
The Death Treatment (2015) - pmoriarty
http://www.newyorker.com/magazine/2015/06/22/the-death-treatment
======
pmoriarty
I used to unequivocally support the right to euthanasia, but as I learned more
about it, I realized it was a complex issue, without simple black and white
answers.

One of the stories that made me reconsider my position was about a young man
who was severely burned in an accident which also killed his father. He spent
a long time in the burn ward, and was completely disfigured and disabled. He
was in constant agony and felt he had nothing to live for.

He made a video about himself called "Let Me Die", and submitted it to his
state's legislature, begging them to allow him to legally end his own life.
His appeal was denied, his injuries eventually healed (to the extent that he
was no longer in the burn ward, not completely), he was glad that he lived,
and went on to a career of educating others about these issues.

Another story that affected me was about some island where the population
discovered a readily available fruit that grew on trees on the island was
deadly. So they had a rash of suicides, with teenagers killing themselves
because they were told by their parents to clean their rooms or some such.

I may be confusing bits of that last story with some others that I've read.
But I have read multiple stories of teenagers killing themselves over things
that most mature adults consider trivial and blown out of proportion by
teenage angst that the kids would most likely would have been able to put
behind them as they got older, if only they hadn't killed themselves.

There are legitimate concerns about autonomy, self-determination, and
paternalism. I'm the first to admit those are serious concerns, and in some
extreme cases the decision to allow or even help someone take their own life
is clearly ethical. But there are also a lot of cases where the ethics of the
situation are not so clear-cut, and I find it disturbing that some people are
so dogmatic about their position that they can't see any dillema, are
unwilling to seek other ways of helping or alleviating these people's
suffering, and seem to view suicide as the default answer to difficult
situations.

I'm also disturbed to hear that Etienne Vermeersch, a philosopher of ethics
and "the most influential intellectual in Flanders", can confidently proclaim
that Belgium "stands, ethically, at the top of the world." This smacks of
hubris, and is unworthy of a man or nation so distinguished.

~~~
jfoutz
The state of our body affects our mental state. Everyone has experienced that
awkward hungry angry time that makes people a little crazy. I can't imagine
the horror of being a burn victim. I agree, perhaps people in horrible pain
can't actually make those decisions for themselves. The pain makes them
insane.

I feel like you're arguing from the exception though. This one person suffered
and made it, but i think many others suffer and do not make it. There are also
others who suffer, but want to continue.

I think there's room for the state to have a limited override. It's clear this
person is miserable, but the doctors are sure the misery is temporary, ok.
Give doctors the power to override the patients wish for some limited time.

My personal experience is the opposite extreme. There was nothing doctors
could do. My relative was stuck in a hospital for about 3 weeks before she let
go. Doing that to a dog would be considered torture. I think this case is much
much more common than the complete recovery you described.

IMHO, people who want to live, regardless of how hopeless the situation is,
should be cared for as well as possible. People who do not want to live, who's
chances are very slim, should be given the option.

~~~
nommm-nommm
How would it be torture go keep a dog in the hospital for three weeks?

~~~
jfoutz
The pain medication didn't keep up with the pain.

------
Ataraxic
I tend to support euthanasia, but its practice in that article scares me.

I guess I believe that people ultimately do have a responsibility to others.
Her son did not ask to be born and Tom's quote "You’ve just taken away the
suffering of one person and transposed it to another!" convinces me that
euthanasia is not as clean as we might believe. What if Tom having suffered
this triggering event and having a genetic predisposition to depression
applies for euthanasia? It seems euthanasia for the whole family is ethically
above board in Belgium, but I still feel that outcome is unacceptable.

The only thing that really bothers me is that so many ethicists in Belgium (as
far as this article describes) believe this is clear cut. I generally don't
have too many disagreements with most concepts of western philosophy, but if
this is the end result of the application of self-determination, I definitely
have plenty of reservations.

Finding out that your parent committed suicide after the fact is just
unacceptable to me, especially because the parent in this article did honestly
express to the doctor that she cares for them.

~~~
tremon
I'm not sure that I agree with your belief that voluntary termination (I
prefer that term over euthanasia) can ever be clean. It is a process that is
necessarily fraught with pain, even if that pain isn't visible on the outside.
I'd like to believe that no doctor would take such a decision lightly, but
that of course is hard to ascertain.

I do agree with your sentiment about the ethicists. The article paints a
picture like the review boards and experts are closing ranks against the
"outside world". It's somewhat understandable given that these are considered
hard-won "victories" by the humanist camp and still under constant pressure,
but it reduces transparency in an area that absolutely requires both
transparency and accountability. It's almost like regulatory capture: it
encourages practitioners to play it fast and loose knowing they will be
backed, and that should not be allowed.

However, in this particularly case: I understand it can be very hard for next-
of-kin to learn that someone close has chosen to die, and that they were not
involved in the process. I've watched it happen twice from somewhat nearby,
and I certainly hope never to experience it any closer. The anger, hurt and
guilt from not being included in such a life-altering decision can be
enormous.

At the same time, I don't see how drawing more people into the situation
should be up to the physician; that choice too should be squarely in the
patient's hands. For me it is enough that the doctor suggested she should
contact her children.

For me, the bigger question is why these doctors felt qualified to assess her
wish: it does not sound like any of the doctors that approved her request had
more than a cursory involvement in her (long-term) treatment.

~~~
nommm-nommm
>For me, the bigger question is why these doctors felt qualified to assess her
wish: it does not sound like any of the doctors that approved her request had
more than a cursory involvement in her (long-term) treatment.

Big problem. Doctor shopping is a big issue in euthanasia.

------
eth0up
Terry Pratchett made a very interesting documentary on the subject, titled:
Choosing to Die. Here's a link to the documentary:
[http://www.dailymotion.com/video/xnu340_terry-pratchett-
choo...](http://www.dailymotion.com/video/xnu340_terry-pratchett-choosing-to-
die_shortfilms) \- while it lasts, I guess.

It covers the Dignitas[1] facility in Switzerland, which specializes in
euthanasia (eu = good & thanatos = death), mostly for the wealthy ... if I
remember correctly. It's one heck of a subject and the above documentary
really hit me quite hard. For those interested in the subject (hopefully not
the action), you might also find Exit International[2] pretty intriguing.

1\. [https://en.wikipedia.org/wiki/Dignitas_%28Swiss_non-
profit_o...](https://en.wikipedia.org/wiki/Dignitas_%28Swiss_non-
profit_organisation%29) 2\.
[https://en.wikipedia.org/wiki/Exit_International](https://en.wikipedia.org/wiki/Exit_International)

~~~
hexane360
I'm going to have to start using the word "dysthanasia" as a euphemism more
often. (dysphemism?)

~~~
eth0up
Well, just avoid " _Dis_ thanasia", as I just learned of an actual Dis, which
might be confused with Orcus, some deity of the underworld. I play linguist
and get pushed down a Greek rabbit hole...

------
MichaelMoser123
Old and dependent people might be pressured by their families into agreeing to
euthanasia. After reading this article i think that they don't have enough
safeguards that could prevent such a scenario from happening. I have come to
think that any framework that allows for euthanasia is creating the
possibility of abuse in similar situations. The physician in the article kept
referring to the free will of the patient; now Free will in personal matters
is not an absolute entity, in practice it may quite often be
limited/influenced/determined by ones environment.

------
nicolas_t
I am a proponent of Euthanasia but regulating it in a way that prevents abuse
is extremely tricky and I think there should be a lot of transparency for the
remaining family who should be informed and have the right to know who made
the decision and how the decision was made.

~~~
pmoriarty
Do you believe there should be any limits placed on legal euthanasia? Such as
who can get it or why? Are mentally ill people capable of deciding of what's
in their best interests? Children?

If children are allowed legal euthanasia, should they be able to decide
independent of their parents or guardians? Could their parents or guardians so
decide without the child's consent? Should there be any age limit at all?

~~~
nicolas_t
As I said. I don't have all the answers. I can see that the system in place in
Belgium has some issues and I believe that there while it's important to have
legal euthanasia, there's a huge potential of abuses and it's important to
find a way to prevent abuses...

So, yes, all the questions you ask are really good ones. And, exactly mentally
ill people and children are two categories ripe for abuse and where there
needs to be tight regulations. It's extremely complex.

------
woliveirajr
Few days ago I went through some surgery. During the recover I didn't get all
the drugs I was supposed to. Then I learnt what pain is. How much pain you can
feel if you don't have your dose of morphine.

It made me think a lot. I knew my pain would go away, there were drugs for it,
etc. But and those who are suffering a great pain, with no drug making effect
to reduce it, and knowing that the time is coming?

It's not humane not to provide an end for those who want it, those who are
suffering and the end is near.

It was not my case. But I'm sure it's the case of someone else.

------
DanielBMarkham
A note on terminology: "euthanasia" is something you do to somebody/something.
Euthanize is a transitive verb. You euthanize a pet.

I firmly believe in the right of anybody, for any reason, to self-terminate.
But that's not euthanasia. When we start getting society involved in the
business of terminating people who request it? It's another level of moral and
utilitarian complexity.

I think a lot of folks are mixing it all together and demanding that my right
to self-terminate should force the doctor down the street to help out. These
two things do not have to be related. People have been offing themselves for
eons. They will continue doing so without the medical establishment.

I don't have any easy answers for what society should do for the mentally ill.
It seems obvious to me, however, that we should certainly be able to provide
food, housing, and medical treatment to them before we'd consider setting up a
system to euthanize them.

~~~
pmoriarty
_" I firmly believe in the right of anybody, for any reason, to self-
terminate."_

So if your child was about to jump out a window or run in to a busy street you
wouldn't try to stop them?

~~~
ci5er
It's interesting that you jump directly to that interpretation. I would have
interpreted it to mean that GP believes that the state should not restrict the
right of an adult of sound-mind to self-terminate. Given the nature of the
state, there would probably be forms and evaluations.

Even if I were to agree with GP, I'd probably still stop my friend high on
ketamine from walking in front of a bus (if he actually exists, that is).

~~~
khedoros1
"anybody, for any reason" is extremely inclusive. You could argue that they
meant "an adult of sound mind", or some other somewhat reasonable thing, but
that's not what they said. Without a clearer specification, I think it's
reasonable to push at the the edge cases to try to figure out what exactly
they meant, and what limits (if any) they might like to add.

~~~
ci5er
Oh, I agree. When I read GP, I was actually a bit confounded by how my reading
was so automatically self-limiting.

~~~
DanielBMarkham
Thanks guys. I meant adult of sound mind.

I was going to correct or reply, but I felt it would be more useful to the
forum to have folks push the edges and discuss them.

I don't claim to have an in-depth analysis of those edge cases. As a suggested
place to start, if the state feels that you are able to live on your own --
provide yourself food and clothing, make choices about your location and
lifestyle -- you should probably be able to make the decision to self
terminate. Or rather, you are able to do that whether we like it or not, the
question is really whether or not we feel we should use force to stop you. I
don't think we should.

------
reitanqild
I have read about parents begging for euthanasia before I think - in notes
about poster parents of the nazi empire or something.

------
jbob2000
The author makes Tom out to be a loving son, but the mother writes a note to
him saying that there was a rift between them and he didn't return her love.
C'mon Tom, you spend your life ignoring your mother, then she's gone and _now_
you care about her life?

This was a bit of a hit-piece on euthanasia, but also a lesson to spend time
with your family before the inevitable happens (whether intentional or not).

~~~
pmoriarty
_" you spend your life ignoring your mother, then she's gone and now you care
about her life?"_

Sometime you don't realize what you have until it's gone, as the old saying
goes.

Besides, whatever emotional or psychological issues existed between this
person and his mother, they don't discredit the central points of this
article, which were to bring attention to the complexities surrounding the
question of euthanasia, to question whether euthanasia is being performed in
cases which aren't hopeless after all, and to ask at what point should
euthanasia be legally permitted.

------
wtbob
> “Who am I to convince patients that they have to suffer longer than they
> want?”

One wonders who he is to convince them that they may end their suffering.

I think that there's something very cold about a society which says, 'on net,
the world is better without you in it' not to someone who is a murderer,
rapist or traitor but to someone who is depressed or afflicted with cancer.

> Last year, De Standaard, a prominent Flemish newspaper, published a long
> tribute to a depressed mother who was euthanized after being abandoned by
> her boyfriend and becoming disillusioned by her psychiatric care. “I am
> forever grateful to her that she handled this so well,” her twenty-four-
> year-old son told the paper. “I am so glad we were able to say goodbye in a
> beautiful way.”

One wonders if the son attempted to support his mother in life, rather than
tell her goodbye.

> On the morning on which the euthanasia was scheduled, Boeykens’s daughter,
> Kerstin, said that she called De Deyn, crying, and begged him to move her
> mother’s 9 A.M. appointment a few hours later, so that she would have time
> to drop her children off at school and then drive to the clinic. But De Deyn
> said that he was booked for the rest of the day. (De Deyn denies that this
> happened.) Records show that Boeykens died at 9:20 A.M., at which point De
> Deyn removed her brain and performed an autopsy.

I don't really know if there's anything more to add to this vignette. It's
like something out of Brave New World (a book which, incidentally, I've always
found far more prophetic than 1984).

~~~
ubernostrum
Your whole comment is kinda coming across as searching for the worst possible
interpretations of statements so you can attack the person delivering them and
hope it'll rub off on the argument. Maybe don't do that?

 _One wonders if the son attempted to support his mother in life, rather than
tell her goodbye._

Also: when my mother was diagnosed with (terminal) cancer, she tried the
treatments at first. Chemo, radiation, everything. Doctors told her at best it
might buy her a few more months.

After learning what those treatments would do to her, she made the decision
that a few months of _that_ wasn't worth it, and stopped treatment. Do you
think it was my job as a son to try to force her to continue, out of "support"
for her?

~~~
wtbob
> Do you think it was my job as a son to try to force her to continue, out of
> "support" for her?

No; there's a major difference between refusing further treatment and pursuing
suicide.

~~~
AstralStorm
There is not really. Refusing euthanasia to a cancer patient is essentially a
sentence to a painful death or morphine overdose if that even works as a pain
killer. The latter is a bit better but not too much.

