Forced Diaper Wearing Is Not "Human Dignity"
The anti-euthanasia movement is an assault on what is best in man
I don’t have much anxiety about death. One day you’re here, next day you’re not. Big deal. I wasn’t around during the Roman Empire and it wasn’t that bad. I do worry, however, that one day I’ll have a stroke, or a blood vessel will pop or something, and I’ll be rushed to the hospital. I’ll be incapacitated, turned into a vegetable, and then our nice Christian society will for decades keep me hooked up to machines. When an adult comes into my room, it will be to change a diaper or move me so I don’t get bed sores. My enemies on Twitter will laugh. I’ll be nothing but a burden on the taxpayer, and maybe my children, who make their lives smaller and perhaps forgo opportunities to form families of their own in order to take care of me.
One thing I’m going to stress to them when they’re old enough is that they definitely should not do that, and if they decide differently I would consider that a failure to transmit my values, which say that if and when I get to be too much of a burden I should be put on the proverbial iceberg and allowed to drift off to sea.
To be reduced to such a state of dependency would be the worst imaginable fate. I feel the same way about other people’s lives. Hearing that someone I liked or respected died is much better than hearing that they’re in constant pain and unable to take care of themselves.
Opponents of euthanasia often invoke the idea of “human dignity.” I find the way they use the term very odd, and frankly repulsive to how I understand the concept. To me, human dignity means things like being an autonomous agent, with the freedom to make my own choices in life; not being a burden on those I care about, or the rest of society; having a sense of privacy, in the form of say not needing to wear diapers and be changed by other adults; and not losing the essential features of my intellect and personality.
I believe that paternalism in all its forms robs people of their dignity. This is why I almost always oppose it, even though I’m sure that there are some things you can force people to do for their own good. Giving you the choice to ruin your own life grants you respect. Forcing a cone on a creature’s head so it doesn’t harm itself is befitting a dog, but not a human being. If I was going to spend my life prioritizing the well being of creatures who can’t be trusted to take care of themselves, I’d rather we focus on factory farming instead of people who are stupid and weak.
The anti-euthanasia position is of course much worse than normal paternalism. It not only seeks to take away a choice, but demands government have final say over the most fundamental question an individual can face — whether he should, given his circumstances, continue to exist or not. Putting such a decision in the hands of the state is a much more serious offense against human dignity than something like stopping people from eating trans fats.
Making matters worse is that one of the recurring arguments of the anti-euthanasia position is that people might choose to kill themselves because they don’t want to be a burden on others. But not wanting to burden others is virtuous! To invoke paternalism to stop people from acting immorally is one thing, to do so in order to mandate forced parasitism is another. It’s like if one justified taking away people’s money by saying they might feel pressured to give it to charities, or make the lives of their children better.
An academic paper from last year cites this newsletter for the claim that “[s]ome commentators have lauded the Canadian system for endorsing that citizens opt for MAID to avoid being a burden on their families or society.” I haven’t seen any indication that the Canadian system actually does endorse this idea, whatever that means, but it should. Nonetheless, professors usually prefer to cite peer reviewed journals rather than newsletters, so the fact that they had to refer to my essay indicates that this is an argument very few people are willing to make publicly. I find this very odd. If I knew someone who was completely indifferent to how much suffering they brought to others around them, I would think this person was immoral. Yet critics of euthanasia take the fact that people sometimes consider the greater good in their decision-making process as a reason to restrict the practice, and this point is supposedly so obvious that they don’t feel the need to explain why.
What these types are saying is that you have to wear diapers and get them changed twice a day for your dignity. You have to transform from a proud man in control of his own destiny to a drooling mess spending your days soaked in feces for your dignity. You will go from living a life in which you put your children and family first to being in a state of existence that ensures they will always remember you as an emotional and financial drain for your dignity.
For people who oppose euthanasia in all circumstances, from my perspective there is nothing that can be said to them. The chasm in values is too vast. I try not to hate people for their political views, but feel tempted to create an exception in this case. What opponents of euthanasia want to do to their fellow humans after they grow old is generally worse than what they would experience if they fell into the hands of ISIS, and they should be ashamed of themselves.
More common is the moderate position that grants the right to euthanasia in extreme situations but argues that places like Canada and the Netherlands have gone too far. To me, it’s worth defending euthanasia even in the most difficult cases, like when a person is suffering solely from mental illness, for the same reason we defend free speech rights for NAMBLA. Sure, free speech can be abused and have negative consequences. But the principle is too important to allow government to decide what to ban on a case-by-case basis. Once the state can restrict some speech, the temptation to keep going is too great.
Yes, this is a slippery slope argument. But unlike the anti-euthanasia position, it’s one that clearly understands the characteristics of Western societies. Our culture cares a great deal about stopping people from dying, and not too much about individual liberty. This means that we are way too biased against death to trust the state to decide when euthanasia is appropriate. What kind of slippery slope you find plausible should depend on cultural context. If we lived in Tokugawa-era Japan you might be worried about going too far in glorifying suicide or making it seem like an acceptable option.
I wish there was a kind of testament I could leave that says that if I’m ever in a position where my mind is so gone that I can’t be treated as an adult in the eyes of the law, I want to die. As far as I know, such a document wouldn’t be enforceable anywhere, at least in the United States. I’d probably be much quicker to kill myself if I ever get diagnosed with an illness that might eventually leave me incapacitated than I would be if I lived in a society that I was sure would honor my wishes.
A few years ago in The Netherlands, there was an elderly patient who declared she wanted to be euthanized, but then later developed dementia. Her doctor put a sedative in her coffee to render her unconscious and fulfill her wishes. The woman woke up, so she had to be held down by her husband and daughter while the doctor administered the lethal drug. This was controversial even in the Netherlands, so the doctor ended up in court, although she was thankfully cleared. The press in the US and UK ran with the story as a kind of cautionary tale about what happens when you legalize euthanasia. A doctor simply honoring the wish a woman had when she had been of sound mind became an international scandal, showing that we have a long way to go before we accept an approach to end of life issues that is centered around human dignity.
In other words, the moderate anti-euthanasia position worries about mistakes in the wrong direction. In Canada in 2021, for example, only 2% of euthanasia deaths involved someone without a terminal condition, or about 200 cases. Most of those were likely in unbearable pain. Meanwhile, 368,000 people in Canada have dementia. If you figure even 10% of them would not have wanted to live in that state if you asked them earlier in their lives, which I think must be an underestimate, then that’s almost 37,000 cases of assisted suicide that should have happened by now but didn’t. And this is only one disease. I support the least restrictive euthanasia regime possible because practically all modern societies are prone to err on the side of life, and the costs of keeping too many people alive in terms of suffering and lost dignity are much higher than those that might result from giving mentally ill people too much autonomy.
I think that if you make the most basic assumptions of how many people who have terrible illnesses would reasonably want to die and compare them to how widespread euthanasia is, you would find it difficult to come up with numbers that indicate that even countries like Canada and the Netherlands are too liberal on end-of-life issues. When you read anti-euthanasia articles you’ll often be transplanted into an alternative reality where Canada is ruled by the spiritual descendants of Nazism intent on ruthlessly culling the weak, instead of being a modern welfare state that is at best ambivalent towards personal freedom and prides itself on how much it can do for the most helpless members of society.
As Scott Alexander once wrote, relying on his experience working in hospitals,
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.
An opponent of euthanasia of course might say that one can’t treat false positives and false negatives as equivalents here. Preventing one death that shouldn’t happen is more important than letting a thousand people make an informed decision to commit suicide. This is a plausible argument if you consider death the worst possible outcome. But it’s hard for me to think of a value system more antithetical to a noble conception of man’s existence.
This article hits me really hard right now. My dad is in his late 70s and has Parkinson's, and my mom is in her mid 70s and has Alzheimer's. Both, as you know, are neurodegenerative diseases that will only get worse and worse over time. Both parents require a lot of care right now, and it's eating up a lot of resources and time on the part of both my brother, his family, and myself.
My dad has signed a bunch of end of life documents, indicating that he doesn't want any lifesaving or life prolonging interventions. He's already so weak that his balance is unstable, which led to a fall last week and he broke 4 ribs. He can still feed himself, but barely because he's too weak to lift a regular fork (has to use a plastic one). He has to have help to get on the toilet.
My mom's short term memory is basically gone at this point, and she is constantly asking about her folks and where they are (they've been dead for over 40 years), and when you tell her this, she asks why no one told her, then 2 minutes later asks the same question again (and over and over) You can't reason with her, you can't argue with her, and you can't correct her recollection of anything really because she doesn't remember and therefore can't make mental connections. Sometimes she remembers her husband, sometimes she claims she's never been married, sometimes I think she thinks he's her father. At this point she still remembers me, but I know that day is coming too. We can't leave her alone anymore because she will literally decide she wants to go "home" (from the house that she's lived in for the past 15 years) and walk down the driveway and down the road. There is no cure, and this will only get worse and worse, forcing us to eventually put her into a memory care facility. If you've never visited a nursing home or memory care facility, you really should just to get a sense of how sad and depressing those places are (in addition to expensive).
I have owned animals and horses for many years. and I will say that we would never subject an animal to living the kind of life the elderly have to endure. I've defended friends and clients who've put their horses down upon retirement or some sort of major injury that would've left them pasture sound but basically unusable. I do know a client who retired a horse at age 20, then proceeded to fund that horse's retirement in a pasture for the next 20 years to the tune of $400/month, time and funds that could've been spent on another, younger horse or pretty much anything else.
Anyway, there are no easy answers here. I do agree with Richard though, that I would not want to be such a burden on my family at the end of life and I think euthanasia should be a more socially acceptable option.
The young healthy Dutch woman killing herself is the best argument against euthanasia. Young healthy people should not be killing themselves, period. To not only allow that they do so, but to even actively approve of and assist in the suicide, is surely a sign of a deeply sick society and culture. If you want euthanasia for old people who are suffering, you should be arguing as vehemently as possible against letting anyone else who isn't severely ill access it, because seeing young healthy people using it to kill themselves is going to turn people off of the idea really fast.
Likewise, the concern with telling people to kill themselves so that they won't be a burden is what happens when this shifts to become the standard. You can portray it as noble for someone to kill themselves for this reason in a culture which is otherwise telling them to live, sure. What about the opposite situation? If everyone adopted your view, the social norm would quickly change such that people are expected to kill themselves at a certain point, and those who desire to live may face social sanction for daring to "be a burden."
You say that it's bad for the state to have a say in this, but the state must always have a say in matters of literal life and death. What kind of policies will the state adopt with the shifting of euthanasia into common practice for the elderly? Will the government decide that perhaps people should lose all of their benefits, such as social security, at a certain point, under the logic that they are now enough of a burden that they should just kill themselves? Hopefully nothing that drastic, but I would expect 100% that the government would begin looking for ways to encourage the elderly to hurry up and die and stop costing the taxpayer so much money.
As with abortion, I think you are leaning too heavily into simply insulting the other side, and not doing enough to engage with their actual concerns.