
I am Dutch so this is a familiar topic for most of my life :-( A large part of my life when I was part of the what was then called left, I supported your line of reasoning enthusiastically. However, some cases in Holland changed my mind. The taboo on killing is imho a Chesterton fence, it is sacred for a reason. Once you remove this fence, I fail to see why your eloquence and logic reasoning skill could not take it further. Where is the next fence?
I strongly believe that our moral intuition evolved to develop successful offspring. It does not have logic, it is not scientific, it is just a tool of the evolution to let us do the heavy work for the next generation. It motivated us quite well for many eons and brought us in a time where we're extremely prosperous by historic standards.
Alas. In the last decades your kind of logic reasoning and eloquent style brought our prosperous societies on a glide slope; I blame the universities. Agree, I am often seduced and charmed but if we take a step back and see how well we do on the next generations, both quantitatively and qualitative then it is hard to deny that we seem to be failing in our most basic task. Many of our girls seem to have given up on having kids (and their mothers were already quite reluctant) and now you seem to want to give up on our old, sick and disabled because they are a nuisance.
I agree that I lack the eloquent reasoning that fatally destroys your argument; I stand here with only my moral conviction. A believe that some fences attacked by your arguments actually have a reason. Even if they are hard to articulate now.
I remember a comparable situation with Haidt's moral story about incest. If it is consensual, legal, surefire prophylactics, and safe, why not? Liberals tend to answer (reluctantly) that it should then be OK, conservatives reject it out of hand. However, feeling torn for some time on this topic I realized one day why we have this taboo. If it was a normal practice, there were bound to be cases where younger siblings mimicked it and then the prophylactics might be missing. In this case, my intuition just warned me for something that was not obvious in the problem description.
I believe there is a good reason why actively killing people feels so morally repulsive for humans; I could never ask a doctor to do this for me. I think we should tread very carefully in this area.
"I am Dutch so this is a familiar topic for most of my life :-( A large part of my life when I was part of the what was then called left, I supported your line of reasoning enthusiastically. However, some cases in Holland changed my mind. The taboo on killing is imho a Chesterton fence, it is sacred for a reason. Once you remove this fence, I fail to see why your eloquence and logic reasoning skill could not take it further. Where is the next fence?"
It's individual liberty and consent, that's what stops the nightmare scenario. I've never seen much evidence that any society has gone too far in defending that principle. Perhaps the West has taken it too far, but our problems pale in comparison to the problems of every other society that has ever existed.
"Consent" seems to have failed pretty spectacularly when it comes to "gender-affirming surgery." Lots and lots and lots of people have consented to this barbaric mutilation, including minors. Of course I would agree, as would anyone, that consent is usually a principle worth defending, but any single-variable view of the world is bound to have limits. Would you support, for instance, someone's "right" to have both of their arms amputated as part of their "trans-abled" identity, under this premise of "well, they consented, so it must be okay?"
As far as "individual liberty," you'll have to excuse me, but this concept has proven to be a poor joke that crumbles like sand in the face of government coercion.
Gender affirming surgery is extremely rare, and if that’s the literal worst thing you can think of when taking individual liberty too far it shows that it’s better than any other principle we have.
OPs point about taboo on killing being a Chesterton's fence is a strong point which you haven't really addressed. This practice of surgical mutilation of children based on pure consent enabled by a social contagion spread by people who hate individual liberty on matters everythign else except trans surgeries and abortions is less than 5-10 years old. This is purely a product of the Great Awokening & Transgenderism.
If something as brutal like this can be developed in 5-10 years doesn't this give you reasons to at least wonder what horrors a pure consent based system for killing will produce in the next 10, 50, 100 years? That's the Chesterton's fence we are worried about.
What the trans phenomenon and COVID have shown us beyond any remaining doubts is that "individual liberty" is simply no match for social pressure and state power. It's a nice thought to imagine that everyone is some kind of rational island who can make fully informed and well-reasoned choices, free from pressure or coercion.
A rare few people might be able to approximate that. In reality, most people outsource their decision-making to the herd and comply with social standards, whatever those standards might be. Even if the standards are evil and insane. Richard seems to acknowledge this when talking about the pesky low IQ right wingers and anti-vaxxers who are too stupid to deserve any respect, so it's a bit funny to see him try and fall back on "individual liberty" as if he's some kind of strong libertarian.
Rare by comparison to what? It sure is a hell of a lot more common now than it was 10 years ago. Either way, this is an implicit concession that yes, "well they consented so it must be a good idea" obviously does have a limit.
Small compared to the things that have been done in the name of every other principe people have defended as the basis for organizing society. It doesn’t affect 99% of people.
Neither does euthanasia, yet here you are. It is interesting that you simultaneously use "it doesn't happen very often" to both dismiss gender mutilation as unimportant and also to dismiss concerns about euthanasia as overblown fear-mongering. If "it doesn't affect 99% of people" renders a topic meaningless and not worthy for comment, why are we even sitting here reading this?
So who cares if something's small? So by that logic no one should care if a law gets passed that legalizes murder, but only people named Richard Hanania. No big deal right?
>> Where the is the next fence?
> It's individual liberty and consent,
Surprisingly optimistic take after what we've just witnessed with the vaccine mandates. I am vaccinated but I've been horrified how the public opinion turned on anti-vaxxers with cruelty and glee.
I’m disgusted by the long winded arguments on assisted suicide in many variations, this one MAiD. The folks who have the luxury of time and health go on and on about the morality, politics and expense or damage to society. For those of us facing the reality of needing options these arguments are ludicrous.
Who among us would deny the justice of facilitating the euthanasia for a suffering animal? Yet it changes entirely for a human. I’ve got a severely disabled adult son with chronic pain. My goal is to relieve his intractable extreme suffering and thus honor his dignity. At some point I’ll have to make decisions as his guardian and I’ve always known there are limits to any options for him.
Quality of life is most important to him, daily. Just as important is a “good death”. It all is part of HIS existence. I fight for his “good life” and I’ll fight for his “good death” when inevitable and the only way for him to stop unbearable, severe and excruciating suffering.
Thanks for your message. Opponents of euthanasia act as if they have a monopoly on compassion, the implications of their views lead to some of the most extreme cruelty imaginable.
I almost wrote back about my own comment. Overall, my feeling is that these kind of discussions/conversations and even arguments will go better if one keeps in mind that your loved one who is nearing the end of life is listening in.
I realize I am up close and personal with these topics and sometimes have a very emotional reaction. Because the policies are so intensely affect our own lives, I have to listen in when I have the opportunity. Sometimes families like ours have the feeling all the most important discussions are made behind closed doors, and sometimes medical decisions are kept quiet too, out of our hearing. I do appreciate hearing what people think about these things and your article.
Amazing how 1st world people fight for the right to die, and 3rd world people fight for the right to live.
Your son's efforts and your own are heroic. I believe that the job of the living is to live, and that the rest of us must do our best to make life worthwhile for those who suffer.
Yes, desperate people will reach the end and let go, but the idea that medical personnel will help them do so to save healthcare costs is ghastly.
This highlights an important divide on the issue that perhaps needs to be addressed more clearly. I am quite sympathetic to the idea of euthanasia as a means to alleviate suffering for those who truly have no other option for relief, because they are suffering from chronic debilitating pain. However, when we move into the realm of advocating euthanasia simply because someone is a financial burden on the state, now we are talking about something else entirely.
In order for me to have any chance of supporting euthanasia overall, I need to be firmly convinced that we will only get the former without slippery-sliding into the latter. I would imagine this is also true for many who are wary of euthanasia, and we are certainly not reassured by Richard's perspective that it's fine to casually throw away human lives just because they are costing other people money. This is one step away from outright eugenics (and yes, it occurs to me that Richard may unironically support eugenics, but I wonder whether he'd have the balls to write an article like this one trying to articulate that position in detail).
You write about this often, yet you still haven't explained why do these people need doctors to kill them? Why don't they just kill themselves? Suicide is one of the most common causes of death, so a lot of people figured it out.
"Yes, for most people you can always kill yourself by jumping off a bridge, but I don’t think people should be tortured because they lack the courage to do that.“
What happened to revealed preferences? People who "don't have the courage" to kill themselves do not, in fact, want to end their lives. It's like saying "I really like to practice violin, but someone please force me".
"And many are of course disabled and unable to commit the physical act of suicide."
An overwhelming majority of euthanasia patients are not disabled to the point of not being able to commit suicide through multiple means. Even terminal neurological patients typically know months ahead what is in store and can act on their supposed preferences.
That's not what revealed preferences means. You seem to be using the term to mean something like "an action you would take no matter what even if we stack the deck against it and make it as difficult as possible."
Revealed preference is whatever is revealed by actual behavior, such as committing suicide, as opposed to mere words, e.g. "I want to die". Those who want to die don't need doctors to do it for them. They don't need a 'gentle push' or 'compassion'. In fact, they often kill themselves despite repeated and desperate attempts by their family to save them.
What euthanasia does is not help people carry out their decision to die, but rather, it helps them make that decision. Clearly, you think this is the right decision for them and all that, but that is every bit, if not more, patronizing than opposing euthanasia is.
You might as well say we should ban personal trainers because if people really want to lose weight they’ll do it themselves, because if you do anything that makes a decision easier or more convenient it’s not a real preference, which is not how people understand the concept of choice in any other context.
No, my point is not that there are some pure, absolute preferences. All preferences are, trivially, context-dependent. It was your argument that euthanasia is nothing more but compassionate assistance to people in accomplishing their true goals that every lover of liberty must embrace. And what I am telling you is that people's hesitance to kill themselves reveals underlying tradeoffs - they might want to die, but they also want to live.
A lot of people believe that when it comes to major irreversible decisions such as ending one's life, those should be hard. After all, nobody can stop those who really want it; the act itself works to filter only the most committed. You, want to tilt the scales so that the hesitant, the ambivalent, and the confused also go through. But you are doing that because you have a certain set of beliefs and values (that many lives are not worth living, that being dependent on others is undignified etc), not because you are some principled defender of liberty.
It's the same as your argument for freedom of speech. Very few care about the principle, only what gets to be banned. You want a more spartan society and this would help it go there. No need to dress it up as liberty and compassion.
This may be hard for you to understand, as lack of concern for liberty seems to be a common theme whenever I argue with Slavs, but a lot of people feel very strongly about the principal of freedom of speech, myself included. You should not assume that everyone else shares your own inclinations, let alone accuse them of disingenuity. And I hardly see how offering the suffering a humane and dignified end is more 'Spartan' than your own suggestion—that they instead be told to go jump off a bridge.
As long as I am fit enough and conscious enough to kill myself, I do not absolutely need MAID. True. Sorry for those who have to clean up the mess when I crush on the pavement. Or blow my brains with a gun (hard to get in Germany) on the couch - sorry for the kid finding me, too. Or the train-driver who ran me over. And gets some weeks+treatment for the trauma (on average a train driver runs over 1.7 in his career. Some less lucky.) - When I am 80, diabetic, somewhat senile, unable to read or to find my way around - it will be harder. And PLEASE put away then this vegetable that happens to have my finger-prints. How about a compromise: Hand everyone at 21 proper medication - heard there are some fine pills. And stop that ungodly medical assistance. Fine now?
Canada lets you either self administer fatal drugs or have a doctor do it for you. Only 1% of MAID patients choose the DIY option. People would clearly rather have an authority figure kill them than do it themselves. I find that strange, I’m much more of a DIY type, but I defer to the data.
>"Why don't they kill themselves"
Sorry for being gory, but have you ever witnessed a splattered brain on the carpet of the living room? I am very sadly speaking from familial experience from a case that would have been a no-brainer for MAID.
Going to a doctor is cleaner, won't traumatize for life the poor souls that will need clean up, and ensures you don't end up in a vegetative state/paralyzed because you missed.
In a perfect world there would be no need for this debate. We are not in one.
Assisted suicide solves all the supposed logistical problems of suicide. California introduced assisted suicide at the same time Canada introduced euthanasia. Yet, 20 times fewer people took advantage of it. As I said - euthanasia is not about carrying out the patients' wishes, but shaping them.
What is the difference between "assisted suicide" and euthanasia? Purely curious here, I wasn't aware of this policy you mention California having.
In California, a doctor will provide the drugs to commit assisted suicide, but will not administer the drugs. The patient must administer the drugs to themselves. On the other hand, in Canada, the physician will administer the drugs, in a procedure essentially identical to lethal injection in the US (with minor differences in drugs).
California
> The law requires that an individual must be over the age of 18 and possessing full capacity to make an independent decision to end their own life, as well as be able to administer the drugs themself. Participation in all aspects of the bill is voluntary for all involved and the application must be made to both an attending and consulting physician with a gap of no fewer than 15 days,[17] and should either physician request one, a mental health specialist such as psychiatrist or licensed psychologist.[1] The patient must also be certified by the physician as having a life limiting illness with estimated less than 6 months to live and other palliative care options must have been previously discussed and considered.[6] The law does not specify which drugs must be prescribed.[1]
Canada:
> The patient must give written consent to receiving euthanasia at the time of the procedure. The patient is also given the opportunity to rescind verbally their request for euthanasia immediately prior to the procedure taking place.[8]
> IV Drugs
> A lethal dose of propofol is used for euthanasia in Canada to quickly induce deep coma and death, but rocuronium is always given—even when patient dies as a result of Propofol injection. Delivery order of IV medication is as follows, with saline flushes between medications:[8]
> Step 1: Midazolam 10–20 mg 2-4ml of 5 mg/ml preparation (pre-anesthetic, induces sleep in 1–2 minutes).
> Step 2: Lidocaine 40 mg 4ml of 1% preparation; pause to allow effect. (reduces possible burning in a peripheral vein due to Propofol).
> Step 3: Propofol 1000 mg 100ml of 10 mg/ml preparation (loss of consciousness within 10 seconds, induces coma in 1–2 minutes; death may result from the Propofol but Rocuronium is always given.).
> Step 4: Rocuronium 200 mg 20ml of 10 mg/ml preparation (cardiac arrest after Rocuronium injection usually occurs within 5 minutes of respiratory arrest).
Interesting. I wonder if that 20-fold difference in use of these is due to this difference, or some other difference between Canada and California (or some combination of both). Requiring that those claiming a wish to die self-administer their own death, thus making it a true suicide, is..... reasonable, I suppose? It at least defeats Richard's complaint about "forcing grandma to blow her brains out."
"The patient must also be certified by the physician as having a life limiting illness with estimated less than 6 months to live" not sure how many in that group are physically able to kill themselves with medication - or fire a gun.
From having worked with patients in such situations, frankly, they don’t know how to - even with the books/advice out there. That is, it isn’t as easy as one thinks to kill oneself. Also there is the real risk of failing and ending up with brain damage or additional maladies.
Moreover it is common to see patients get medicine like in Oregon and not take it. Knowing that it is there for a backup, in case things become too rough, is often a solace itself.
I think you're getting the right-wing antipathy towards COVID restrictions completely wrong - they don't feel that way because they have less care for the value of life. They feel that way because they believe that people should be able to choose their own level of risk in living (on this issue - same cannot be said for drug use, premarital sex, etc.). Euthanasia is the opposite of that self chosen risk - it's an end to risk and suffering made in the belief that there is no more hope on this earth for a good life.
I'm ambivalent. Suicide has a social contagion effect, and I could easily see this becoming the next gender dysphoria, with autistic/mentally ill kids being told that the real road to the happiness is through the gas chamber rather than hormone treatments.
God bless you for this post! (recently I read that hit-piece by Ross Douthat and was taken aback.)
2 "references" to add: - the 2004 Clint Eastwood movie Million Dollar Baby
- and MD Scott Alexander, the greatest blogger of'em all, about "culture of life" in one of his top-posts (his choice) https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ :
I work in a Catholic hospital. People here say the phrase “culture of life” a lot, as in “we need to cultivate a culture of life.” They say it almost as often as they say “patient-centered”. At my hospital orientation, a whole bunch of nuns and executives and people like that got up and told us how we had to do our part to “cultivate a culture of life.”
And now every time I hear that phrase I want to scream. 21st century American hospitals do not need to “cultivate a culture of life”. We have enough life. We have life up the wazoo. We have more life than we know what to do with. We have life far beyond the point where it becomes a sick caricature of itself. We prolong life until it becomes a sickness, an abomination, a miserable and pathetic flight from death that saps out and mocks everything that made life desirable in the first place. 21st century American hospitals need to cultivate a culture of life the same way that Newcastle needs to cultivate a culture of coal, the same way a man who is burning to death needs to cultivate a culture of fire.
Let start with two caveats: 1) I am generally a big fan of Richard's and 2) I am quite torn on the topic of MAID.
With those two notes out of the way, his philosophical arguments in favor of MAID are quite weak and actually might have pushed me further to the anti-MAID side. Let's review:
"A moment’s thought, however, reveals that “doctor shopping” is an inevitable part of any but the most totalitarian healthcare systems. When one doctor refuses to carry out euthanasia and another does, Raikin simply assumes that the one who chooses the outcome he likes is correct. Doctors disagree on treatments all the time. Dentists often can’t agree on whether the same tooth needs a root canal, and that doesn’t even involve the complex psychological judgments necessary to decide whether someone is “really” allowed to end their life. To demand complete consistency in the application of a euthanasia program is holding it to an impossible standard, one we do not apply anywhere else in medicine."
-Here Richard compares doctor shopping for state-sponsored suicide to <checks notes> if someone needs a root canal. I hope I don't need to explain to anyone why this comparison is ludicrous. Further, we don't apply this unanimity standard anywhere else in medicine because there is no other procedure in medicine with this degree of dire circumstances. Should the standard for this "care" be higher than any other... particularly a freaking root canal?
"If your standard for accepting euthanasia is “the healthcare system can never make mistakes and should have 100% consistency in its applications,” you will never be satisfied."
-So what should the standard be for this program? 90%? So if 10% of people are killed by the state's hand, who otherwise shouldn't have been, Richard chalks that up to an oopsie? Sorry, not good enough. Not even close.
"I’m not going to lie to you and say Canada, or any other country, never makes mistakes. But one has to also worry about cases where people are forced to live decades in miserable conditions. Yes, for most people you can always kill yourself by jumping off a bridge, but I don’t think people should be tortured because they lack the courage to do that. “Grandma doesn’t need state-sponsored euthanasia, she should have the balls to blow her brains out on the carpet” isn’t a humane approach."
-To Richard, since the above is inhumane, the 10% oopsies are the humane option?
"I don’t think we need many safeguards in a euthanasia program because the best safeguard is that people usually want to live, and despite what MAID opponents say, our culture generally discourages suicide."
-Culture can change, and it can change rapidly, especially in the days of social media. Has Richard seen the increase in LBGT kids in the last 5-10 years? The fact that in our culture today people "usually want to live" (his words not mine) should not be good enough justification for anyone especially since if the tide turns, stopping it will be a major lagging indicator that something as gone haywire.
"Those who don’t want to continue living are very rare, and since no one can truly understand the mental state of another person, I will defer to their own judgments about their condition."
-Remind me to never ask Richard for a recommendation to a physiatrist. I'll just say this, as someone with family members who have severe mental illness...deferring judgement to everyone about their own mental condition is so incomprehensibly stupid, it's hard to believe it was written. Using this logic, why should people even have to see a doctor before using MAID? Why can't they just walk into a clinic and be killed right there on the spot, since "no one can truly understand the mental state of another person." Simply nuts.
"One could just as easily say that people who want to kill themselves after becoming disabled are seeing things more objectively, and when they accept their condition they’re coping and living under a kind of false consciousness."
-Adapting to a difficult circumstance is "living under a false consciousness?" Please also remind me to never ask Richard for recommendations on a motivational coach.
"The data from the Netherlands and Belgium stresses something that really should be obvious and go without saying, which is that most people do not want to put children to death except to alleviate the most extreme and pointless suffering."
-Again, five years ago you'd say that "something that really should be obvious and go without saying, which is that most people do not want to cut the healthy breasts, testicles, and uteruses, off of and out of young boys and girls..." but yet, here we are.
"If you think that Canadian medicine is turning out psychos who want to start slaughtering children in their offices, and they’d be able to get away with it, we have much bigger problems then any deficiencies in MAID."
-One more time for the people in the back...they're turning out people who cut the various organs out of children, so is it so crazy to think this evolution could happen in the near future because it is the "humane" thing to do?
This was more I was planning to cover, but these are the highlights. Richard's logic on a wide array of his arguments is severely deficient and his hand waving away of people who have serious concerns about the program does nothing to help is cause. These are serious issues which need to be addressed and his weak thought process here actually dissuades me from his side.
https://www.gordoncomstock.com/
"-So what should the standard be for this program? 90%? So if 10% of people are killed by the state's hand, who otherwise shouldn't have been, Richard chalks that up to an oopsie? Sorry, not good enough. Not even close."
The question of how you would even determine that someone was "wrongly killed" via MAID seems like a whole discussion unto itself. As long as the dead person signed on the dotted line, it seems impossible to prove, and trying to do so would surely get messy as you have family members with highly vested interests in portraying the situation one way or another. For example:
https://aleteia.org/2022/10/13/canadian-moms-harrowing-tale-shows-the-real-dangers-of-legal-euthanasia/
Here being a case of a young man who wants to off himself due to diabetes and depression, and being stopped from doing it by his mother. If his mother had failed to stop him, how would she even go about showing that he was "wrongly killed" via MAID?
"-Culture can change, and it can change rapidly, especially in the days of social media. Has Richard seen the increase in LBGT kids in the last 5-10 years? The fact that in our culture today people "usually want to live" (his words not mine) should not be good enough justification for anyone especially since if the tide turns, stopping it will be a major lagging indicator that something as gone haywire."
This is a blind spot he seems to have on this issue. People worry more about the future trajectory than the current situation, and if you look at history, they're often right to do so. If you told someone in the early 2000s that gay marriage would be legal nationwide within a decade, you could easily be accused of worrying too much about a slippery slope that shows no signs of manifesting yet. Likewise if you told someone in the early 2010s that in less than a decade their governments would begin to enforce mandatory deference to transgenderism in public spaces.
Richard isn't doing anything to alleviate such concerns by openly arguing that euthanasia should be expanded while simultaneously treating slippery-slope concerns as ridiculous. It's a dishonest inside-outside game typically played by the left, wherein they will typically claim that something doesn't exist or barely exists so why do you care about it, but also it's a Good Thing and we need more of it (i.e. "no one is coming for your guns don't be ridiculous, but also hell yes we're coming for your AR-15").
Thank you, this is a really interesting discussion.
"The state’s interest in saving costs, as long as it’s going to pay for healthcare, is also legitimate, although I won’t dwell on that here."
I think this is the central issue that people are going to have a fundamental divide on, and which you should perhaps be talking about more instead of all this other stuff, although to be fair I doubt you could change many minds on it. You say that you are completely okay with the idea of the state encouraging suicide simply to save money on healthcare costs. But to many people, perhaps most, that is an abhorrent concept on a deep first-principles level, and you're just not going to reason and logic your way past it.
I guess, but in that case, why require that money be attached to suicide? That seems rather grim and unnecessary compared to simply letting the person give money to their descendants freely with no need for suicide as part of the process.
I can see what you're getting at, though I still don't see why suicide would be required as part of the deal. At most, one would just offer it as an option, if the end-of-life patient wanted it (as opposed to simply letting nature take its course).
Either way, the potential for moral hazard here is obvious. You would certainly have cases of children encouraging their parents to hurry up and die already so they can get more money via this mechanism. If your view that this form of suicide is an act of "bravery and love" were to be adopted as the social standard, we would have a situation where the elderly are expected to kill themselves at a certain point, and those who had the audacity to desire that they continue living for a while longer would be looked down upon as selfish and petty.
Maybe you end up deciding that this would be a Good Thing, but again, I don't think it's hard to see why it would make people uneasy, especially with its being administered by the state. Once state-administered suicide at a certain age becomes a societal expectation, it's only one step away from being made mandatory.
I suppose this comes down in large part to your confidence in our governments and in our culture more broadly to handle something like this responsibly. It probably goes without saying that I have no such trust, but obviously others might.
You made a quite good argument about euthanasia, but not about MAiD.
You almost got the point when you correctly state "If the state is going to provide healthcare, it should acknowledge that suicide is a legitimate choice for people to make." but in your first instance you openly state that "The state’s interest in saving costs, as long as it’s going to pay for healthcare, is also legitimate, although I won’t dwell on that here.".
In fact, under a truckload of rethoric, the true argument for Canandian MAiD is to cut the healthcare public spending: i frankly find nothing "free" in a poor guy that the government push to suicide not to pay for his healthcare bill.
Funnily enought, one of the strongest argument for lockdown and forced administration-of-a-serum-never-tested-for-immunization-so-not-labellable-vaccine-without-definition-manipulation is to cut healthcare pubblic spending: "save the NHS" is the most reknown.
So, i find your argument "“Dying of Poverty” as Emotional Manipulation" a strawman at best: i want you to argue how "The state’s interest in saving costs through euthanasia, as long as it’s going to pay for healthcare, is also legitimate".
P.s. to attack Raikin because "he’s against all euthanasia no matter what condition a patient is in [so] Complaints about shortcomings of MAID should be understood from this perspective" is an ad hominem fallacy: otherwise, i should dismiss your whole argument as anti-elderly bigotry, because you made clear you are against the gerontification of the modern world.
I find it notable that Richard will acknowledge how absurdly tyrannical, corrupt and irresponsible governments often are in some cases, then in a case like this one, completely brush aside any concerns that the state might ever possibly overreach or begin to act in an abusive manner.
He has a similar inconsistency when it comes to the COVID vaccine--despite claiming to hold to libertarian/choice principles, I have never once seen him condemn the insane coercion campaigns that were enacted WRT the COVID shots, because he is always too busy going on about how stupid and dangerous those gosh darn low IQ "anti-vaxxers" are.
My fellows neapolitans Say "ogni scarrafone è bello a mamma sua": a cockroach/ugly guy is beautiful for his mom.
It Is simply prejudice, he likes euthanasia/covid-serum so no argument is needed: human but sad from a so-gifted person.
Have you read Helen Dale's "Kingdom of the Wicked" series? She sets up an alt-hist technologically advanced Roman Empire in part to contrast its morality with Judeo-Christian morality, and show us that the Roman alternative, though flawed, had its attractions. I bet based on this and your other writing that you will sympathize more or less completely with the Roman worldview Dale portrays, more than the vast majority of people would and even more than I would-- and I view the book as making a pretty compelling pro-Roman case. In any case it'd make a fascinating review post for your newsletter.
I have not read it, but it sounds really cool and I might.
Look you can delete comments and put “pressured” in scare quotes, but MAID is a moral disgrace, and getting the state to kill grandma is a proper nazi style slippery slope, no matter how many 1000 words you write
Well, I am mostly against euthanasia, but he's right we haven't seen this slippery slope materialize in countries that allow euthanasia.
I think America has a unique capacity to make things dumber and more prevalent/normalized. E.g. it's easy to imagine #DeathTok where influencers discuss how amazing it's going to be to snuff out your life, and an army of hack doctors encouraging them and doing whatever the euthanasia version of "yeet the teats" is
It seems like the way he gets there is just by saying that all the ways Canada has expanded euthanasia are good, so it's not a slippery slope. He seems to take it on faith that the expansion will never pass a line into what he would consider bad.
Germany in the 30s..
Come on, Nazi logic around this is completely different from what Canada is thinking.
First time reading a post on a substack and interrupting my reading to go and find the "subscribe" button. I've encountered your writing from time to time (most recently in the comment section at ACX) and liked it, but absolutely loved this. Higher agreement-per-word for me reading this than almost anything other than reading back over something I wrote myself. Back when the MAID fake news was heating up I irritated friends on both sides of the political aisle with my constant debunks. I wish I'd just had this link to send them.
Now, this comment comes too late for anyone ever to be likely to read it, but despite my complete agreement with it I have an additional angle on the motivations of those who oppose assisted suicide. I needn't duplicate any of Robin Hanson's talking points -- it is obvious that there is tremendous signalling value in proclaiming our willingness to support at any expense those who are too disabled to do so themselves (even if we have to force them to stay alive so that we can do so). No, rather I would like to comment on other, [post]Christian motivations. It will be offensive to objectors from the right and left that I lump them together, but I do so for good reason, likely nobody will ever read this, and my own authentic thoughts are apparently classified as 'trolling' so what the hell.
One lens (like all lenses it is imperfect and is best used in conjunction with other lenses) with which to understand what this looks like from the inside (for objectors) is to consider shifts in thinking in/with/around the rise of Christianity. Rather than one's life belonging to one's paterfamilias, one's polity, or one's (democratic) peers, it belongs solely to the Lord God, who alone can dispose of it justly (sometimes through [tacitly] divinely-approved kings). This coincides with and helps explain the preciousness of the individual: each person is like a coin that even if minted of base metal is stamped with the face of the one King of Kings. Thus when (according to legend) St. Lawrence (of the grid-iron) was told to hand over the ill-gotten gains he was presumed to have as chief deacon of Rome, he gathered up all the beggars (mostly crippled, blind, and lame) and proclaimed, "here are the treasures of the church". Islam, though obviously different, continued this new ownership-relation: one's life is not one's own, but belongs rather to Allah. Centuries later, Marxists were not facetitious in referring to the Acts of the Apostles in saying "from each according to his means, to each according to his needs". However changed might have been the frame, within even the worst times under communism we see a similar dynamic -- every person stands in relation not to God but the People, and if comrade Stalin has the power to dispose of a human life it is because he is merely a pawn of this People. "But this is a facile and obvious fraud!" one might respond. Sure, but so was the divine right of kings -- that doesn't mean neither expressed and augmented the underlying ideology. Consider the gulag practice of having prisoners send birthday well-wishes to comrade Stalin. Though literally dying of mistreatment yet even still they were (symbolically-only) regarded as part of the People and part of the political process.
Any descendant of this kind of thinking regards a human life as something outside ordinary disposal (however thirsty for exceptions or excuses any particular person who holds this view may be). The simple statement "your life is your own to dispose of as you will" at a stroke undercuts a primary value on either side. Thus freed, individuals might have premarital sex, get tattoos or abortions, publically blaspheme, kill themselves, or make decisions with economic consequences beyond the State's duty to ameloriate.
Don’t worry, at least one person has read and enjoyed the comment!
I am a cryonicist and the topic is of great importance to me. The success of cryonics, that is being able to return to life after a period of cryonic suspension in liquid nitrogen, crucially depends on the length of time between your last heartbeat and the beginning of the cryonic suspension procedure. Ideally you would want to stop your living functions at a time and place of your choice, with the cryonics team ready to start cooling your body and preserving your brain while your heart is still beating. Unfortunately this approach would under current laws in the US land the cryonics providers in prison and the cryonics patient autopsied and thoroughly dead.
I am angry at the world that curtails my right to extend my life through cryonics, while making incoherent noises about the sanctity of life. My life is my own, for me to dispose of as I see fit, not for others to play ideological games with. Hopefully, by the time I am old and decrepit enough that cryonic suspension is needed to avoid death from dementia and infirmity, laws will change and I will be able to make the right choice for myself, on my own terms.
You have definitely shifted my view on this topic. I’m still a little worried about some slippery slope scenarios, but overall I’m pro MAID now. Thanks.
While I had a vague sense of disagreement with you going into this article, I'm now open to being persuaded. Wondering if aesthetics is the main problem here again. Thanks for that.
I am VERY happy to see you bring up Nuclear Power & the Death Penalty--as I am very much in favor of both. However, I noticed you seemed more focused on what people on Twitter were saying as opposed to the article Kass wrote. I realize that responding to a philosopher like Kass would be a huge article in and of itself--but I think we might benefit from a critique of the other side's "best to offer." Or maybe a link to someone who has a good case against Kass?
One point I'm not seeing addressed by either side in this debate is this: Both California and Canada have similar-sized populations, and both are pretty "woke" and secular. Yet, I believe the per capita use of MAID is much higher in Canada than California. Not that it would affect the moral argument you put forward--but I really wonder if there's a good explanation for that? Is there any data point we can look at and say, "THIS is why Canadians are more comfortable with MAID than Americans?"
Related Topic: Forgive me as I meant to post this on a previous post of yours (congrats on having a wonderful daughter this year!) but I was wondering if this article might shift your stance on abortion somewhat:
https://www.theamericanconservative.com/welfare-reform-and-dobbs/
I'm starting to do just that.
Thanks and Happy New Year! Can't wait to read the new book on Civil Rights.
As I say in the article, I think the difference between California and Canada is probably Canada makes it easier and therefore has the better policy.
I don't buy what the TAC article is selling. "A recent survey asserts that 1 in 5 single adults are more hesitant to engage in sex since the Dobbs ruling." Come on, of course many liberals will say something like that as a way to say they don't like Dobbs. People who are smart enough to be influenced the law are smart enough to use birth control already. We're not going back to the 1950s.
Thanks for the well wishes.
I'm Canadian, and I'm not interested in the general question of euthanasia for terminal conditions; I'm interested in my government expanding the criteria so it can kill people who have depression and "fibromyalgia," which is usually depression. The second-order question is how this national psychology affects everyone else. There are already multiple friends of friends who are considering it, despite having no terminal issues.
Negative psychology is a loop. It causes problems that cause problems. Whiplash doesn't exist in places where people don't know about whiplash. People don't kill themselves due to fibromyalgia in cultures where fibromyalgia isn't accepted as a thing or as a valid reason to kill yourself.
Killing yourself is like divorce: we make it difficult for a reason.
This is also occurring in an environment where the government is desperately flooding the country with immigrants to prop up housing values for Boomers, flushing out the poor and vulnerable (and making new people poor and helpless). Our housing costs have increased 500% in 20 years due to government policy. This country is becoming the epitome of despair. I'd be interested to hear someone from Toronto or Vancouver who doesn't own property roll in here holding the opinions expressed in this essay.
I'm sure you know that thing about survivors who jumped from the Golden Gate bridge mostly regretting the jump. I'm not going to break the bank trying to stop them, but I hate this government that will steal your life's work and then push you.
The state is spending $400 million on a suicide barrier for the Golden Gate. I would call that breaking the bank, personally. https://www.insider.com/suicide-net-golden-gate-bridge-will-cost-400-million-contractor-2022-12
People who are dead can’t have regrets, though, so it’s not clear what you think the harm of suicide actually is.
I didn't say anything in support of spending that money to stop them from jumping. I said that I don't support my government killing non-terminally-ill suicidal people, or creating an environment consistent with such a thing.
So people who survive regret jumping, but if they'd only died, it wouldn't matter because they can't have regrets? No harm? This is just like saying it doesn't matter if you die, since you're dead. How about I come find you and kill you since you can't be upset about it, since you'll be dead? If you're going to make some argument about your family and the people who care about you, I can just kill them all too.
Ultimately we'll all be dead and nothing will matter. Why don't we just get it over with?
Not a joke.
From what I have read about survivors of the Golden Gate jump they all think “oh god what did I do no no no” right after they go over the railing.
It doesn’t matter if you’re dead, because you’re dead. The dying part and the leadup to it frequently involve additional suffering that makes them harmful. If one was able to painlessly kill someone in their sleep who had no idea it was happening, that person wouldn’t be harmed; they would be gone. And I would absolutely reject the idea that their loved ones have a meaningful claim here, because that just leads to enslavement at the hands of one’s family.
I honestly find it bizarre to think that it does matter to oneself if one is dead. I mean, it’s a nonsense concept if you don’t believe in an afterlife.
I'll get started on making plans to look you up and kill you in your sleep. Don't worry; it will be a surprise, so you won't have to worry about it coming. And I will leave your loved ones alive since it would be wrong to let their emotions get in the way; I might even put your head in one of their beds like that scene from The Godfather. That's what my utility function would enjoy.
In fact why do I even need to surprise you in your sleep? If I just kick the door in during the day, you'll experience 30 seconds of fear but so what? That's less total suffering than a few jump scares in a movie theatre. This will save a lot of planning. In fact I'm not even sure that it matters if you worry about it before I do it, since I could get going on this tonight and it would be less than 24 hours between me and... wherever you are. 24 hours of worrying; I'm sure you've experienced a lot more than that at work.
In FACT, all that worry of yours is irrational too, since you're worrying about something that has no harm associated with it. It's an evolutionary instinct, sure, but it's irrational, and if you can't learn to suppress it I don't even know why I should take it into account.
I'm sorry, you believe that depriving someone of their life does them no harm? I guess Epictetus would agree with that, but as a society we have very good reasons to make it illegal.
"Negative psychology is a loop. It causes problems that cause problems. Whiplash doesn't exist in places where people don't know about whiplash. People don't kill themselves due to fibromyalgia in cultures where fibromyalgia isn't accepted as a thing or as a valid reason to kill yourself."
You should read "Crazy Like Us" or Scott Alexander's review at least.
Is this a Swiftian satire? "A Modest Proposal"?