If euthanasia is illegal, access will be difficult. My grandmother was blind and in excruciating pain during her final months. She wanted to die. I wanted to help her but didn’t want to risk prison. Her doctors were just as afraid of prison and even less inclined to help her. She suffered needlessly.
Don’t ask don’t tell doesn’t work for end of life decisions for the same reason it doesn’t work for abortions. This isn’t like prostitution or pot where s conviction would be a misdemeanor and illegality can chill excesses without ruining any one’s life. If someone chooses to prosecute, you are at risk of years or decades in prison. If doctors aren’t willing to break abortion laws to help sympathetic young women, why would they break laws with even stricter penalties to help old people?
Yeah, I agree Matt's suggestion just isn't going to work. Watching both of my grandmothers end of life situations has left firmly in the camp that euthanasia should be allowed. It was heartbreaking to listen to one of them tell me over and over again that she desperately wanted to die because she was in so much pain and being unable to help.
I also think it's a little silly that I can have an advanced care directive that states that I don't want to be revived in certain situations because I think the quality of life would be too low for me to consider it worth living, but that if I happen to just slide into that exact mental situation, which I've already described as one where I don't want to be alive, there is nothing my family could do to help me end my life.
True. But swinging too hard the other way like Canada is arguably worse. Read the AP coverage. If half the reporting is true we are looking at massive human rights violations, to put it mildly. The type of stuff the next generation will issue endless public apologies for and will build memorials to commemorate the victims and denounce the crimes being legally committed right now.
So the answer must be sensible laws that work hard to minimize abuse. Some Western European countries maybe closer to that.
I read the article Matt linked and I can't really tell what people are objecting to. It kind of takes a tone of "what if people are getting euthanized who don't want to be?" but it doesn't provide any evidence that that is happening at all. Is there more reporting on this elsewhere?
The very first example presented is a man who was euthanized without a terminal medical condition. End-of-life euthanasia care and fully legalized assisted suicide are completely different propositions.
Thanks for sharing this article. It's a good reminder of all the hard cases out there to consider. I will say that I support some level of legal euthanasia, which still places me left-of-center of this issue. I just think there should be strong guard-rails in place. I agree with Matt and think Canada probably went too far.
It does provide evidence that someone felt pressured towards euthanasia despite not wanting it. I guess it’s possible that he’s the only one, or that no such pressure has ever had an effect, but I don’t think those are smart bets.
The article matt linked to only discussed a single case. The dude’s family didn’t want him to die, but it appears that he did. I see no problem with that. If his family are willing and able to make his life enjoyable, great! But if dude is depressed/unhappy, over 25, and wants to die for an extended period of time, what’s the problem?
Are you talking about the AP article? Because a guy mentioned in that article did *not* want to die and started recording his meetings with doctors and ethicists because he had the feeling they were encouraging him to. Pardon an extended quote:
“Roger Foley, who has a degenerative brain disorder and is hospitalized in London, Ontario, was so alarmed by staffers mentioning euthanasia that he began secretly recording some of their conversations.
In one recording obtained by the AP, the hospital’s director of ethics told Foley that for him to remain in the hospital, it would cost “north of $1,500 a day.” Foley replied that mentioning fees felt like coercion and asked what plan there was for his long-term care.
“Roger, this is not my show,” the ethicist responded. “My piece of this was to talk to you, (to see) if you had an interest in assisted dying.”
Foley said he had never previously mentioned euthanasia. The hospital says there is no prohibition on staff raising the issue.”
It'd be very difficult to enforce for the same reason that elder abuse can be difficult to catch--the most vulnerable elderly people are often very isolated.
Regarding someone wanting to die: why do doctors have to get involved? Why not just leave it to the individual to commit suicide? Of course, some people who want to die may be too incapacitated to kill themselves, but that excludes the vast vast majority of over-25s with suicidal feelings.
I think if someone wants to commit suicide, it would be better for them to have the ability to do so in some sort of palliative context, with painkillers, rather than with a gun or whatever pills they have lying around at home.
The thing is that I think if someone wants to commit suicide it would almost always be better for them not to do it. Now, earlier I was criticizing people for suggesting someone else might be wrong to think their life is worth living, so maybe I'm a hypocrite for saying someone is wrong to think their life ISN'T worth living, but I think there are both philosophical and practical reasons to say the second and not the first, and while obviously botched suicides can have horrendous results, I just can't see a good way to extend euthanasia to people who have hope of a healthy life but are plagued with suicidal feelings—the tradeoffs and slopes just seem too great and too slippery.
Off topic (to say the least) but I've often wondered: why isn't that approach followed in US states where capital punishment is practiced? Can't the condemned simply be given a large dose of narcotics? Aren't there cases of badly botched lethal injections causing suffering?
As someone who’s seen a family member go through Alzheimer's, I am personally worried about not having a euthanasia option for myself should I be in a similar position one day. I’d particularly like the option to pre-file for euthanasia under certain conditions since a patient in this mental state is in no position to understand their condition and make such a consequential decision.
Yes, there are risks that patients that are mentally and physically weakened may be convinced to accept euthanasia when options exists to improve their condition. Particularly when it would require great expense from the state or a private insurer to treat the individual.
Yet, I personally don’t find this to be a particularly concerning outcome. Should my future self find themselves in a state of mental and physical dimishment where they can be convinced to accept euthanasia rather than lobby for better options then I find that an acceptable outcome. At that point I’d be quite far gone and couldn’t properly contemplate the tradeoffs. I’d much prefer that early ending than the alternative of possibly being kept alive in a diminished state as long as possible; particularly so if it comes at great social cost.
I completely get this concern and have similar fears myself. My challenge is that I don't find it morally appropriate to kill mentally challenged children who otherwise can have a reasonably enjoyable life, so why do i find it acceptable to do the same for older people - including myself. I think the situation might be different if there is a massive amount of pain, but even then many people live in pain for years and don't choose death. I wouldn't support the government, doctors, etc. encouraging functioning people living in chronic pain to die, what changes the situation for older people?
If I'm honest with myself (and this is just me), its because my current self is sufficiently prideful that I don't want to be that. Though I often frame it as not wanting to be a burden on others. Perhaps my future self in that situation would be the same, but I don't know. A moral belief I have, which is best expressed by butchering a quote: do not go gently into the night, but to fight the dying of the light. Its hard to reconcile what feels like violating that belief over pride.
I want to live in a society in which every human life is considered precious and cannot be deprived without due process. I believe this principle is it used to be , widely accepted and is enshrined in the un declaration of human rights, the us constitution and many other comparable documents. I don’t see how a principle where the lives of whole classes of people is considered expendable is in line with that.
Did you read the AP article? The danger here is not primarily that which you outline but a project of “euthanizing” the perfectly healthy disabled in mass.
Good people have a tendency to assume all other people are like they are. This is usually a good trait. But when it comes to life-and-death, we need to realize there are a lot of people who are ... not like us.
My grandmother, in Oregon where assisted suicide is legal, lived alone (with my folks about a ten minute drive) until the very end. She initiated whatever the process looks like with her doctors. One day, some particular daily life activity was beyond her (I don't know what that was), and she called her daughter and said "that's it, it's time". Later that day, it was all over.
It's important to have effective and thoughtful guardrails for the reasons Matt identifies, but I think that's pretty good.
The system looks good for mentally capable folks living relatively independently. But folks who are in long term care at great expense to the state or to different institutions are another question. We can pay attention and put in place guardrails. We could say, ‘this option is only available to XYZ folks who we feel confident can make the choice free from pressure’ but that’s like enshrining peoples fears of unequal access under Matt’s ‘benign neglect’ scheme into the actual law.
It’s just not an easy question to solve and gets harder the more elder care burden falls on the states expense, which is going to continue imo.
A little bit like the DC trash situation, the only real solution is for it to be something practical voters pay attention to. I just don’t know how plausible that is.
Honestly, while this is something of an invasion of privacy, I think the single most effective and least intrusive guiderail would be a requirement for a close friend or family member to be involved in the decision. No requirement for their agreement or permission, simply that they must be in a position to confirm that this decision is genuinely being made by the person in question and not any of the constellation of providers and caretakers around them.
Anything else would just be an attempt to have the state half-assedly simulate the same guiderail, at greater expense and with less effect.
I guess she had already been talking to doctors about it, but deciding to go through with euthanasia and then dying the same day is somewhat unsettling to me. Even a 24-hour waiting period seems good.
Oregon has a waiting period, there are exemptions only if you are likely to die within 15 days. She probably didn’t tell your mom until the waiting period was over.
Some questions have no good answers. Its just a question of which tradeoffs we are more willing to accept. Do we accept that some people will live longer in more pain than they would choose to otherwise, or do we setup a system where older people who might want to live longer will be pressured into dying.
I’ll be the first to admit i’m just more pro death than the median voter. Deaths of old people do not bother me, they are often a relief. Deaths of very ill people or long term addicts don’t bother me either. They are predictable and unavoidable.
Objectively, keeping old, unproductive people alive is expensive. Much of this cost is socialized through medicare and social security. The typical person runs up five or six figures of medical bills in their final months and doesn’t really enjoy those expenditures. I’d much rather focus on nurturing the young and having better conditions for healthy workers than caregiving for the old and very infirm.
Given that the federal government pays most of the cost of keeping old, unproductive people alive and families don’t have to internalize most of those costs, there’s already a huge fist on the scales in favor of living longer than is socially optimal. A certain amount of encouragement to die seems ok given the fact that the negative externalities of staying alive are inflicted on the treasury.
It is a fine line between "87 year old Mary wanted to die" and "87 year old Mary's kids convinced her to die because she is a drain on their resources."
I suspect that David would bite that bullet. Perhaps her kids have a filial duty to support her, but why should David be forced to do so (and if we are already taking his money, why force him to do that rather than to buy more school lunches in a world of finite state resources). Mary's medical care must necessarily rationed, the question is how and by whom (prices? Trump/Hillary? some agency? Mary's kids who would otherwise be able to send *their* kids to school?).
I am less, ah, ghoulish [sorry] than David but there is a real tendency in these debates to say "we should just spend some of the infinite resources society has available and never have to make tradeoffs about what we prioritize!" which is not a real option. People are better at noticing this when talking about "free" college for all, then they are when talking about end of life care choices.
But we aren't talking about health care rationing in the sense of not using public funds to pay for expensive treatments with a low risk of success and low improvements to QoL. We're talking about "if we killed this person it would save us money."
I think "focus on quality of life, not just length of life" is a more politically palatable statement that probably gets you to about the same place in the end.
Politically, I agree. However, as someone who doesn’t want to live if I’m terribly infirm, I don’t like having the costs of other people living too long inflicted on me.
I understand where you are coming from on this, but it's worth noting that there is a considerable amount of fuzziness around what does and does not qualify as "very infirm" or "very ill," and different people will have different views about where to draw the line. So that's why this is a problem, and considering that we are literally talking about life-or-death, it's a big deal.
I believe back at ThinkProgress that Matt suggested (or at least conducted a thought experiment about) lowering the age for Medicare to 55, but capping it at 95. His calculations were that this would cost about the same or less, but spectacularly improve total "quality of life years" at the obvious trade off of "premature" (by a matters of weeks or a few months in most cases) deaths of super elderly people.
Yes, probably? There's definitely good arguments to be made that government policy could be a lot more coercive on "stopping the cycle of poverty" by coming up with ways to reduce the numbers of children lower income people have/need to support, although that would obviously run counter to our host's "OBA" proposal.
Maybe not 'encouraging', but the state could certainly offer that as an option, perhaps in exchange for cash. My priors being that anyone who would trade their kid for cash shouldn't be a parent anyways, so we're effectively filtering for the right crowd
Well, my start point is that the state should not offer many of these types of benefits at all. If it does, I think it should have pretty broad freedom to attach conditions on accessing them to deter use of the benefits or reduce the need for such benefits in the future. (This is contrary to numerous SCOTUS rulings, but we're talking idealized here, not actual permissible policy.)
I think what Matt is implicitly suggesting is something like decriminalization vs. legalization. Instead of treating assisted suicide like murder, make it a misdemeanor or civil penalty. If an institution pressured people to choose euthanasia to save money, they'd face a huge fine, and it wouldn't be worth it. But if a lone doctor euthanized someone out of compassion, they'd face little consequence.
It occurs to me that you're not taking your own advice when it comes to popularism in your TV reviewing. If you want to effect change in real America you have to be suggesting improvements in the story telling of Yellowstone.
It's also not obvious to me that "on the margin wards of the state that live unpleasant lives at great taxpayer expense will be pressured to end them painlessly" is a horrible tradeoff (if actually true) compared to "we routinely lock people into unimaginable torture".
Geez, I don't know ES. Even if the utilitarian calculus produced a wash, my act/omission worries get triggered here. Dying slow painful deaths has been ubiquitous throughout human history, and is still ubiquitous throughout the animal kingdom. We didn't cause that; it's the default. Yes, medicine and technology should be used to improve our lot over the state of nature. But the pain of dying is not in and of itself our fault.
The moral issues involved in pressuring people to end their lives, on the other hand, look quite serious. Inter alia, do you want to create the sort of people whose job it is to pressure said seniors into ending their lives? We have some experience with self-appointed "angels of mercy," i.e. medical professionals who take it upon themselves to do this. The track-record is not good; they often go way over whatever line they originally thought they were respecting.
1. The act/omission distinction lies on pretty shaky philosophical ground (walking past drowning babies being blameworthy).
2. Even accepting that such a distinction is morally relevant, most don't hold it to be *determinative* in the face of starkly different outcomes--unless you are talking to Kant himself, you can pretty much always add enough innocent people to the other track in a trolley problem to get people to switch (kill 1 to save 40 trillion is an easy call).
3. Even if it *were* determinative, the state is already acting to save these people. The "natural" course would be for them to die ill in the streets, not receive expensive care as a ward of the state. It does not strike me as some new intervention in the natural course of events to say "we'll still keep giving you all this expensive medical care we paid for with money extracted through force from taxpayers...but it really would be better if you elected to painlessly end your life instead".
4. To be clear, I do not in fact want to create people whose job it is to do this. I think it is bad to do it. However, in the veil of tears we live in, where we have limited resources and have to make tradeoffs, it seems to me "maybe some people on the margin will still act like way despite all of our efforts to regulate these conversations to ensure it does not happen" vs "we will for sure lock people into involuntary and unceasing torment", call seems easy to make.
In the one case, you have people leading mostly miserable lives using money that could be spent on feeding children or deworming or private enterprise or building hospitals or anything else than "expensive end of life care for people dying soon anyway" ending them a little earlier than they otherwise might. In the other case you have someone for sure suffering significant agony. I also think there are a lot more people in camp "needlessly suffering" than camp "tricked into suicide by bureaucrats".
TL DR: I don't think Logan's Run is a plausible outcome of relaxing treatment rules. You face similar but more difficult questions when it comes to institutionalizing the mentally ill too, but properly regulated mental health hospitals still make sense.
Determining for yourself that these other people are living miserable lives--when their defining characteristic is that they want to keep living--is also a rationalization that has led to some awful places. But it doesn’t need to lead there to be bad on its face. If we think the money is better spent on deworming, then we should cut the budget for medical care. Or cut some other part of the budget. Or raise more revenue, or do more deficit spending. “See if we can talk some people who we’re taking care of into dying” should not be Plan B, C, or even Z.
Good thing nobody is arguing that pressuring people into suicide as a cost saving measure is a good outcome to strive for then, rather than a risk to be avoided to the greatest extent possible while achieving other even worthier goals.
I certainly don’t want to think that other people want me dead. A world in which I was afraid that my family and neighbors wanted to kill me would suck. No one should be shamed into dying. Even withholding expensive care seems cruel in a country as rich as ours.
And yet suicide is so stigmatized that there are often strong social pressures not to do it. We should certainly move the slider towards less stigma against suicide.
Part of this should be 1) speaking frankly about the costs of largely futile medical treatments and 2) admitting that suicide is often a courageous and unselfish act.
I'm sorry if I misapprehended your view, but I didn't see any suggestion in your comment that there are reforms or restrictions to the euthanasia regime that we should consider—only a binary between "leave people in agony" and "pressure people who want to live towards suicide, which is not such a horrible tradeoff."
It's only the public facade of popularism that leads him to pretend that any television has artistic value. En famille, he only has eyes for Knausgård and Saramago.
Matt’s been pretty consistent that educated cosmopolitan class snobbery should stay where it belongs, in cultural consumption, rather than in politics.
Also, suggesting improvements to the somewhat aimless state of the Marvel Cinematic Universe post-Endgame. Though that might go over here even more poorly than the guest posts.
I'm nowhere near retirement age, but I work in the sciences and have had more than a few coworkers who've retired recently (across an age span, from early 60s to early 70s). We all enjoy (or enjoyed) our jobs, but it's stressful and eventually you want to enjoy your life. The ones in their early 60s have told me things like "I'm still relatively physically healthy, there are a lot of things I want to do (travel etc.) while I'm still able to do them." Or they want to spend more time with their grandchildren. Or they want to take up a hobby. Or they want to volunteer giving walking tours in a historical setting. Or they are content to do things like contract patent writing.
Always seemed to me as though you have a plan to keep yourself occupied and intellectually stimulated in retirement and you'll be fine. Sit around watching Fox News all day and your mind turns to mush.
My dad retired from his research job at a pretty conventional age a year or two ago, and he commented that he would dearly have loved to take on some sort of part-time emeritus role and consult (maybe even for free) with his younger colleagues who were still active in the lab.
There wasn't a way to make that happen, unfortunately, but that sounds like a good retirement to me.
Law firms, for all their problems as workplaces, often do this, at least for their more eminent partners. They'll put on suits and come into the office well into their 80s, mostly to use the office phone to call various customer service lines.
Law firms also genuinely benefit from these arrangements because those partners can help to maintain their client relationships and pass them on to younger partners.
I think the concept of "institutional knowledge" is a lot broader, or should be understood to be broader.
I have an excellent personal relationship with my former boss, and neither of us minds an occasional phone call of "hey bossname, do you remember why we did X this way?". Very valuable.
When my dad retired, I witnessed, I believe, a dramatic fall in cognitive abilities etc and it scared the hell out of me.
I will reach the age when I don't need a job for financial reasons fairly soon but my wife will want to work some seven years after my date of retirement. Part-time work would combine the need for mental stimulation, deadlines etc with opportunities to travel, play more games and sports and so on.
I think all of this is true and also pretty obvious.
The first main factor, as MY points out is, do you like your job or is it making you depressed? This is a good sign you should retire.
But the second factor is, you can't just retire into a life of nothing or you are just accelerating your own death. Unfortunately, at least a majority of people are pretty bad at managing their own health through lifestyle choices. So there are plenty of people who maybe aren't very happy in their jobs, but if they could retire would end up wrecking their own mental health. And the default assumptions of US society make the challenge of developing a suitable mental and social life after retirement greater than it could be.
I am a late 30s DINK and my friends in similar situation chat on retirement a lot, as so much of retirement advice intersects with grand parenting advice. As none of us have or plan to have kids, being purposeful about what an alternative retirement looks like becomes more important. Big thing is all of us owning property within walking distance of each other. As that is hard in VHCOL cities we need to start working towards it now.
you may already be doing this, but one thing i would suggest is telling your local government about this vision you have so that they know their constituents care about stuff that's not 100% parking.
I’ve always thought that going part time was underrated as an alternative to early retirement, if you like your job. Or our company (in old-school engineering) has “pensioners” where former employees who retired and now collect a pension are allowed to work some small number of hours a year, maybe 500 or less, and still collect their full pension. Seems like best of both worlds?
This is a great option if available. But for operational and leadership roles, it's hard to find part-time assignments that work for the business and for the retiree.
Consulting is an option but (a) requires being comfortable with the sales effort needed to build a practice and (b) becomes a full-time effort if successful in (a). The solution I evolved to is consulting almost exclusively via the knowledge networks - GLG, Alphasights, Guidepoint etc. They bring the work to you, it's interesting but relatively low stakes, it's only an hour or two a week. What's missing from this option is the social interaction involved in working in the office with the same cast of characters every week.
I'm interested that your org has retirees with company pensions. I thought that the private sector was ~ 100% defined contribution pensions now. The impact of that shift on family finances is an interesting topic. I think it has been positive, but I am an optimist.
My company still has pensions for anyone who started prior to 2011 (including, luckily, me), but they froze them in 2020. My husband (same boat) and I still expect a healthy amount of retirement income from it tho. But we also have 401ks. I don’t know anyone at our company who was planning to be totally reliant on the pension. Still waiting on a lump sum offer to buy us out, hasn’t happened yet.
I had final salary pensions from two employers when I worked in the UK. UK pension plans have to give you an offer of the "Cash Equivalent Transfer Value" on request. I only found this out about 20 years after leaving the UK. The transfer values then were about 30x the annual pension amount based on immediate commencement (I was 58 then, and had just retired early). The only challenge was finding a financial advisor that would provide the mandatory (UK law) opinion that transfer was a wise choice. Hope that your employer steps up to the plate with good cash buyout offers.
Law firms generally let partners maintain offices perpetually, so it's common for them to go from fully active status to winding down, then semi-retired, then retired-but-still-helping-out-here-and-there from their 60s through their 80s. It's one of the nice parts of the profession.
I retired at 58 and was completely shocked at loss of distance in my golf shots compared with when I was playing regularly in my mid-40s. About 30 yards on drives. And the expert golfers I play with tell me that the distance is never coming back. Not that important to me -- that's what the yellow tees are for.
Very cool. Retirement options probably vary by industry and country.
My dad is in his 60s, retired in the last few years after initially trying part-time work. The main reason he retired was that he couldn't find employment anymore. Even when he was okay with pay cuts, pay in the (Indian) IT services is often tied to experience, and that made it difficult. There were also a couple of unnerving overt incidents of ageism, which probably was off-putting.
I'll repeat my pushback that "illegal while also allowing for a fair amount of hypocrisy, lax enforcement, and unasked questions" is a bad recipe for selective enforcement that tend to hurt the most vulnerable. Like Matt, I don't have a strong view on euthanasia, but I've seen this state of law suggested for other things like gambling and especially sex work where I think it can be more commonly damaging. Abortion law could also easily fall into this trap depending on how the post-Dobbs world shakes out.
Either way we are thinking about the most vulnerable getting harmed. As these things often shake out. On the one hand we have fear about vulnerable folks experiencing unnecessary pain. On the other we fear the most vulnerable will be killed for profit. The fears need to be weighed. Saying the downsides from one will fall on the vulnerable just doesn’t answer the problem. It’s always ‘the vulnerable’ who are vulnerable.
I mean, the gambling situation is one we had until very recently, but I think the new model is going to be much harder on the most vulnerable (specifically, the poor, and also anyone who is predisposed to gabbling addiction) than the old model. Don’t you?
In other words, as Nick says, we can’t just think of the harm of being arrested, or of not getting the thing desired, but also of the harm of getting it when it isn’t what one wants.
If euthanasia is illegal, access will be difficult. My grandmother was blind and in excruciating pain during her final months. She wanted to die. I wanted to help her but didn’t want to risk prison. Her doctors were just as afraid of prison and even less inclined to help her. She suffered needlessly.
Don’t ask don’t tell doesn’t work for end of life decisions for the same reason it doesn’t work for abortions. This isn’t like prostitution or pot where s conviction would be a misdemeanor and illegality can chill excesses without ruining any one’s life. If someone chooses to prosecute, you are at risk of years or decades in prison. If doctors aren’t willing to break abortion laws to help sympathetic young women, why would they break laws with even stricter penalties to help old people?
Yeah, I agree Matt's suggestion just isn't going to work. Watching both of my grandmothers end of life situations has left firmly in the camp that euthanasia should be allowed. It was heartbreaking to listen to one of them tell me over and over again that she desperately wanted to die because she was in so much pain and being unable to help.
I also think it's a little silly that I can have an advanced care directive that states that I don't want to be revived in certain situations because I think the quality of life would be too low for me to consider it worth living, but that if I happen to just slide into that exact mental situation, which I've already described as one where I don't want to be alive, there is nothing my family could do to help me end my life.
True. But swinging too hard the other way like Canada is arguably worse. Read the AP coverage. If half the reporting is true we are looking at massive human rights violations, to put it mildly. The type of stuff the next generation will issue endless public apologies for and will build memorials to commemorate the victims and denounce the crimes being legally committed right now.
So the answer must be sensible laws that work hard to minimize abuse. Some Western European countries maybe closer to that.
I read the article Matt linked and I can't really tell what people are objecting to. It kind of takes a tone of "what if people are getting euthanized who don't want to be?" but it doesn't provide any evidence that that is happening at all. Is there more reporting on this elsewhere?
The very first example presented is a man who was euthanized without a terminal medical condition. End-of-life euthanasia care and fully legalized assisted suicide are completely different propositions.
Are they? I don't know. Forcing someone who feels their life is unbearable to live despite their wishes seems barbaric to me.
This is something a friend of mine wrote on the topic that's deeply shaped how I feel about this - https://badsciencewriting.wordpress.com/2014/08/18/suicide-and-self-identity/
Thanks for sharing this article. It's a good reminder of all the hard cases out there to consider. I will say that I support some level of legal euthanasia, which still places me left-of-center of this issue. I just think there should be strong guard-rails in place. I agree with Matt and think Canada probably went too far.
How about forcing someone to die against their will?
Was just about to jump in with "this seems like the person in question likely *didn't* want to die."
It does provide evidence that someone felt pressured towards euthanasia despite not wanting it. I guess it’s possible that he’s the only one, or that no such pressure has ever had an effect, but I don’t think those are smart bets.
The article matt linked to only discussed a single case. The dude’s family didn’t want him to die, but it appears that he did. I see no problem with that. If his family are willing and able to make his life enjoyable, great! But if dude is depressed/unhappy, over 25, and wants to die for an extended period of time, what’s the problem?
Are you talking about the AP article? Because a guy mentioned in that article did *not* want to die and started recording his meetings with doctors and ethicists because he had the feeling they were encouraging him to. Pardon an extended quote:
“Roger Foley, who has a degenerative brain disorder and is hospitalized in London, Ontario, was so alarmed by staffers mentioning euthanasia that he began secretly recording some of their conversations.
In one recording obtained by the AP, the hospital’s director of ethics told Foley that for him to remain in the hospital, it would cost “north of $1,500 a day.” Foley replied that mentioning fees felt like coercion and asked what plan there was for his long-term care.
“Roger, this is not my show,” the ethicist responded. “My piece of this was to talk to you, (to see) if you had an interest in assisted dying.”
Foley said he had never previously mentioned euthanasia. The hospital says there is no prohibition on staff raising the issue.”
"there is no prohibition on staff raising the issue."
This seems like the better place for Matt's ban to go, rather than formally banning the process but letting it happen under the table.
I agree with that. Staff can't bring up the issue, cost can't be brought up as a topic, etc.
It'd be very difficult to enforce for the same reason that elder abuse can be difficult to catch--the most vulnerable elderly people are often very isolated.
Regarding someone wanting to die: why do doctors have to get involved? Why not just leave it to the individual to commit suicide? Of course, some people who want to die may be too incapacitated to kill themselves, but that excludes the vast vast majority of over-25s with suicidal feelings.
I think if someone wants to commit suicide, it would be better for them to have the ability to do so in some sort of palliative context, with painkillers, rather than with a gun or whatever pills they have lying around at home.
The thing is that I think if someone wants to commit suicide it would almost always be better for them not to do it. Now, earlier I was criticizing people for suggesting someone else might be wrong to think their life is worth living, so maybe I'm a hypocrite for saying someone is wrong to think their life ISN'T worth living, but I think there are both philosophical and practical reasons to say the second and not the first, and while obviously botched suicides can have horrendous results, I just can't see a good way to extend euthanasia to people who have hope of a healthy life but are plagued with suicidal feelings—the tradeoffs and slopes just seem too great and too slippery.
Off topic (to say the least) but I've often wondered: why isn't that approach followed in US states where capital punishment is practiced? Can't the condemned simply be given a large dose of narcotics? Aren't there cases of badly botched lethal injections causing suffering?
"...and wants to die for an extended period of time, what’s the problem?"
You don't see any problem with dying for an extended period of time? Only a nut-case would want that. I'd rather have it short and sweet, thanks.
As someone who’s seen a family member go through Alzheimer's, I am personally worried about not having a euthanasia option for myself should I be in a similar position one day. I’d particularly like the option to pre-file for euthanasia under certain conditions since a patient in this mental state is in no position to understand their condition and make such a consequential decision.
Yes, there are risks that patients that are mentally and physically weakened may be convinced to accept euthanasia when options exists to improve their condition. Particularly when it would require great expense from the state or a private insurer to treat the individual.
Yet, I personally don’t find this to be a particularly concerning outcome. Should my future self find themselves in a state of mental and physical dimishment where they can be convinced to accept euthanasia rather than lobby for better options then I find that an acceptable outcome. At that point I’d be quite far gone and couldn’t properly contemplate the tradeoffs. I’d much prefer that early ending than the alternative of possibly being kept alive in a diminished state as long as possible; particularly so if it comes at great social cost.
I completely get this concern and have similar fears myself. My challenge is that I don't find it morally appropriate to kill mentally challenged children who otherwise can have a reasonably enjoyable life, so why do i find it acceptable to do the same for older people - including myself. I think the situation might be different if there is a massive amount of pain, but even then many people live in pain for years and don't choose death. I wouldn't support the government, doctors, etc. encouraging functioning people living in chronic pain to die, what changes the situation for older people?
If I'm honest with myself (and this is just me), its because my current self is sufficiently prideful that I don't want to be that. Though I often frame it as not wanting to be a burden on others. Perhaps my future self in that situation would be the same, but I don't know. A moral belief I have, which is best expressed by butchering a quote: do not go gently into the night, but to fight the dying of the light. Its hard to reconcile what feels like violating that belief over pride.
I want to live in a society in which every human life is considered precious and cannot be deprived without due process. I believe this principle is it used to be , widely accepted and is enshrined in the un declaration of human rights, the us constitution and many other comparable documents. I don’t see how a principle where the lives of whole classes of people is considered expendable is in line with that.
Did you read the AP article? The danger here is not primarily that which you outline but a project of “euthanizing” the perfectly healthy disabled in mass.
Good people have a tendency to assume all other people are like they are. This is usually a good trait. But when it comes to life-and-death, we need to realize there are a lot of people who are ... not like us.
My grandmother, in Oregon where assisted suicide is legal, lived alone (with my folks about a ten minute drive) until the very end. She initiated whatever the process looks like with her doctors. One day, some particular daily life activity was beyond her (I don't know what that was), and she called her daughter and said "that's it, it's time". Later that day, it was all over.
It's important to have effective and thoughtful guardrails for the reasons Matt identifies, but I think that's pretty good.
The system looks good for mentally capable folks living relatively independently. But folks who are in long term care at great expense to the state or to different institutions are another question. We can pay attention and put in place guardrails. We could say, ‘this option is only available to XYZ folks who we feel confident can make the choice free from pressure’ but that’s like enshrining peoples fears of unequal access under Matt’s ‘benign neglect’ scheme into the actual law.
It’s just not an easy question to solve and gets harder the more elder care burden falls on the states expense, which is going to continue imo.
A little bit like the DC trash situation, the only real solution is for it to be something practical voters pay attention to. I just don’t know how plausible that is.
Honestly, while this is something of an invasion of privacy, I think the single most effective and least intrusive guiderail would be a requirement for a close friend or family member to be involved in the decision. No requirement for their agreement or permission, simply that they must be in a position to confirm that this decision is genuinely being made by the person in question and not any of the constellation of providers and caretakers around them.
Anything else would just be an attempt to have the state half-assedly simulate the same guiderail, at greater expense and with less effect.
I guess she had already been talking to doctors about it, but deciding to go through with euthanasia and then dying the same day is somewhat unsettling to me. Even a 24-hour waiting period seems good.
Oregon has a waiting period, there are exemptions only if you are likely to die within 15 days. She probably didn’t tell your mom until the waiting period was over.
https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/faqs.pdf
I should say--it wasn't a secret from the family or anything. We totally supported her in her decision, not that this should be a precondition.
Assisted suicide is legal here in Oregon but euthanasia is illegal. You have to be able to take the medicine yourself.
Some questions have no good answers. Its just a question of which tradeoffs we are more willing to accept. Do we accept that some people will live longer in more pain than they would choose to otherwise, or do we setup a system where older people who might want to live longer will be pressured into dying.
I’ll be the first to admit i’m just more pro death than the median voter. Deaths of old people do not bother me, they are often a relief. Deaths of very ill people or long term addicts don’t bother me either. They are predictable and unavoidable.
Objectively, keeping old, unproductive people alive is expensive. Much of this cost is socialized through medicare and social security. The typical person runs up five or six figures of medical bills in their final months and doesn’t really enjoy those expenditures. I’d much rather focus on nurturing the young and having better conditions for healthy workers than caregiving for the old and very infirm.
Given that the federal government pays most of the cost of keeping old, unproductive people alive and families don’t have to internalize most of those costs, there’s already a huge fist on the scales in favor of living longer than is socially optimal. A certain amount of encouragement to die seems ok given the fact that the negative externalities of staying alive are inflicted on the treasury.
I gotta say, this sounds pretty ghoulish to me.
It is a fine line between "87 year old Mary wanted to die" and "87 year old Mary's kids convinced her to die because she is a drain on their resources."
I suspect that David would bite that bullet. Perhaps her kids have a filial duty to support her, but why should David be forced to do so (and if we are already taking his money, why force him to do that rather than to buy more school lunches in a world of finite state resources). Mary's medical care must necessarily rationed, the question is how and by whom (prices? Trump/Hillary? some agency? Mary's kids who would otherwise be able to send *their* kids to school?).
I am less, ah, ghoulish [sorry] than David but there is a real tendency in these debates to say "we should just spend some of the infinite resources society has available and never have to make tradeoffs about what we prioritize!" which is not a real option. People are better at noticing this when talking about "free" college for all, then they are when talking about end of life care choices.
But we aren't talking about health care rationing in the sense of not using public funds to pay for expensive treatments with a low risk of success and low improvements to QoL. We're talking about "if we killed this person it would save us money."
>>>I’ll be the first to admit i’m just more pro death than the median voter.<<<
This could be the start of one helluva political career.
I think "focus on quality of life, not just length of life" is a more politically palatable statement that probably gets you to about the same place in the end.
Politically, I agree. However, as someone who doesn’t want to live if I’m terribly infirm, I don’t like having the costs of other people living too long inflicted on me.
I understand where you are coming from on this, but it's worth noting that there is a considerable amount of fuzziness around what does and does not qualify as "very infirm" or "very ill," and different people will have different views about where to draw the line. So that's why this is a problem, and considering that we are literally talking about life-or-death, it's a big deal.
I believe back at ThinkProgress that Matt suggested (or at least conducted a thought experiment about) lowering the age for Medicare to 55, but capping it at 95. His calculations were that this would cost about the same or less, but spectacularly improve total "quality of life years" at the obvious trade off of "premature" (by a matters of weeks or a few months in most cases) deaths of super elderly people.
Are there enough 95+ year olds for that to make a significant difference?
The premise of Matt's post at the time was that there were. I have no clue if the numbers, either then or now, actually work or not.
It doesn't take that many if the care they get is extremely expensive (which I believe is the claim that is sometimes made).
“A certain amount of encouragement to die seems ok given the fact that the negative externalities of staying alive are inflicted on the treasury.”
Talk me through this. Should we also be encouraging parents on welfare to give their kids up for adoption?
Yes, probably? There's definitely good arguments to be made that government policy could be a lot more coercive on "stopping the cycle of poverty" by coming up with ways to reduce the numbers of children lower income people have/need to support, although that would obviously run counter to our host's "OBA" proposal.
Maybe not 'encouraging', but the state could certainly offer that as an option, perhaps in exchange for cash. My priors being that anyone who would trade their kid for cash shouldn't be a parent anyways, so we're effectively filtering for the right crowd
I feel like it would also run counter to the role the state should play in people's lives.
Well, my start point is that the state should not offer many of these types of benefits at all. If it does, I think it should have pretty broad freedom to attach conditions on accessing them to deter use of the benefits or reduce the need for such benefits in the future. (This is contrary to numerous SCOTUS rulings, but we're talking idealized here, not actual permissible policy.)
I think what Matt is implicitly suggesting is something like decriminalization vs. legalization. Instead of treating assisted suicide like murder, make it a misdemeanor or civil penalty. If an institution pressured people to choose euthanasia to save money, they'd face a huge fine, and it wouldn't be worth it. But if a lone doctor euthanized someone out of compassion, they'd face little consequence.
Great response, David. A rare total whiff by Matt.
It occurs to me that you're not taking your own advice when it comes to popularism in your TV reviewing. If you want to effect change in real America you have to be suggesting improvements in the story telling of Yellowstone.
It's also not obvious to me that "on the margin wards of the state that live unpleasant lives at great taxpayer expense will be pressured to end them painlessly" is a horrible tradeoff (if actually true) compared to "we routinely lock people into unimaginable torture".
Geez, I don't know ES. Even if the utilitarian calculus produced a wash, my act/omission worries get triggered here. Dying slow painful deaths has been ubiquitous throughout human history, and is still ubiquitous throughout the animal kingdom. We didn't cause that; it's the default. Yes, medicine and technology should be used to improve our lot over the state of nature. But the pain of dying is not in and of itself our fault.
The moral issues involved in pressuring people to end their lives, on the other hand, look quite serious. Inter alia, do you want to create the sort of people whose job it is to pressure said seniors into ending their lives? We have some experience with self-appointed "angels of mercy," i.e. medical professionals who take it upon themselves to do this. The track-record is not good; they often go way over whatever line they originally thought they were respecting.
Fair, but a few thoughts here:
1. The act/omission distinction lies on pretty shaky philosophical ground (walking past drowning babies being blameworthy).
2. Even accepting that such a distinction is morally relevant, most don't hold it to be *determinative* in the face of starkly different outcomes--unless you are talking to Kant himself, you can pretty much always add enough innocent people to the other track in a trolley problem to get people to switch (kill 1 to save 40 trillion is an easy call).
3. Even if it *were* determinative, the state is already acting to save these people. The "natural" course would be for them to die ill in the streets, not receive expensive care as a ward of the state. It does not strike me as some new intervention in the natural course of events to say "we'll still keep giving you all this expensive medical care we paid for with money extracted through force from taxpayers...but it really would be better if you elected to painlessly end your life instead".
4. To be clear, I do not in fact want to create people whose job it is to do this. I think it is bad to do it. However, in the veil of tears we live in, where we have limited resources and have to make tradeoffs, it seems to me "maybe some people on the margin will still act like way despite all of our efforts to regulate these conversations to ensure it does not happen" vs "we will for sure lock people into involuntary and unceasing torment", call seems easy to make.
In the one case, you have people leading mostly miserable lives using money that could be spent on feeding children or deworming or private enterprise or building hospitals or anything else than "expensive end of life care for people dying soon anyway" ending them a little earlier than they otherwise might. In the other case you have someone for sure suffering significant agony. I also think there are a lot more people in camp "needlessly suffering" than camp "tricked into suicide by bureaucrats".
TL DR: I don't think Logan's Run is a plausible outcome of relaxing treatment rules. You face similar but more difficult questions when it comes to institutionalizing the mentally ill too, but properly regulated mental health hospitals still make sense.
Determining for yourself that these other people are living miserable lives--when their defining characteristic is that they want to keep living--is also a rationalization that has led to some awful places. But it doesn’t need to lead there to be bad on its face. If we think the money is better spent on deworming, then we should cut the budget for medical care. Or cut some other part of the budget. Or raise more revenue, or do more deficit spending. “See if we can talk some people who we’re taking care of into dying” should not be Plan B, C, or even Z.
Good thing nobody is arguing that pressuring people into suicide as a cost saving measure is a good outcome to strive for then, rather than a risk to be avoided to the greatest extent possible while achieving other even worthier goals.
I certainly don’t want to think that other people want me dead. A world in which I was afraid that my family and neighbors wanted to kill me would suck. No one should be shamed into dying. Even withholding expensive care seems cruel in a country as rich as ours.
And yet suicide is so stigmatized that there are often strong social pressures not to do it. We should certainly move the slider towards less stigma against suicide.
Part of this should be 1) speaking frankly about the costs of largely futile medical treatments and 2) admitting that suicide is often a courageous and unselfish act.
I'm glad you're not arguing for that but there is at least someone arguing for that in this comments section! https://www.slowboring.com/p/better-call-mailbag/comment/8493408
I'm sorry if I misapprehended your view, but I didn't see any suggestion in your comment that there are reforms or restrictions to the euthanasia regime that we should consider—only a binary between "leave people in agony" and "pressure people who want to live towards suicide, which is not such a horrible tradeoff."
Did you reply to the wrong post?
Looks like many of the replies got scrambled? Like the entire comments section list it's threading.
It's only the public facade of popularism that leads him to pretend that any television has artistic value. En famille, he only has eyes for Knausgård and Saramago.
Matt’s been pretty consistent that educated cosmopolitan class snobbery should stay where it belongs, in cultural consumption, rather than in politics.
Also, suggesting improvements to the somewhat aimless state of the Marvel Cinematic Universe post-Endgame. Though that might go over here even more poorly than the guest posts.
MCU isn't aimless: it's dead on for profits without effort.
I cannot wait for Matt's Purple Hearts takes.
I'm nowhere near retirement age, but I work in the sciences and have had more than a few coworkers who've retired recently (across an age span, from early 60s to early 70s). We all enjoy (or enjoyed) our jobs, but it's stressful and eventually you want to enjoy your life. The ones in their early 60s have told me things like "I'm still relatively physically healthy, there are a lot of things I want to do (travel etc.) while I'm still able to do them." Or they want to spend more time with their grandchildren. Or they want to take up a hobby. Or they want to volunteer giving walking tours in a historical setting. Or they are content to do things like contract patent writing.
Always seemed to me as though you have a plan to keep yourself occupied and intellectually stimulated in retirement and you'll be fine. Sit around watching Fox News all day and your mind turns to mush.
My dad retired from his research job at a pretty conventional age a year or two ago, and he commented that he would dearly have loved to take on some sort of part-time emeritus role and consult (maybe even for free) with his younger colleagues who were still active in the lab.
There wasn't a way to make that happen, unfortunately, but that sounds like a good retirement to me.
Law firms, for all their problems as workplaces, often do this, at least for their more eminent partners. They'll put on suits and come into the office well into their 80s, mostly to use the office phone to call various customer service lines.
Law firms also genuinely benefit from these arrangements because those partners can help to maintain their client relationships and pass them on to younger partners.
I think the concept of "institutional knowledge" is a lot broader, or should be understood to be broader.
I have an excellent personal relationship with my former boss, and neither of us minds an occasional phone call of "hey bossname, do you remember why we did X this way?". Very valuable.
Especially if he was a white male. No opportunities.
Isn't part-time work a solution to the issue?
When my dad retired, I witnessed, I believe, a dramatic fall in cognitive abilities etc and it scared the hell out of me.
I will reach the age when I don't need a job for financial reasons fairly soon but my wife will want to work some seven years after my date of retirement. Part-time work would combine the need for mental stimulation, deadlines etc with opportunities to travel, play more games and sports and so on.
I think all of this is true and also pretty obvious.
The first main factor, as MY points out is, do you like your job or is it making you depressed? This is a good sign you should retire.
But the second factor is, you can't just retire into a life of nothing or you are just accelerating your own death. Unfortunately, at least a majority of people are pretty bad at managing their own health through lifestyle choices. So there are plenty of people who maybe aren't very happy in their jobs, but if they could retire would end up wrecking their own mental health. And the default assumptions of US society make the challenge of developing a suitable mental and social life after retirement greater than it could be.
I am a late 30s DINK and my friends in similar situation chat on retirement a lot, as so much of retirement advice intersects with grand parenting advice. As none of us have or plan to have kids, being purposeful about what an alternative retirement looks like becomes more important. Big thing is all of us owning property within walking distance of each other. As that is hard in VHCOL cities we need to start working towards it now.
you may already be doing this, but one thing i would suggest is telling your local government about this vision you have so that they know their constituents care about stuff that's not 100% parking.
Am a very involved local YIMBY 👍
I’ve always thought that going part time was underrated as an alternative to early retirement, if you like your job. Or our company (in old-school engineering) has “pensioners” where former employees who retired and now collect a pension are allowed to work some small number of hours a year, maybe 500 or less, and still collect their full pension. Seems like best of both worlds?
This is a great option if available. But for operational and leadership roles, it's hard to find part-time assignments that work for the business and for the retiree.
Consulting is an option but (a) requires being comfortable with the sales effort needed to build a practice and (b) becomes a full-time effort if successful in (a). The solution I evolved to is consulting almost exclusively via the knowledge networks - GLG, Alphasights, Guidepoint etc. They bring the work to you, it's interesting but relatively low stakes, it's only an hour or two a week. What's missing from this option is the social interaction involved in working in the office with the same cast of characters every week.
I'm interested that your org has retirees with company pensions. I thought that the private sector was ~ 100% defined contribution pensions now. The impact of that shift on family finances is an interesting topic. I think it has been positive, but I am an optimist.
My company still has pensions for anyone who started prior to 2011 (including, luckily, me), but they froze them in 2020. My husband (same boat) and I still expect a healthy amount of retirement income from it tho. But we also have 401ks. I don’t know anyone at our company who was planning to be totally reliant on the pension. Still waiting on a lump sum offer to buy us out, hasn’t happened yet.
I had final salary pensions from two employers when I worked in the UK. UK pension plans have to give you an offer of the "Cash Equivalent Transfer Value" on request. I only found this out about 20 years after leaving the UK. The transfer values then were about 30x the annual pension amount based on immediate commencement (I was 58 then, and had just retired early). The only challenge was finding a financial advisor that would provide the mandatory (UK law) opinion that transfer was a wise choice. Hope that your employer steps up to the plate with good cash buyout offers.
Law firms generally let partners maintain offices perpetually, so it's common for them to go from fully active status to winding down, then semi-retired, then retired-but-still-helping-out-here-and-there from their 60s through their 80s. It's one of the nice parts of the profession.
If you want an active retirement (golf, ski etc) you can hit a golf ball much farther at 58 than 68. depends hat is important to you.
I retired at 58 and was completely shocked at loss of distance in my golf shots compared with when I was playing regularly in my mid-40s. About 30 yards on drives. And the expert golfers I play with tell me that the distance is never coming back. Not that important to me -- that's what the yellow tees are for.
Very cool. Retirement options probably vary by industry and country.
My dad is in his 60s, retired in the last few years after initially trying part-time work. The main reason he retired was that he couldn't find employment anymore. Even when he was okay with pay cuts, pay in the (Indian) IT services is often tied to experience, and that made it difficult. There were also a couple of unnerving overt incidents of ageism, which probably was off-putting.
I'll repeat my pushback that "illegal while also allowing for a fair amount of hypocrisy, lax enforcement, and unasked questions" is a bad recipe for selective enforcement that tend to hurt the most vulnerable. Like Matt, I don't have a strong view on euthanasia, but I've seen this state of law suggested for other things like gambling and especially sex work where I think it can be more commonly damaging. Abortion law could also easily fall into this trap depending on how the post-Dobbs world shakes out.
Either way we are thinking about the most vulnerable getting harmed. As these things often shake out. On the one hand we have fear about vulnerable folks experiencing unnecessary pain. On the other we fear the most vulnerable will be killed for profit. The fears need to be weighed. Saying the downsides from one will fall on the vulnerable just doesn’t answer the problem. It’s always ‘the vulnerable’ who are vulnerable.
I mean, the gambling situation is one we had until very recently, but I think the new model is going to be much harder on the most vulnerable (specifically, the poor, and also anyone who is predisposed to gabbling addiction) than the old model. Don’t you?
In other words, as Nick says, we can’t just think of the harm of being arrested, or of not getting the thing desired, but also of the harm of getting it when it isn’t what one wants.
I guess I just see “risk of being turned into a criminal” as much worse.
But if one does want to make something illegal, then stick in that lane and enforce it fair and consistent.
I don’t know. This Douthat column, along with my observations on the ground, helped convince me that consistency is overrated and that, once again, hypocrisy is the homage vice pays to virtue. https://www.nytimes.com/2022/02/12/opinion/super-bowl-gambling-sports.html?smid=nytcore-ios-share&referringSource=articleShare
I just feel like it's easy for people to tolerate inconsistency until they're the ones that are on the wrong end of the inconsistency.