Is it not dystopian for the apparatus of state to be involved in suicide? Is killing not a gross violation of the Hippocratic Oath?
Assisted dying seems an evil thing to me - all the more so because suicide is feasible without society’s involvement and encouragement. One worries that the state and doctors will at some point go from saying “you may” to saying “you should.”
I hear you but what’s the alternative though? Provide a DIY guide on how to do it yourself in a painless way? And what about those people who just can’t because are paralyzed for example? There are a million different cases and someone has to have the power to help someone who has decided that they don’t want to live their lives that way anymore.
Your comment resonates with me because I remembered the Spanish movie Mar Adentro, who explores that topic on a nuanced way to me. I recommend that movie to anyone reading this who is interested on the topic and likes good fiction.
In our present marvelous age of information, instructions for painless suicide abound. In societies which grant primacy to the rights of individuals to live and die as they see fit - that is, in which there is a degree of free speech - these resources are easily accessible.
He'd rather people suffer so he could feel better about himself. Personally, I'm pro-euthanasia for selfish reasons too - I'd like to be able to end it cleanly, alternative ways are a mess.
You can't fix everything. Drugs don't fix everything. Not everything can be treated. Seen too many people slowly detoriating, waiting to die for incurrable diseases.
If I have a right to live, I should have a right to die, otherwise I'm a slave.
No, I’m not an advocate of suffering. I’m a skeptic of the state’s role in its ultimate antidote. As a cadaver may not be incarcerated productively, I question if one’s right to death is - or can be - denied.
Moreover, is not assisted dying treated as a privilege, rather than a right? Like a driver’s license, one must apply. It is alienable.
The application process is in place to create friction so that people wouldn't off themselves for silly reasons, also to try to address concerns like yours.
Who else than state? Random people? You can always off yourself, but that is messy. Might as well have a process for that.
> Is killing not a gross violation of the Hippocratic Oath?
being 'alive' and suffering versus dying and ... being dead and not suffering. pretty easy decision.
ultimately the hippocratic oath is about upholding good ethics and being a just individual. the misconception at the heart of all this is that death is unjust or an invalid solution when in fact it is and the stigma around it should be dropped.
I do believe death is unjust, though not an invalid solution. Death is the fundamental injustice of existence. That something is natural does not make it just. The quest to vanquish death is a perpetual motif in recorded history, across cultures, and a recurrent religious fantasy.
I didn’t understand why you put a sad face/frowny at the end of your last sentence. IMO, granting the freedom for people to choose to die (with checks and balances) is a good thing. I’m sure there will always be debates on whether the approval for one person was correct or wrong. The discomfort that most people have about other people dying cannot be easily alleviated.
Is it thought? If you don't succeed you basically are incarcerated by way of mental institutions (at least in the USA). Obviously they can't hold your un-alived body "accountable" but it sometimes does feel like suicide is illegal.
My grandfather, from Belgium, suffered from mesothelioma - I flew back to see him and attended the conversations and sign offs, secondary sign offs, etc necessary for him to be able to be euthanized. He was already in a lot of pain and his quality of life was very different than the man I knew growing up. I was already back in the States when the waiting period was over, and we had a final video call prior to him being administered the medications that would ease him in to cardiac arrest -- he had deteriorated so much more in that month. Death was unfortunately the only outcome in his scenario, and giving him the ability to pass away while at home surrounded by loved ones, was a choice he had and took. I am very Americanized, having been here in the States for so long now, and it was a bit surreal going through all this, but, I am very happy he had that option.
If you look at this[1] 2023 report on euthanasia in Belgium, I don't think the numbers are anywhere near a height that it would be something I would say they "excel" at.
There is usually a religious reasoning behind such people’s opinion/argument, not logical reasoning.
If someone doesn’t want to live, why does the state, or anyone for that matter, get a say? A person didn’t have a say in being born, they should at least be allowed to die on their terms.
BTW, the same states don’t have a problem sending soldiers to their deaths when it suits them.
Usually, but not always. In my case, I'm against religion and my state can't (or shouldn't be able to) send me anywhere - but it has a duty to protect me from myself if I'm unfit to decide.
Well, I lived through that personally. There was a court hearing where they appointed a legal representative (an attorney) and a public defender, and then they argued about it for several hours during multiple hearings. The representative was checking on me, my conditions at the hospital and my treatment frequently and reported it to the court. As soon as they all deemed me to be back in my own head, they gave me my rights back.
I hated that they took my agency back then, but looking back it was fair and all of the people involved tried their best to represent my interests, and I'm grateful they did it.
That is a special case and I agree that in that case authorization is needed since older people can be especially vulnerable to evil relatives.
How about, one is allowed to go to some authority or doctor, 3 times at the space of 10 days, and express their desire. They can always change their mind. At the end of their 3 visits they are given a prescription.
This is just an example, there can be other ways.
Edit: to clarify, 3 visits, 10 days apart is 30 days. And, the person has to do themselves so obviously need to be healthy and the person receiving the affidavit/declaration can notice if there are any mental health concerns. Make it 6 visits for total of min 60 days. As long as there is a good and relatively easy process I’m good.
what is the consequence of allowing someone to die? regardless of the circumstance. there is absolutely zero reason to force someone to live if they do not want to.
a bird hits a glass window of a skyscraper and falls to the ground. no big deal.
a squirrel is run over by a truck. no big deal.
an individual is sick of living and decides to leave, no big deal.
The consequence is that a unique intelligent, sentient being ceases to exist. That's absolutely terrible. And worse, they might die without receiving proper treatment or it might become available soon after.
> The consequence is that a unique intelligent, sentient being ceases to exist.
Why is this such a bad thing? I see no issue here. Forcing another to exist just because they have some kind of untapped value that hasn't manifest yet is antiquated thinking.
Obviously rehabilitation and therapy should be on the table, to try and bring someone back to normalcy - but if that fails we should not falter.
It's a bad thing because I have personal experience with the court taking over my decision making when I wasn't in a mental state to do it for myself. I'm immensely grateful even though I didn't think so at the time, fought it and thought they have no right to do so. I had no idea things can change so much and wasn't thinking clearly, life is beautiful now.
none of that should even matter. remove morals from the equation. remove religious conditioning. we are all just animals. total freedom and agency would suggest that you should have just as much control over whether you live or die as anything else in your life.
no justification required. you want out? ok, cya bud.
I for one am glad that it's not easy to commit suicide, because my sister tried and failed and after 10 years is finaly better. She has scares on the hands that she's hiding with tattoos. Mental problems can be resolved. Not all of them and not easy but it can work out.
If that's really true, then perhaps. But those people would probably argue that these two conditions are mutually exclusive. Again, can't say I totally disagree.
If only there was another way... We can't fix it now, but if we could put that person in suspended animation or some other kind of stasis, we might revive them once treatment was available...
This all is really sad and I don't wish anyone to suffer. But I also don't want people to die because they thought their situation is hopeless and it might turn out it isn't...
Having ten years of therapy and then spending three and a half years to get approval for euthanasia…I can only empathize without knowing the depth of her suffering. Based on the description of her experience, some laws related to privacy of the individual choosing euthanasia may be helpful. Not surprised, but it did sound atrocious that many people around the world — who didn’t know her — believed and decided that they know better about what she ought to do.
Reminds me of “suicide booths” in Sheckley’s “Immortality Inc”. How long until we “grant” euthanasia approval for any reason at all, including no reason? I can imagine there’d be a ton of people willing to accrue enormous debts or commit crimes if they could then painlessly off themselves instead of facing the consequences.
Opiates aren’t easily available to most, and illegal. I’m talking about totally legal and totally painless method here, as in the novel. There’d be a lot of takers if friction is reduced. Heck, I bet every person’s life has low points where continuing seems pointless. I had a few moments like that myself when I was younger and expect to have more of them as I get older. I’m only really still alive because dying is a high friction process.
> There’d be a lot of takers if friction is reduced.
A legal process that involves the state and possible years of monitoring, age limits, etc is much more friction than the very quick ways one can do it on their own without the state's involvement.
People should be allowed to quietly go out of this world with dignity.
What worries me is the image of an understaffed public hospital, with a single nurse walking from bed to bed softly asking the patients if they want permanent release.
Sure, but where does that leave children of a (temporarily) down on her luck mother, or indeed parents of a depressed child? We’re extending medical autonomy to 13 year olds at this point.
As someone who lost one of their best friends to schizophrenia, I can guarantee you it that in his case it was a terminal illness. It was an ugly, dirty battle he slowly lost over the course of the 15 or so years he was diagnosed with it, and his family suffered every step of the way, and well beyond his final moment.
Just because a suffering isn’t visible, or doesn’t prevent someone from walking or getting up from a couch doesn’t mean it’s not every little bit as painful as a physical affliction.
Mental illness can absolutely be a terminal condition, she has specified that she has had suicide ideation. A far more significant issue plaguing society is the perception that mental illness is not real illess, not the minuscule amount of people who want to freely control their own destiny.
(a) I have suffered from severe mental health issues in the past and struggle with better-controlled ones to this day,
(b) I was pretty explicitly suicidal for several years (I still have the note I wrote on my desktop as a reminder; it's something I keep close to my heart as a thing that is precious to me),
(c) I very, VERY strongly believe in the idea of mental health as a health problem and not a moral one, largely because of my own experiences, and
(d) I agree with you that the failure to recognize (c) is a far larger problem than even poorly-justified assisted-dying would be.
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All that being said, though, I think there's legitimate reasons for concern here. I absolutely would have said my life was unendurable and that it could never improve, and I would have said that persistently for a long period of time (for around two years, so a substantial chunk of the approval period here). And the claim that my life wasn't going to improve was, in retrospect, a fairly reasonable belief - my life was in bad shape and even if I could talk to myself at the time I'm not sure how I'd ever justify the way it worked itself out.
But it did work itself out. Things did turn around, in a way I could never have predicted. My life improved, and in the years since, I have overcome basically every personal issue I thought I never would. That's not to say my life is perfect, by any means, but it's better than - and I use this phrase in its full literal sense - I could have imagined at the time.
I suffer(ed) from basically the same spectrum of conditions this woman does. I was roughly the same age. I had tried medical treatments that, while transformative in terms of the way I looked at mental health, had not offered sustained relief (and to this day have never found a medication that works effectively for me).
I have no doubt her desire for relief is sincere, because I have no doubt that mine was too. She's quoted in the article as saying:
> People think that when you’re mentally ill, you can’t think straight, which is insulting
I can't speak for her. But I think if someone had told me this during the depths of my own worst battles with it, what that would have sounded like to me is "you're not really in this much pain". In that sense, I agree (and would have agreed at the time) that it would be insulting.
But, again, while I can't speak for her, I was empirically not thinking straight, in the sense that my perceptions of the world and of myself were distorted. I was trapped in a system of mental processes that rounded "my life is really bad and I can't see any way it gets better" to "my life is unbearable and it is impossible that it ever gets better". I was, objectively, wrong in my predictions of the future and my judgements of myself, and that's not someone else talking, it's me, with the benefit of greater experience.
I didn't have the options on the table that she does. But if I had, and things had continued for more years the way they were? I might have taken them. I'm not sure. I know I had a plan for how I would end my life painlessly. I never got to the point of quite executing it, but that was as much a statement about how hard it was for me to do anything at the time than it was a statement about how much pain I was in. And my life came within hours and a lucky roll of the dice of going further down into despair.
When I think I might have made that choice, and I think I would have been incorrect to make it, it's hard for me to feel entirely comfortable with her choice as the correct one. Perhaps it's a choice she nevertheless should have the right to make (I think you can make pretty good arguments for that), but the choice you have the right to make, and the choice you should make, and the choice that deserves social endorsement, are different matters.
One important thing to remember: Belgium requires the sign off of three medical doctors intimitaly familiar with the case, and they must assert that all courses of treatment have been exhausted, that the patient is incurable, and that the patient is suffering from "unbearable pain", and crucially: that the patient is sound enough of mind to make the request.
Making the request itself is grounds for significant psychological involvement. Doctors are opening themselves up for lawsuits for manslaughter if the conditions are not met (see the Tine Nys case[1]).
All this to say: it's not just a matter of making the request twice and wham bam thank you ma'am.
I recognize that, which is why my response is sympathetic concern and not outright opposition.
I am sure that everyone involved here thinks they're doing the right thing, and that they're approaching it with the seriousness and gravity the topic deserves. And I think this is a topic on which reasonable compassionate people could disagree. I'm just not sure if the solution here is the correct one.
Mental illness is sometimes worse than physical; I have known multiple people (who did commit suicide) who said they would prefer cancer or sit in a wheelchair then the hell they lived in. I guess it’s hard to image if you never had that or don’t know anyone who had.
You can induce this state with drugs. Then it will be easy to imagine and understand. If drugs can reproduce this state of mental anguish it is imaginable that someone's brain chemistry might be off in a way where they are in similar constant mental hell.
Medical science has had significant breakthroughs with physical diseases (ie, genetic therapy to help parents grant children with hearing). But still feels like mental health is stuck in the 1930s-1950s.
- electroshock therapy (wtf)
- throw a bunch of mood stabilizers, SSRIs (Selective serotonin reuptake inhibitor) and see what sticks
- therapy/talking
- lock em up in prison or psychiatric “hospital”
- in some cases people resort to self medication with various mind altering substances (LSD, microdosing MDMA) and see what sticks
At least we aren’t doing lobotomy procedures anymore.
Medical science has failed her. Society has failed her.
Speaking as a person who once suffered from extreme mental illness (see my other post in this thread), mental health treatment saved my life. Full stop. If not for the very, very persistent efforts of a psychiatrist and a therapist both, there's no way I would ever have been able to sort myself out.
Mental health care is hard because people are complicated. It's been almost seven years since the woman who saved my life sat with me in her office for no less than four hours telling me that yes, I should really take these pills, and I am still sorting things out to some extent.
SSRIs don't work for me. But one of them worked for a short time, and that short time was enough to completely change my understanding of myself. It changed me from thinking of myself as a terrible person who deserved all the considerable suffering I was enduring at the time, to thinking of myself as someone who was very very very sick and needed help to survive. If you've never been severely depressed, it's hard to explain what a revelation that is. I broke down sobbing for hours at the feeling of understanding for the first time that my suffering wasn't my fault. It was (in part) due to my actions, but my actions were due to my mental state, and my mental state was not something I had gotten to choose. So when I say that I strongly, strongly, with all my heart, recommend that you try them if you're depressed even though they only worked for me for a couple of days - well, that should tell you just how important that was to me.
Therapy didn't fix me. But it did give me the tools to work on myself, in fits and starts, for what is now half my adult life. Having someone I spoke to every week, who understood the patterns of mental illness, helping me to see the feedback loops for what they were, was critical in understanding the nature of how I was sick. That didn't make those loops go away. But it did train me to listen to them less, and helped me know where to find them when I had the mental energy to work on them.
Without mental health care, I would be dead. With mental health care, I've shed my constant fear of the smallest changes, I no longer scream at myself for the smallest mistakes, I've had healthy romantic relationships, I have a career most people would envy, I take care of my personal environment, I'm in the best physical health of my life and have shed 40% of my body weight to be not-obese for the first time since childhood, and I smile. I smile a lot.
Has society failed many people? Yes. Environmental factors are relevant to mental health. In fact, it's part of why mental health is so dangerous: once your health deteriorates and you lose control and maintenance of your environment, you create a feedback loop that worsens mental illness. I am by no means arguing that we could not take care of people far better than we are. But I, at least, believe in the importance of mental health care as strongly as I believe in anything else on this Earth, because of what it did for me.
There is an enormous conflict here. On the one hand a certain degree of mental illness means that you are legally incapable of making choices, while, on the other hand you obviously need to be mentally well enough to make an informed medical decision of such gravity.
How many people are so mentally ill that death is the only conceivable escape, but at the same time so mentally well that they can make an informed medical decision about the end of their life. Certainly I believe that number to be very low, potentially it might just be zero.
It's actually really not so uncommon, if you classify dementia as "mental illness". Many people prefer (or say that they prefer) euthanasia to dementia, yet one has to make the final decision before the dementia is overly advanced.
This doesn't relieve the conflict. What if someone says they want to die with less advanced dementia, but when the illness has advanced further they say they want to live?
Many medical decisions are put into the hands of relatives when people become mentally unfit to make those decisions. Certainly in this case it shouldn't be allowed.
The law in my country is that the final decision has to be made by the patient itself, shortly before the euthanasia (no advance directives), and while mentally fit.
The mental fitness has to be confirmed by the personal physician, and in reality, they will also take into account whether the decision has been maintained consistently, over a longer period of time before the onset of serious dementia, and if so, they might relax mental fitness criteria somewhat.
Relatives don't enter the picture (as opposed to withdrawing of life support).
>Relatives don't enter the picture (as opposed to withdrawing of life support).
But their doctor does? That is just bizarre.
Here in Germany, if you aren't fit to make your own medical or legal decisions, the state will try to appoint a family member as your formal caretaker in those matters.
Honestly hearing this made me significantly more apprehensive about the whole thing. This seems like an awful idea.
The doctor certifies whether the patient is of sound mind when making the decision. In practice, both the doctor's history with the patient and the relatives may influence that certification in edge cases.
That's the whole problem with euthanasia in The Netherlands.
Most would opt for it when they have mental illnesses like Alzheimers or dementia in general but most often they would too ill to be able to make required informed decision. I am glad it's offered because why would someone need to wait until they die? Especially, when the person can't be treated further like when having cancer.
I think it is understandable when the person is suffering from a painful and untreatable illness, but can otherwise make their own medical decisions. But that is a completely different scenario, with a mental illness, what you are escaping from is what makes you unable to make the decision.
> How many people are so mentally ill that death is the only conceivable escape, but at the same time so mentally well that they can make an informed medical decision about the end of their life. Certainly I believe that number to be very low, potentially it might just be zero.
People suffering from non-suicidal mental illnesses could fit this description. For example, consider a patient who has undergone various therapies and medical examinations but remains irrationally terrified of fluids and can only receive them via injection. They'll be mentally sound enough to make an informed decision, and the patient concludes that life is not worth living.
Is that just a thought experiment? Almost all mental illnesses I am aware of seem to be experienced continuously, maybe with an ebb and flow in intensity.
But even if such a person existed and the phobia wasn't persistent without a doubt the person would suffer from related anxieties. I don't believe that you could suffer from such a condition and be mentally well for any amount of time, although I certainly see your point that during certain periods the person might be able to make an informed decision.
Assisted dying seems an evil thing to me - all the more so because suicide is feasible without society’s involvement and encouragement. One worries that the state and doctors will at some point go from saying “you may” to saying “you should.”