Great guy, very sociable, knew everyone in the little town he lived in. Kept in touch with a lot of students. Good neighbour, friendly guy who'd talk to everyone.
He got Alzheimers. He started forgetting stuff, and it frustrated him. He got caught driving dangerously, and cursed the doctor who took away his license.
He argued with me about the state of some chicken he wanted to cook. I told him "this is pink all over, you have to cook it more". He got angry. I understood he'd become like this to everyone.
He pissed off everyone on his street, and all police, medical and social workers sent to help him. The disease made him blow up every relationship he had with anyone that he didn't know well, like me and a couple of colleagues.
He got found in his house, having left the gas on, endangering the whole street. He ended up in a care home, not knowing who he was, or who I was.
If he'd been run over by a car, or died of a heart attack at the age of 80, people he knew would remember him as that nice old guy who had a dog and made a lot of art, and was friendly to everyone. Instead he was that 83 year old guy who pissed off everyone, nearly blew up the neighbourhood, and drove like a maniac.
You really don't want to end up with dementia and related illnesses, it totally sours everyone's view of you.
> You really don't want to end up with dementia and related illnesses, it totally sours everyone's view of you.
This seems like such an absurd conclusion to this, as though the opinions of other people of you are what matter when you functionally lose your personhood and then die.
Maybe a better focus would be that there often isn't a good way for a community to manage a person who suddenly becomes irrational because of an illness.
The parent described someone who went above and beyond the norm of other members in his community in his constant positive interaction with his neighbors, collegues, and former students. It is highly likely this kind of person would give a considerable shit if he knew he would become a nightmare for the same community.
There may be others reading in the thread who also can relate to the personality of the teacher and may care about their affect on others when they are "not themselves".
There's a difference between "I don't want the disease because I don't want to become a menace to others" (what you're saying) and "I don't want the disease because it would make me lose social status" (what the original commenter said).
In my experience having had a parent suffer this way, you lose them before they are dead and you grieve along the way. I can understand the "souring" phrasing - in that there is less affection for the altered person in the present even while feeling a duty for their care and a deep love for who they were.
I'm grateful for this story - it's powerful to see examples of autonomy at end of life - and contrasts starkly with the experiences many of us have with aging parents. End of life, at least in the US, can be deeply flawed and misery for all.
the conclusion is true, though obviously the worst part is that this guy spent at least a year in varying states of despair, anger, and even worse psychological terrors.
you don't want dementia because it damages and hurts you and everything and everyone around you
(my grandpa physically attacked grandma multiple times in his last year)
Valuing how others remember you is definitely a motivation in life for many. I respect that it is not your own, respect that it may be mine. It is by no means "absurd".
It is absurd because it places subjective opinions over objective goods. This is the vice of “human respect”. Human beings do not have a final say about others. They can opine, but opinions are like buttholes, everyone has one.
Sure, it is nice to be remembered well, if you deserve it, but I do not live for the opinions of others. This is slave mentality and pathetic. I care about being good, and if I am hated for that, then so be it. Sad, but better to be hated for being a good person than loved for being a mediocrity or a knave.
And to off yourself out of concern with how people remember you is a condemnation of our society, our lack of charity, our lack of magnanimity, and our selfish prioritization of convenience. Full throttle consumerism.
The definition of good is probably the closest to doing the opposite of inflicting pain on others. There’s very little chance that you will be hated by being good. So definitely behaving or being good is not so different than behaving in a way that other people don’t hate you.
To go down this rabbit hole, presumably someone is hating somebody in this immoral hierarchy though? If everyone is happy with everyone, where's the immoral part? I do think the OP is right that in many circumstances of everyday life, being good usually correlates with being appreciated by people you actually have relationships with. Of course, this being real life, there are exceptions. However, while a child may complain and claim they hate you for not letting them have too much candy, they do love and appreciate you in a deeper way for taking care of them.
Jesus, Socrates, et al, are extreme examples that clearly debunk the comment made above. There are much more mild versions of that everywhere and everyday. Being ‘good’ in no way guarantees you will be loved. In fact, if you have integrity you will probably end up butting heads with people who are ‘not good’, and those folks will likely not hesitate to do underhanded and manipulative things to make you hated by others and not just them. Thankfully that is not everyone, but it is childish to believe that somehow being ‘good’ will make you beloved. If that were the case, being ‘good’ would be the easy choice that everyone makes. It is not.
There is no such thing as objectivity in human experience. Every single thing, even attempts to be objective, are all filtered through the subjective experience of life. Our brains interpret objective reality and provide us a subjective translation.
I would posit that caring for helpless infants is an objective good. It’s not clear to me how I’d explain that to someone who doesn’t inherently understand it.
The point is he deserved to be remembered well but due to recency bias and the severity of whatever he did during the end stages of his disease he will not be.
I personally suffered immense trauma in my early 20s when I moved to a really cheap place. My parents refused to believe me that there was a black mold and general mold problem in the place I was living and that it was causing me psychological distress and flaring up my eczema.
Despite all evidence that I had they dismissed it because I had told them I was depressed beforehand. They are not very in touch with empathy or compassion or mental health. Very old-fashioned view that these things are character flaws which are not to be spoken of.
Anyways they dismissed my concerns did not read my messages or view my pictures of personal property being destroyed and the landlord not responding to me, the whole rental was illegitimate and I had identified that early on they even ignored that I got a scalp infection which I had to take oral anti-fungal medication to get rid of. The preponderance of evidence was so overwhelming, but for whatever reason they could not admit I had been right and that they were wrong and refused to help me and actively discouraged me from taking legal action or even to move home for months.
Eventually I was blessed with an extended relative who gave me shelter.
During one of the worst parts of this period my parents even went so far as to assert that what was actually happening to me was the onset of paranoid schizophrenia.
I was close to the right age and sex for it to happen.
I knew that paranoid schizophrenics often become homeless and violent and the general awfulness of the condition. If it was not for my own investigation that there was no family history of it and a friend who believed what I was saying and told me that I needed to leave the house and then finally extended family I had a plan to no longer exist.
This was partially out of not wanting to be remembered badly, but also so many other things like; not wanting to hurt my loved ones, not wanting to hurt strangers, not wanting to slowly degrade into an unstable and potentially dangerous person and of course the median life expectancy for that condition is so low.
I lacked the constitution to allow myself to become someone who would likely damage the world and severely damage those close to me so my logical conclusion based on a false premise during those couple days was to nip it in the bud so to speak as it's a progressive condition.
My relationship with my parents has not been the same since, but how could it be. I am forever indebted to a friend and extended family... they quite literally saved my life.
The end point being that with the parents I have there was nearly a guaranteed outcome of only objectively bad things happening for me, for them, for people around me. During that state I saw my plan as honorable and wrote it down in what I was to leave to explain my actions.
>This seems like such an absurd conclusion to this, as though the opinions of other people of you are what matter when you functionally lose your personhood and then die.
They do matter.
Being concerned with how your behavior affects your family or your community, and the opinion they have of you, above your own self-interest, is how good parents, good friends, good citizens, and so on, are made.
> Being concerned with how your behavior affects your family or your community, and the opinion they have of you, above your own self-interest, is how good parents, good friends, good citizens, and so on, are made.
You've changed the meaning behind the original comment in a subtle but important way. The original commenter wasn't concerned about their effects on other people, they were concerned about how the disease would ruin their public image. Maybe they didn't mean that but it's what they wrote.
This distinction matters because those people whose top priority is their public perception (i.e. social status) are never "good people". It's normal to care about your social status to some degree but it shouldn't be the first thing you consider.
As I mentioned in a another comment, framing it as "how one is remembered" is leading to pointless tangents in this thread.
The important point is this: are you causing emotional, psychological, physical distress in the real world to those you care about when you have this disease? Yes or no. That's what I care about. Whether they are able to remember me well despite that, or poorly because of that should be completely secondary.
That’s irrelevant here. What is relevant is that we have a contempt for human life and a lack of charity. The teacher was not at fault for his condition. We should learn magnanimity.
Sure, we can think about how the burdens of caring for our family can be lessened as they age, or how we may help reduce that burden for our family, but family does have the duty to care for its members, and to place such considerations above the intrinsic value of human life is very sad indeed.
> The teacher was not at fault for his condition. We should learn magnanimity.
This is equally true of conditions like paranoid schizophrenia or psychopathy. Sometimes a person is just born with wiring that makes you dangerous to others. Does this mean that everyone around them must have the magnanimity and charity to them attacking people at random?
Yes, everybody should be interested in getting them treatment, just like they are interested in getting people treatment who have leukemia, were born with a malfunctioning liver or need an artificial hip. Instead, they get thrown in prison for the rest of their life because they are evil and we all can feel good about having made the city safer.
People with leukemia want treatment and are willing to suffer uncomfortable treatment to get cured.
Paranoid schizophrenia have lower compliance rates and fairly large collateral damage. Psychopathy is a trait not a disease, but again, issue is that they do not cooperate and dont want to "cure". Psychopaths are fine as they are from their point of view.
It's not like life stops when someone (with a grave an irreversible condition that causes suffering) dies. It goes on with the young generations (i.e. the billions of them!). I think too much clinging to a single life causes the whole (which is more important) to suffer. That's not to say we shouldn't value and respect elders, but clinging to life excessively is ignorant and potentially cruel, in my humble opinion. I defend the right to die in the face of incurable diseases that cause a lot of anguish and suffering.
I think clinging to life is partially rooted in an egoist/solipsistic metaphysics that you yourself are all that matters (to yourself at least, of course). Relax, we're just a small part of the cosmos. Ancient and immortal :)
The alternative being when someone becomes inconvenient to others we should encourage their death? What good is compassion or empathy when the lesser in society could just go off and die, right? Why stop at incurable diseases? Political opponents, coworkers, nasty service workers, double parkers, lawyers, and many other groups cause a lot of anguish and suffering.
No. But I think that people should be able to decide when they want to end their lives if it is because of pain that won’t get any better, a terminal illness that causes pain etc. while they have all of their cognitive functions.
But we should put guardrails around if the reason for assisted suicide is not pressure from relatives, depression, etc.
My brother had schizophrenia. No one thought well of him. I guess he should have killed himself as well by the logic some are professing on here. Oh, he tried, but he ended up dying of heart disease.
> Maybe a better focus would be that there often isn't a good way for a community to manage a person who suddenly becomes irrational because of an illness.
Yes, this is the focus. Science has stalled when it comes to neurological disorders. But the response is love and understanding. I do not understand how someone would "sour" on a person because they have an illness. A very absurd conclusion indeed.
Dementia and Alzheimer is not something that can simply be managed throught treatment. It is an inexorable descent into suffering for both the person and its entourage with absolutely zero hope of getting better. At best in the last stages you get very short glimpses of normality within hours of confusions, frustrations, anger and pain.
If I am ever diagnosed with one of those, I absolutely want the chance to end my life before I reach a stage I become a burden to my loved ones and can't give a trustable consent. I'd rather go too soon than too late.
It doesn't seem pleasant for the person themself either. Constant frustration, gaps in your memory growing ever larger, disorientation, loss — periodically augmented by brief flickers of recollection of what you used to be — and yet no one can legally end your misery, because you can likely no longer unequivocally consent to euthanasia or assisted suicide, even if you explicitly signed a declaration that you did not want to end up like this — legally, the current husk of your former self must consent, and it can't.
It’s still absurd despite what you say that we are implying that we should euthanize another human because they have become difficult to manage due to illness. Where do we draw the line?
You are shiftinf the topic. This is about self-euthanization, assisted suicide. Not others.
> Where do we draw the line?
As written elsewhere, having to draw a line does not mean that the only reasonable conclusion is to make it illegal in general. It's a hard topic without easy answers. "Don't allow it" is an easy answer that doesn't do justice to the topics complexity.
A good friend of mine passed away a year ago with an incurable disease, diagnosed 3 months before his death, and it was essentially guaranteed that he'd have to endure unbelievable suffering during the last weeks of those months. He didn't have the choice to end it early. It was heartbreaking.
I for my part hope that I can choose myself when the time has come.
It is not really a shift. The slippery slope is the heart of the debate. Once assisted suicide is allowed, the line between respecting autonomy and others making that decision blurs. Safeguards may help, but asking where to draw the line is the central problem.
I am not implying that at all. People should be free to choose when to die, and people should be free to set conditions for their future wherein they no longer wish to live even if they could not express that at point.
That's a personal choice. Anyone not interested in that won't have to do anything and can just wait for the end.
You can quite easily draw a line that society does not get to force someone to live a tormented existence in spite of their prior declaration that they do not want to be tormented.
“It shouldn't be that way” is not an excuse to torture people through your moralizing indifference to the fact that it is that way.
I've wondered about this for my hypothetical future self.
Currently? I'd say that I wouldn't want to live with dementia, but what if my "demented self" (kinda hate the phrasing, sorry) in the future wants to live, or doesn't remember they don't want to live?
Do I have a say over the life of someone who doesn't remember they were me?
If you visit an elderly care home you'll find plenty of people who express their wish that they don't want to live any longer.
It's not getting better for them - they are just waiting for the day to come, often in agony.
But do people who have dementia or say a mental illness have the capacity to make that decision?
It sounds like Daniel Kahneman was suffering from depression after his wife's death and all he saw in the rest of his life was sadness. He had no hope. What day was the best day to die? What if the next day his hope came back?
What if he tried that, but every day just got worse than the last day?
And people don't get any younger.
My grandmother is 98. She hates her life since she could not go out anymore. But she is catholic and suicide would be a mortal sin. So she waits till gods take her. And suffers till then.
I would make a different choice for sure. If life is hell and no one depends on me, why should I continue the suffering? (At the cost of others, if I would need help?)
But my plan is of course to reach 120+ in good health. But if I decide I had enough, it will be my decision.
> What if he tried that, but every day just got worse than the last day?
Anyone can say that about their life right now, can't they? How many people struggling today think that their life will get no better? Look at all those who made it through slavery, what hope did they have? Their hope came from their faith.
Suffering has a purpose, this is something your grandmother understands through her faith. Buddhists understand this as well. Maybe the problem is not our suffering, but our lack of faith in others and in in something bigger than ourselves.
Well, but what if I ain't a christian nor a buddhist and don't think suffering as a normal living condition is necessary? (Can you proof it is? Also I don't think all christians/buddhists share that believe)
So sure, suffering and pain are part of life. And accepting that helps a lot to not get stuck in that condition by avoiding painful things, you cannot avoid.
"Anyone can say that about their life right now, can't they?"
So no, not anyone is saying that.
Only those with a death wish.
And I don't consider having a death wish as a mental condition. It can of course result of a illness, but it can also be a consciouss wish and then finally a decision.
And if other people decide they may not do this, but have to remain in their state of living hell, then this is just torture to me.
> Well, but what if I ain't a christian nor a buddhist and don't think suffering as a normal living condition is necessary? (Can you proof it is? Also I don't think all christians/buddhists share that believe)
At the very least, suffering (through childbirth) is a prerequisite to bringing life into this world.
edit: strange that this is flagged. my parent asked for proof that suffering is inherent in life, and I don't know anyone who has said that the physical act of giving birth is anything but painful.
I read your comment and it strikes me as a cautionary tale that can be used by bad people to justify or push for eugenics: "they took him; they said he developed Alzheimer's".
As we're currently seeing happen: whatever is left unsaid in the body of the law can and will be abused by evil people to concentrate more power (even if the spirit of the law advocates for something kind).
So, we have to normalize some sort of stress tests for laws... because you sure don't want to be dragged against your will because you're poor.
Yes, there is a danger of that in general. I think someone made a movie in Japan about the subject, specifically because there is a culture of the elderly not wanting "to be a burden on the younger generation." Some said it hit closer to reality than science fiction because of that specific cultural characteristic in Japan. It also supports Kahnemen's position of pulling the plug when "the going is good" from a ethical point of view, since it leaves no doubt of intention.
This was also mentioned in the debate about euthanasia in the UK; that it could lead to pressuring elderly relatives to off themselves. I can imagine the pressure might not even be explicit, it could be implied, and maybe not even consciously, but through behavior.
Like a more subtle form of Shakespeare's "Will no one rid me of this meddlesome priest?".
Leading cause of death in older populations in Canada is assisted suicide. People have killed themselves for not getting timely services and the medical professionals bring it up as an option.
Yeah but if you are in that state, you probably don’t give a shit and everybody else seems to be the problem. So how do you solve this? When dementia isn’t too far progressed, your life seems to be still worthwhile to live and once the dementia gets worse, it’s too late to realize this.
If you don’t make it back you would die of starvation and lack of water. These are some of the worst ways of dying. What do you find comforting and peaceful about it? The person has been abandoned by their community and could suffer terribly for days.
I have this childhood memory of my neighbour's dog, that grew old and one day decided to go out in the woods and die peacefully. They found it a few days later.
I wish to remain so lucid when the time comes, that I can go sit under a tree and let myself go like that old dog. Perhaps I should leave a note.
I always think of that scene from Donnie Darko - where he says when his dog got sick, she went to hide under the porch. “To die?” His therapist prompts him. “To be alone” he corrects her pointedly. [0]
That’s kind of what I want when I die too - I don’t think I want to be around other people when it happens. I want to have my final moments to face death on my own, without feeling like I have to perform for other people.
… that said, give me another 60 years to chew on it and maybe I’ll feel different.
I think people tend to underestimate the risks in allowing suicide —- here’s a blurb from the linked article:
However, social acceptance may lead to more egregious abuses: the issue gained a higher profile in early 2010, when an 80-year-old man escaped after discovering his intended fate and heard his family members discussing how they were going to "share" his lands, and took refuge in a relative's home.
If you think that "cannot feed themselves" is when a person is already completely gone and it's okay to "leave them under a tree to die of hunger and thirst", I've got news for you.
Unfortunately someone with advanced dementia does not know if she has eaten or not. Most of the time there will be no eating, unless someone else puts food in your mouth.
You could express your wishes about how you would like to be treated in advance, while you are still clear in the head. That’s already possible for other situations, like when you are braindead and entirely dependent on machines to keep you alive, with no chance of recovery.
Having a living will is a great idea in general. My dad got a brain tumor and had no documentation on what he wanted do with his estate, in the event he became vegetative, etc. By the time he realized he needed one, it was too late for "sound mind judgement" and my mom had to go through this ridiculous legal process to ensure she held on to his assets and whatnot while she was directly caring for a dying man.
Save your loved ones some grief, create a living will with a trusted lawyer, update it about once a year. It's worth it. There are so many insane snafus one can get into with estranged family members, the state/gov't, medical institutions, etc that make the situation even more difficult and stressful to deal with. Don't expect anyone coming out of the woodwork to act according to honor. They are vultures and know no such kindness.
Even if you express this in a wish, but you probably don’t remember it when you are deep into this, how does it get executed? I’m curious about this, so does the court overrule the current you with the previous you?
I get it’s easy with other diseases such as cancer, though.
Same as with other similar agreements. A doctor needs to declare your mental fitness. When in doubt, a court gets involved.
As a rule of thumb, if you are able to understand enough to getter law involved you’re likely still mentally fit.
> You could express your wishes about how you would like to be treated in advance, while you are still clear in the head.
You can't express in advance that you want to have assisted suicide.
Your former self might express wishes, but what if your later self doesn't feel like this anymore? In a way, we can all get the same feeling when doing another round of "lose weight this year" new year's resolutions just to realize a couple weeks later that the former self wasn't that trustworthy to begin with (or was it the other way around, the future self can't be trusted?)
Point is: you can wish for whatever you want, but dementia is probably a tough case and it shifts your priorities, making everything before obsolete and I'm not sure that people beginning to suffer from dementia ever find the right point in time to end life early.
The same argument would apply to any other kind of will or testament. You need to update it frequently.
It’s not uncommon for people to change their mind quite late, and (at least in Germany) that’s perfectly possible even until late. If people dispute this later change of mind a judge needs to get involved, and being married to one I can tell you that they treat each case differently and with the appropriate care.
Arguably the best qualified person to decide what to do with Future You is Present You.
Uh, new years resolutions are not exactly what I would call the ideal metaphor for assisted suicide.
Plenty of people here who reacted negatively to OP's suggestion seem to not have had to deal with a loved one who dealt with Alzheimer's or other forms of dementia. It's not hard like taking care of a toddler is hard. It's hard like, "this is not the same person I know for my whole life, they don't recognize me, they say and do mean things to me and their grand-kids and neighbors all the time, and require 24x7 supervision to not hurt themselves or break everything in the room."
Oh, and remember that in the US, all nursing homes for this kind of thing are for-profit companies backed by venture capital, meaning they are expensive as hell. Take your current middle-class apartment, shrink the size to just a bedroom (that you now have to share with someone else), and then quadruple the rent. Just a few years of that can decimate the life savings of the average retiree and/or their children's.
I speak with some authority here because all of this happened to my father. He was "alive" in the last few years of his life, but not what anyone would call "living." I absolutely do not want that to happen to me. If it were legal in the US, I would absolutely opt for an assisted suicide plan for myself.
There are ways to handle it that avoid all the "whatabouts" that you and others have already brought up. One rough draft of an example: 1) Have a lawyer write up a kind of will expressing my wishes. 2) Get three unbiased negative diagnoses to show I am of sound mind prior to signing the will. 3) Go in for regular testing (every year, maybe two). After each negative diagnosis, add another (witnessed and/or notarized) signature to the will. The will is not valid if testing or a signature is missed. 3) If there is ever a positive diagnosis, it must be confirmed by two other clinics. 4) If three years pass with doctors and clinical tests confirming increasing dementia symptoms along the way, the assisted suicide clause is invoked and I get to pass peacefully surrounded by loved ones instead of being a stressful burden on them for years or decades to come.
Yes, there are details and unintended consequences that neither me nor anyone else can see ahead of time. Like everything else, they are dealt with as they come up. No, you won't convince me that your favorite corner case means the entire idea is invalid.
> Plenty of people here who reacted negatively to OP's suggestion seem to not have had to deal with a loved one who dealt with Alzheimer's or other forms of dementia. It's not hard like taking care of a toddler is hard. It's hard like, "this is not the same person I know for my whole life, they don't recognize me, they say and do mean things to me and their grand-kids and neighbors all the time, and require 24x7 supervision to not hurt themselves or break everything in the room."
This is exactly it. It's like dealing with a curmudgeonly toddler with extreme agency and no self-awareness. The rest of your comment is so spot on or at least matches my experience. I'm sorry you had to go through it but you genuinely seem to have become stronger from it and I'm grateful you could share your experience with us.
Being braindead is pretty different from having Alzheimers. How do we account for people who change their minds? Do we just forcibly murder them anyway?
This is such a cruel perspective, implying that he'd be better off dead, for what, 3 years of inconvenience to his community, despite the previous 80 years being spent contributing positively to it?
You even literally show that he isn't solely remembered for those last 3 years of his life. We owe people like that care and understanding, not murder framed as mercy.
It's always so painful to see old people around who are clearly living alone, forced to do everything themselves, having to ask strangers for help because they're afraid of being a burden, and their actual children can't find time for them. Only to now see people actually supporting murder because old people become a burden for a couple of years near the end of their life.
I've known at least 2 old persons who were literally looking forward to their death because of chronic pain and general boredom and frustration of requiring 24h/7 assistance and not being able to live the way they used to.
They would have likely used assisted suicide if it had been an option back then.
In medical research on treatments the outcome is often measured in quality adjusted years of life, because just keping people alive at any cost is a bad metric.
A beautiful woman dies twice as the old saying goes.
While what you say is extreme there is a point in the decline past which there is no point of living. If you have something worth living for - cling to life and to 107 if you like. But if the only thing that waits you is to slowly decay and fade and lose yourself - what is the point?
By that logic we should invoke the death penalty for everyone who has been sentenced to life in prison and has exhausted all their appeals, or any seniors convicted of a crime.
Their life probably won't improve anymore, and in the latter case they're going to die in a few years anyway, so might as well just lighten the load on society?
But this guy wanted to die right? Bit different. Agreed that 'how others view you' is such nonsense. People are cruel that way and also: those children who couldn't be bothered visiting or helping out, will be standing at the funeral sniffling and telling 'such great dad stories'. Makes my blood boil.
This comment really bothers me. I am not put off by the idea that the memory of a person is worth protecting, what I am put off by is the suggestion that death is a good option here, or that death is better than having lived those 3 years of life. The idea that when someone loses the capacity to retain their reputation and dignity it would be better for them and others that they were dead and that they have nothing good to offer is such a dangerous one and is just wrong. It applies to many people who are not near their end of life too. I am really pro assisted suicide as a way of shortening suffering when made as a conscious decision by people of sound mind, but comments like these make me very very uneasy.
I don't think the average amount of suffering for people with Alzheimer's and their families is sufficient to warrant euthanasia as a solution. I don't doubt there are some cases where it could be warranted, but I find it very difficult to get behind the idea that consent should pass from the individual. I obviously see that people with Alzheimer's and their families do suffer, the degree to which depends on the availability of proper care. We're essentially debating whether euthanasia is a better option to high quality care, and that's where the life of a person becomes a pretty gross economic equation. High quality care deprives families of assets. That tension between selfish (or so called "practical") interests and prioritising the interests of the dying is non-trivial, particular where the dying can't reasonably consent. The gentleman mentioned in this scenario would have had a more dignified death had he been provided the correct facilities, and probably shouldn't have been left to run riot in the community. It pains me that this is a story about how some guy became an asshole in his final years and not one of how a guy was deprived of a dignified death by the structures of society. I suspect to some degree people see euthanasia as a simple way to offer compassion and dignity in death, but I do think it's highly informed by ableist prejudice. There is a wide spectrum of dignity and life left to live in an end of life pathway and jumping to euthanasia as the solution is a pretty dangerous one in my opinion.
That's the issue with assisted suicide. A lot of old people bring burden and stress on loved ones at some point. How many old people will be guilt tripped into an assisted suicide because of this philosophy?
I don't see what that has to do with my comment, but okay: A lot less than are unwillingly bringing undue burden and stress to their family and neighbors because there is no legal mechanism to avoid it. Even fewer if we acknowledge that assisted suicide should be an option with a very high bar for those who would qualify. I wrote another comment about one way it might work.
I interpreted your argument that suffering that years of burden and stress on loved ones bring is a good reason for an assisted suicide. Or did I misunderstood you?
Regarding your estimates, are you just making up a lot of assumptions or do you have any data backing up your relative numbers? In your other comment you seem to assume that anyone not agreeing with OP's suggestion doesn't have personal experience with close relative having a dementia. I'm very sorry for your loss. At least some others (me included) also have had this unfortunate experience, but don't agree. High bar is actually very hard to quantify. All old people are in gradual decline and are relatively close to their deaths. One alternative to your suggestion would be that a state would provide quality professional care for people with dementia. That way the things OP described wouldn't happen and the family of the patient wouldn't have to bear the financial burden of the disease. We are more advanced and richer that we have ever been in human history, but it seems like we are unable, as a community, to provide very ill people with quality care they need.
>You really don't want to end up with dementia and related illnesses, it totally sours everyone's view of you.
I completely agree that the disease is horrible, but your conclusion is bizarre. When you are in that condition, how anyone views you is the least of your worries.
Framing it as an obsession of rememberance or legacy distracts from the more crucial point: the fact that you will be causing chaotic emotional, psychological and physical distress in the real world to those you cared about. Again we should stop framing it as some weird obession with legacy and instead stick to the facts on the ground.
Of course I don't. Life is a short, temporary experience, and I don't want to spend this time wondering what others think of me. It does not matter at all. I am nothing, just a briefly conscious lump of cells. I will die and turn to dust, just like about 100 billion of others before me. Nothing that I say, think, dream, experience, do, or how I act or look like will ever matter.
My issue is, anyone with half a clue should know that a formerly nice respected man doesn’t automatically turn into a mean guy that “pisses them off” because he wants to be. They should have known that he had dementia and it wasn’t his fault.
I’ve never been close to anyone who had dementia. My grandparents on both sides died with their mental facilities in tact and my parents who are 83 and 81 are independent and just as of 6 months ago passed a cognitive test. I can imagine if they started acting out of character and being mean to me or forgot who I was that I would be hurt, overwhelmed etc. But not pissed.
That's just as much failure of everybody as it is of him. This was dementia speaking and society needs to learn that.
You wouldn't tell somebody with a broken leg to get it together and it's just their personality that they can't walk. Nor should you treat dementia like that. Yes, people seem to shift personalities and anger others. But those others need to understand that it's a medical condition, an untreatable and fatal one, so should have even more sympathy than with somebody who broke a leg (cause that will likely just be temporary). Not alienate the person and speak ill of them.
We are human. Unfortunately all of our experiences with others change our perception of them, no matter how much awareness of their motivations and our history with them. We can try to ignore it and have patience. Apologies can help but relationships will constantly change.
It's certainly a failure point within us and something to be aware of to make effort towards understanding our own impact as you suggest. Sadly a problem with no full solution over long enough time periods.
I agree alzheimers turns everything to shit in every meaning of the word.
I disagree it’s up to you to conclude it would have been better if he had been killed 3 years earlier (which you imply).
In general you don’t have the right to such a statement.
Now, if you were discussing _your own_ condition this would be a totally valid consideration IMHO. But you (almost) _never_ have the right to conclude from someone elses part when it’s their time to go.
Assisted suicide is a humane option but ”I hope he had died with some dignity years ago instead of pissing everyone off” tarnishes the entire concept and is exactly the type of argument which stops assisted suecide becoming a more widely accepted option.
It’s basically getting rid of somebody when they become an inconvenience to others. Outside the bubble of HN, I suspect most people that talk about it as humane for the person actually mean humane for them.
Many countries hesitate to execute criminals despite very clear criteria that could be used to justify it. (Many countries banned entirely.)
Why would we have a lower bar for someone who hasn’t committed any crimes?
Not all Alzheimers patients get aggressive/angry. I know it happens, I’ve known one person who did almost exactly what you describe above. He lived with his partner of many years, and seemed superficially very cogent and together. It was just that he started to see insults and conspiracies against his person everywhere around him. Not until later did the cognitive and memory decline become apparent, giving him a diagnosis that explained his bad behavior.
But my personal anecdata puts that man in a minority. None of my older relatives with Alzheimer’s have become aggressive or troublesome. Worry, anxiety and confusion seem to be much more common states of mind, which admittedly also doesn’t seem like such a fun way to spend your days.
>Instead he was that 83 year old guy who pissed off everyone, nearly blew up the neighbourhood, and drove like a maniac.
I find the people who remember him as this guy somewhat contemptible though, so I guess my theory would be he wasn't remembered badly by anyone whose opinion mattered.
But on the other hand I guess that's the way the world works.
Well sure — I’m not talking about euthanasia, I’m talking about compassion towards the aging. An 80 year old who has dementia needs community more than ever. If you’ve been there for your community and their opinion of your turns when you age, what is the purpose of community?
Jason Zweig, Kahneman's friend, wrote about this and many other thoughts Kahneman would have gone through in making the decision.
As Barbara Tversky, who is an emerita professor of psychology at Stanford University, wrote in an online essay shortly after [Kahneman's] death, their last days in Paris had been magical...
One afternoon, according to her online essay, she asked what [Kahneman] would like to do. "I want to learn something," he said.
Kahneman knew the psychological importance of happy endings. In repeated experiments, he had demonstrated what he called the peak-end rule: Whether we remember an experience as pleasurable or painful doesn't depend on how long it felt good or bad, but rather on the peak and ending intensity of those emotions. "It was a matter of some consternation to Danny's friends and family that he seemed."
You know how the story is going to end if you stick around for it. I would make the same choice he made. And I would do it before I was ruled mentally incompetent to do so. My wife and I have already had conversations on doing exactly this having watched multiple family members succumb to dementia. It's horrific and the state salivates at institutionalizing you for the final lap.
No cure for getting old and no cure for dementia on the useful horizon. Having made it to 90 intact, he had knocked living out of the park already. I completely understand his thinking here and support it. He likely could have gone a little longer, but he also might have had a stroke or some other nonfatal cataclysmic event that took away his options.
Kahneman's family & friends who knew beforehand apparently did object.
You should read the piece by Jason Zweig, if you haven't. The decision was deeply personal and was most certainly not an endorsement of euthanasia.
... Kahneman's final email said: "Not surprisingly, some of those who love me would have preferred for me to wait until it is obvious that my life is not worth extending. But I made my decision precisely because I wanted to avoid that state, so it had to appear premature. I am grateful to the few with whom I shared early, who all reluctantly came round to support me."
Kahneman's friend Annie Duke, a decision theorist and former professional poker player, published a book in 2022 titled "Quit: The Power of Knowing When to Walk Away." In it, she wrote, "Quitting on time will usually feel like quitting too early."
She is frustrated by his decision. "There's a big difference between it feeling early and it actually being too early," she says. "You're not terminal, you're fine. Why aren't you taking the outside view? Why aren't you listening to people who will give you good objective advice? Why are you doing this?"
Paul Slovic, a psychologist at the University of Oregon who befriended Kahneman more than 50 years ago, says, "Danny was the type of person who would think long and hard about things, so I figured he must have thought about it very slowly and deliberatively. Of course, those of us who spend our lives studying decisions, we think a lot about the reasons for those decisions. But often the reasons aren't reasons. They're feelings."
This is a heartbreaking story to read. But I think that pushing for assisted suicide as a "fix" like you're suggesting misses the bigger picture. We have a responsibility as a society to support people through these diseases, not cut their lives short because it's tough on everyone else.
The real issue is our broken systems for handling dementia and underfunded homes, overworked staff, no real community nets. Fixing that honors the full life someone led, instead of saying their value drops when they need help. Assisted suicide opens doors to abuse, like pressuring people who feel like burdens.
Not sure how to react. This is the second time in a month that someone thinks I used AI to write an HN post.
All I can say is that I didn't, and thank you for implying that it was so well written that it could only have been authored by a machine that has all of humanity's cultural output to hand.
> If he'd been run over by a car, or died of a heart attack at the age of 80, people he knew would remember him as that nice old guy who had a dog and made a lot of art, and was friendly to everyone. Instead he was that 83 year old guy who pissed off everyone, nearly blew up the neighbourhood, and drove like a maniac.
I've really thought about this a lot after seeing a number of family members and friend's family members go through dementia, and it seems like it can go two ways: like this, which is how it went with my grandmother (whose hoarding behavior increased aggressively, and she started slapping people), or how it went with my grandfather on the other side (he became quieter and quieter, watched tv every day while understanding less and less of it, and when you caught his eye would repeat how much he loved you and how much seeing you "made an old man feel good.")
It has something to do with how you feel about the nature of people in general, and whether you feel they are all suspicious and possibly conspiring against you, or that you think they are basically good and want the best for you. When you have all of your mind, you can beat the demons or the angels back with your reasoning enough to have the personality that you want. My grandmother was very loving, and my grandfather was very shrewd and practical. But when that higher function can't regulate you, what shows is if you were someone who taught yourself how to see the good in people, or someone who taught yourself how to see the bad in people.
I suspect I'll end up like my grandfather, as much as I think of myself as like my grandmother. Deep down, I've always been crippled by the feeling that everyone is a wonderful person. My aggression and judgemental nature on a lot of things can really, embarrassingly, be interpreted as me looking for excuses for everyone's behavior.
>> You really don't want to end up with dementia and related illnesses, it totally sours everyone's view of you.
I don't think this is fair. I know several people who died with Alzheimer's and although their final years were very difficult for them nobody has a bad opinion of them. It's certainly a strain on the family but intimating that if you have dementia you better kill yourself or your legacy will be ruined is not ok.
I think the suggestion needs more thought, but I don't necessarily disagree with the idea of making my exit before the dementia really sets in. I've directly cared for two family members who suffered from it (collective 5 years of my life, which I'd like to think gives me a pretty good view of what the disease can actually do to people) and I decided for myself that I'd rather be quietly killed than put my loved ones through what I went through as a caretaker. While also trying to work a full-time job and maintain my own sanity while I watched people I'd known all my life be destroyed, becoming tortured versions of themselves like something out of a body-snatchers horror film.
We, the loved ones, made the decisions to keep them going and I wonder how fair that was to them. We tend to not want to let people go, choosing to sacrifice quality of life for the sufferer and those around them for, what, a few fleeting moments of possible clarity? The opportunity to say goodbye to someone who may or may not even understand what is happening?
The events I went through with my family hurt us in ways that will not likely ever heal, despite effort on at least a few of our part, and it did leave me wondering if I would put my son or wife through that should something similar ever happen to me. I decided against it, seeing as I am at the age where these are very real possibilities. In the US, we have DNRs ("do not resuscitate") and living wills that offer prior directives, but something like assisted suicide is not allowed here unless some very extreme circumstances are met, because insurance companies and hospitals make more money from suffering people than dead ones. I'm a strong advocate of the right to die, but it is a decision that needs to be made some extensive consideration and documentation before one actually needs it.
You're not missing anything. I did not want to get too deep into it here, because let's be honest; thinking about having to take our own life is a really, really dark place to go, even if it with the best of intentions. I'm not really sure that HN is the place for that type of discussion, at least not on any detailed level.
At the moment, I have standing orders in place that no heroic measures or treatments should be enacted in the event that I am in a terminal or vegitative state. I've communicated clearly to family members that would be responsible for my decision making that things are not to be prolonged or dragged out for the sake of emotional contrivance.
Without knowing how we will die, it's really quite impossible to plan around it, of course. My comment, more or less, expresses my desire to have more control over my exit in the event that I am put in a position to become a massive burden on those I love; this is something I consider a reasonable and rational request, where the folks that make our laws do not. None of that changes without discussing and sharing our viewpoints on the matter, though, which I suppose was all that I was doing.
Thanks for sharing. I asked because I've had similar thoughts, and I'm not sure what can be done about it. I believe that there is usually a time window where it's possible to know what's coming your way and have the capacity to do something about it. Easier said than done.
Neither does mine unless you leave out a key phrase and replace it with [...]. The point is that having dementia does not necessarily "sour everyone's view of you" as the parent said.
Disagreeing with the “sour everyone's view of you” aspect is one thing, but you called out parent comment for a potential conclusion that they neither made nor intimated.
I would say that this is a societal problem, not an individual one. Society needs to do better in taking care of people who do slip by the wayside, with mental illness and diseases like Alzheimer's.
I'm part of the Jain community in Bangalore, and the version of this in society exists, called Sallekhna [1], a tradition that's developed over millennia, and this is venerated and celebrated.
The philosophical underpinning is giving up of materialness. The practicality of the 5 instances that I witnessed over the past year - typical terminal individuals choose this. They pass away surrounded by loved ones (they typically medicate for any pain, and the body starts shutting down when food and water stops). This is observed with somberness, but celebrated as very positive act.
When someone starts this process, it's a unique experience speaking with them, as there's usually nothing that comes up, and the moment does not really lend itself to small talk :)
Thank you for sharing this. My grandpa passed away earlier this year at the young age of 97. We discovered a kidney cancer and decided not to treat him and bring him back home.
During his final days, he became unresponsive, only sleeping. The doctors gave us the option of feeding him through a tube. We made the hard decision of not doing it. Gave him all the medicine to help his body heal, but no invasive procedures.
We stayed by his side for the next 5 days. Playing songs that he enjoyed. Audiobooks that he loved. And just taking care of him.
Finally, his breath became slower and slower until it stopped and he passed away. I had the opportunity of being beside him during his last breath.
The passing of loved ones is always difficult, but I am grateful for how he went. He lived a full life and was incredibly healthy until the end.
Without knowing, we decided on a sallekhana-like process for him. It was the right thing to do.
This is essentially what hospice is in the US. They stop curative treatment and focus on comfort. Then at the end when the person can no longer function to eat or drink they increase the morphine dose to a high level until they pass.
Right. It's a not-so-well-kept secret that hospice care is actually assisted suicide in disguise. It's done with a wink and a nudge, hiding behind the principle of double effect, but it's a mercy everyone knows is happening. It's sad that it has to be done covertly.
There are many who will raise their hands with anecdotal counters to this, but I think much of that is borne from misunderstandings about end of life generally, which is a charged and difficult topic lots of people would rather not learn more about.
I highly recommend the book Being Mortal by Atul Gawande for anyone who wants to explore the topic further—or really for anyone who has loved ones at all!
Which is highly illegal, especially as a form of monetizing pain and lack of agency from elders incapable of decision making but flush with money and inheritors
Hard fast (e.g. hunger strikes) usually take about 2 months to kill a healthy adult.
On the one hand according to the wiki this is more progressive removing food by degrees which would make the process a lot longer.
On the other hand being a mostly ascetic practice I'd assume it's done by people who have a lot less reserves (body fat and muscle) which would shorten the process significantly (the 207kg Angus Barbieri famously fasted continuously for 382 days[0] breaking his fast at 82kg, although he supplemented his liquids — water, tea, and coffee — with vitamins, electrolytes, and yeast extract, the latter for essential amino acids).
[0]: technically he was put on a recovery diet of salting then sugaring his water for 10 days, so ate no solid food for 392 days, breaking his fast with a boiled egg and a slice of buttered bread
I was curious about how he actually died and found an [1] article describing it:
> Kahneman used the services of Pegasos in the village of Roderis in Nunningen, Switzerland. In the death room with a view over green hills, wearing a suit and tie, he lay on the bed and turned on an infusion of sodium pentobarbital himself. A companion held his hand and told him they were holding it on behalf of his loved ones. Kahneman's last words were "I feel their love."
> Pegasos, a non-profit based in Basel, Switzerland, believes that it is the human right of every rational adult of sound mind, regardless of state of health, to choose the manner and timing of their death.
I found this bit "regardless of state" really interesting.
I wonder what their views would be for someone who wouldn't have a family and nothing much to do or explore after a certain age? Does it matter what nationality they are from? What if someone's reason is - they had savings and now they have run out of it and area already 55-60 or more and have no intention or plan to work anymore and don't want to go through the struggle of life? (Of course they would have had paid the euthanasia fees)
Daniel wrote one of my favorite books, Thinking: Fast and Slow (https://www.amazon.com/Thinking-Fast-Slow-Daniel-Kahneman/dp...). If you haven't read it, and you're into economics, behavioral psychology, and thinking about thinking then I'd highly recommend it. The first half of the book is especially compelling.
You will be missed! Sad to hear he passed, but glad he was able to go out on his own terms.
Part of the book has been swept up in the replication crisis facing psychology and the social sciences. It was discovered many prominent research findings were difficult or impossible for others to replicate, and thus the original findings were called into question. An analysis[51] of the studies cited in chapter 4, "The Associative Machine", found that their replicability index (R-index)[52] is 14, indicating essentially low to no reliability. Kahneman himself responded to the study in blog comments and acknowledged the chapter's shortcomings: "I placed too much faith in underpowered studies."[53] Others have noted the irony in the fact that Kahneman made a mistake in judgment similar to the ones he studied.[54]
A later analysis[55] made a bolder claim that, despite Kahneman's previous contributions to the field of decision making, most of the book's ideas are based on 'scientific literature with shaky foundations'. A general lack of replication in the empirical studies cited in the book was given as a justification.
I had read so many raves about that book, and heard the author got a Nobel prize for his ideas, so I started reading it.
I just could not digest it. I understood the words but I couldn't make whatever message he was trying to convey... it felt too "dense" for me. Maybe im just stupid, but I could not get past I think the first two chapters.
I really didn't get on with that one. Felt very much like a book that could have easily been shortened down to an essay and suffered for the additional length.
I disagree about "next". I wasn't confused by the original usage. "Next" is more associated with "subsequent" than "upcoming". The "future" component is contextually inferred.
Probably nobody at all got confused by that word choice.
It didn’t take me long to parse out the meaning but the phrasing was confusing.
“The next book he wrote, Noise, ….” Would have been better or “After that book he wrote Noise….”.
I absolutely was confused for a second or two and thought “wait, are we talking about a different person? He isn’t going to have a ‘next’ book unless he had one queued up?”.
Did I need the explanation above? Not really, I’d come to the right conclusion on my own but I can imagine someone who isn’t a native speaker (reader?) might stumble on that more and I enjoyed the confirmation.
You seem quite interested in right versus wrong. I wonder if you will be intellectually honest if/when I reveal errors, mistakes, oversimplifications, and so on?
> I looked up the word in a few different dictionaries and the top entry aligns more with "subsequent" in every one.
Even if you had looked at every dictionary, would you claim such a process resolves ambiguity in general? I hope not.
As you know, there are other entries other than the first in a dictionary. Multiple entries means there are multiple usages: there can be ambiguity. Sometimes usage diminishes or eliminates ambiguity, but not always.
> I looked up the word in a few different dictionaries...
You only took a small sample. How can you offer this as definitive evidence? You can't.
In case you didn't check it or overlooked it, here is the first entry from the Apple Dictionary:
> 1 (of a time or season) coming immediately after the time of writing or speaking: we'll go next year | next week's parade.
Anyhow, my argument does not rely on pointing to a dictionary and saying "I'm right" and "you are wrong". I am saying:
1. Reasonable people see ambiguity (in this specific case and in general)
2. No one person is the arbiter of what is ambiguous for others.
3. Claiming there is a definitive process to resolve ambiguity for everyone is naive.
The sheer irony of your unwarranted pedantic critique of the usage of “next” is that all HN threaded comments, including yours, have a “next” link in their headers which clearly does NOT refer to unwritten future comments.
> all HN threaded comments, including yours, have a “next” link in their headers which clearly does NOT refer to unwritten future comments.
You are claiming this resolves written ambiguity in comments? I hope not.
Also: I hope you recognize that the "next" link doesn't appear until a comment has a reply. So think about what someone sees when they are writing a comment; namely, there is no "next" link visible. This undermines your implied argument, which seems to be "the word 'next' is visible in the headers, which will make the use of 'next' in the comment itself unambiguous".
Forgive me for saying so, but what a silly argument -- on either level. You are clearly upset and bothered and resorting to rationalization and attacks.
This is inaccurate. Here is what troll means to many people "a person who makes a deliberately offensive or provocative online post." My response clarified without being offensive. I was careful to word it neutrally. I hope than a charitable reader can see this.
To put in the terms of Kahnemann's Thinking Fast and Slow: it is worth considering if maybe the commenter above got triggered first (a System 1 emotional reaction) and then later sought to rationalize (System 2) a "reason" for that: namely "he's a pedantic troll".
> If people can construct a simple and coherent story, they will feel confident regardless of how well grounded it is in reality. - Daniel Kahneman
I'm reasonably sure this is not what happened, judging by my own recollection of when I have been tempted to write similar things, and my discussions with people who have written similar things. However, your story is both simple and coherent.
It's much easier to point out others' alleged irrational thinking, but the main purpose of books like this is to help you better understand your own thinking.
> It's much easier to point out others' alleged irrational thinking, but the main purpose of books like this is to help you better understand your own thinking.
That sounds right. I only can make probabilistic guesses as to what is happening in someone else's brain. By posing a question to someone else, there is some chance that person may ask it of themselves. If not today, then perhaps in future.
This kind of defensive and dismissive response is so common we should make a name for it! Perhaps we could call it the "It Was Obvious To Me" Fallacy.
Here's one way to commit the fallacy: when someone points out a communication issue, mock them for being "too literal" or "pedantic" rather than acknowledging the ambiguity existed.
> I literally thought some unpublished book. But you shouldn't have doubled down on 'next'. Your first para was enough.
Thanks for the feedback.
To focus on "should" for a second. If I would not have written my second paragraph, I would not have made my main point: I'm trying to get people to pay attention to ambiguity more broadly and tamp down this all-too-common tendency for people to think "the way I see things is obvious and/or definitive" which pervades Hacker News like a plague. Perhaps working with computers too much has damaged our cognitive machinery: human brains are not homogeneous nor deterministic parsers of meaning.
Perhaps the second paragraph got some people thinking a little bit. We are discussing Kahnemann's life's work after all. This is a perfect place to discuss our flawed intellectual machinery and our biases. Kahnemann would be happy if people here improved their self-understanding and communication with each other.
Meta-commentary on how people might react to the above comment: Some people that think "X is so obvious" that they will frown upon people who think "X is not obvious".
> The irony is that people who insist something is "obvious" are often demonstrating a lack of awareness about how communication actually works. Clear communicators tend to be more empathetic about ambiguity precisely because they understand how easily misunderstandings occur. [1]
> “The curse of knowledge is the single best explanation I know of why good people write bad prose.” [2]
[1] Claude Sonnet 4.5 in response to """Some people that think "X is so obvious" that they will frown upon people who think "X is not obvious"."""
The sad demise of Robin Williams made me a believer of assisted suicide. The option to go out with dignity should be available to everyone.
That said, there is a problem in at least some places where assisted suicide is available where it keeps getting recommended to disabled people who don't want to die. That needs to be solved. Seems like an easy solve. Just don't do it.
There is a cost reduction incentive, though, which is why it happens. Costs can be reduced for abled people by convincing them to exercise and eat more fiber, so the same pressure can do good instead of evil. At some point we have to decide to care about people.
I find it really weird. So someone pays CHF 10K to be given a lethal injection then it becomes dignified and the other way isn't? I think it is an insult to the departed if you question the path they choose - because then both the choices can be questioned and judged.
And did you just go to eating more fibre from euthanasia in the same few sentences? :D
> That said, there is a problem in at least some places where assisted suicide is available where it keeps getting recommended to disabled people who don't want to die.
Where? This is a thing which always pops up in these debates because it is a deep-rooted fear, but are there countries where this is a thing?
> 60% of the patients who died with Kevorkian's help were not terminally ill, and at least 13 had not complained of pain....The report also stated that Kevorkian failed to refer at least 17 patients to a pain specialist after they complained of chronic pain and sometimes failed to obtain a complete medical record for his patients, with at least three autopsies of suicides Kevorkian had assisted with showing the person who committed suicide to have no physical sign of disease. Rebecca Badger, a patient of Kevorkian's and a mentally troubled drug abuser, had been mistakenly diagnosed with multiple sclerosis. The report also stated that Janet Adkins, Kevorkian's first euthanasia patient, had been chosen without Kevorkian ever speaking to her, only with her husband, and that when Kevorkian first met Adkins two days before her assisted suicide he "made no real effort to discover whether Ms. Adkins wished to end her life," as the Michigan Court of Appeals put it in a 1995 ruling upholding an order against Kevorkian's activity.[26] According to The Economist: "Studies of those who sought out Dr. Kevorkian, however, suggest that though many had a worsening illness... it was not usually terminal. Autopsies showed five people had no disease at all... Little over a third were in pain. Some presumably suffered from no more than hypochondria or depression."[27]
This doesn't seem to be an example of assisted suicide being recommended to disabled people who didn't want to die. Mainstream medical practice at the time condemned Kevorkian, and anyone seeking out his services was certainly aware that what he offered was death.
Euthanization of the disabled has been a consistent part of the eugenics movement. For example George Bernard Shaw quote
> A part of eugenic politics would finally land us in an extensive use of the lethal chamber. A great many people would have to be put out of existence simply because it wastes other people's time to look after them.
Shaw and other Fabian Society members were supporters of the group now called Dignity in Dying [0], which used to be called The Voluntary Euthanasia Legalisation Society and was founded by a doctor.
Nazi Germany committed involuntary euthanasia of disabled people in a program called Aktion T4 [1]. It's probably not an accident that Dr Kevorkian, an American, started publishing his euthanasia papers in Germany. Before that he was trying to harvest blood and organs from inmates, which is another area where the incentives seem very bad.
I can't comment on how often modern assisted suicide programs recommend it to disabled people who don't want suicide. But it's clear that Kevorkian was not careful about who he recommended assisted suicide to. So given the strong desire of some people to euthanize the disabled against their will, the lack of carefulness is concerning and suggests that it likely happens with some regularity except in exceptionally run programs.
Society puts a lot of pressure on the people at the bottom. The chronically ill and the unemployed. That pressure in combination with an option to permanently relive yourself of that pressure is to many functionally equivalent to a recommendation.
Canada. The critique is that people opt into euthanasia because of poverty, and that the government sees MAID economical alternative to investments in social programs and welfare. https://en.wikipedia.org/wiki/Euthanasia_in_Canada
I don't think things are as bad, but I also think that old age in poverty is a valid reason for euthanasia if there is no alternative. If the society is cruel to the poor, holding poor elderly as hostage to improve situation is cruelty on top of the cruelty.
MAID being inappropriately offered to people who haven't expressed interest in it, and also being extended widely to people without terminal illness, has certainly become a controversy in Canada.
Why should only terminally ill people get this choice? A 16 year old can decide who to kill in the army but apparently they (and we) aren't competent to choose whether to take one's own life.
You're correct, and I'm generally in favor of the right to die.
I watched a documentary where they interviewed a bunch of people who attempted suicide and talked to them about the entire experience and mental state. Out of the maybe ten that they interviewed, only one said that he wished it had worked. That doesn't mean it's only 10% though... they didn't get to interview the ones that succeeded.
With suicide being illegal in most jurisdictions, not everyone interviewed may have been honest in relating their feelings. If you have suicidal ideations, telling others about them can have severely negative consequences. Saying “I wish it had worked” would likely create ongoing jeopardy.
Admitting to a past feelings and actions is quite different than admitting to present feelings and potential future actions. Wishing it worked indicates the a possibility that they might want to try again.
I don't particularly like this wording but can't seem to come up with another one right now:
I think it's okay for us to try and avoid the irreversible mistake, but yes, it's very arguable that living years you didn't want to live is also an "irreversible mistake".
>Her last hope was a $4,000-a-month drug that her doctor prescribed for her, but the insurance company refused to pay.
>What the Oregon Health Plan did agree to cover, however, were drugs for a physician-assisted death. Those drugs would cost about $50.
Randy Stroup [2]:
> Lane Individual Practice Association (LIPA), which administers the Oregon Health Plan in Lane County, responded to Stroup's request with a letter saying the state would not cover Stroup's pricey treatment, but would pay for the cost of physician-assisted suicide.
Stephanie Packer [3] (although in this case she inquired herself):
> Then her doctors suggested that switching to another chemotherapy drug might buy her time. Her medical insurance company refused to pay. She says she asked if the company covered the cost of drugs to put her to death. She was told the answer is yes — with a co-payment of $1.20.
T. Brian Callister, MD, FACP, FHM [4]:
>When I spoke with the insurance medical directors of the patients' insurance companies by telephone on separate occasions, both of the insurance medical directors told me that they would approve coverage for either hospice care or assisted suicide but would not approve the life saving treatment option.
> Neither the patients nor I had requested approval for assisted suicide, yet it was readily offered.
It's a very odd take to think examples of insurance companies refusing life-extending treatment and instead offering assisted suicide indicates a problem with assisted suicide.
Just to be clear: the insurance companies are the problem here; and more broadly this whole for-profit model of healthcare.
I'd argue that sadly something like this is bound to happen for sure because many (if not most) humans are lazy, greedy and don't like sick people outside of movies. If it is happening systematically and encouraged by the government or insurance companies - that's of course a different matter and has to be prevented.
I think that Hunter Thompson basically did this. Kinda "on-brand" for him, really.
I had a friend that decided to stop treatment (dialysis), when he realized that he'd never get off it (he couldn't get a transplant). He was in his late 60s.
It was both a sad, and joyous experience. He took about a month to pass (renal failure). He was Catholic, and wouldn't do assisted suicide.
During that month, a bunch of us would go over to his house, almost on a daily basis, and we'd just hang out. It was actually a great experience.
You omitted the _most_ on-brand part of this story, which is the part where (per his last wishes) Johnny Depp spent $3m on a party that involved firing Thompson's ashes out of a 150-foot tower in western Colorado.
Well, not just the comment, but also the wikipedia article linked to in the comment.
Obviously, Jainism isn't Catholicism, but this part of the wikipedia article got me thinking:
>It is not considered a suicide by Jain scholars because it is not an act of passion, nor does it employ poisons or weapons.
Catholics are probably never going to think suicide is ok, but I wonder if they could come around to a definition of suicide that is more narrow and which excludes death-with-dignity. If they did make that adjustment, I would personally agree with their stance.
There is plenty of precedent for this legislation through definitional scoping in history in general, though I'm not an expert on Catholicism. The book "Legal systems very different from ours" talks about it, and gives examples. It's really the only option for any sort of change when you're dealing with decrees from a supernatural entity or an unchangeable part of a constitution.
"Kill" is another concept that has differing definitional scopes, depending on religion or legal system. Or even differing for the same religion/legal system for different contexts and/or time periods.
You don't speak for or get to decide for other people, you only get to speak for and decide for yourself, and the same goes in principle for everybody else.
I've waffled between support and opposition of MAID a lot, for similar reasons. I think the morality of it depends heavily on social and economic context. In the US specifically, I worry that MAID could serve as a roundabout form of eugenics, even if it wasn't disproportionately recommended to any particular group.
Imagine you're poor, your family is poor, and your friends are poor too. You spend 2 years in and out of inpatient care, and then die. Your family is now saddled with a debt they will never be able to pay. Your medical bills could make them homeless. Now imagine choosing between that, and MAID. MAID is obviously a cheaper "out."
Now remember the demographics of poor people in this country. If poor people end up being more likely to choose MAID, that necessarily means MAID would be used disproportionately on ethnic minorities and disabled people. So you end up with eugenics again, just because of the sorry state of our medical system and class demographics.
Not all assisted suicide is eugenics, to be clear. There's a discussion of Jain practices elsewhere in this comment tree.
But man did I lose sleep at the thought that we could have people volunteering to kill themselves solely because they're poor. You could argue that it's wrong not to give someone the choice to die sooner, given that dying later could cause so much strife for their family. But I hold that the right solution isn't making people die sooner, it's building a medical system where people never have to grapple with this choice in the first place.
That’s the problem. If there’s a financial incentive people will find way to push it.
That’s my biggest concern about assisted suicide for an otherwise healthy person who just wants to avoid the inevitable decline (as in this case). There is a direct financial incentive for families to push people into this.
The only way I can see to remove that would be to require that your estate can’t go to anyone who potentially has influence over you in the case of assisted suicide for with no terminal illness.
Many western countries make dying slowly with Alzheimer’s very expensive, by the standards of normal families.
Between doctors, nurses and lawyers you can burn through a million bucks in five years easily. And most families don’t have a million bucks cash to spare.
On the other hand, if they die after six months, instead of after 5 years? The family doesn’t lose the farm.
> Between doctors, nurses and lawyers you can burn through a million bucks in five years easily
That would indicate there is a financial incentive in keeping them alive, no?
The "incentive" from the family's perspective, if they're that cold-blooded, doesn't make sense because they could just... not take care of that person.
You’re not understanding. They could just not take care of that person sure. But when the person dies, there will be nothing left to inherit because they will have spent it all on medical care.
So we've outlined a society where: healthcare providers, lawyers, etc. ("the system") stand to benefit from keeping a person alive and suffering because they can squeeze money out of them in their final years. Assisted suicide is being made available and "family pressure to commit suicide" is brought up as a concern? Sure, valid concern I guess, but it just seems pointless as there are already guardrails around these processes and we're not recognizing the benefits of giving more autonomy to people which means their suffering can be stopped.
>healthcare providers, lawyers, etc. ("the system") stand to benefit from keeping a person alive and suffering because they can squeeze money out of them in their final years
Insurers and the government have the opposite incentive, but it's something to be concerned about.
>there are already guardrails around these processes
I don't think there are guardrails that can prevent what I'm talking about. Only the most egregious abuses would even be detectable.
As long as you don't literally tell your mom to kill herself I don't think you could make it illegal. As it stands in the US I don't think you could make it illegal for someone to tell someone they "wish they were dead" in this situation.
Inheritance, and for the government/insurance companies, there's the incentive of the one-time cost of euthanization being lower than the cost of care for the poor, disabled and/or the terminally ill.
We don't talk about it a lot as a society, but some people just like killing people.
The ordinary outlet for them is the military. Sometimes they become serial killers.
A euthanasia industry would attract these people similarly to how police and security work attracts authoritarians and how clergy jobs attract pedophiles.
That's not to say that most people in the industry would enjoy killing people, but it would be a problem. And death is final; it's impossible to fix mistakes. This is the same reason many people are opposed to the death penalty.
> This is the same reason many people are opposed to the death penalty.
Death penalty is the government deciding to take your life based on what they believe you did. I agree, mistakes there are bad. Assisted suicide consists of the person dying giving their consent to take their life. Quite different.
Unfortunately consent is not always clear. For example, see my other comment in this thread about the reports on Dr Kevorkian's assisted suicides.
Not only is whether someone gives consent sometimes unclear, it's also unclear if the consent was informed consent and whether it was uncoerced.
Informed consent is obliquely mentioned in my other comment. For example, a patient may falsely believe their illness is terminal.
I realize I replied to a question about financial incentives to talk about non-financial incentives. But coerced consent would often fall under the financial incentive heading. E.g. "consent to be euthanized or I'll contest the will."
Forced "suicide" also has a long history, including in the ancient world. Arguably things like kamikaze might fall into that category. And it's a favorite method of execution in financial and espionage type cases because the method of coercion won't show up in the forensics.
For these sorts of reasons, I think the risk of mistakes is high.
The process in Québec doesn't have those flaws, it is much superior than the one used in the rest of Canada :
To obtain medical aid in dying in Quebec, people must meet all the following requirements:
have a Quebec health insurance card,
be 18 years old or older,
have the mental capacity to make their own decisions about their medical care,
be in one of these situations:
and be in a state where their abilities are severely and permanently getting worse, with no chance of improvement,
have a serious physical impairment that greatly affects their abilities for an extended period,
be in constant and unbearable physical or psychological pain,
be informed about any available means to relieve suffering,
have decided that those means are intolerable.
Once a doctor or SNP assesses the request, they must ask a second doctor or SNP to confirm in writing that the patient is eligible to receive medical aid in dying.
The doctor or SNP must also ensure that several measures to protect the patient have been respected. They must ensure that:
The patient made their request freely and with all the information necessary to make an informed decision.
The patient repeated their request at different moments.
The patient has had an opportunity to discuss the request with their loved ones.
The patient has the opportunity to change their mind right up to the very last moment.
If the patient has trouble communicating, the doctor or SNP must also ensure that the patient was given a reliable means of communication and understands the information they had received.
So... something you're entitled to regardless of how they die? I don't see why, in this hypothetical, a person would spend energy encouraging assisted suicide when they'll get inheritance eventually anyway. Am I missing something?
1. You get the money now as opposed to potentially many years from now.
2. You likely get much more money if they die now without spending it on cost of living, and healthcare.
People do all kinds of awful things in order to get control of an elderly family member’s money—up to and including outright murder. Pressuring a suggestible family member into assisted suicide is a comparatively easy and low risk method.
My brother likely exploited his power of attorney to accelerate our mother's demise and may have injected her with insulin to get the job done. So there's your first datapoint.
What's definite, however, is that he made ~75% of her estate vanish into thin air before throwing her into a low-end nursing home where he wouldn't pay $6/day to have her bathed so she died in her own filth. Nevermind she had a 6-figure pension and longterm care for life. He wanted her gone because dementia had made her unmanageable to him yet he wouldn't let her go to live with any of her other children because he feared he would lose control of the estate through his PoA.
And because he had that PoA, no one could dispute his choices in time to save her. The courts and Adult Protective Services were useless bordering on complicit. The day we finally got a positive court verdict was absolutely 100% coincidentally no connection whatsoever you see 2 days before she suddenly passed.
Lesson learned: when you grow old, don't give anyone on the inheritance train any sort of PoA or they'll instantly become a PoS.
I don’t know how many people are like this. I do know that financial incentives result in more or behavior.
It’s already common for caregivers to begin to resent the people they care for and for old people to worry that they are a liability.
I don’t trust the system to be able to protect vulnerable people who have been coerced. And I don’t want old people in general to feel like suicide is their obligation.
Yet you don't see insurance companies hiring snipers to get rid of their oldest customers. Maybe the solution is to prosecute those who would push MAID too aggressively as we would those who push to suicide.
I'm surprised and fascinated that this is apparently legal in Switzerland. The Netherlands, famous for allowing assisted suicide, has pretty strict criteria for this[1].
In particular, the physician must "be satisfied that the patient’s suffering is unbearable, with no prospect of improvement", which from this article sounds far from the case here.
It is surprisingly hard in NL; we have familiar Alzheimer and had some practice by now, but it is very easy (depressingly so) to arrange your assisted suicide for when you get Alzheimer a long time upfront and still not get it because you did something wrong in the procedures/paperwork and end up going through all the suffering you planned out not to go through. It is not 'oh then they just sit in a home without memories'; it is a devastating process definitely far worse than death.
Euthanasia in Switzerland ^ has been a notorious profitable practice for years, compared to the Netherlands where it's almost exclusively practiced on those with terminal debilitating disease.
^ Yes, it's "illegal" but it's effectively nulled if the means to it are made legal.
Then I do wonder why no company has come knocking to the door of the hospital room where I'm sitting right this minute waiting for my terminally ill mother to die.
Because since years she's member of EXIT, the well-known Swiss institution that is providing assisted suicide services, and it would still take several weeks for us to jump through all the required paper and legal hoops to get the ball rolling.
And now she being already unconcious and therefore incapable, most ways are blocked already, as others pointed out, so I'm not sure we could accelerate the process at all.
Sorry, but your comment smells rather about peddling fakery, especially as you have provided heaps of reliable references.
Some of its wording is weird, like mentioning his wife dying in the same context of two other partners with no explanation. The original is a much better read.
So he was very old without any significant problems, but he wanted to avoid the inevitable problems?
If you’ve already made it to 90 with no major issues, you’re expected to make it to 95 and you could make easily live to 100. My wife’s grandad is 90 and he still lives alone, drives, plays golf nearly everyday, and regularly sees his 12 grandchildren and many great grandchildren. He even made the 9 hour trip to come see us last year.
I’m very wary of making it legal for doctors to euthanize an otherwise healthy person who just wants to avoid an eventual decline.
It’s relatively common for families to push people into nursing homes, but in this case there’s an even stronger direct financial incentive. I don’t trust the system to adequately prevent this.
> If you’ve already made it to 90 with no major issues, you’re expected to make it to 95 and you could make easily live to 100. My wife’s grandad is 90 and he still lives alone, drives, plays golf nearly everyday, and regularly sees his 12 grandchildren and many great grandchildren.
Counter-anecdote, my partners Granddad is 93. Age 90, we said the same as you. Now he's an old, rude, obnoxious liability - he's still great, and I don't hold it against him, he's earned the right. But I've never known anyone naturally age and die without losing their ability to be civil in some way towards the end.
From the article:
> Kahneman knew that many would see his decision as premature. But that was exactly what he intended, he wrote: If you wait until a life is "obviously no longer worth living", it is already too late.
I personally wish my partners final memories of her Granddad were him at 90, and not at 93. I've known for a good 5 - 10 years I will take the same route as Kahneman. I feel the desire to stay alive long enough to be a liability for yourself and those around you is a decision motivated by ego and fear, rather than compassion or logic.
>I feel the desire to stay alive long enough to be a liability for yourself and those around you is a decision motivated by ego and fear, rather than compassion or logic.
Everyone becomes a liability at some point. By that logic we should just go full Logan’s run and kill people as soon as they stop being productive.
There nothing wrong with saying that you aren’t going to take extreme measures to preserve your life past a certain age.
But I don’t want this attitude of “you should kill yourself so you don’t burden your family” to become the norm either.
What if your partner’s grandad heard you calling him a rude obnoxious liability and felt pressured into killing himself?
>I've never known anyone naturally age and die without losing their ability to be civil in some way towards the end.
But many people die suddenly with no serious mental decline at all. That can happen at 95 or 100 the same as it happens earlier.
If you rule out everyone who didn’t die of some nebulous cause as the result of a slow decline you are selecting for people who mentally decline.
> Everyone becomes a liability at some point. By that logic we should just go full Logan’s run and kill people as soon as they stop being productive.
That's ridiculous. People can be unproductive, but not a liability.
> But I don’t want this attitude of “you should kill yourself so you don’t burden your family” to become the norm either.
I can see that, but you haven't explained why. Personally, I don't want to burden myself, my family and those I care about, that's important to me. There must be something more important to you that justifies burdening loved ones with a hard painful death of a loved one. Help me understand: what's that thing for you, if not ego/fear?
> What if your partner’s grandad heard you calling him a rude obnoxious liability and felt pressured into killing himself?
The alternative is he's unnaturally kept alive in a perpetual state of suffering for him and the people around him. If he hadn't suffered mental decline, I know he'd never consciously choose that, another reason why I'd like to make sure I'm gone before serious decline kicks in.
> But many people die suddenly with no serious mental decline at all. That can happen at 95 or 100 the same as it happens earlier.
That doesn't change anything. I agree with Kahnemans point that becoming a burden is too late. If I accept that, without being able to predict the future, it then becomes a game of risk. Kahnamen decided the risk of him becoming a burden was greater than the risk of him continuing to live what he would consider a productive (edit: "valuable" is probably a better word here) life.
>That's ridiculous. People can be unproductive, but not a liability.
That would depend on your definition of liability I suppose. Many people would consider a parent who was no longer capable of productive output (work, helping out around the house, watching the kids) a liability. I suppose you may be using the term to mean "you'd rather not have them around anymore because their company is no longer offsetting the cost to you".
>There must be something more important to you that justifies burdening loved ones with a hard painful death of a loved one. Help me understand: what's that thing for you, if not ego/fear?
This isn't about me. As of right now I don't plan on taking any heroic measures to preserve my life past a certain point. The issue is I don't care why someone wants to stick around. I want them to feel free to do continue to do so.
>The alternative is he's unnaturally kept alive in a perpetual state of suffering for him and the people around him.
Depends on what you mean by being unnaturally kept alive. He could have opted out of medical treatment at any time. Once his capacity to make his own decisions was gone, his family could opt out of that treatment for him.
>That doesn't change anything. I agree with Kahnemans point that becoming a burden is too late. If I accept that, without being able to predict the future, it then becomes a game of risk. Kahnamen decided the risk of him becoming a burden was greater than the risk of him continuing to live what he would consider a productive (edit: "valuable" is probably a better word here) life.
Personally I think trying to predict the future and what the people around me would or wouldn't want is futile. And choosing when to die to prevent this is impossible. Some people will go downhill at 55, some at 110. If you really consider the burden of a few years of decline to be so awful on your family that you place a very high value on avoiding it, you'd need probably need to kill yourself much earlier than 90, probably 75 to really reduce the chance to a small enough level that you don't really need to worry about it very much.
The problems I see are that several.
1. People will feel pressured into suicide because they feel they are might be a burden to their family that their family doesn't want. Even if they aren't. You can't know what your family actually thinks. If they say "no dad I don't want you to kill yourself", are they being honest or not?
2. People will feel pressured into suicide because their family has made it clear that they are a burden on them. These people might want to keep living for whatever reason. Fear/ego whatever. I don't care why they want to. I don't want them to feel obligated to commit suicide.
3. The financial incentives for families to pressure otherwise healthy people into suicide.
FWIW, I think the problems you list are 100% valid.
I still generally think people should be allowed to choose how their life ends.
I also think that, as a society, we should be trying to fix the problems you list so they become of least concern to the person dying (though I'm not optimistic we will).
> That would depend on your definition of liability I suppose.
I mean it in the sense of burdening others. Sure we all have to burden others to some extent, but I mean specifically the unique burdens that come with age, like requiring others to do basic things to keep you alive because you've lost the ability to do so.
> Once his capacity to make his own decisions was gone, his family could opt out of that treatment for him.
There is also no medical treatment for old age: there's no medications you can opt out of to end it all if you're just naturally aging and suffering, but we have to see this suffering more now because medicine has stopped other illness killing people before old age. Also, one problem we didn't anticipate is in the UK, legal and medical power of attorney can only be used when a person has lost the ability to make decisions: if they're able to make terrible decisions that are obviously not in their interest, and leading them to be repeatedly hospitalised, those terrible decisions are still respected over the family/power of attorney.
> The issue is I don't care why someone wants to stick around. I want them to feel free to do continue to do so.
I think we agree here. I want people to be free to end their life how they want, including staying around if they want to.
For the 3 problems you mentioned, you see them as problems because you have the perfectly natural underlying fear/ego/entitlement to stay alive, regardless of who else has to suffer for you.
I don't feel I have that, for better or for worse, so none of those 3 points really are problems for me:
1. This is literally what I'm advocating for! If my family think I'm a liability, and I'm causing more harm than good, then I've told them they need to tell me so we can put things in motion. The only reason for the family to be dishonest is through fear of upsetting/offending my feeling of entitlement to life. The way I see it is Kahneman's approach enabled his family to be honest with him!
2. What about the contrary? I want me and my family to have the best life with minimal unnecessary suffering. Yet you're here, trying to pressure me into making them suffer by being a big ol' age burden. I don't want to feel obligated and forced to stay alive and make my family suffer because some people are scared of their inevitable mortality. My approach maximises the choice to allow for minimising inevitable suffering, whereas yours reduces choices for the _chance_ that maybe you'll be the old person who isn't a burden (but you will be a burden, because nature).
3. This is already a problem: the legality or acceptableness of suicide/death isn't going to stop horrible family members finding creative ways to extract inheritance early.
I'm not advocating for people to be able to top themselves on a whim, there needs to be controls and processes in place, like any big/potentially harmful decision, and these controls are in place. FWIW, a bunch of the points you've raised were discussed and concluded as part of the parliamentary discussion into changing these laws in the UK ("Assisted dying bill"). The bill in the UK was specifically for terminally ill adults, but practically, old age is a terminal illness and most of the same arguments apply.
I see a lot of elder people age very suddenly. It's like the capacity to recuperate from a problem is gone. With some luck no such problems appear and you can become old without much troubles. But once a problem appears, it hits in full force.
No, he was an old man who cared for his wife with dementia until his death, an experience which changed him. And thus he has chosen to go on his own accord.
If the society treats people badly, that's not a reason to deny them the ability to do final exit with dignity. We must fight to fix the problem cases, not take dignity away from those who suffer from it.
> It’s relatively common for families to push people into nursing homes,
So you are rejected by your family and punished even more by taking away a dignified exit strategy?
Nothing is being taken away. Medically assisted suicide to prevent old age has never been a right anyone has had under any legal framework until very recently. And it’s not a right anyone has anywhere but a few countries.
You can argue that more countries should grant that right. But if you’re going to do so, you need to have an answer for the incentives it creates.
I agree with your legal assessment and still think of the case as very interesting. The article explicitly talks about how any such decision could have only been premature, for the slow cognitive decline is typically only noticed when it is too late, and because the change is continuous, there can be no good commitment to "I no longer consider this life worthwhile once condition X is no longer satisfied".
My nan made it to 92 without any mental issues, but then deteriorated significantly over the course of 18 months, forgetting she'd ever been married, had kids, etc, just reverted to believing she was a teenager who wanted to go home to her parents (in a house which was destroyed in ww2)
She couldn't look after herself was was forced into care by the courts. Since going into a home she's physically never been fitter, but mentally she's not the person she was 10 years ago -- it's not that she's changed personality, it's as if her memory of the last 80 years was wiped.
That’s terrible, but you never know when or if the decline is going to happen, so if you pick an arbitrary cutoff you’ll have killed people who had plenty of good years left.
When an individual facing intractable pain is given an estimate of a few months to live, does hastening death become a viable and legitimate alternative for willing patients? Has the time come for physicians to do away with the traditional notion of healthcare as maintaining or improving physical and mental health, and instead accept their own limitations by facilitating death when requested? The Universities of Oxford and Cambridge held the 2013 Varsity Medical Debate on the motion “This House Would Legalise Assisted Dying”. This article summarises the key arguments developed over the course of the debate. We will explore how assisted dying can affect both the patient and doctor; the nature of consent and limits of autonomy; the effects on society; the viability of a proposed model; and, perhaps most importantly, the potential need for the practice within our current medico-legal framework.
> It is difficult to reconcile that citizens may have the right to do almost anything to and with their own bodies– from participating in extreme sports to having elective plastic surgery– yet a terminal patient cannot choose to avoid experiencing additional months of discomfort or loss of dignity in their final months of life.
One issue I think about a fair bit is that without legal assisted suicide aside from all the usual issues with unassisted suicide you need to end things even earlier to make sure you do it while still physically capable: with age the risk of physical debilitation increases sharply, a bad fall or a small stroke will see you in the hospital or incapable of moving an arm. Which is on top of the risks of mental debilitation taking away your right to self determination (through simple incompetence).
My dad is in the early stages of Alzheimer's and it's made me think of what I'll do if I find myself in the same situation
Assisted suicide sounds like a fine option until you think of its impact on your loved ones. Imagining putting my wife and kids through my deciding to die, and the process of them bringing me to the place where it happens - or imagining one of them doing the same thing - just fills me with horror
Death comes for us all. It’s okay to cultivate emotional fortitude to die on own terms, at the place and time of our choosing, with grace. Would you rather them remember you as a shell of who you were, long dead mentally while the body continues on? Death is a part of life we cannot avoid, nor should we.
> If you wait until a life is "obviously no longer worth living", it is already too late —- Kahneman
Live your life in a way that it is worth living until you no longer can, I suppose. To exist is hard, do your best.
Death happens to all of us. I’m 51 and as far as I know have no terminal illness. I stress to everyone that I focus on “living a good life. Not a long life”. My wife and I balance living every year like it might be our last and saving for a long life. We don’t put off traveling, concerts, hanging out with friends and other experiences so we can “retire rich”. If we can’t afford expensive travel in our 60s because we spent our younger healthier years traveling - so what? Statistically we won’t be healthier in ten years than we are now and we are both gym rats.
I “retired my wife” at 46 in 2020, eight years into our marriage so she could enjoy her passion projects and I have turned down more lucrative jobs that would have required me to work harder and be in an office so I could work remotely from anywhere - but realistically in US time zones.
Everyone who knows me, knows that I would die with no regrets. As far as my wife who loves me and my grown (step)kids who I know also love me, I don’t owe physical suffering to anyone. Assisted suicide because of Alzheimer’s is more tricky than something like cancer though. What can you do? Sign something in advance where once you can’t pass a cognitive test three months in a row - kill you?
I saw someone interviewed who had set the criteria of being able to enjoy some ice cream with his children and grandchildren at the regular family dinner on Sunday late afternoons.
He said that alone made life worth living, for him and them, but once any deteriorating conditions rendered him permanently unable to participate in this weekly activity then he felt it was time to go.
Maybe having a pre-set condition like this is less arbitrary, and also allows everyone involved to understand as the time comes closer.
Took care of someone with Alzheimers for six years until they passed away. No one should have to exist like that, for that long. A biological shell simply of automatic inputs and outputs.
I think Alzheimer's is a particularly difficult case. Before diagnosis, many of us imagine that we wouldn't want to exist in a highly deteriorated state with no ability to care for ourselves. But as you start to decline, you still feel like yourself, just a very forgetful version of yourself. On which day do you decide that what remains of your mind isn't enough to make your available future days better than no future days?
The instinct for self preservation is strong. Knowing what will come requires foresight and clarity. You may lose the capacity for informed decision making before the point where it's clear that there's not much to live for.
Many of us lack the insight that Kahneman perhaps had that in order to take control of the end you may need to leave some good days on the table.
> And even at the end, when asked what he would like to do, he said: "I would like to learn something."
Don't have an exact word to describe how I feel after reading above. Find it beautiful that such an accomplished person wanted to learn something even towards the end of his life.
Good account of his reasoning. Off topic, but my Dad’s last girlfriend before he died two years ago was a co-founder of the Hemlock Society/International Right To Die organization - huge effort to get assisted suicide made legal in different tax jurisdictions around the world and different states in the US.
I 100% understand his rationale, and in the same position I'd probably do the same -- "probably" because this is one of those things you can't possibly predict in advance.
I think it's beautiful he got to go out on his own terms, when he felt it was the right time to do so.
I'm often reminded about a case in my own country: a young person had decided it was time to end her life after struggling for many years, without a sign of improvement. She was denied the right to euthanasia. After multiple failed suicide attempts, she went for the nuclear option and jumped in front of a train.
Everyone deserves to die in a dignified and humane way, not in multiple pieces or with a mind deteriorated beyond recognition. Forcing prolonged suffering is unnecessarily cruel. I wish more countries were as progressive with euthenasia as Switzerland.
He had to know it would be. I wonder if that was maybe an attempt to say this is completely personal and I'm not trying to encourage others to do the same or suggest it is the right thing for everyone to do?
Seems like a good way to go out, "my choice, my body" . I realize some psychological exam should be necessary before such things but it really should be self-determined within reason. I hate that USA is so far behind the curve on this, but eventually we might catch up on it with Europe and not have to resort to more ugly methods.
Ever since I watched my father waste away in agony and die in a veterans home, it has become my greatest fear in life to suffer until the bitter end. I choose euthanasia because I don't want to put my family through that, and the last thing I want to do, if you'll pardon me, is to waste away in my own urine and feces in what will likely be a sub optimal care situation.
You can get into a state of living death where the brain is mush and who you were is completely destroyed. That's hell for the family.
I saw my grandmother forget her daughter (my mother) it was heartbreaking. Seeing my mom realize her mom forgot everything about their life together was just painful.
It was just a sad existence to observe as well. Grandma lived for quiet a while with dementia and spent years trying to return to her childhood home. We'd constantly have to trick her into accepting help from us "strangers". Re-convincing her to come inside that these "strangers" wouldn't mind having her for a bit. Watching her read over the same page of a book for hours on end.
That's not an existence I want for myself or my family.
”Daniel Kahneman did not want to make a statement or start a debate. "I am not ashamed of my decision," he wrote, "but I don't want it to be discussed publicly either."”
Seems like we should close this thread to honor these wishes
For every Daniel Kahneman case, there's a case where the victim doesn't give consent, is coerced, or pressured from caregivers. It always rapidly expands from terminal illness to mental illness or non-terminal conditions. There's also weak oversight and misaligned profit motives. The examples in the Netherlands, Switzerland, Canada, and Oregon are shocking.
An interesting choice. It's fascinating that even for very ill or injured people the will to survive is so strong - I wonder if at a certain age this instinct diminishes making a choice like his easier?
> I wonder if at a certain age this instinct diminishes making a choice like his easier?
It's less likely to be "a certain age" and more surrounding factors: if most of your friends have passed and you don't have much chance to do things that interest you because you could pass at any moment yourself there comes a point where life has limited worth.
Essentially, hope runs out, and when it's run out entirely you either wait for death, or ... don't wait.
> It's fascinating that even for very ill or injured people the will to survive is so strong
Maybe at a certain age other instincts strengthen making a choice like this easier? We all have to come to terms. And if you are older than 70 then it is just a fact that every day can be your last without any accident or noteworthy medical complication. And the guy has been probably thinking about this fast and slow for at least two decades then.
If you have (grand)children, an important reason to wanting to stay alive is often not the fear of dying, but wanting to be there for them and fearing the grief they will endure if you are gone.
My grandparents stuck around too long, so I have the opposite fear of burdening my descendants with having to (if not legally, then via social pressure) spend too much time, money, and energy caring for me.
I think it would be valuable to get your parents opinion on whether the burden was worth it or not. Or, unfortunately, to see if your opinion changes if you have to bear the burden of your parents in the future. It's easy to assume the burden isn't worth it when we have a bit more distance (e.g. grandparents) but I think people are more open to it than we realise - even if it comes with immense amounts of stress. Saying that I think it varies person to person. Often in families you have people who are willing to carry the burden and others who aren't and that brings even more stress and disagreement to the situation.
I had real time feedback from my mom (the daughter in law) while growing up. I would never ask or want my wife to live the quality of life my mom did for her parents’ in law.
And I don’t want that for my kids, or even from the rest of society.
There’s a solution to this you can start on right now: structure your life and experiences such that you become an awesome grandparent with hilarious stories, humility and appeal to your grandchildren.
I probably won’t ever meet my grandchildren if there are any, because I am over fifty and single; I probably will never be a parent. So I will have to go a lot sooner if I am not to be a burden on society. But if you think you are going to be a grandparent, you can work on being an irreplaceable and useful one.
I am referring to being so old that you are dependent on others everyday such that the caregivers cannot go on vacation. One set of my grandparents both lived to 100, and they had a 15 year age gap, so that was the first 30 years of my life that my parents sacrificed time with their kids, professional life, and personal life.
Very few people are independent after age 80, and a miniscule amount after 90.
I’m trying to figure out why this feels so unsettling to me. I can understand wanting to end one’s life because of unbearable pain or illness, but something about this just feels wrong.
It's not unsettling for me, but I have a similar feeling. On the other hand, maybe he did have a medical issue, just chose not to disclose it. In any case it is his choice, as is the wish not to discuss it. I think this will be difficult to enforce, but I will personally respect it.
The guy who spent his life researching how to live rationally chooses suicide at age 90, upon seeing “increasing metal lapses”, presumably in order to not ever live irrationally.
Ironic is the opposite of what you mean, don't you think? By your explanation, Kahneman acted according to his life's work.
> The guy who spent his life researching how to live rationally chooses suicide at age 90, upon seeing “increasing metal lapses”, presumably in order to not ever live irrationally.
That was possibly part of his motivation. But also the pain, suffering (goes broader than physical pain), confusion, and cost -- to him and his family.
This always comes up with this prize, but it’s generally considered one of the Nobel prizes, although it’s not one of the original prizes. Your opinion on whether it should count is up to you, but to call it media manipulation is reading a lot of malice into it.
Argument is that economists knew exactly what would happen when they got linked with Nobel Prizes and help solidify economics as hard science like physics, medicine or math in eyes of the public. Begin debate around how scientific is some economics.
Not going to express an opinion, I'll just leave this except from the Hippocratic Oath [1], which reflects society's primary beliefs on this topic approximately up until the 19th century:
The modern hippocratic oath has no mention of poisons, also doesn't require the oath to be sworn before the gods of the pantheon. Up until the 19th century, physicians didn't believe in germs either. Attitudes change with the knowledge we accumulate.
Great guy, very sociable, knew everyone in the little town he lived in. Kept in touch with a lot of students. Good neighbour, friendly guy who'd talk to everyone.
He got Alzheimers. He started forgetting stuff, and it frustrated him. He got caught driving dangerously, and cursed the doctor who took away his license.
He argued with me about the state of some chicken he wanted to cook. I told him "this is pink all over, you have to cook it more". He got angry. I understood he'd become like this to everyone.
He pissed off everyone on his street, and all police, medical and social workers sent to help him. The disease made him blow up every relationship he had with anyone that he didn't know well, like me and a couple of colleagues.
He got found in his house, having left the gas on, endangering the whole street. He ended up in a care home, not knowing who he was, or who I was.
If he'd been run over by a car, or died of a heart attack at the age of 80, people he knew would remember him as that nice old guy who had a dog and made a lot of art, and was friendly to everyone. Instead he was that 83 year old guy who pissed off everyone, nearly blew up the neighbourhood, and drove like a maniac.
You really don't want to end up with dementia and related illnesses, it totally sours everyone's view of you.
This seems like such an absurd conclusion to this, as though the opinions of other people of you are what matter when you functionally lose your personhood and then die.
Maybe a better focus would be that there often isn't a good way for a community to manage a person who suddenly becomes irrational because of an illness.
There may be others reading in the thread who also can relate to the personality of the teacher and may care about their affect on others when they are "not themselves".
I'm grateful for this story - it's powerful to see examples of autonomy at end of life - and contrasts starkly with the experiences many of us have with aging parents. End of life, at least in the US, can be deeply flawed and misery for all.
you don't want dementia because it damages and hurts you and everything and everyone around you
(my grandpa physically attacked grandma multiple times in his last year)
Sure, it is nice to be remembered well, if you deserve it, but I do not live for the opinions of others. This is slave mentality and pathetic. I care about being good, and if I am hated for that, then so be it. Sad, but better to be hated for being a good person than loved for being a mediocrity or a knave.
And to off yourself out of concern with how people remember you is a condemnation of our society, our lack of charity, our lack of magnanimity, and our selfish prioritization of convenience. Full throttle consumerism.
Jesus, Socrates, anyone who stands up against an immoral hierarchy. Rethink your thought
Care to name even a single objective good, and explain how exactly it is objectively good?
The end point being that with the parents I have there was nearly a guaranteed outcome of only objectively bad things happening for me, for them, for people around me. During that state I saw my plan as honorable and wrote it down in what I was to leave to explain my actions.
They do matter.
Being concerned with how your behavior affects your family or your community, and the opinion they have of you, above your own self-interest, is how good parents, good friends, good citizens, and so on, are made.
You've changed the meaning behind the original comment in a subtle but important way. The original commenter wasn't concerned about their effects on other people, they were concerned about how the disease would ruin their public image. Maybe they didn't mean that but it's what they wrote.
This distinction matters because those people whose top priority is their public perception (i.e. social status) are never "good people". It's normal to care about your social status to some degree but it shouldn't be the first thing you consider.
The important point is this: are you causing emotional, psychological, physical distress in the real world to those you care about when you have this disease? Yes or no. That's what I care about. Whether they are able to remember me well despite that, or poorly because of that should be completely secondary.
Sure, we can think about how the burdens of caring for our family can be lessened as they age, or how we may help reduce that burden for our family, but family does have the duty to care for its members, and to place such considerations above the intrinsic value of human life is very sad indeed.
This is equally true of conditions like paranoid schizophrenia or psychopathy. Sometimes a person is just born with wiring that makes you dangerous to others. Does this mean that everyone around them must have the magnanimity and charity to them attacking people at random?
Paranoid schizophrenia have lower compliance rates and fairly large collateral damage. Psychopathy is a trait not a disease, but again, issue is that they do not cooperate and dont want to "cure". Psychopaths are fine as they are from their point of view.
It is just their victims who mind.
I think clinging to life is partially rooted in an egoist/solipsistic metaphysics that you yourself are all that matters (to yourself at least, of course). Relax, we're just a small part of the cosmos. Ancient and immortal :)
But it being a hard topic does not imply the easy solution of banning it.
But we should put guardrails around if the reason for assisted suicide is not pressure from relatives, depression, etc.
> Maybe a better focus would be that there often isn't a good way for a community to manage a person who suddenly becomes irrational because of an illness.
Yes, this is the focus. Science has stalled when it comes to neurological disorders. But the response is love and understanding. I do not understand how someone would "sour" on a person because they have an illness. A very absurd conclusion indeed.
If I am ever diagnosed with one of those, I absolutely want the chance to end my life before I reach a stage I become a burden to my loved ones and can't give a trustable consent. I'd rather go too soon than too late.
You are shiftinf the topic. This is about self-euthanization, assisted suicide. Not others.
> Where do we draw the line?
As written elsewhere, having to draw a line does not mean that the only reasonable conclusion is to make it illegal in general. It's a hard topic without easy answers. "Don't allow it" is an easy answer that doesn't do justice to the topics complexity.
A good friend of mine passed away a year ago with an incurable disease, diagnosed 3 months before his death, and it was essentially guaranteed that he'd have to endure unbelievable suffering during the last weeks of those months. He didn't have the choice to end it early. It was heartbreaking.
I for my part hope that I can choose myself when the time has come.
That's a personal choice. Anyone not interested in that won't have to do anything and can just wait for the end.
“It shouldn't be that way” is not an excuse to torture people through your moralizing indifference to the fact that it is that way.
Currently? I'd say that I wouldn't want to live with dementia, but what if my "demented self" (kinda hate the phrasing, sorry) in the future wants to live, or doesn't remember they don't want to live?
Do I have a say over the life of someone who doesn't remember they were me?
It sounds like Daniel Kahneman was suffering from depression after his wife's death and all he saw in the rest of his life was sadness. He had no hope. What day was the best day to die? What if the next day his hope came back?
What if he tried that, but every day just got worse than the last day?
And people don't get any younger.
My grandmother is 98. She hates her life since she could not go out anymore. But she is catholic and suicide would be a mortal sin. So she waits till gods take her. And suffers till then.
I would make a different choice for sure. If life is hell and no one depends on me, why should I continue the suffering? (At the cost of others, if I would need help?)
But my plan is of course to reach 120+ in good health. But if I decide I had enough, it will be my decision.
Anyone can say that about their life right now, can't they? How many people struggling today think that their life will get no better? Look at all those who made it through slavery, what hope did they have? Their hope came from their faith.
Suffering has a purpose, this is something your grandmother understands through her faith. Buddhists understand this as well. Maybe the problem is not our suffering, but our lack of faith in others and in in something bigger than ourselves.
So sure, suffering and pain are part of life. And accepting that helps a lot to not get stuck in that condition by avoiding painful things, you cannot avoid.
"Anyone can say that about their life right now, can't they?"
So no, not anyone is saying that. Only those with a death wish.
And I don't consider having a death wish as a mental condition. It can of course result of a illness, but it can also be a consciouss wish and then finally a decision.
And if other people decide they may not do this, but have to remain in their state of living hell, then this is just torture to me.
At the very least, suffering (through childbirth) is a prerequisite to bringing life into this world.
edit: strange that this is flagged. my parent asked for proof that suffering is inherent in life, and I don't know anyone who has said that the physical act of giving birth is anything but painful.
(Vouched for it to be able to reply)
And please don’t bring some mythical being in the argument.
https://news.ycombinator.com/item?id=45548996
As we're currently seeing happen: whatever is left unsaid in the body of the law can and will be abused by evil people to concentrate more power (even if the spirit of the law advocates for something kind).
So, we have to normalize some sort of stress tests for laws... because you sure don't want to be dragged against your will because you're poor.
Like a more subtle form of Shakespeare's "Will no one rid me of this meddlesome priest?".
If you ended back in camp you’d be welcomed. If you didn’t, that was your end. I found that remarkably comforting and peaceful.
I wish to remain so lucid when the time comes, that I can go sit under a tree and let myself go like that old dog. Perhaps I should leave a note.
That’s kind of what I want when I die too - I don’t think I want to be around other people when it happens. I want to have my final moments to face death on my own, without feeling like I have to perform for other people.
… that said, give me another 60 years to chew on it and maybe I’ll feel different.
[0] https://youtu.be/8j1IMBM-QyE?si=jfCe9YUvKW_t5m5e
https://en.wikipedia.org/wiki/Thalaikoothal
However, social acceptance may lead to more egregious abuses: the issue gained a higher profile in early 2010, when an 80-year-old man escaped after discovering his intended fate and heard his family members discussing how they were going to "share" his lands, and took refuge in a relative's home.
I want to be free to die on my own terms. Conversely, I do not want the healthcare system to be allowed to even suggest it.
What you call "comforting" is leaving a helpless prison in the wilderness to succumb to thirst, hunger or predators
Go to a dementia facility and hang out with your those people. You will see suffering.
If you think that "cannot feed themselves" is when a person is already completely gone and it's okay to "leave them under a tree to die of hunger and thirst", I've got news for you.
Save your loved ones some grief, create a living will with a trusted lawyer, update it about once a year. It's worth it. There are so many insane snafus one can get into with estranged family members, the state/gov't, medical institutions, etc that make the situation even more difficult and stressful to deal with. Don't expect anyone coming out of the woodwork to act according to honor. They are vultures and know no such kindness.
It includes a one hour zoom session with an actual attorney to explain things.
They make it so easy.
I get it’s easy with other diseases such as cancer, though.
You can't express in advance that you want to have assisted suicide.
Your former self might express wishes, but what if your later self doesn't feel like this anymore? In a way, we can all get the same feeling when doing another round of "lose weight this year" new year's resolutions just to realize a couple weeks later that the former self wasn't that trustworthy to begin with (or was it the other way around, the future self can't be trusted?)
Point is: you can wish for whatever you want, but dementia is probably a tough case and it shifts your priorities, making everything before obsolete and I'm not sure that people beginning to suffer from dementia ever find the right point in time to end life early.
Arguably the best qualified person to decide what to do with Future You is Present You.
Plenty of people here who reacted negatively to OP's suggestion seem to not have had to deal with a loved one who dealt with Alzheimer's or other forms of dementia. It's not hard like taking care of a toddler is hard. It's hard like, "this is not the same person I know for my whole life, they don't recognize me, they say and do mean things to me and their grand-kids and neighbors all the time, and require 24x7 supervision to not hurt themselves or break everything in the room."
Oh, and remember that in the US, all nursing homes for this kind of thing are for-profit companies backed by venture capital, meaning they are expensive as hell. Take your current middle-class apartment, shrink the size to just a bedroom (that you now have to share with someone else), and then quadruple the rent. Just a few years of that can decimate the life savings of the average retiree and/or their children's.
I speak with some authority here because all of this happened to my father. He was "alive" in the last few years of his life, but not what anyone would call "living." I absolutely do not want that to happen to me. If it were legal in the US, I would absolutely opt for an assisted suicide plan for myself.
There are ways to handle it that avoid all the "whatabouts" that you and others have already brought up. One rough draft of an example: 1) Have a lawyer write up a kind of will expressing my wishes. 2) Get three unbiased negative diagnoses to show I am of sound mind prior to signing the will. 3) Go in for regular testing (every year, maybe two). After each negative diagnosis, add another (witnessed and/or notarized) signature to the will. The will is not valid if testing or a signature is missed. 3) If there is ever a positive diagnosis, it must be confirmed by two other clinics. 4) If three years pass with doctors and clinical tests confirming increasing dementia symptoms along the way, the assisted suicide clause is invoked and I get to pass peacefully surrounded by loved ones instead of being a stressful burden on them for years or decades to come.
Yes, there are details and unintended consequences that neither me nor anyone else can see ahead of time. Like everything else, they are dealt with as they come up. No, you won't convince me that your favorite corner case means the entire idea is invalid.
This is exactly it. It's like dealing with a curmudgeonly toddler with extreme agency and no self-awareness. The rest of your comment is so spot on or at least matches my experience. I'm sorry you had to go through it but you genuinely seem to have become stronger from it and I'm grateful you could share your experience with us.
You even literally show that he isn't solely remembered for those last 3 years of his life. We owe people like that care and understanding, not murder framed as mercy.
It's always so painful to see old people around who are clearly living alone, forced to do everything themselves, having to ask strangers for help because they're afraid of being a burden, and their actual children can't find time for them. Only to now see people actually supporting murder because old people become a burden for a couple of years near the end of their life.
By your logic we should kill everyone at their peak.
They would have likely used assisted suicide if it had been an option back then.
While what you say is extreme there is a point in the decline past which there is no point of living. If you have something worth living for - cling to life and to 107 if you like. But if the only thing that waits you is to slowly decay and fade and lose yourself - what is the point?
Their life probably won't improve anymore, and in the latter case they're going to die in a few years anyway, so might as well just lighten the load on society?
You don't consider years of mental trauma on the individual and years burden and stress on loved ones to be suffering?
Regarding your estimates, are you just making up a lot of assumptions or do you have any data backing up your relative numbers? In your other comment you seem to assume that anyone not agreeing with OP's suggestion doesn't have personal experience with close relative having a dementia. I'm very sorry for your loss. At least some others (me included) also have had this unfortunate experience, but don't agree. High bar is actually very hard to quantify. All old people are in gradual decline and are relatively close to their deaths. One alternative to your suggestion would be that a state would provide quality professional care for people with dementia. That way the things OP described wouldn't happen and the family of the patient wouldn't have to bear the financial burden of the disease. We are more advanced and richer that we have ever been in human history, but it seems like we are unable, as a community, to provide very ill people with quality care they need.
I completely agree that the disease is horrible, but your conclusion is bizarre. When you are in that condition, how anyone views you is the least of your worries.
Folks I know who have passed on also wanted to be remembered when they were strong, not when they were ill.
I’ve never been close to anyone who had dementia. My grandparents on both sides died with their mental facilities in tact and my parents who are 83 and 81 are independent and just as of 6 months ago passed a cognitive test. I can imagine if they started acting out of character and being mean to me or forgot who I was that I would be hurt, overwhelmed etc. But not pissed.
That's just as much failure of everybody as it is of him. This was dementia speaking and society needs to learn that.
You wouldn't tell somebody with a broken leg to get it together and it's just their personality that they can't walk. Nor should you treat dementia like that. Yes, people seem to shift personalities and anger others. But those others need to understand that it's a medical condition, an untreatable and fatal one, so should have even more sympathy than with somebody who broke a leg (cause that will likely just be temporary). Not alienate the person and speak ill of them.
It's certainly a failure point within us and something to be aware of to make effort towards understanding our own impact as you suggest. Sadly a problem with no full solution over long enough time periods.
I disagree it’s up to you to conclude it would have been better if he had been killed 3 years earlier (which you imply).
In general you don’t have the right to such a statement.
Now, if you were discussing _your own_ condition this would be a totally valid consideration IMHO. But you (almost) _never_ have the right to conclude from someone elses part when it’s their time to go.
Assisted suicide is a humane option but ”I hope he had died with some dignity years ago instead of pissing everyone off” tarnishes the entire concept and is exactly the type of argument which stops assisted suecide becoming a more widely accepted option.
Many countries hesitate to execute criminals despite very clear criteria that could be used to justify it. (Many countries banned entirely.)
Why would we have a lower bar for someone who hasn’t committed any crimes?
But my personal anecdata puts that man in a minority. None of my older relatives with Alzheimer’s have become aggressive or troublesome. Worry, anxiety and confusion seem to be much more common states of mind, which admittedly also doesn’t seem like such a fun way to spend your days.
I find the people who remember him as this guy somewhat contemptible though, so I guess my theory would be he wasn't remembered badly by anyone whose opinion mattered.
But on the other hand I guess that's the way the world works.
Maybe in a different city, or with different friends.
If he did “learn something new”, could he have incrementally improved upon it, using his brilliant mind? Could he have made one more wise observation?
It seems he likely left something on the table.
No cure for getting old and no cure for dementia on the useful horizon. Having made it to 90 intact, he had knocked living out of the park already. I completely understand his thinking here and support it. He likely could have gone a little longer, but he also might have had a stroke or some other nonfatal cataclysmic event that took away his options.
You should read the piece by Jason Zweig, if you haven't. The decision was deeply personal and was most certainly not an endorsement of euthanasia.
The real issue is our broken systems for handling dementia and underfunded homes, overworked staff, no real community nets. Fixing that honors the full life someone led, instead of saying their value drops when they need help. Assisted suicide opens doors to abuse, like pressuring people who feel like burdens.
We owe better to people like your teacher.
All I can say is that I didn't, and thank you for implying that it was so well written that it could only have been authored by a machine that has all of humanity's cultural output to hand.
I've really thought about this a lot after seeing a number of family members and friend's family members go through dementia, and it seems like it can go two ways: like this, which is how it went with my grandmother (whose hoarding behavior increased aggressively, and she started slapping people), or how it went with my grandfather on the other side (he became quieter and quieter, watched tv every day while understanding less and less of it, and when you caught his eye would repeat how much he loved you and how much seeing you "made an old man feel good.")
It has something to do with how you feel about the nature of people in general, and whether you feel they are all suspicious and possibly conspiring against you, or that you think they are basically good and want the best for you. When you have all of your mind, you can beat the demons or the angels back with your reasoning enough to have the personality that you want. My grandmother was very loving, and my grandfather was very shrewd and practical. But when that higher function can't regulate you, what shows is if you were someone who taught yourself how to see the good in people, or someone who taught yourself how to see the bad in people.
I suspect I'll end up like my grandfather, as much as I think of myself as like my grandmother. Deep down, I've always been crippled by the feeling that everyone is a wonderful person. My aggression and judgemental nature on a lot of things can really, embarrassingly, be interpreted as me looking for excuses for everyone's behavior.
I don't think this is fair. I know several people who died with Alzheimer's and although their final years were very difficult for them nobody has a bad opinion of them. It's certainly a strain on the family but intimating that if you have dementia you better kill yourself or your legacy will be ruined is not ok.
We, the loved ones, made the decisions to keep them going and I wonder how fair that was to them. We tend to not want to let people go, choosing to sacrifice quality of life for the sufferer and those around them for, what, a few fleeting moments of possible clarity? The opportunity to say goodbye to someone who may or may not even understand what is happening?
The events I went through with my family hurt us in ways that will not likely ever heal, despite effort on at least a few of our part, and it did leave me wondering if I would put my son or wife through that should something similar ever happen to me. I decided against it, seeing as I am at the age where these are very real possibilities. In the US, we have DNRs ("do not resuscitate") and living wills that offer prior directives, but something like assisted suicide is not allowed here unless some very extreme circumstances are met, because insurance companies and hospitals make more money from suffering people than dead ones. I'm a strong advocate of the right to die, but it is a decision that needs to be made some extensive consideration and documentation before one actually needs it.
It seems like DIY methods could be risky to your family if you're already impacted by the disease, and your own competency is called into question.
At the moment, I have standing orders in place that no heroic measures or treatments should be enacted in the event that I am in a terminal or vegitative state. I've communicated clearly to family members that would be responsible for my decision making that things are not to be prolonged or dragged out for the sake of emotional contrivance.
Without knowing how we will die, it's really quite impossible to plan around it, of course. My comment, more or less, expresses my desire to have more control over my exit in the event that I am put in a position to become a massive burden on those I love; this is something I consider a reasonable and rational request, where the folks that make our laws do not. None of that changes without discussing and sharing our viewpoints on the matter, though, which I suppose was all that I was doing.
Good luck to you.
Parent comment doesn’t say this, does it?
If you apply at scale the same logic with more sensibility you will also be able to rationalize a genocide because someone felt bad about something.
What defines demonic inspiration?
And here I don't say "demonic" metaphysically but philosophically.
The philosophical underpinning is giving up of materialness. The practicality of the 5 instances that I witnessed over the past year - typical terminal individuals choose this. They pass away surrounded by loved ones (they typically medicate for any pain, and the body starts shutting down when food and water stops). This is observed with somberness, but celebrated as very positive act.
When someone starts this process, it's a unique experience speaking with them, as there's usually nothing that comes up, and the moment does not really lend itself to small talk :)
[1] https://en.wikipedia.org/wiki/Sallekhana
During his final days, he became unresponsive, only sleeping. The doctors gave us the option of feeding him through a tube. We made the hard decision of not doing it. Gave him all the medicine to help his body heal, but no invasive procedures.
We stayed by his side for the next 5 days. Playing songs that he enjoyed. Audiobooks that he loved. And just taking care of him.
Finally, his breath became slower and slower until it stopped and he passed away. I had the opportunity of being beside him during his last breath.
The passing of loved ones is always difficult, but I am grateful for how he went. He lived a full life and was incredibly healthy until the end.
Without knowing, we decided on a sallekhana-like process for him. It was the right thing to do.
Thank you for showing me this.
https://www.sciencedirect.com/science/article/pii/S088539240...
There are many who will raise their hands with anecdotal counters to this, but I think much of that is borne from misunderstandings about end of life generally, which is a charged and difficult topic lots of people would rather not learn more about.
I highly recommend the book Being Mortal by Atul Gawande for anyone who wants to explore the topic further—or really for anyone who has loved ones at all!
[0] https://en.wikipedia.org/wiki/Thalaikoothal
On the one hand according to the wiki this is more progressive removing food by degrees which would make the process a lot longer.
On the other hand being a mostly ascetic practice I'd assume it's done by people who have a lot less reserves (body fat and muscle) which would shorten the process significantly (the 207kg Angus Barbieri famously fasted continuously for 382 days[0] breaking his fast at 82kg, although he supplemented his liquids — water, tea, and coffee — with vitamins, electrolytes, and yeast extract, the latter for essential amino acids).
[0]: technically he was put on a recovery diet of salting then sugaring his water for 10 days, so ate no solid food for 392 days, breaking his fast with a boiled egg and a slice of buttered bread
> Kahneman used the services of Pegasos in the village of Roderis in Nunningen, Switzerland. In the death room with a view over green hills, wearing a suit and tie, he lay on the bed and turned on an infusion of sodium pentobarbital himself. A companion held his hand and told him they were holding it on behalf of his loved ones. Kahneman's last words were "I feel their love."
[1]: https://www.aargauerzeitung.ch/schweiz/suizidhilfe-weltstar-...
> Pegasos, a non-profit based in Basel, Switzerland, believes that it is the human right of every rational adult of sound mind, regardless of state of health, to choose the manner and timing of their death.
I found this bit "regardless of state" really interesting.
I wonder what their views would be for someone who wouldn't have a family and nothing much to do or explore after a certain age? Does it matter what nationality they are from? What if someone's reason is - they had savings and now they have run out of it and area already 55-60 or more and have no intention or plan to work anymore and don't want to go through the struggle of life? (Of course they would have had paid the euthanasia fees)
How does it all happen?
You will be missed! Sad to hear he passed, but glad he was able to go out on his own terms.
A later analysis[55] made a bolder claim that, despite Kahneman's previous contributions to the field of decision making, most of the book's ideas are based on 'scientific literature with shaky foundations'. A general lack of replication in the empirical studies cited in the book was given as a justification.
I just could not digest it. I understood the words but I couldn't make whatever message he was trying to convey... it felt too "dense" for me. Maybe im just stupid, but I could not get past I think the first two chapters.
Probably nobody at all got confused by that word choice.
“The next book he wrote, Noise, ….” Would have been better or “After that book he wrote Noise….”.
I absolutely was confused for a second or two and thought “wait, are we talking about a different person? He isn’t going to have a ‘next’ book unless he had one queued up?”.
Did I need the explanation above? Not really, I’d come to the right conclusion on my own but I can imagine someone who isn’t a native speaker (reader?) might stumble on that more and I enjoyed the confirmation.
This is overconfidence; e.g. it "it is clear to me, so it must have been clear to everyone else."
Indeed, there is a person in this overall thread [1] saying the use of "next" was ambiguous:
> I literally thought some unpublished book.
[1]: https://news.ycombinator.com/item?id=45548294
It was made clear to everyone because of the word choice in context. If someone didn't get it then they didn't put two and two together.
I looked up the word in a few different dictionaries and the top entry aligns more with "subsequent" in every one.
You are wrong on this.
> I looked up the word in a few different dictionaries and the top entry aligns more with "subsequent" in every one.
Even if you had looked at every dictionary, would you claim such a process resolves ambiguity in general? I hope not.
As you know, there are other entries other than the first in a dictionary. Multiple entries means there are multiple usages: there can be ambiguity. Sometimes usage diminishes or eliminates ambiguity, but not always.
> I looked up the word in a few different dictionaries...
You only took a small sample. How can you offer this as definitive evidence? You can't.
In case you didn't check it or overlooked it, here is the first entry from the Apple Dictionary:
> 1 (of a time or season) coming immediately after the time of writing or speaking: we'll go next year | next week's parade.
Anyhow, my argument does not rely on pointing to a dictionary and saying "I'm right" and "you are wrong". I am saying:
1. Reasonable people see ambiguity (in this specific case and in general)
2. No one person is the arbiter of what is ambiguous for others.
3. Claiming there is a definitive process to resolve ambiguity for everyone is naive.
>> there is a person in this overall thread ... saying the use of "next" was ambiguous
> Ok, fine, probably someone will get confused about anything.
You exaggerated and trivialized. You deflected and moved the goalposts. These are signs you want to win more than discuss in good faith.
Not sure why I bothered responding to a troll.
You are claiming this resolves written ambiguity in comments? I hope not.
Also: I hope you recognize that the "next" link doesn't appear until a comment has a reply. So think about what someone sees when they are writing a comment; namely, there is no "next" link visible. This undermines your implied argument, which seems to be "the word 'next' is visible in the headers, which will make the use of 'next' in the comment itself unambiguous".
Forgive me for saying so, but what a silly argument -- on either level. You are clearly upset and bothered and resorting to rationalization and attacks.
This is inaccurate. Here is what troll means to many people "a person who makes a deliberately offensive or provocative online post." My response clarified without being offensive. I was careful to word it neutrally. I hope than a charitable reader can see this.
To put in the terms of Kahnemann's Thinking Fast and Slow: it is worth considering if maybe the commenter above got triggered first (a System 1 emotional reaction) and then later sought to rationalize (System 2) a "reason" for that: namely "he's a pedantic troll".
> If people can construct a simple and coherent story, they will feel confident regardless of how well grounded it is in reality. - Daniel Kahneman
It's much easier to point out others' alleged irrational thinking, but the main purpose of books like this is to help you better understand your own thinking.
That sounds right. I only can make probabilistic guesses as to what is happening in someone else's brain. By posing a question to someone else, there is some chance that person may ask it of themselves. If not today, then perhaps in future.
Here's one way to commit the fallacy: when someone points out a communication issue, mock them for being "too literal" or "pedantic" rather than acknowledging the ambiguity existed.
Thanks for the feedback.
To focus on "should" for a second. If I would not have written my second paragraph, I would not have made my main point: I'm trying to get people to pay attention to ambiguity more broadly and tamp down this all-too-common tendency for people to think "the way I see things is obvious and/or definitive" which pervades Hacker News like a plague. Perhaps working with computers too much has damaged our cognitive machinery: human brains are not homogeneous nor deterministic parsers of meaning.
Perhaps the second paragraph got some people thinking a little bit. We are discussing Kahnemann's life's work after all. This is a perfect place to discuss our flawed intellectual machinery and our biases. Kahnemann would be happy if people here improved their self-understanding and communication with each other.
So beside pedantic it’s unnecessary.
- product development: why make someone "do one extra click" when you can make the extra click unnecessary?
- writing: respect your audience's time.
- humility: take one minute of your time to save other's time.
- databases: optimize for reading not writing
> The irony is that people who insist something is "obvious" are often demonstrating a lack of awareness about how communication actually works. Clear communicators tend to be more empathetic about ambiguity precisely because they understand how easily misunderstandings occur. [1]
> “The curse of knowledge is the single best explanation I know of why good people write bad prose.” [2]
[1] Claude Sonnet 4.5 in response to """Some people that think "X is so obvious" that they will frown upon people who think "X is not obvious"."""
[2] Steven Pinker, author of The Sense of Style
That said, there is a problem in at least some places where assisted suicide is available where it keeps getting recommended to disabled people who don't want to die. That needs to be solved. Seems like an easy solve. Just don't do it.
There is a cost reduction incentive, though, which is why it happens. Costs can be reduced for abled people by convincing them to exercise and eat more fiber, so the same pressure can do good instead of evil. At some point we have to decide to care about people.
And did you just go to eating more fibre from euthanasia in the same few sentences? :D
Where? This is a thing which always pops up in these debates because it is a deep-rooted fear, but are there countries where this is a thing?
https://en.wikipedia.org/wiki/Jack_Kevorkian
> A part of eugenic politics would finally land us in an extensive use of the lethal chamber. A great many people would have to be put out of existence simply because it wastes other people's time to look after them.
Shaw and other Fabian Society members were supporters of the group now called Dignity in Dying [0], which used to be called The Voluntary Euthanasia Legalisation Society and was founded by a doctor.
Nazi Germany committed involuntary euthanasia of disabled people in a program called Aktion T4 [1]. It's probably not an accident that Dr Kevorkian, an American, started publishing his euthanasia papers in Germany. Before that he was trying to harvest blood and organs from inmates, which is another area where the incentives seem very bad.
I can't comment on how often modern assisted suicide programs recommend it to disabled people who don't want suicide. But it's clear that Kevorkian was not careful about who he recommended assisted suicide to. So given the strong desire of some people to euthanize the disabled against their will, the lack of carefulness is concerning and suggests that it likely happens with some regularity except in exceptionally run programs.
[0] https://en.wikipedia.org/wiki/Dignity_in_Dying
[1] https://en.wikipedia.org/wiki/Aktion_T4
I don't think things are as bad, but I also think that old age in poverty is a valid reason for euthanasia if there is no alternative. If the society is cruel to the poor, holding poor elderly as hostage to improve situation is cruelty on top of the cruelty.
https://archive.is/bd0PV
https://thewalrus.ca/assisted-dying/
https://www.ctvnews.ca/politics/article/doesnt-line-up-mps-c...
Eg maybe a 16 year old who wants to end their otherwise healthy life might, 20 years later, be glad they didn't.
That seems less likely with someone who is almost certainly going to die (and probably painfully to boot) "soon".
Equally, they might spend decades of their life in misery wishing that they had been able to.
I watched a documentary where they interviewed a bunch of people who attempted suicide and talked to them about the entire experience and mental state. Out of the maybe ten that they interviewed, only one said that he wished it had worked. That doesn't mean it's only 10% though... they didn't get to interview the ones that succeeded.
Especially if the person has already admitted to trying to commit suicide (which they presumably did considering the context from parent comment).
I think it's okay for us to try and avoid the irreversible mistake, but yes, it's very arguable that living years you didn't want to live is also an "irreversible mistake".
What's downvote-worthy about this comment?
It's in response to mine, and even though I don't really agree with it, I don't see what's so objectionable that it needs some sort of admonition?
>Her last hope was a $4,000-a-month drug that her doctor prescribed for her, but the insurance company refused to pay.
>What the Oregon Health Plan did agree to cover, however, were drugs for a physician-assisted death. Those drugs would cost about $50.
Randy Stroup [2]:
> Lane Individual Practice Association (LIPA), which administers the Oregon Health Plan in Lane County, responded to Stroup's request with a letter saying the state would not cover Stroup's pricey treatment, but would pay for the cost of physician-assisted suicide.
Stephanie Packer [3] (although in this case she inquired herself):
> Then her doctors suggested that switching to another chemotherapy drug might buy her time. Her medical insurance company refused to pay. She says she asked if the company covered the cost of drugs to put her to death. She was told the answer is yes — with a co-payment of $1.20.
T. Brian Callister, MD, FACP, FHM [4]:
>When I spoke with the insurance medical directors of the patients' insurance companies by telephone on separate occasions, both of the insurance medical directors told me that they would approve coverage for either hospice care or assisted suicide but would not approve the life saving treatment option.
> Neither the patients nor I had requested approval for assisted suicide, yet it was readily offered.
[1] https://abcnews.go.com/Health/story?id=5517492&page=1
[2] https://www.foxnews.com/story/oregon-offers-terminal-patient...
[3] https://nypost.com/2016/10/24/terminally-ill-mom-denied-trea...
[4] https://www.cga.ct.gov/2018/phdata/tmy/2018HB-05417-R000320-...
Just to be clear: the insurance companies are the problem here; and more broadly this whole for-profit model of healthcare.
However, the price difference is probably a strong incentive.
I had a friend that decided to stop treatment (dialysis), when he realized that he'd never get off it (he couldn't get a transplant). He was in his late 60s.
It was both a sad, and joyous experience. He took about a month to pass (renal failure). He was Catholic, and wouldn't do assisted suicide.
During that month, a bunch of us would go over to his house, almost on a daily basis, and we'd just hang out. It was actually a great experience.
https://www.nyswritersinstitute.org/post/hunter-s-thompson-s...
I thought Jain the perspective shared in this comment is valuable: https://news.ycombinator.com/item?id=45548178
Well, not just the comment, but also the wikipedia article linked to in the comment.
Obviously, Jainism isn't Catholicism, but this part of the wikipedia article got me thinking:
>It is not considered a suicide by Jain scholars because it is not an act of passion, nor does it employ poisons or weapons.
Catholics are probably never going to think suicide is ok, but I wonder if they could come around to a definition of suicide that is more narrow and which excludes death-with-dignity. If they did make that adjustment, I would personally agree with their stance.
There is plenty of precedent for this legislation through definitional scoping in history in general, though I'm not an expert on Catholicism. The book "Legal systems very different from ours" talks about it, and gives examples. It's really the only option for any sort of change when you're dealing with decrees from a supernatural entity or an unchangeable part of a constitution.
Imagine you're poor, your family is poor, and your friends are poor too. You spend 2 years in and out of inpatient care, and then die. Your family is now saddled with a debt they will never be able to pay. Your medical bills could make them homeless. Now imagine choosing between that, and MAID. MAID is obviously a cheaper "out."
Now remember the demographics of poor people in this country. If poor people end up being more likely to choose MAID, that necessarily means MAID would be used disproportionately on ethnic minorities and disabled people. So you end up with eugenics again, just because of the sorry state of our medical system and class demographics.
Not all assisted suicide is eugenics, to be clear. There's a discussion of Jain practices elsewhere in this comment tree.
But man did I lose sleep at the thought that we could have people volunteering to kill themselves solely because they're poor. You could argue that it's wrong not to give someone the choice to die sooner, given that dying later could cause so much strife for their family. But I hold that the right solution isn't making people die sooner, it's building a medical system where people never have to grapple with this choice in the first place.
That’s my biggest concern about assisted suicide for an otherwise healthy person who just wants to avoid the inevitable decline (as in this case). There is a direct financial incentive for families to push people into this.
The only way I can see to remove that would be to require that your estate can’t go to anyone who potentially has influence over you in the case of assisted suicide for with no terminal illness.
What financial incentives are there in killing someone?
Between doctors, nurses and lawyers you can burn through a million bucks in five years easily. And most families don’t have a million bucks cash to spare.
On the other hand, if they die after six months, instead of after 5 years? The family doesn’t lose the farm.
That would indicate there is a financial incentive in keeping them alive, no?
The "incentive" from the family's perspective, if they're that cold-blooded, doesn't make sense because they could just... not take care of that person.
Insurers and the government have the opposite incentive, but it's something to be concerned about.
>there are already guardrails around these processes
I don't think there are guardrails that can prevent what I'm talking about. Only the most egregious abuses would even be detectable.
As long as you don't literally tell your mom to kill herself I don't think you could make it illegal. As it stands in the US I don't think you could make it illegal for someone to tell someone they "wish they were dead" in this situation.
The ordinary outlet for them is the military. Sometimes they become serial killers.
A euthanasia industry would attract these people similarly to how police and security work attracts authoritarians and how clergy jobs attract pedophiles.
That's not to say that most people in the industry would enjoy killing people, but it would be a problem. And death is final; it's impossible to fix mistakes. This is the same reason many people are opposed to the death penalty.
Death penalty is the government deciding to take your life based on what they believe you did. I agree, mistakes there are bad. Assisted suicide consists of the person dying giving their consent to take their life. Quite different.
Not only is whether someone gives consent sometimes unclear, it's also unclear if the consent was informed consent and whether it was uncoerced.
Informed consent is obliquely mentioned in my other comment. For example, a patient may falsely believe their illness is terminal.
I realize I replied to a question about financial incentives to talk about non-financial incentives. But coerced consent would often fall under the financial incentive heading. E.g. "consent to be euthanized or I'll contest the will."
Forced "suicide" also has a long history, including in the ancient world. Arguably things like kamikaze might fall into that category. And it's a favorite method of execution in financial and espionage type cases because the method of coercion won't show up in the forensics.
For these sorts of reasons, I think the risk of mistakes is high.
2. You likely get much more money if they die now without spending it on cost of living, and healthcare.
People do all kinds of awful things in order to get control of an elderly family member’s money—up to and including outright murder. Pressuring a suggestible family member into assisted suicide is a comparatively easy and low risk method.
Okay, sure, but how much of the population is this awful and does it actually matter since they can't consent to someone else's suicide anyway?
I don't think this is as much of a widespread issue as its made out to be, to be honest.
What's definite, however, is that he made ~75% of her estate vanish into thin air before throwing her into a low-end nursing home where he wouldn't pay $6/day to have her bathed so she died in her own filth. Nevermind she had a 6-figure pension and longterm care for life. He wanted her gone because dementia had made her unmanageable to him yet he wouldn't let her go to live with any of her other children because he feared he would lose control of the estate through his PoA.
And because he had that PoA, no one could dispute his choices in time to save her. The courts and Adult Protective Services were useless bordering on complicit. The day we finally got a positive court verdict was absolutely 100% coincidentally no connection whatsoever you see 2 days before she suddenly passed.
Lesson learned: when you grow old, don't give anyone on the inheritance train any sort of PoA or they'll instantly become a PoS.
It’s already common for caregivers to begin to resent the people they care for and for old people to worry that they are a liability.
I don’t trust the system to be able to protect vulnerable people who have been coerced. And I don’t want old people in general to feel like suicide is their obligation.
I don’t do it, but I’m not sure how that solves the problem of other people doing it.
In particular, the physician must "be satisfied that the patient’s suffering is unbearable, with no prospect of improvement", which from this article sounds far from the case here.
[1] https://www.government.nl/topics/euthanasia/is-euthanasia-al...
^ Yes, it's "illegal" but it's effectively nulled if the means to it are made legal.
Every assisted suicide is then investigated by the police to ensure no profit motives exist.
Sorry, but your comment smells rather about peddling fakery, especially as you have provided heaps of reliable references.
Some of its wording is weird, like mentioning his wife dying in the same context of two other partners with no explanation. The original is a much better read.
If you’ve already made it to 90 with no major issues, you’re expected to make it to 95 and you could make easily live to 100. My wife’s grandad is 90 and he still lives alone, drives, plays golf nearly everyday, and regularly sees his 12 grandchildren and many great grandchildren. He even made the 9 hour trip to come see us last year.
I’m very wary of making it legal for doctors to euthanize an otherwise healthy person who just wants to avoid an eventual decline.
It’s relatively common for families to push people into nursing homes, but in this case there’s an even stronger direct financial incentive. I don’t trust the system to adequately prevent this.
Counter-anecdote, my partners Granddad is 93. Age 90, we said the same as you. Now he's an old, rude, obnoxious liability - he's still great, and I don't hold it against him, he's earned the right. But I've never known anyone naturally age and die without losing their ability to be civil in some way towards the end.
From the article:
> Kahneman knew that many would see his decision as premature. But that was exactly what he intended, he wrote: If you wait until a life is "obviously no longer worth living", it is already too late.
I personally wish my partners final memories of her Granddad were him at 90, and not at 93. I've known for a good 5 - 10 years I will take the same route as Kahneman. I feel the desire to stay alive long enough to be a liability for yourself and those around you is a decision motivated by ego and fear, rather than compassion or logic.
Everyone becomes a liability at some point. By that logic we should just go full Logan’s run and kill people as soon as they stop being productive.
There nothing wrong with saying that you aren’t going to take extreme measures to preserve your life past a certain age.
But I don’t want this attitude of “you should kill yourself so you don’t burden your family” to become the norm either.
What if your partner’s grandad heard you calling him a rude obnoxious liability and felt pressured into killing himself?
>I've never known anyone naturally age and die without losing their ability to be civil in some way towards the end.
But many people die suddenly with no serious mental decline at all. That can happen at 95 or 100 the same as it happens earlier.
If you rule out everyone who didn’t die of some nebulous cause as the result of a slow decline you are selecting for people who mentally decline.
That's ridiculous. People can be unproductive, but not a liability.
> But I don’t want this attitude of “you should kill yourself so you don’t burden your family” to become the norm either.
I can see that, but you haven't explained why. Personally, I don't want to burden myself, my family and those I care about, that's important to me. There must be something more important to you that justifies burdening loved ones with a hard painful death of a loved one. Help me understand: what's that thing for you, if not ego/fear?
> What if your partner’s grandad heard you calling him a rude obnoxious liability and felt pressured into killing himself?
The alternative is he's unnaturally kept alive in a perpetual state of suffering for him and the people around him. If he hadn't suffered mental decline, I know he'd never consciously choose that, another reason why I'd like to make sure I'm gone before serious decline kicks in.
> But many people die suddenly with no serious mental decline at all. That can happen at 95 or 100 the same as it happens earlier.
That doesn't change anything. I agree with Kahnemans point that becoming a burden is too late. If I accept that, without being able to predict the future, it then becomes a game of risk. Kahnamen decided the risk of him becoming a burden was greater than the risk of him continuing to live what he would consider a productive (edit: "valuable" is probably a better word here) life.
That would depend on your definition of liability I suppose. Many people would consider a parent who was no longer capable of productive output (work, helping out around the house, watching the kids) a liability. I suppose you may be using the term to mean "you'd rather not have them around anymore because their company is no longer offsetting the cost to you".
>There must be something more important to you that justifies burdening loved ones with a hard painful death of a loved one. Help me understand: what's that thing for you, if not ego/fear?
This isn't about me. As of right now I don't plan on taking any heroic measures to preserve my life past a certain point. The issue is I don't care why someone wants to stick around. I want them to feel free to do continue to do so.
>The alternative is he's unnaturally kept alive in a perpetual state of suffering for him and the people around him.
Depends on what you mean by being unnaturally kept alive. He could have opted out of medical treatment at any time. Once his capacity to make his own decisions was gone, his family could opt out of that treatment for him.
>That doesn't change anything. I agree with Kahnemans point that becoming a burden is too late. If I accept that, without being able to predict the future, it then becomes a game of risk. Kahnamen decided the risk of him becoming a burden was greater than the risk of him continuing to live what he would consider a productive (edit: "valuable" is probably a better word here) life.
Personally I think trying to predict the future and what the people around me would or wouldn't want is futile. And choosing when to die to prevent this is impossible. Some people will go downhill at 55, some at 110. If you really consider the burden of a few years of decline to be so awful on your family that you place a very high value on avoiding it, you'd need probably need to kill yourself much earlier than 90, probably 75 to really reduce the chance to a small enough level that you don't really need to worry about it very much.
The problems I see are that several.
1. People will feel pressured into suicide because they feel they are might be a burden to their family that their family doesn't want. Even if they aren't. You can't know what your family actually thinks. If they say "no dad I don't want you to kill yourself", are they being honest or not?
2. People will feel pressured into suicide because their family has made it clear that they are a burden on them. These people might want to keep living for whatever reason. Fear/ego whatever. I don't care why they want to. I don't want them to feel obligated to commit suicide.
3. The financial incentives for families to pressure otherwise healthy people into suicide.
I still generally think people should be allowed to choose how their life ends.
I also think that, as a society, we should be trying to fix the problems you list so they become of least concern to the person dying (though I'm not optimistic we will).
I mean it in the sense of burdening others. Sure we all have to burden others to some extent, but I mean specifically the unique burdens that come with age, like requiring others to do basic things to keep you alive because you've lost the ability to do so.
> Once his capacity to make his own decisions was gone, his family could opt out of that treatment for him.
There is also no medical treatment for old age: there's no medications you can opt out of to end it all if you're just naturally aging and suffering, but we have to see this suffering more now because medicine has stopped other illness killing people before old age. Also, one problem we didn't anticipate is in the UK, legal and medical power of attorney can only be used when a person has lost the ability to make decisions: if they're able to make terrible decisions that are obviously not in their interest, and leading them to be repeatedly hospitalised, those terrible decisions are still respected over the family/power of attorney.
> The issue is I don't care why someone wants to stick around. I want them to feel free to do continue to do so.
I think we agree here. I want people to be free to end their life how they want, including staying around if they want to.
For the 3 problems you mentioned, you see them as problems because you have the perfectly natural underlying fear/ego/entitlement to stay alive, regardless of who else has to suffer for you.
I don't feel I have that, for better or for worse, so none of those 3 points really are problems for me:
1. This is literally what I'm advocating for! If my family think I'm a liability, and I'm causing more harm than good, then I've told them they need to tell me so we can put things in motion. The only reason for the family to be dishonest is through fear of upsetting/offending my feeling of entitlement to life. The way I see it is Kahneman's approach enabled his family to be honest with him!
2. What about the contrary? I want me and my family to have the best life with minimal unnecessary suffering. Yet you're here, trying to pressure me into making them suffer by being a big ol' age burden. I don't want to feel obligated and forced to stay alive and make my family suffer because some people are scared of their inevitable mortality. My approach maximises the choice to allow for minimising inevitable suffering, whereas yours reduces choices for the _chance_ that maybe you'll be the old person who isn't a burden (but you will be a burden, because nature).
3. This is already a problem: the legality or acceptableness of suicide/death isn't going to stop horrible family members finding creative ways to extract inheritance early.
I'm not advocating for people to be able to top themselves on a whim, there needs to be controls and processes in place, like any big/potentially harmful decision, and these controls are in place. FWIW, a bunch of the points you've raised were discussed and concluded as part of the parliamentary discussion into changing these laws in the UK ("Assisted dying bill"). The bill in the UK was specifically for terminally ill adults, but practically, old age is a terminal illness and most of the same arguments apply.
There is no financial incentive. No-one is making any money from assisted suicide in Switzerland.
> It’s relatively common for families to push people into nursing homes,
So you are rejected by your family and punished even more by taking away a dignified exit strategy?
You can argue that more countries should grant that right. But if you’re going to do so, you need to have an answer for the incentives it creates.
She couldn't look after herself was was forced into care by the courts. Since going into a home she's physically never been fitter, but mentally she's not the person she was 10 years ago -- it's not that she's changed personality, it's as if her memory of the last 80 years was wiped.
Many people die suddenly with no decline at all.
Should assisted dying be legalised?
Philosophy, Ethics, and Humanities in Medicine volume 9, Article number: 3 (2014)
Thomas D G Frost, Devan Sinha & Barnabas J Gilbert
https://peh-med.biomedcentral.com/articles/10.1186/1747-5341...
Abstract
When an individual facing intractable pain is given an estimate of a few months to live, does hastening death become a viable and legitimate alternative for willing patients? Has the time come for physicians to do away with the traditional notion of healthcare as maintaining or improving physical and mental health, and instead accept their own limitations by facilitating death when requested? The Universities of Oxford and Cambridge held the 2013 Varsity Medical Debate on the motion “This House Would Legalise Assisted Dying”. This article summarises the key arguments developed over the course of the debate. We will explore how assisted dying can affect both the patient and doctor; the nature of consent and limits of autonomy; the effects on society; the viability of a proposed model; and, perhaps most importantly, the potential need for the practice within our current medico-legal framework.
> It is difficult to reconcile that citizens may have the right to do almost anything to and with their own bodies– from participating in extreme sports to having elective plastic surgery– yet a terminal patient cannot choose to avoid experiencing additional months of discomfort or loss of dignity in their final months of life.
Assisted suicide sounds like a fine option until you think of its impact on your loved ones. Imagining putting my wife and kids through my deciding to die, and the process of them bringing me to the place where it happens - or imagining one of them doing the same thing - just fills me with horror
> If you wait until a life is "obviously no longer worth living", it is already too late —- Kahneman
Live your life in a way that it is worth living until you no longer can, I suppose. To exist is hard, do your best.
I “retired my wife” at 46 in 2020, eight years into our marriage so she could enjoy her passion projects and I have turned down more lucrative jobs that would have required me to work harder and be in an office so I could work remotely from anywhere - but realistically in US time zones.
Everyone who knows me, knows that I would die with no regrets. As far as my wife who loves me and my grown (step)kids who I know also love me, I don’t owe physical suffering to anyone. Assisted suicide because of Alzheimer’s is more tricky than something like cancer though. What can you do? Sign something in advance where once you can’t pass a cognitive test three months in a row - kill you?
He said that alone made life worth living, for him and them, but once any deteriorating conditions rendered him permanently unable to participate in this weekly activity then he felt it was time to go.
Maybe having a pre-set condition like this is less arbitrary, and also allows everyone involved to understand as the time comes closer.
Robin Williams had to hang himself.
There should be easy medical options in the US.
The instinct for self preservation is strong. Knowing what will come requires foresight and clarity. You may lose the capacity for informed decision making before the point where it's clear that there's not much to live for.
Many of us lack the insight that Kahneman perhaps had that in order to take control of the end you may need to leave some good days on the table.
Don't have an exact word to describe how I feel after reading above. Find it beautiful that such an accomplished person wanted to learn something even towards the end of his life.
I'm often reminded about a case in my own country: a young person had decided it was time to end her life after struggling for many years, without a sign of improvement. She was denied the right to euthanasia. After multiple failed suicide attempts, she went for the nuclear option and jumped in front of a train.
Everyone deserves to die in a dignified and humane way, not in multiple pieces or with a mind deteriorated beyond recognition. Forcing prolonged suffering is unnecessarily cruel. I wish more countries were as progressive with euthenasia as Switzerland.
I guess we are all Dying, Fast and Slow.
You can get into a state of living death where the brain is mush and who you were is completely destroyed. That's hell for the family.
I saw my grandmother forget her daughter (my mother) it was heartbreaking. Seeing my mom realize her mom forgot everything about their life together was just painful.
It was just a sad existence to observe as well. Grandma lived for quiet a while with dementia and spent years trying to return to her childhood home. We'd constantly have to trick her into accepting help from us "strangers". Re-convincing her to come inside that these "strangers" wouldn't mind having her for a bit. Watching her read over the same page of a book for hours on end.
That's not an existence I want for myself or my family.
What is the point of living your last 10 years of life bed ridden? This is how I will go.
I want every second. Even if it’s painful.
I am still alive.
Seems like we should close this thread to honor these wishes
It's less likely to be "a certain age" and more surrounding factors: if most of your friends have passed and you don't have much chance to do things that interest you because you could pass at any moment yourself there comes a point where life has limited worth.
Essentially, hope runs out, and when it's run out entirely you either wait for death, or ... don't wait.
> It's fascinating that even for very ill or injured people the will to survive is so strong
Sometimes. Chronic illnesses are a massive contributing factor to suicide rates for instance: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7...
And I don’t want that for my kids, or even from the rest of society.
I probably won’t ever meet my grandchildren if there are any, because I am over fifty and single; I probably will never be a parent. So I will have to go a lot sooner if I am not to be a burden on society. But if you think you are going to be a grandparent, you can work on being an irreplaceable and useful one.
Very few people are independent after age 80, and a miniscule amount after 90.
For physical illnesses.
The guy who spent his life researching how to live rationally chooses suicide at age 90, upon seeing “increasing metal lapses”, presumably in order to not ever live irrationally.
Ironic is the opposite of what you mean, don't you think? By your explanation, Kahneman acted according to his life's work.
> The guy who spent his life researching how to live rationally chooses suicide at age 90, upon seeing “increasing metal lapses”, presumably in order to not ever live irrationally.
That was possibly part of his motivation. But also the pain, suffering (goes broader than physical pain), confusion, and cost -- to him and his family.
Obviously not bluewin.ch
> οὐ δώσω δὲ οὐδὲ φάρμακον οὐδενὶ αἰτηθεὶς θανάσιμον, οὐδὲ ὑφηγήσομαι συμβουλίην τοιήνδε
In English:
> Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course.
[1]: https://en.wikipedia.org/wiki/Hippocratic_Oath