Comment by BugsJustFindMe | Hacker News Reader

Comment by BugsJustFindMe | Hacker News Reader

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I have a small amount of experience with a similar process that exists in another country. It's easy enough to reason about the people in the last stages of cancer, but there are many other situations that are conceptually much murkier.

The first thing we need to make clear is that "severe, incurable, and unbearable" does not necessarily mean terminal or even physical pain. Plenty of psychiatric conditions often accompanying significant trauma are severe, incurable, and unbearable. But they're not terminal (except by suicide), and the reason they're incurable is because we know fuck all about psychic damage, and some might argue that if you've made it this far without killing yourself then it's de-facto bearable. And yet they definitely qualify unless the law specifically says that they don't, because "deemed unbearable by the patient" is not the same as definitively unbearable.

The biggest flaw I see in the model is if there's no significant determination of qualifications for whether a particular doctor should be allowed to approve the request (e.g. some might demand that the doctors be trained in appropriate specialties and have detailed knowledge of your history and situation), or whether you can ask 100 doctors who say no until you find 2 who say yes. I've seen firsthand that systems which don't mandate strict selection criteria create additional strife.

I think that fundamentally one has to decide whether a person gets to just say "I want to die" one day and forget that there are doctors involved. Because believe me there are many scenarios that basically feel that way to friends and family. Many people with trauma are extremely suicidal but also scared of the process. Do we establish a structure that makes it easy to get help dying or do we want to instead mandate state resources for helping them stay alive? For a lot of people the answer is not so clear _even_ when people want to be ok with letting people make their own choices.

[edit: sorry for using british slang, drive-by commenter. "fuck all" does indeed mean "nothing"]

Is not only 'I want to die', is 'I want you to kill me' (and deal with it, and deal also with my sons or family if they don't want the same as me), that is a different case and involves more that "me, me, me".

The law allow conscientious objection in doctors (for now), but also will justify death angels manipulating vulnerable people. We shouldn't forget that unbearable pain can be easily created with the appropriate medicines. People can be drugged and turn into addict puppets also. Has happened before. Even recently in US.

And that will taint the statistics also, removing a safety guarantee for everybody. Before the law, a warn was triggered when more than average people died in part of an hospital. After that, the hospital with an interest in lowering this value has a way to do it (falsifying consent). Protecting their public image, but also hiding any rotten apple present in their staff. Bad news for everybody.

If there is something that vulnerable elder don't need now is a new exception to kill them legally.

By that reasoning, then gun ownership should be completely banned anywhere, to prevent self defense justifications in what are now legal scenarios. Surely, you'd support such a law change as well?

> By that reasoning, then gun ownership should be completely banned anywhere, to prevent self defense justifications in what are now legal scenarios. Surely, you'd support such a law change as well?

You're not starting from the belief that nobody supports banning gun ownership are you? Because many people do. I'm not sure where this is going.

Is a typical red herring, just ignore it

Oh, but we already do this - just with a small subset of patients... and pets. Vets have to kill pets quite often.

As far as patients are concerned: We have life support, and we withhold life support once we conclude that there is little to no chance of recovery. Assisted suicide allows this sort of thing sooner, for folks that are suffering.

Those death angels you speak of aren't angels. These are murderers. You are afraid folks are going to murder others. This already happens, and we already have laws against this. We can very quickly produce statistics on what sorts of people seek out assisted death: We can look to other places.

> The biggest flaw I see in the model is if there's no significant determination of qualifications for whether a particular doctor should be allowed to approve the request

Living in a country where I have the right to die, there's a formal framework that details the process that a patient goes through.

By handing healthcare professionals a framework, it allows them to build hands-on experience and develop best practices in how to actually have an on-going, involved and empathic disucssion with patients and their surroundings.

The big flaw in this "model" isn't the qualifications of doctors, it's pulling a moral and emotional conundrum into a set of abstract assertions and reducing the debate to the medical act itself: a doctor euthanizing a patient.

> Many people with trauma are extremely suicidal but also scared of the process. Do we establish a structure that makes it easy to get help dying or do we want to instead mandate state resources for helping them stay alive? For a lot of people the answer is not so clear _even_ when people want to be ok with letting people make their own choices.

The right to die, paradoxically, keeps patients from committing suicide. The knowledge that you have that right acts as a 'safety net' to open up towards healthcare professionals. Your wish to die is not a taboo, it's not an elephant that nobody wants to discuss. Any openings towards reflection on trauma isn't burdened by the imperative "you can't die, you must live" from the get-go. Taking that away, paradoxically, creates space to reach out and connect.

The answer your question, in that regard, isn't "either or". It's both.

The right to die can only be implemented in a meaningful fashion if healthcare and social infrastructure provides enough facilities to properly help, guide and reach out to individuals.

That's why it's paramount to invest in mental healthcare, hospice care, palliative care, local physicians, nurses, social workers, schooling, education and so on and see all of that as a commons embedded in communities.

Even so, the right to die isn't a silver bullet. Neither is healthcare a silver bullet. They don't provide or offer wholesale answers or solutions to social, medical, ethical issues on an individual or societal level. It's fallacious to look at these issues and discuss them in moral absolutes, those are tarpits and they leave no room for moving forward.

At the end of the day, death is an intrinsic part of life. However, the vast majority of people will feel uncomfortable discussing their own end of life. It's only when they are personally confronted with the finality of life that they will start to reflect. Personally, I think that a meaningful discussion about the right to die can only begin once you've recognized that your own life and your own health aren't self-evident.

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