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Your framing of the problem is wrong.
In a suicide, the fault for the death ultimately lies with the one who pulls the trigger.
Overdose deaths are suicides.
That was their choice to make, and an isolated demand for rigor: if we actually cared about this for human beings more generally, cryopreservation would be a much larger industry.
If overdose deaths are suicides, then they're accidental suicides. The proper term for an accidental suicide is "fatal accident". Normally, when someone suffers a serious accident but survives, we give them medical attention to try to keep them alive.
I actually don't have a problem with suicide, provided it's intentional and done right. I think the authorities should make you wait a few weeks to confirm you're really sure you want to die, then shoot you up with lots of fun but deadly drugs.
What I do have a problem with is denying lifesaving treatment to people on the (unproven!) basis that they're a drain on society.
If you choose to repeatedly engage in an activity that you know has a high risk of death, that's just suicide with plausible deniability. I don't consider someone who loses a game of Russian roulette to have suffered a "fatal accident".
No, mere thrill-seeking is not "suicide with plausible deniability" nor is engaging in dangerous activities with more tangible rewards (e.g. tower-climbing as a job). Probably most addicts aren't trying to kill themselves either, they're just chasing a high. But since they aren't sharing the reward with the rest of us, I don't see why we should socialize the risk either.
I would distinguish activities that have a tangible, elevated risk of death from ones that have a risk of death high enough that the odds of dying in repeated acts over time approaches 1. Riding a motorcycle or smoking is risky, but someone who does those things, even their whole life, is not likely to die from them even though they might. Consuming recreational doses of street narcotics is something that, if you do it frequenlty enough, is very likely to kill you sooner or later.
I believe your distinction is arbitrary. And in any case I suspect the actual value of the thing you're trying to compute (probability of dying from the drugs instead of something else) is not something available, or even well-defined.
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Philosophy question: to what extent do we as people owe each other to stop suicide attempts? Discuss.
On one hand, we've put up nets and installed phones and nationwide hotlines and circulated narcan. On the other, some Western states have legalized euthanasia for increasingly minor medical issues. To me, the former feels reasonable (although I find OPs argument about narcan to be at least darkly intriguing), and the latter feels like it starts reasonably but quickly slides down the slippery slope. I know some moral codes (Catholicism, for one) are blanket-opposed to aiding suicide.
I'm interested to hear other opinions on where the line should be.
I think euthanasia should be legal. I think there should be quite a lot of oversight of the process, but I'm not against governments doing cost-benefit analyses of who gets care.
By revealed preferences, it's impossible to care infinitely about a given life. If that wasn't the case, then the entire global economic output would be spent on the first kid who showed up with terminal cancer. Not even those who claim that Life Is Priceless act like that's true. The Pope isn't selling his mobile to save one more starving child in Africa. Even the Dalai Lama has personal possessions, and expensive ones.
Once you accept that (and no population on earth could function without doing so) , all that remains is figuring out how much society implicitly or explicitly values life and making it legible. Yes, it sucks. But we're not gods with unlimited resources.
(If you wish to spend your own funds on your care, then I have no objection to you spending as much as you can afford, your money, your choice. But if you're spending my money, through taxes..)
I also think that anyone who can prove they possess capacity (in the medicolegal sense) should have the right to end their lives.
I'd be open to that being a difficult process, you'd need doctors to sign you off as sane and not suffering from a disease that impairs judgement (and can be cured).
No, I avoid tautology by not claiming that just wanting to die is sufficient grounds to be diagnosed with a mental illness and hence lack capacity. I think there are philosophical reasons that are consistent with wanting to die, for reasons other than depression.
(Severe depression that is resistant to all treatment is, IMO, a terminal illness)*
I hold this position despite being severely depressed, with occasional suicidal ideation. I recognize that I don't want to be depressed or suicidal, and want that part of me excised. I'm quite confident I would never act on that (and doctors know how to make it quick, painless, and irreversible), and if my disease somehow overwhelmed my true volition, I would want to be saved.
I think that unless someone has formally applied for a Suicide License, the default presumption should be that something is wrong with them, and they don't actually want it. This allows us to try and save people who jump off bridges or take paracetamol after a bad breakup. I differ from most people in that I would accept people wanting to die for more considered reasons.
Of course, in the Real World, my hands are tied by laws and code of conducts that physicians must agree to if they want to stay out of jail and in their job. But that's my stance on the matter.
*I haven't exhausted all options, far from it. I even expect that we'll have a generalized cure for depression in my lifetime. I still am not comfortable with telling someone with depression so bad life has lost meaning that they must hold out in hopes of a cure, suffering all the way.
"Safe,
lethallegal, and rare." I've been fooled by this before.That is to say, I believe you and believe your earnestness, but I just cannot conceive of how you would stop cultural slide on this without a solid Chesterton fence.
I'm a radical transhumanist who aspires to live forever, and wants that for everyone else. I can't think of any conclusive argument that proves beyond reasonable doubt that such measures won't be taken to a place that's not palatable for me, and I really wish I had them.
I just think it's worth a shot, even as a small pilot program.
Even if this never happens, I wouldn't lose sleep over it. I think that the kind of person who was that intent on dying would find a way, you don't have to be a doctor to figure out ways to kill yourself. It just makes it easier to achieve without leaving a mess.
Clayton Atraeus managed it, and he was down to two arms and a head.
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But how confident are you that you would never act on that if you had been raised in a society that not only tolerates suicide but excuses and justifies it? In the depths of despair, when the abyss swallows your vision and knowing that doctors could do it quickly, easily and painlessly, then are you confident you would never go through with it?
Quite confident. If my heterodox views are any indication, I'm not someone particularly susceptible to conformity or peer pressure. How many people do you think were born and raised in my circumstances and turned out the way I did? I defy neat classification.
If society was unchanged in terms of medical technology and overall technological progress, but actively encouraged suicide, I still don't think I'd opt for it. I'd demand that every possible treatment be tried first, then possibly ask for a legal document put in place that debarred me from applying for a lengthy period of time, no matter the cause. I'd spend the rest of my life hoping for a cure, and wouldn't give up until I was dying of other causes. If I really wanted to die, I already have more opportunities than I can count (not that the average person doesn't, bridges and busses aren't rare objects).
Do note that I would prefer that even if euthanasia on demand was an option, that there were multiple safe-guards in place to minimize impulse decisions. That would include medical review for reversible causes, counseling with therapists paid a bonus for every patient they talk out of it (to align incentives), and a wait time of a few months. If at any point someone has second thoughts, the wait time gets pushed back another few months.
Hell, keep it a secret under NDA that the first time they put you in the suicide pod, it's actually a drill. If you start screaming and want to be let out, that's when they tell you and swear you to secrecy. Even during the real thing, leave a big red button that would stop the process, if it's a lethal drug, have a bottle of antidote by their side when they're given it.
There was an incredibly poignant video of an elderly francophone lady taking her euthanasia meds for a terminal illness. She was lucid and in absolute control, and speaking till she went to sleep and never woke up. That's what I want the average person who takes this route to look like.
At that point, I'd be content that we're looking at people with incurable illnesses who can't be talked out of their intent. My confidence in an eventual cure for almost all disease isn't so strong that I would demand people hold out for it, that's their choice to make. My choice, at every point in the 10+ years I've been depressed, is to live for a better future.
Those are good measures, although like pusher_robot I would expect them to scope creep a lot. Rules or laws with any ambiguity seem to inevitably fall victim to the death of a thousand cuts. We've already seen euthanasia for a depressed 29 year old in the Netherlands.
But I'm not so worried about patients requesting assisted suicide as I am about the people with access to buses and bridges who suffer in silence and don't have educated medical professionals to help them. It's not really peer pressure, I'm talking more about a society where the emotional valence of suicide is not negative and how that will impact the depressed in general. A world where the water we breathe says 'suicide is an option actually' instead of 'suicide is a tragedy'. I am strong enough in this world to not submit to despair, but I don't know if I would be strong enough in that world. Not when that black dog has me and suicide seems like the only chance for something resembling relief.
It genuinely seems to me that the case you linked to is the system working as intended. I'm 100% serious:
...
She has a point. If you're not familiar with the management of severe depression, then by the time you reach ECT, you've exhausted all the options. I don't know if she tried things along the lines of ketamine or psychedelics, but those don't work for everyone.
She's tried everything, it didn't work, and she's clearly suffering immensely.
This woman, the purported victim, seems entirely lucid and defending the medical establishment that's carrying out her wishes. What more can you possibly ask for? It is clearly not spur of the moment decision, she's engaged with the options that the medical field can offer her.
The only thing that I would (personally) say that strikes me as untrue is that there "there's no hope". I think I have strong reasons to hope got a cure for depression, but that isn't a certainty, and could take decades even for myself.
If someone doesn't have the same degree of confidence in future medicine or a technological singularity, then I think that's acceptable shorthand. Strictly speaking, there's always a possibility that someone might just develop a brain tumor that makes them not depressed (or at least makes them manic), but that's not particularly reliable.
Suicide is always an option, regardless of what the law has to say in that regard. It is also often a tragedy. The two aren't mutually incompatible statements!
In the UK, we have things called living wills or advanced care plans. In your case, since you're afraid that you might make the wrong call during a depressive spiral, in my described world, I would advocate that you draft something along those lines so that any doctor who isn't malevolent (in a manner that breaks the law at that point) would note that you don't you don't want to die, and stymie it then.
Yep that's because while editing my post I seem to have dropped the words that should have followed the linked text. My point was supposed to be that we had previously been assured that assisted suicide would never be used for anything except terminal illness and certainly never for depression, and yet here we are.
It feels like you are deliberately missing the point of my argument. When society is more permissive of something it happens more. Not just in medically approved settings, everywhere. And suicide is already considered less of a tragedy than it used to be. The valence is changing in front of us.
You live in a world where you see doctors all day every day so talking to one is nothing, hell you can do all that shit yourself if you like, but otherwise your buddy will bang it out for you as a favour after work. I live in a world where every fifteen minutes I spend with a doctor costs me $90, I can address one issue and if I bring up another it will cost me another $90 even if the last one only took two minutes to address. I do not go to the doctor unless I have no choice and I am incapacitated. And in my working class social circles I am considered a hypochondriac. I am regularly told that I trust doctors too much. That is the world I live in about half the time, and those people are not going to the doctor to ask him or her to promise not to kill them if they ask. I don't think you or @Throwaway05 understand how shot trust in medicine is amongst the working class. It's kind of terrifying.
Fake edit:
In case this is the point of confusion, I'm not concerned about that, I'm not concerned about me at all, I have the perspective of age now. I am worried about the young adults out there like me when I was a young adult, the undiagnosed schizophrenics (and the undiagnosed bipolars and major depressives) who would never give strangers power of deciding their fate, believe suicide is a personal decision and only hold back because of a sense of wrongness. Those people are going to die in your world before a doctor even knows there is something wrong.
Be careful with this kind of thinking, I see a wider swathe of the working class than you do (because everybody shows up in the hospital eventually). You do see some doctor skepticism and such but most people are quite happy to follow most types of recommendations unless something basic gets in the way (we tell everyone to exercise, not everybody listens).
A small fraction are upset and anti-doctor in a vocal way, but most people shut up in the room for a variety of reasons (including things like not listening to the doctor suddenly becomes very costly if you are having a significant medical event).
The people who actually cause us problems are the woke more often. I acknowledge that this is likely due to my location but keep in mind that a lot of bitching is just bitching and is essentially a luxury belief that fades on actual contact with illness.
The best explanation for the gap between things like online sentiment and what I actually see in clinical practice is probably just people talking a big game, but the issue of a loud minority or hyper geographic concentration are other possible explanations.
Good news and bad news here. Basically the people who are well and truly sick don't have a choice. Their friends, family, or the police drag them into interaction with healthcare if they really actually for real sick.
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As I've said above, I consider an intractable case of severe depression to be a terminal illness. I have no personal involvement in matters of euthanasia (beyond deciding if a patient is palliative and needs comfort care).
I presume that you're not in the Netherlands either, so when you say that "we were assured", who's the we?
I didn't provide that assurance, and regardless of whether, in the Netherlands, it was in fact a statement made some kind of authoritative figure, I consider this particular case an outcome I endorse!
And the case seems to be entering litigation, so it's not like the government ignored objections and killed the woman right away. I presume a court will rule on whether the actual law allows this.
If you point to an example of a clearly inappropriate decision for euthanasia, say someone who went to their doctors and said they're feeling sad, and that was the first suggestion made, then I would certainly say that's against my views.
I do see doctors every day. But I'm afraid that they're unable to help me in any way, in terms of medical problems that require a prescription and not just casual advice.
In the UK, the GMC strongly frowns on prescribing or treating colleagues, I have ADHD, there are several senior psychiatrists who could have written me a prescription for my meds. I even asked, but as expected, they declined, saying it was inappropriate.
I personally think this is bullshit, and I should personally have been allowed to write my own script if needed (though stimulants require a psychiatrist who has completed training). In India, it wouldn't have been an issue at all.
I had to wait three months to be seen by a psychiatrist for my depression. I took the opportunity to also get him to prescribe for my ADHD. But if it had been just my ADHD, then I would have had to wait 2 years to be seen!
Trust me, at least in the UK, getting a doctor to see you, even if you're a doctor yourself, isn't trivial at all. I won't deny that they take me more seriously as a fellow medical professional, if I were to tell a psychiatrist I'm clinically depressed and I calculated it to be moderate-severe, they'll take me at my word. But the typical doctor will not react to someone telling them they're suicidal and don't want to be in a dismissive manner.
Look, if I had ended up giving up on waiting for the NHS and gone private, I'd be paying anywhere from 400 to 700 pounds for an appointment that could be anywhere from 15 minutes to an hour. You can see how the rates compare.
And it might surprise you, but it's entirely possible that you make more money than I do! As a resident, I make about $50k a year. That would be well within the range of what a working class individual makes in the States. It's entirely possible for a skilled tradesperson in the States to out earn a senior doctor in the UK. If they start a small business and stick to it, they can leave us in the dirt.
And the cost of living in the UK is probably quite comparable to the US, while we pay more in tax to boot. I'm much closer to you than @Throwaway05 is in financial terms. I have technically free access to healthcare courtesy of taxes paid to the NHS, but even that isn't much good for anything but an ER visit straight away, or an appointment with a GP in weeks/months.
It is unavoidable that media coverage of suicide, or more permissive social norms, will likely increase the number of people opting to commit it both through (hypothetical) legal means as well as taking it on themselves.
I value free speech and personal autonomy strongly enough that I do not foresee the numbers rising to the point that I can't accept the cost, even if I wish it wasn't so.
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I think importing doctors from poor countries gives you doctors with lower than average amounts of empathy. Seeing human misery up close creates calloused human beings.
I'd be ok with writing a 30 day high dose script of dilaudid that a terminal patient could take all at once to kill themselves with, but the physical act of administering that lethal dose is where I draw the line. If they need help let the family do it.
I hope euthanasia never becomes legal here because I wouldn't like that in my job description and I wouldn't like to interact professionally with anybody who is ok with that. I wouldn't want to work alongside a high-kill-count sniper or kamikaze-drone operator either.
I think I've got plenty of empathy, or at least the average as doctors go. That being said, while empathy is always nice to have in a doctor, I'd personally prefer one that was incredibly competent at addressing your problems even if they weren't tearing up over your plight.
Would you say that a doctor who volunteers for the MSF has lower empathy because of their experience with crushing poverty and disease? Probably not, though I'm happy to note there are selection effects involved. What about one that grew up in an inner-city ghetto but was bright enough to enter med school? Is that a bad thing?
I've seen crushing poverty, and when I volunteered to transfer to one of the largest hospitals in my home country (to work for free), I saw things that emotionally wrecked me. As the essay notes, you either harden your heart or exsanguinate.
It didn't make me a worse doctor, quite the contrary. I went out of my way to help people, and still do.
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I think it’s probably good to help create a minimum effort threshold for suicide; things like putting railings on bridges and nets on high buildings make it so that individuals struck by an acute but fleeting suicidal urge are protected from doing something they’d almost immediately regret.
The people accessing medically-assisted suicide, or using other high-effort methods of suicide requiring persistent and focused intent, are probably people who genuinely are better off dead. Not every human life is destined to last until a peaceful death in old age. Not every person is psychologically constituted in a way that’s resilient to all of the various tribulations that life throws at us. I probably wouldn’t personally pull the trigger or inject the deadly solution myself if one of those people asked me, but I’m fine with professionals existing who are willing and able to do so.
As for hard drug addicts, my impression is that only a small percentage of junkies are the sorts of people who’d be very valuable contributors to society if we managed to fix their addictions. Drugs are not taking our best, in other words. I’m aware that there are some unknown number of totally normal middle-class individuals who got hooked on opiates because they were led astray by unscrupulous doctors overprescribing them; my impression is that this represents only a very small percentage of addicts, and that their numbers are being inflated by a populist coalition determined to treat impoverished white Americans as hypoagentic victims.
Junkies killing themselves, whether through overdoses or other means, is overwhelmingly a boon to society, and I think almost zero effort should be taken to prevent them from doing so.
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Suicide is a form of murder: self-murder. We make efforts to stop murders, we should make efforts to stop suicide. Overall, society must signal disapproval of suicide. Cultures that honor or otherwise approve (even the implied approval of not bothering to do anything about it) fall into failure modes that our current society doesn't, without much obvious benefit. See Imperial Japan, for instance, which continued fighting long past the point where there was no hope of victory because their culture venerated honorable death over defeat. It did their society active harm. Their suicide rate remained high up until around 2010, when it began to drop and has continued to drop until today, where the suicide rate is actually a little less than the United States (it went from a high of 25.6 per 100K people in 2003 to around 12.2 today, compared to the US's 14.5).
Why did suicide rates drop so significantly in Japan? Well, in 2007 the government released a nine-step plan to lower suicide rates. Since then they funded suicide prevent services, suicide toll lines, mental health screenings for postpartum mothers, counseling services for depression, and in 2021 created a Ministry of Loneliness whose job is to reduce social isolation. In other words, when the Japanese government tried to make a societal effort towards preventing suicide, suicide rates dropped.
Which is good, because Japan needs every citizen it can get. Population is still dropping, and everyone who kills themselves can no longer contribute to society nor create and raise society's next generation.
Those people don't owe Japan their lives. Maybe if Japan wants them to contribute to society or create and raise society's next generation, it can make doing those things seem better than literal oblivion.
People owe the societies they live in, actually. If you want to go live in the woods with wolves and bears for neighbors then more power too you, that’s the condition for opting out.
Giving someone a service they never asked for, then claiming they owe you for it, is a classic scam. And this isn't the 16th century. There is nowhere you can run that a government won't find you. They own everything.
Oh BS. You can move to a society which doesn’t have a government(Haiti) or remote parts of limited state capacity societies. Yes there’s a good chance that the locals in rural parts of the Congo will rob and then murder you, but ‘basic security’ is a service from the state.
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If the world owes you nothing, you owe nothing to the world.
But society does owe its members things. Not infinite things, but some things.
Then actually say that, and not just be dismissive with 'if you want to go live in the woods with wolves and bears for neighbors' with all that implies.
As I put in the other reply, if society has gotten to the point where a sizable portion of people are going 'Fuck this, I'm out', then something about society has been broken fundamentally and needs to be addressed. You can't just brush it off and absolve society of any responsibility.
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What a strange thing to believe. Do you believe parents have no duties to their children, and that children have no duties to their parents?
Quite the opposite. (Note that statement starts with 'If'.)
I've seen the argument that people should suffer for society far too much, with the condescending, sneering reply of 'Just go live in the wilderness, see how you like it' in response to people having issues with parts of current society to the point it's almost a cliché.
I'm a firm believer that door swings both ways - that society has an obligation to the people therein, and that people have an obligation to the society, but only when this operates in a fair, back and forth, equitable fashion. If society has gotten to the point where a sizable portion of people are going 'Fuck this, I'm out', then something about society has been broken fundamentally and needs to be addressed.
My argument is the statement of 'people owe the societies they live in', without any caveats, and the follow up of 'if you want to go live in the woods with wolves and bears for neighbors' with the implied threat therein, is just blind adherence, bordering on slavery.
Either it goes both ways, or it doesn't go at all.
Hence my reply of 'If the world owes you nothing, you owe nothing to the world'. Because if society owes you nothing, you owe nothing to society.
(Yes, there's the fair debate of how much society owes the individual, but let's not go into that right now...)
That makes a great deal of sense, and I would broadly agree. Thanks for clarifying.
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Why is living in the woods a valid way to opt out, but killing yourself isn't?
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No. Commun
istsitarians tend to think this because it allows them to demand infinite sacrifice for zero benefit, but the social contract is continually and constantly renegotiated.In this case, society isn't holding up its end of the bargain- the "owes its members a future that's at least as good as it was before" part- and as a result, the individuals that make up society will under-deliver in TFR until it starts delivering.
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Kind of seems that that is exactly what they are doing: providing mental health services, attempting to find ways to reduce social isolation, trying to change social norms so that literal oblivion does not look like such a nice choice in comparison to social disgrace, etc.
No, they're trying to convince them not to choose oblivion despite not actually changing the conditions. That is, they're trying to get some marginal people from "life sucks so bad I'd rather be dead" to "life sucks almost bad enough I'd rather be dead", not generally improving conditions.
Kind of seems like they're trying to change the conditions. That 9 step plan they started off with in 2007 consisted of:
Seems like doing more to treat depression, improving access to mental healthcare, and creating supportive community environments are all ways of changing the conditions. What would you want them to do?
Make Japan better. Not concentrate on those who are near the border of offing themselves.
They're trying to make Japan better by making it easier to access mental healthcare and find ways to fight societal isolation. That you would want them to make Japan better is obvious, what specifically should they be doing to make it better that they're refusing to do? Give everyone a check each month? Let the zombie corporations die? Mail everyone a waifu pillow?
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I'd argue that Japan is already in a pretty good place in most respects. Trapped in a local maximum, perhaps, but it's not the worst local maximum to be in.
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