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Comment by elevaet | Hacker News Reader

I have a very hard time believing that doctors will be suggesting euthanasia to patients who might not otherwise consider it.

There is no financial incentive behind it on a personal level for doctors, given Canada's one-payer medical system, and euthanasia is counter to many doctors' interpretation of the Hypocratic oath.

You could argue that on a system-level there is an incentive to encourage euthanasia, since it could take expensive terminal patients off the bill. This bit does make many people (myself included) uncomfortable and there definitely needs to be checks and balances in place.

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A one payer system doesn’t insulate doctors from personal incentives to cut costs.

The details of compensation can easily encourage one time injections over long term care.

Even if the injection is poison.

I know for a fact that “bounty” type programs are used by Canadian public health authorities, and for-profit actors make money from them.

I don’t know if this extends to long-term care scenarios, but there’s nothing about the way the Canadian health system is structured that offers strong protection against perverse incentives.

Arguably, the horrible US for-profit health system offers stronger protection against this. A dead patient can’t be charged for more services. But a system that equates medical consumption with good care has it’s own set of problems too obvious to mention.

Respectfully this just display ignorance on how doctors are compensated in Canada. They are paid by the act, meaning that "doing X" gives them money. Euthanizing someone is compensated as a single act so there really isn't an incentive to do it. Most doctors are actually refusing to do it because of their oath (and yes they can refuse).

Plenty of "specialists" make their living this way.

This post (and many others here) kind of put the ignorance of the "Canadian" system on display. It's not really one uniform system and has varying levels of privatization across the country because it is handled by provinces.

> Arguably, the horrible US for-profit health system offers stronger protection against this. A dead patient can’t be charged for more services. But a system that equates medical consumption with good care has it’s own set of problems too obvious to mention.

This isn't stronger protection; it just creates a different perverse incentive to effectively drag out someone's suffering.

> It's not really one uniform system and has varying levels of privatization across the country because it is handled by provinces.

Does that structure offer strong protection against perverse incentives in all provinces?

> I have a very hard time believing that doctors will be suggesting euthanasia to patients who might not otherwise consider it. There is no financial incentive behind it

This article provides evidence to the contrary:

"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."

I’d note that the hospital administration was mentioning this, rather than a particular doctor providing care. Or, the former has a financial incentive to keep care costs low (especially given the current government in Ontario).

The one person named was an administrator, but it's not particularly clear who the "staffers" were. It's possible some of them were doctors, but it's hard to say.

That said, I feel like the point here was that it wasn't likely to be pushed at people who hadn't asked, and yet it was, not that it was uniquely bad coming from a doctor vs. an administrator.

The comment you quoted explicitly mentioned doctors and specifically mentioned the Hippocratic oath. You omitted that part of the sentence from the quotation in your reply but it was very clearly about Doctors.

But "staffers" may well include doctors, and there's nobody here who can say either way unless someone steps up with the recordings. I left out the rest because I wanted to point out that there are people with financial incentives who did push this and I don't see why it matters if they're doctors or "staffers" or the hospital's Director of Ethics.

If the Director of Ethics and their staff think this is appropriate, it'd be more surprising if the doctors didn't engage in the same.

I initially thought along the same lines from first principles, that there is no incentive for physicians to suggest euthanasia.

But in addition to the case from Foley quoted by another commenter, the article backs it up with another claim given by a named source: "Frazee cited the case of Candice Lewis, a 25-year-old woman who has cerebral palsy and spina bifida. Lewis’ mother, Sheila Elson, took her to an emergency room in Newfoundland five years ago. During her hospital stay, a doctor said Lewis was a candidate for euthanasia and that if her mother chose not to pursue it, that would be “selfish,” Elson told the Canadian Broadcasting Corporation."

So, it looks credible that it's happening in practice. I can only speculate as to why, but I revised my initial belief because it was hypothetical, after reading about the accounts that look objective.

You should talk to disabled folk about how they are often treated by doctors. It's often a version of average people telling them "if I had what you had, I'd kill myself" (a disturbingly common statement), but with the added dimension of having a lot of power over the patient.

Surely there is an ethical duty for the doctor to offer options. It is not for them to decide what path the patient should take and holding back something that the patient may want is unethical.

There are doctors who cut off foreskins of babies who would never ever consider it. Get it into your head that many doctors don’t have a real moral center.

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