Medically assisted deaths constituted 4.1 per cent of all deaths in Canada | Hacker News Reader

Medically assisted deaths constituted 4.1 per cent of all deaths in Canada

cbc.ca

42 pointsdjkivi74 comments

Some people are uninterested in suffering for the sake of it.

Why the article felt the need to give voice to a self-righteous religious organization[0] funded by the Koch Foundation, while calling them "non-partisan" is not mentioned.

[0] https://en.wikipedia.org/wiki/Cardus

Someone needs to find the people who are the most against it and then follow up when they get brain cancer, als, or other terminal disease that causes a lot of suffering.

It’s easy to have a strong opinion against this when the last time you went to a physician was 10 years ago.

This argument is similar to ones criticizing pro-lifers for sometimes getting abortions. Nobody denies that, in moments of suffering, people might depart from their moral stances. Humans are weak. But shouldn’t your moral stances be determined when you are clear-eyed, and are thinking about society as a whole rather than your personal situation?

Your argument is couched in the same form as the argument: “Someone needs to find people who are in favor of criminal’s rights and follow up when their child gets raped or murdered.”

> But shouldn’t your moral stances be determined when you are clear-eyed, and are thinking about society as a whole rather than your personal situation?

No. If your morals are conditional, they are not morals.

> But shouldn’t your moral stances be determined when you are clear-eyed, and are thinking about society as a whole rather than your personal situation?

Have you thought that, being clear-eyed, you may not yet have the experience of being terminally ill and in pain that cannot be medicated away? The only prospect for life being permanently chained to a bed awaiting your death?

How easy it is to serve these strong opinions when you are healthy.

> Your argument is couched in the same form as the argument:

If you have no experience of something you need a much stronger argument to prove you are not only correct, but correct to the point it overrides somebody elses freedom.

If a "moral stance" is one you only hold when it applies to other people's decisions, it's illegitimate and those stances have a name we give them: hypocrisy.

Also. Comparing support for MAID with defendant rights is a false equivalence. The correct equivalence there is whether or not someone still favors criminal rights if they were personally on trial. Not someone who personally becomes less magnanimous to criminals they are personally affected by. The equivalence the other direction would be asking loved ones about someone else's decision to undergo MAID, and asking them subset of folks around them who aren't ready to let them go yet how they feel about MAID. (Though in both cases of MAID and not wanting the wrong person to be thrown in jail for a criminal action as a victim, I suspect the drop in support is less than you think it is.)

> a "moral stance" is one you only hold when it applies to other people's decisions, it's illegitimate and those stances have a name we give them: hypocrisy

Hypocrisy doesn’t make the moral stance wrong, it just means humans are weak and sinful.

I'm still not very clear why you can't just leave this as a personal moral decision rather than a legal one.

There are no personal moral decisions, certainly not the decision to end a life. Decisions affect everyone.

I agree with other poster who responded to this.

Just want to add context matters and comparing my argument to arguments against pro-lifers is unfair.

Assisted suicide only terminates a single life of an individual who has made a choice in a good state of mind.

Even if argument seems the same as your second example it isn’t. Not every issue is the same and context matters.

Less disturbing than the raw percentage is the context in which some of these suicides have reportedly been carried out. People who are simply lonely, who have addictions, who don't have money, who feel they simply don't have options. In sum, not the kind of people who have a truly terminal illness and will pass away in a few weeks or months, but people who could potentially live well and flourish if resources existed to support them.

IMO, a society that reaches for suicide as a solution is going to be a society that consistently fails its most vulnerable.

> people who are simply lonely, who have addictions, who don't have money...not the kind of people who have a truly terminal illness

Source? According to my understanding of the Canadian law, loneliness and poverty are not eligible conditions.

They're not eligible conditions. And yet of course when you have a law like this, some cases will slip through the cracks due to the slippery slope nature of the thing. They're not a high percentage but there are many anecdotes. Here is an AP article from the middle of last year:

https://apnews.com/article/covid-science-health-toronto-7c63...

"Equally troubling, advocates say, are instances in which people have sought to be killed because they weren’t getting adequate government support to live."

What is eligible is pretty broad according to the article. "The law was later amended to allow people who are not terminally ill to choose death, significantly broadening the number of eligible people. Critics say that change removed a key safeguard aimed at protecting people with potentially years or decades of life left.

Today, any adult with a serious illness, disease or disability can seek help in dying."

There are many shocking anecdotes in that article, including the one it opens with. They don't all speak to "loneliness" or "money" but when I first read it last year I found it pretty shocking. Maybe you won't, but I think it's worth a read. Especially troubling to me are all of the disability advocates who disagree with the law:

"Landry said she shares the “grave concern” voiced last year by three U.N. human rights experts, who wrote that Canada’s euthanasia law appeared to violate the agency’s Universal Declaration of Human Rights. They said the law had a “discriminatory impact” on disabled people and was inconsistent with Canada’s obligations to uphold international human rights standards.

Tim Stainton, director of the Canadian Institute for Inclusion and Citizenship at the University of British Columbia, described Canada’s law as “probably the biggest existential threat to disabled people since the Nazis’ program in Germany in the 1930s.”"

From multiple perspectives:

Far left: https://jacobin.com/2023/01/canada-medically-assisted-dying-...

Center left (citing multiple troubling cases reported in public media):

https://www.theatlantic.com/magazine/archive/2023/06/canada-...

Academic literature:

https://www.cambridge.org/core/journals/palliative-and-suppo...

And Canadian media:

https://globalnews.ca/news/10023956/maid-prisons-canada/

https://globalnews.ca/news/9888810/suicidal-bc-woman-medical...

https://globalnews.ca/news/9784867/ontario-quadriplegic-moth...

https://www.cbc.ca/news/politics/maid-access-debate-contenti...

A "bad apple" sort of scenario but disturbing nonetheless:

https://www.cbc.ca/news/politics/veterans-maid-rcmp-investig...

Finally:

"Dr. Sonu Gaind, psychiatrist-in-chief at Sunnybrook Health Sciences Centre in Toronto, expressed concern about how the report describes people who accessed MAID whose natural deaths were not reasonably foreseeable. According to the report, 3.5 per cent of all MAID recipients — 463 people — did not have reasonably foreseeable deaths."

A small percentage, true, but it will grow absent efforts to limit these situations.

I came to post a similar thought too. I meet and help 4 old couples occasionally - in my neighbourhood, and some of my friend's parents - who now live alone. And all of them are physically healthy (as much as 70+ years old can be), and economically well off, but feel depressed due to crippling loneliness. Two of them openly tell me that they curse God for giving them a long life and just wish for death. If India had assisted suicide for old people, these are the kind of people who would be in front of the queue.

And that's one issue I have with such programs - one of the symptoms of depression is suicidal thoughts / ideation, which tends to disappear when depression is successfully treated. And depression also manifests itself in people with other illness. At the very least, these kind of assisted suicide programs should screen for depression in individuals opting for the program, and deny it to those depressed. They should instead be alternatively treated for depression.

What if their depression isn't treatable?

It's rare. The answer would then depend, I guess, on how comfortable are you in allowing mentally troubled people to opt-in in for suicide.

Look at the success rate of SSRIs and other common antidepressants and you might find it's far from rare. You say yourself that the depression is near universal amongst the old people you know, have any of them had successful treatment?

No, unfortunately psychological treatment are neither easily available or popular in India. There is also a cultural aversion in the previous generation to availing such treatment. (On SSRIs note that the medical community is increasingly of the opinion that SSRIs don't help with depression in the long-term and may even be responsible for suicidal tendencies in those who never even had it in the first place. Cognitive Therapy is now the gold standard for the treatment of depression.)

Ideally medically assisted deaths should be 100% of all deaths right?

Lots of people get unlucky and die. That doesn't mean they should not take the risk in the first place.

Perhaps OP is saying that in an ideal world no one would die by accident.

That's not an ideal world. That's a fantasy world.

An ideal world is a fantasy world.

There's more than accidental deaths too. For example, surgeries carry risk.

That's still accidental.

If you flip a coin and it lands on heads, that’s not an accident, it’s just chance. You get a risky procedure and die, well that’s chance too.

You're getting downvotes but what you say follows logically, we all suffer to some extent, we all die at some point. The distinction between maid eligible cases and ineligible cases seems arbitrary to me.

Not all death involves suffering. Some people just go to bed one night and die quietly in their sleep.

Right but ideally we would be able to prevent that so it never happens unexpectedly and we all only ever go out on our own choice when we're done/ready/whatever

It sounds better to me to just not wake up one day than to know when death is near, but maybe there are some great anti anxiety/depressant drugs to deal with existential doom feelings when that time comes.

You can't, sudden cardiac arrest could happen anytime to anyone.

No. Don't screw with nature, it doesn't end well.

So, life saving medications should be illegal by that logic too?

So people die suddenly without precondition, some die by accident, some die by murder, some die peacefully from age.

No, it should always be up to individual choice. There is no “ideal” because you can’t substitute your preferences for those of others.

To hit the 100% number you would have to prematurely kill many people that die peacefully but unexpectedly, and then forcibly kill many people who want to die naturally.

No but that's their point: you can't do this cause life is tragic.

But supposing we were to live in a ideal world, we'd wish it to be so that every death that occurs happened by the wish of the deceased, in the best comfort that can be offered to them.

I think that is a very different point than stated.

They said “ medically assisted deaths should be 100%”, not that everyone should have full control and choice. This is a very different point. The former takes what a personal preference to be a universal value, and supposes that an ideal world would conform the their preference, not just have choice.

They clarified below that this is what they meant for what it's worth.

I'm not sure what position you're ascribing to them, that we should have everyone killed by doctors at birth? I mean that could work if interpretated literally for the stated case, but who in their right mind would believe that?

Barring some far future medical scifi stuff becoming real, that wouldn't be my ideal. It would mean we stopped striving for anything so completely that zero people went too far and accidentally offed themselves and that's a stagnant and depressing culture to live in.

Also barring some far future medical scifi stuff, it would also mean nobody lived a long and healthy life and went to bed when they were very old and had something give out overnight and just didn't wake up. That also seems like a pretty sad place to live, because that would seem like the ideal to me. If I'm not going to die miscalculating a win suit run and hitting a mountain, or discovering a new exotic form of matter (that accidentally vaporizes me), then I want to live a long life and randomly go to bed one night to not wake up, ideally post 85 years old, or even better post 100 years old. Having a reason to ask the doctor to kill me seems really sad (while also being understandably necessary in certain cases, i.e. I'm not waiting for the cancer to incapacitate me in utter agony for very long before I tap out on my above ideal).

There's no dignity in suffering. Not allowing people to die with dignity and forcing them to suffer till the very end is the infliction of Judeo-Christian values on the populace.

We claim to have religious freedom yet we don't when the religious are able to use the force of law to impose their religion on us at the time of our death - the time we need freedom from their religious nonsense the most.

This appears to be the same for the Netherlands which is around 5%. Although like Canada, the Netherlands is seeing an increase in a yearly basis. It isn’t clear when this plateaus.

I am not an expert in end of life care but I think it is messy for a lot of people (eg dementia) so it may become quite a high number eventually.

They're expanding it to more and more, notably drug addicts.

This will keep increasing. The government has a strong incentive to do this.

End of life care is incredibly expensive. With an aging population this because a major issue. It makes sense.

At least you're being honest.

I've known 3 people of my grandparents' generation to survive over a decade after their dementia had progressed to the point that they couldn't recognize their children, their spouse, etc., and life was a confusing, terrifying existence without being medicated into further oblivion. They were all highly religious and would not have considered MAID when they were lucid enough to do so. Folks of my parents' generation have seen enough similar cases, they don't want to put their children through that. So yes, I do believe the rate of MAID will continue to grow as the Silent Generation dies out and Boomers enter their twilight years.

> life was a confusing, terrifying existence without being medicated into further oblivion

I thought that was just life already. I feel like most people don't pay enough attention.

It gets worse: you could be imprisoned in a care facility, with no recollection of how you got there, no recollection of anything really, occasionally punctuated by visits from doctors and attendants you've never met, getting in your space, putting their hands on you... but hey, the pudding is a universal fave.

I assume when my time comes, I'll just be thrown into the street. I already see plenty of mentally incapacitated people living there. I guess I'd take your alternative.

>To access MAID, an individual must have a serious illness, disease or disability which causes irreversible decline and unbearable suffering that "cannot be relieved under conditions [the patient considers] acceptable," says the federal government.

>"We should be ensuring that we never get to that point because we have better care available," Vachon said.

This seems like wishful thinking. Ultimately until we have regenerative medicine (SENS etc.) people are gonna get old and die. Trying to keep them alive even when they have terrible quality of life is not necessarily a humane option: https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...

Sometimes I fantasize about replacing end-of-life care with a cryopreservation option. Given how expensive medicine is, with economies of scale, I could imagine cryonics being cheaper than current end-of-life care. And it actually delivers on the promise of possibly giving people a meaningful extension on life, depending how medical technology develops in the future.

I'd be especially excited about replacing my current health insurance with a cheaper health insurance option that aggressively cryopreserves me (instead of taking care of me 'til the end) if I get a terminal illness.

Fun fact: there are north of a million cryopreserved persons in the USA alone right now.

Can you provide a source for this claim?

I can not believe it is that high? Really?

I understand that the ice crystals created in current processes basically further destroy the tissue so that rranimation is likely impossible.

It is. Here[1] is one source.

[1] https://www.elle.com/culture/a12445676/the-leftover-embryo-c...

Oh, embryos. That is a little different.

This paper says there are 200:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275130/

(well, it says "more than 200" as of 2010, but that's unlikely to mean "north of a million" today)

Cryonics has been a thing now for what, 50-60 years? In that time has anyone ever been a) brought back and b) saved with a medical breakthrough?

No. The focus is on far-future speculative medical technology. Cryonicists tend to be very concerned about making sure that cryonics organizations are fiscally solvent for many decades in to the future, so they can keep everyone cold.

My attitude is, I think the odds of cryonics working are a lot higher than the odds from praying to $diety. If I'm gonna be dying anyways, no reason not to roll the dice.

It's a pity there's not a good indication of how many of these MAID deaths fall into the "certain death within (say) six months otherwise" category.

Choosing death on your own terms, should you so wish, rather than suffering through irreversible decline and suffering is not a bad thing by my reckoning.

I question why inevitable death or substantial decline even have to be criteria, if someone sincerely wishes to die that should be their right.

We are all brought into this world unilaterally without any regard to what we might desire, the least we could do after that fact is let everyone end their existence on their terms.

Yeah my take is, instead of preventing people from killing themselves, the government should use it as a key performance indicator for social services. For example maybe you'd go through a survey/"exit interview" before getting the pill, and the government could keep statistics on how people are responding in order to know what could be addressed. I'm not keen to remove the option and force people to suffer in silence.

I'm doubtful that Cardus[0] would advocate for better care:

FTA:

Here’s just a quick snapshot of some of the think tank’s latest research:

• One report, titled “Marriage is good for your health,” claims the traditional institution of marriage has numerous “health advantages,” including “quicker recovery from illness” and “better odds of surviving a heart attack” while an additional report claims common law relationships can lead to “negative health outcomes” – neither report is authored by a medical doctor.

• Another report accuses the International Monetary Fund of “coercing Canadian mothers into the workforce” by calling for childcare investments, while other reports argue social assistance for single mothers gives them an incentive to never get married.

• Elsewhere, the social conservative think tank, which says it is called upon to uphold the free market, calls on unions to stop focusing on collective bargaining and organize social activities for their members instead.

[0] https://pressprogress.ca/why-is-the-media-citing-this-social...

I can agree with them specifically with regards to the odds of surviving heart attacks. If you're alone in your home and you drop to the floor suffering a heart attack, you're almost guaranteed to die. If someone (eg: your spouse) is nearby, you have a slim chance of waking up in a hospital room.

As for the other stuff though: Screw that noise.

Yet they're not advocating for living with roommates, they're pushing a binding institution with legal and social consequences. Because they don't care about peoples' health at all, they care about pushing narratives of marriage being good.

> Trying to keep them alive even when they have terrible quality of life is not necessarily a humane option

Maybe this is too off-topic, but I've always thought that vegetarianism is not a very well thought through philosophy. Animals kept alive under uncomfortable, stressful, and undignified conditions are ok but putting them out of their misery is not? I know there's a wide fuzzy boundary between the two (some dairy cows are really happy; some slaughter cows die slow, painful deaths) but it doesn't seem like the quality of life of dairy cows, egg-laying hens, etc. is considered. Personally I'd much rather die than be forcibly impregnated, separated from my child, and milked, repeating this cycle for years.

The vegan argument I've heard is that buying animal products creates demand for more animals, which leads to more miserable animal lives. See e.g. https://reducing-suffering.org/how-much-direct-suffering-is-...

Yes, that's veganism. I understand divesting completely from animal-based food production. I'm speaking to vegetarianism.

People choose vegetarianism for different reasons, not only compassion for animals. Those that do it for animals but still drink milk could be unaware of how dairy operates, or they could be making an effort to be more humane than average, while under constant counter messaging from the food environment around them. It's a wide spectrum, vegetarians aren't a homogeneous group.

When life has no value, it is easily discarded.

You must first master fear, or fear will be your master.

He who questions training only trains himself at asking questions.

Shampoo is better. I go on first and clean the hair. Conditioner is better. I leave the hair silky and smooth.

Stop looking at me swan.

If early-21st-century ethos teaches us anything, it's the opposite.

When life has no value, we can finally iterate effectively to achieve enlightenment:

https://www.youtube.com/watch?v=_DRJ-Wwj6_A

NB: This guy beats all four bosses a second time! And why? Just to find out if there's a special ending for beating them all during the same run.

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