Again, the non-medical approach would address this. Although there would still be criteria, they would no longer specify which medical conditions are required to qualify.
***************************
Actually, in the jurisdictions that have taken the non-medical route, there are no criteria, other than capacity to choose. In fact, that is the whole point. The key examples are Switzerland and Germany.
Which is ironically more strict than present Canadian criteria (if you have medical issues).
This illustrates the true meaning of euthanasia as a medical procedure (of the highest priority as judged by the commitment to provide): Capability is not logically an issue. For we have an ethical requirement to provide medical treatment to the incapable. Also the inference that some people should (at least consider) being euthanized is explicit. For just as some people really should take their insulin, so also (as a direct logical requirement of the medical status presently accorded) some people really should be euthanized; and (to underscore the irony) they must effectively invoke their right to refuse treatment in order to avoid being killed!
One question that comes up for me in considering the rights-based discussion of this issue is how it leads to the formation of a particular culture. You can see this in some areas of the USA re: the Second Amendment: the culture is deeply pro-gun ownership. It's not just about the right, but flaunting guns, etc. There's a big debate in the USA about our society's relationship with guns.
When we consider this right to end of one's life, I worry about the judgments required to inform it. Your proposal would free it from medical authority and place more power in the hands of individuals, but cultures are the accumulation of individual behaviors and decisions. So, if enough people say, "I would never want to live like *that.* *That* is not a life worth living," then a culture eventually comes to devalue that life. You see this devaluing as people refer to severely cognitively impaired people as "vegetables," for example.
I'm also struck by David Velleman's dinner party analogy (https://pubmed.ncbi.nlm.nih.gov/1479311/). He's having a dinner party and you're not invited, so you're not coming by default. No choice for you to make. If he invites you, though, you can choose to come or not to come, but the one thing you can no longer do, the one thing his offer has taken from you, is the possibility of not coming by default. There may be certain circumstances in which it would have been better for you not to come, but now that you have the choice, you must choose to go.
The offer of death, in Velleman's view, operates similarly. Most people don't wake up every day consciously deciding to live. They just live by default. Now here comes someone saying, "You know, you could kill yourself," or "We could euthanize you." The person can certainly decide to do so or not, but the one thing they can no longer do is live by default. That puts them in the precarious position of justifying, if only to themselves, their continued existence. "Hm, I'd never thought about that before. Why *is* my life worth living?" I don't see a way of overcoming this challenge. Once ending one's life is made a viable option (rather than one that's discouraged, even resisted), it changes the context of all of one's decisions and self-evaluations, even for those who weren't chomping at the bit to get it.
I think it's very hard to make predictions about this. So many people predicted that suicide rates would rise during the pandemic, but the opposite happened. From the outside, one would think that New Hampshire have allow assisted dying given the whole "live free or die" approach. And when I worked in Texas, multiple patients told me they found it strange that the state prides itself on freedom but doesn't allow assisted dying. I'm therefore skeptical of any predictions about the large-scale effects of some phenomenon.
Velleman's papers against assisted dying are worth taking seriously. I'm unmoved by his Kantian points about dignity, and it's worth pointing out that he's focused on whether there's a positive obligation to help others die, which isn't what I mean by a right to die. But, more specifically, one thing that I always think about his paper is whether it's actually true that expanding choice has the effect he says it does. I accept that more choice isn't always better, but it's better in some cases, and it's hard to know which is the good kind.
There are lots of options open to me that I don't think I've actively chosen against. It's just that I've never considered them seriously, such as becoming a priest or joining the military. The possibility is open to me, but I've never found myself wondering, "well, why *don't* I join the military?" In other cases, perhaps there's value in having to make the choice. In places where abortion is legal, perhaps people more carefully think about what they really want.
Or, to make a very different analogy, people in gay, lesbian, queer, or non-monogamous relationships often bring up how, since there isn't an expectation of how the relationship is supposed to go, they have to figure it out, which is more work but often framed positively. In general, a new choice can be beneficial because it makes the person consider what they really want. So, what Velleman sees as a bug might be a feature.
It also strikes me that his worry might better apply to the medical model, where patients are actually told about the choice. This is a point I mention in the post above. In the non-medical model, the physician isn't required to bring it up, but right now, they should be offering it.
I also think that death is such a taboo that most people don't think about it enough. There are positives to thinking about death, including that it often leads to appreciating life more. Obviously, experiences will differ, but most people won't go from thinking about their own mortality to feeling unable to justify why they're alive.
One final point: even people who are against assisted dying argue that the culture of medicine is too focused on length of life. This is Atul Gawande's argument in Being Mortal. So, if the argument is that assisted dying gets people to confront whether continued life is worth it for them, instead of the current default of aggressive treatment almost no matter what, that's a positive effect. There's a trade-off, which is that it might have the effect on people who really need other support, which is why the medical model is still attractive.
Great discussion. I agree that the existence of the option would make people consider whether they want to continue living, and I agree that it may be a good thing, not only because it may enhance autonomy but also well-being.
One of the main reasons in favor of assisted death is that death can be good for some people in some circumstances. So if the existence of the option (or any option for that matter) forces you to consider it carefully, it may lead you to make a prudentially good decision. To use a personal example, once I discovered philosophy, it made me think about pursuing it as a career. And, all things considered, I'm glad that that happened because it was good for me.
This is false. There are currently five criteria and only one of them is "be at least 18 years old and mentally competent".
**********
hmm... criteria:
-eligible for health services
-voluntary request
-informed consent
**three of five irrelevant to the present discussion (other than the implication of capability which is inherent in voluntary request and informed consent)
The other two are:
-major and capable
-grievous medical condition
However, Canada is already on record as wishing to authorize for: mental illness (merely postponed), mature minors, infanticide, and dementia by advance request. Hence the major and capable requirements are basically toast as we speak.
All that is left then, is grievous medical condition. If you have that you are good to go. Quite definitely, then, this is assisted death for sick people. Not for anyone else. Hence the discriminatory nature which cannot be finessed.
But interestingly, I note that the Swiss criminal law does not mention the age or capability of the suicide. So I guess my claim was false on that score.
Gordon
P.S. Deleting my comments would not be a good thing, because, quite frankly, there are not a whole lot of people in Canada (or elsewhere) who are able to discuss these issues at the level you clearly aspire to. Our interaction is potentially beneficial for both of us.
Again, the non-medical approach would address this. Although there would still be criteria, they would no longer specify which medical conditions are required to qualify.
***************************
Actually, in the jurisdictions that have taken the non-medical route, there are no criteria, other than capacity to choose. In fact, that is the whole point. The key examples are Switzerland and Germany.
German High Court decision February 26, 2020 https://www.bundesverfassungsgericht.de/SharedDocs/Pressemitteilungen/EN/2020/bvg20-012.html accessed Oct 28, 2023
Swiss criminal code art. 115 https://www.fedlex.admin.ch/eli/cc/54/757_781_799/en#art_115 accessed Nov 4, 2023
Best,
Gordon
Yes, the criteria could just be age and capacity.
Yes, the criteria could just be age and capacity.
*****************
Which is ironically more strict than present Canadian criteria (if you have medical issues).
This illustrates the true meaning of euthanasia as a medical procedure (of the highest priority as judged by the commitment to provide): Capability is not logically an issue. For we have an ethical requirement to provide medical treatment to the incapable. Also the inference that some people should (at least consider) being euthanized is explicit. For just as some people really should take their insulin, so also (as a direct logical requirement of the medical status presently accorded) some people really should be euthanized; and (to underscore the irony) they must effectively invoke their right to refuse treatment in order to avoid being killed!
This is false. There are currently five criteria and only one of them is "be at least 18 years old and mentally competent". https://www.canada.ca/en/health-canada/services/health-services-benefits/medical-assistance-dying.html
I'm going to start deleting comments if you keep making false claims.
One question that comes up for me in considering the rights-based discussion of this issue is how it leads to the formation of a particular culture. You can see this in some areas of the USA re: the Second Amendment: the culture is deeply pro-gun ownership. It's not just about the right, but flaunting guns, etc. There's a big debate in the USA about our society's relationship with guns.
When we consider this right to end of one's life, I worry about the judgments required to inform it. Your proposal would free it from medical authority and place more power in the hands of individuals, but cultures are the accumulation of individual behaviors and decisions. So, if enough people say, "I would never want to live like *that.* *That* is not a life worth living," then a culture eventually comes to devalue that life. You see this devaluing as people refer to severely cognitively impaired people as "vegetables," for example.
I'm also struck by David Velleman's dinner party analogy (https://pubmed.ncbi.nlm.nih.gov/1479311/). He's having a dinner party and you're not invited, so you're not coming by default. No choice for you to make. If he invites you, though, you can choose to come or not to come, but the one thing you can no longer do, the one thing his offer has taken from you, is the possibility of not coming by default. There may be certain circumstances in which it would have been better for you not to come, but now that you have the choice, you must choose to go.
The offer of death, in Velleman's view, operates similarly. Most people don't wake up every day consciously deciding to live. They just live by default. Now here comes someone saying, "You know, you could kill yourself," or "We could euthanize you." The person can certainly decide to do so or not, but the one thing they can no longer do is live by default. That puts them in the precarious position of justifying, if only to themselves, their continued existence. "Hm, I'd never thought about that before. Why *is* my life worth living?" I don't see a way of overcoming this challenge. Once ending one's life is made a viable option (rather than one that's discouraged, even resisted), it changes the context of all of one's decisions and self-evaluations, even for those who weren't chomping at the bit to get it.
I think it's very hard to make predictions about this. So many people predicted that suicide rates would rise during the pandemic, but the opposite happened. From the outside, one would think that New Hampshire have allow assisted dying given the whole "live free or die" approach. And when I worked in Texas, multiple patients told me they found it strange that the state prides itself on freedom but doesn't allow assisted dying. I'm therefore skeptical of any predictions about the large-scale effects of some phenomenon.
Velleman's papers against assisted dying are worth taking seriously. I'm unmoved by his Kantian points about dignity, and it's worth pointing out that he's focused on whether there's a positive obligation to help others die, which isn't what I mean by a right to die. But, more specifically, one thing that I always think about his paper is whether it's actually true that expanding choice has the effect he says it does. I accept that more choice isn't always better, but it's better in some cases, and it's hard to know which is the good kind.
There are lots of options open to me that I don't think I've actively chosen against. It's just that I've never considered them seriously, such as becoming a priest or joining the military. The possibility is open to me, but I've never found myself wondering, "well, why *don't* I join the military?" In other cases, perhaps there's value in having to make the choice. In places where abortion is legal, perhaps people more carefully think about what they really want.
Or, to make a very different analogy, people in gay, lesbian, queer, or non-monogamous relationships often bring up how, since there isn't an expectation of how the relationship is supposed to go, they have to figure it out, which is more work but often framed positively. In general, a new choice can be beneficial because it makes the person consider what they really want. So, what Velleman sees as a bug might be a feature.
It also strikes me that his worry might better apply to the medical model, where patients are actually told about the choice. This is a point I mention in the post above. In the non-medical model, the physician isn't required to bring it up, but right now, they should be offering it.
I also think that death is such a taboo that most people don't think about it enough. There are positives to thinking about death, including that it often leads to appreciating life more. Obviously, experiences will differ, but most people won't go from thinking about their own mortality to feeling unable to justify why they're alive.
One final point: even people who are against assisted dying argue that the culture of medicine is too focused on length of life. This is Atul Gawande's argument in Being Mortal. So, if the argument is that assisted dying gets people to confront whether continued life is worth it for them, instead of the current default of aggressive treatment almost no matter what, that's a positive effect. There's a trade-off, which is that it might have the effect on people who really need other support, which is why the medical model is still attractive.
Great discussion. I agree that the existence of the option would make people consider whether they want to continue living, and I agree that it may be a good thing, not only because it may enhance autonomy but also well-being.
One of the main reasons in favor of assisted death is that death can be good for some people in some circumstances. So if the existence of the option (or any option for that matter) forces you to consider it carefully, it may lead you to make a prudentially good decision. To use a personal example, once I discovered philosophy, it made me think about pursuing it as a career. And, all things considered, I'm glad that that happened because it was good for me.
This is false. There are currently five criteria and only one of them is "be at least 18 years old and mentally competent".
**********
hmm... criteria:
-eligible for health services
-voluntary request
-informed consent
**three of five irrelevant to the present discussion (other than the implication of capability which is inherent in voluntary request and informed consent)
The other two are:
-major and capable
-grievous medical condition
However, Canada is already on record as wishing to authorize for: mental illness (merely postponed), mature minors, infanticide, and dementia by advance request. Hence the major and capable requirements are basically toast as we speak.
All that is left then, is grievous medical condition. If you have that you are good to go. Quite definitely, then, this is assisted death for sick people. Not for anyone else. Hence the discriminatory nature which cannot be finessed.
But interestingly, I note that the Swiss criminal law does not mention the age or capability of the suicide. So I guess my claim was false on that score.
Gordon
P.S. Deleting my comments would not be a good thing, because, quite frankly, there are not a whole lot of people in Canada (or elsewhere) who are able to discuss these issues at the level you clearly aspire to. Our interaction is potentially beneficial for both of us.