It’s not that simple. Granting a right to die shifts a heavy burden of responsibility onto the patient. The current situation in most countries is that euthanasia is not legal. That means the patient’s family had a sense of obligation to support a terminal patient as best they can for as long as they can (and in geographies with universal healthcare “family” extends to a much broader definition of society). Granting the patient the right to die also puts them into a place where they have to make considerations about how much of a burden they are to those around them. The status quo allows a terminally ill patient to be selfish without guilt (well, modest amounts of guilt) because the alternative is illegal. It comes at the cost of undue suffering for many at the end. The alternative shifts this and risks people who’d have otherwise been able to eek out some continued enjoyment from what remains being forced into a thought decision out of a sense of guilt and obligation to not burden those around them.

It’s a complicated issue with lots of unsatisfying trade-offs. I’m personally conflicted about which path is better. It’s definitely not as simple as obvious as to which way is better that people want to imply.

Hard disagree. People already kill themselves. They already reason about how much of a burden they are and they already kill themselves because they think they are too much of a burden. People already do everything that you said.

The only major difference between the two worlds is that in one, death is grizzly, painful and traumatic and usually preceded by an enormous amount of suffering — and in the other death is none of those things.

You are clearly very naive and you clearly have never been in the position of needing to die.

I found his opinion enlightening and pointed, unlike your own, rather barbed, post.

Also, being in a "position of needing to die" isn't an absolute predicate for debating this issue.

Apparently it is because the only people who find themselves advocating it are people for whom the topic has become real rather than just words on a screen. Just like everything else in life. Nobody gives a shit until it’s their own skin.

>Nobody gives a shit until it’s their own skin.

I hope that your life improves and one day you can meet emphathetic people who do give a shit about others skin. Maybe that day, you can make good posts online.

Interesting. The fact that people already do kill themselves regardless of it being permitted or not seems to me to be an argument against legalizing it because it being illegal doesn't stop many people... but it may help them avoid being coerced into it.

I wouldn't care to argue that case-- I think assisted suicide should be legal, but the concern that the legality of it can lead to people feeling pressured into it seems quite legitimate to me.

There's a huge difference between attempting suicide and succeeding. Also, there are people who aren't physically capable of trying.

Legally forcing people to live just to suffer is wrong.

You're arguing we should force people to live against their will in terrible pain so that a few people don't have to feel guilty?

How many people have you watched die? By the time you get to the point anyone is talking about hospice or refusing life saving care that person's life has been nothing but misery, pain and suffering for a while.

This kind of comment is exactly why I'm glad you don't have the option of deciding that my life is not worth living.

I'm not sick or anything right now but people who say things like this terrify me.

Everyone is going to have to depend on other people's judgement sooner or later, and by the numbers, most people still think there is some kind of soul or afterlife, or at least don't assume there isn't! The only protection from people like that is for there to be no mixed messages and no option for them to commit what they believe to be mercy.

> I'm glad you don't have the option of deciding that my life is not worth living.

The comment you are responding to is not asking for the option to decide if your life is worth living. It is asking for everyone to have the option to decide for themselves if their own life is worth living.

> I'm not sick or anything right now but people who say things like this terrify me.

Things like what?

He is also saying that you don’t have that option either.

I made no such argument. I even specifically called out how conflicted I am in how to even assess what the right answer is.

To answer your question: numerous, with a multiple of that impacted in terms of the long painful witnessing of someone dying and/or carrying the emotional and physical burden of supporting the patient. Which is precisely why I am so conflicted.

Though I feel like your question was rhetorical and not an actual attempt to engage in understanding an alternate perspective.

Your experience must be vastly different from mine.

Did you have the experience where people were talking about end of life care before the afflicted individual was ready to go, and you believe if euthanasia were legal they would have pressured the individual to go through with it?

Yeah... if you continue that idea, you just might end up with a society where everybody customarily commits suicide at the age of 60 to avoid being a "burden to society", like in this Star Trek episode: https://en.wikipedia.org/wiki/Half_a_Life_(Star_Trek:_The_Ne...

This would greatly increase our ability to enjoy our earnings instead of having to save a retirement fund large enough to take us to 90. Sixty is silly, though; my parents do more for me than I do for them and they're 70.

> It’s a complicated issue with lots of unsatisfying trade-offs

I can't see it as complicated. The absence of a safe, legal exit for the terminally ill is unethical.

I understand that death affects more than just the individual passing, but that doesn't give anyone a right to force them to suffer.

If this issue is personal to you, I am sorry. It is for me as well.

Nurses will do it, too.

My Mother worked in the palliative unit and shared stories about how the staff regularly collectively decided to inform the patient that the button to administer morphine was in their control, and that they controlled enough dosage to peacefully end a person's life and so to be careful with it. Patients routinely ended their lives. This would have been in the late 80s, in Canada.

Since then Canada has legalized medically assisted dying; and I wonder if the increased regulation has made it _more difficult_ for patients to access it. No longer can a ward of palliative nurses simply opt to inform patients of their ability to die, but now those patients need the approval of doctors to do so.

Yeah this account of mine has been kept separate from my true identity as well as I could, but I think I've observed this when my SO passed. They were also in palliative care from cancer.

I'll never forget that last night, I slept next to them on an extra cot.

I won't go into details because of the survivors but my SO had a new machine that was keeping them awake.

They were suffering.

The nurse gave them a very strong sedative. They curled up in their favorite sleeping position and went to sleep. Just a couple hours later they stopped breathing.

At the time I was in shock but I remember thanking the nurses when we left the ward and calling them angels.

> to inform the patient that the button to administer morphine was in their control

Sometimes (I don't have a statistic) in Israel this is used for placebo effect. Patient doesn't control anything, but still might feel a relief.

Typically its not that they have no control, in the cases you're talking about, but the machines do have specified dose limits still. You can press the button as many times as you like, but it typically won't let you hit yourself with a gram of morphine or something. So in that case, I can see the button being an applied placebo effect.

Is there any reason why the new law would make it harder for the nurses to do that?

Probably because now that there is a protocol, an ethical nurse would feel compelled to follow it.

I recently heard about this in my stage 4 support group. No doctor will go on record that they do it however. God forbid there be dignity in choosing when to shuffle off the mortal coil.

Being a doctor must be tough. My brother is a doctor, though we aren't close or even on speaking terms. But I hear his tales via our mom.

A recent tale is that a family member got a bad cancer. Our mom called him to get the scoop, who he'll only give to her, apparently. He said 'Mom, she'll be dead in two years. She'll initially respond really well to treatment, then just get worse until the end.'

Doctors know these things, but many won't tell the patient because it's depressing, and also there's a tiny chance they're wrong.

Of course neither told said family member, and she's currently in the responding well phase. It's shattering hearing their hope, so I guess their doctor wasn't blunt either...

My mother spent thirty years in the OR saving cancer patients, so I know a thing or two about this topic. Different patients respond differently to treatment, life expectancy can vary greatly even in the terminal stage, so doctors are unlikely to know “she'll be dead in two years. She'll initially respond really well to treatment, then just get worse until the end.” Delivering that information when there actual is non-negligible hope left would be imprudent.

I think the pendulum might be swinging the other way - me and a lot of other folks in my stage 4 support group got given a very grim diagnosis and subsequent prognoses from our oncologists even though the 5 year survival statistics are outdated.

It was quite depressing in the beginning but after connecting with some people who have survived years past their onc's expiry date, I feel hopeful.

I'm hopeful for you!

Apologies if my previous comment was doom and gloom - was just thinking about the things doctors do and perhaps even know and have to decide... sounds incredibly stressful. But of course that was one specific case, and every case and person is different.

Anyhow, stay strong, and best of luck to you, truly.

> My brother is a doctor, though we aren't close or even on speaking terms

Given the nature of this post, maybe consider working on this relationship and at least getting back to the point of talking to each other.

Thanks.

Rereading what I'd written sounded awkward, I guess I was trying to explain it was third hand information without being evasive/mysterious.

Didn't mean it as a complaint or even bad thing. Last time we saw each other he kept making incredibly racist comments about and even to my (nonwhite) wife and kid's face - it was the first time they'd even met!

> Last time we saw each other he kept making incredibly racist comments about and even to my (nonwhite) wife and kid's face - it was the first time they'd even met!

Well, that's certainly unfortunate. I honestly do not know how you can bridge a gap that wide.

Yes — my grandfather, who had a chest infection aged 99¾, was given an increasing amount of morphine for the pain (instead of antibiotics). The death came at the point he could no longer recognise his children, where his quality of life was basically nil. It was a release.

There is nothing illegal about causing death in the pursuit of treatment or reducing pain and suffering. It's obviously a fine line, but giving a patient who is in severe pain so much morphine it hastens their death is not illegal.

God bless you.

I always felt reason right to die isn't universal is religion. It makes it hard to argue logically when the other person has orders from above that suicide is a sin.

For what it's worth, I have concerns about legalizing suicide, and I'm not religious. My main concern is there's no changing your mind. A friend tried to commit suicide, and she is grateful every day she was stopped. I'm deeply uncomfortable imagining a legal and economic reality where people in distress can make such a decision quickly and permanently. This is not the same thing as euthanasia, and not intended as an argument against it. I have some concerns about a slippery legal basis, but I'm confident we could successfully separate these issues.

A friend of mine succeeded just over 6 months ago and I regret not joining her every day. I live in a gun-free country so no easy way out. I’m currently in a rural area and considering bashing a policeman’s head in to get his gun and get it over with. The alternative is synthesizing Nembutal myself. All the other techniques are riddled with risks of failure.

I know too many people who regret their suicide attempts to let this comment go unanswered: Call whatever service is available in your country to speak about your thoughts.

I’m not going to involve myself any further, because I’m afraid I’d do more harm than good.

Please don't involve another human if you have to do it.

ok i wont

I know from personal experience how seductive and attractive thoughts of ending your own life can be. Imagining and looking forward to the escape from this horrible world can be so full of joy. The calm, clarity and bliss you experience is only known to those that have been there. But you are clearly looking for help. Otherwise you wouldn't have posted this. You would just have done it. Risks of failure? Anyone can find safe and foolproof methods on the Internet. So this is clearly not what you are looking for. Seek help. Doing this always feel like failure. But you become empowered. You will grow. I did. Need a rope to cling to? Go stoic. Solid navigation methods for life and the world.

I'm sorry you're struggling so much. Having a close friend kill themself can be a major trigger if you're depressed. I've lost friends by their own hands before, and attempted once myself, so your comment worries me and I'm concerned for you.

One thing I've (personally) found helpful is keeping a bucket list, ordered from least to most dangerous/life-changing. If your job is making you miserable? Quit. Wanted to move to a different country? Get a tattoo? Go skydiving? Smoke DMT? Transition? Go for it! You literally have nothing to lose, relative to suicide.

I don't know your life, but I hope you do what's right for you.

Barbiturate synthesis isn't particularly easy, for what it's worth. Though that depends on what precursors and equipment/glassware you can get, and whether you have organic chemistry experience.

Hey, do you want or need to talk to somebody?

What is causing you enough pain to justify suicide?

Don’t forget about carbon monoxide. It would be much easier and less painful to just get a tent or car and a propane heater. Shooting yourself is way too risky in my opinion.

Legalising suicide means something different than what you seem to be implying. Legalising suicide means that we don't throw people like your friend into a prison.

Probably you are just using it as a shorthand for "legalising assisted suicide. I assume you live in a modern western country where the idea of punishing someone for trying to end their live is unthinkable. Sadly there are still countries where they would have punished your friend. Because of this it's better to be aware of the distinction between the terms.

Right to die is a fundamental human right in my book. It is but one of many rights curtailed by the sectarian majority. Abortion, kink, birth control, homosexuality… you name it. God hates personal freedom.

Sometimes I get the feeling the US medical industry is 50% people who would sell an allergy pill that gave ten percent of patients lung cancer and 50% people who would rather watch thousands of people die in screaming agony than test a pancreatic cancer treatment that caused erectile dysfunction.

No this isn't true. There are many things wrong with the medical industry, but this takes it too far.

I don't think it's appropriate to debate about policy here. Her final blog post isn't about that.

The fact that she can’t legally die in her own country even though she has a terminal illness and that she mentions she is worried that if her family and friends knew where she is going that there might be legal repercussions does open the debate to policy imo.

"Her"

edited

Survivors can vote. I got to watch my mom die of cancer like this.

I'm reminded of the line from Constantine, where he says, "Like pulling demons out of little girls. WHO IS THAT FOR?"

https://youtu.be/-828wM9lpLw?t=107

It’s worth voting, too. It’s one of few things I’ve advocated for in my life but I’ve actually seen real progress in my country and in many others.

I also watched my mom suffer a terrible death (a rocky 7 year decline into pain and madness), and she literally asked us to help her die many times along the way. She only stopped asking once her mental faculties left her. Her suffering was intolerable and we weakly watched her endure it out of fear of repercussions if people found out her death was assisted. It hurts so much to think, had she gotten sick only a little later, she could have left with some dignity and knowing who her family was. If only more people had supported the movement sooner!

It’s absolutely worth every ounce of support to give people (and maintain) the right to die.

So after my brother passed this was one of the things our family discussed with the palliative care doc and the therapist assigned to our family by the insurance company. The way it was explained do me, and take it or leave it as you will, was that while morphine can certainly end a life, in most end of life scenarios the morphine has two roles: it reduces pain and suffering, and it actually makes breathing easier (even while it depresses respiratory rate). In my brother's case it was her opinion that it actually extended his life.

I'll never know if that was just what I was being fed, but my wife is an NP and has never shot that down, and she's not shy about correcting medical misconceptions.

I've seen this in action with a wealthy old 90+ friend of the family. At the time I was very young and thought it was odd how well timed our visit was, with him dying there only a few hours after, doctor at his side, in his home. (Perhaps it was just a nurse?) I distinctly remember the adults whispering to each other about how he was being medicated to take care of his pain, and his breathing; there was a very long pause before each inhale.

No, the problem is the slippery slope of "this patient wants to die because their life isn't worth living" to "this patient can't communicate, but it's clear their life isn't worth living, so we should end it".

I just do not see the problem. The urge to live is way stronger than a bad week. The urge to live is strong. And we already have systems in place to determine the course of medical treatment in the case of unresponsiveness, all you’d do is tack on euthanasia.

It’s not your business to determine whether or not a person should live. Why don’t you sit in the corner with people who think it’s their business to determine whether or not women have abortions?

If you think euthanasia is like abortion you're already contributing to the slippery slope by conflating different situations, but hey nuance has never been HN's strong suit.

"It’s not your business to determine whether or not a person should live.", as a member of society it sure as hell is. If some woman is suffering from post-partum depression (highly treatable) it's societies responsibility that she get proper treatment and not support for killing herself.

Violating the rights of a minority group based on a moral crusade to “save people”. It’s definitely similar. Similar also in the insane amount of suffering it causes. If you care so much about depressed people then donate some money to the effort to find a cure instead of causing innocent people to suffer with your armchair morality lectures

Wait, you're "violating the rights" of a depressed person (who isn't capable of actually judging the situation accurately) by not helping them kill themselves?

You're so far off the mark I'm not sure where you are.

The dead can't vote but their survivors sure can.

> The only reason right-to-die isn’t something universal is because the dead can’t vote

Oh cut it out. This is a gross oversimplification of an overly complex moral quandary. It misses the point on both sides of the argument -- the agency of the dying and the sanctity of life -- for cheap reddit upvotes. At least familiarize yourself with some of the literature before trying to contribute to the debate.

I think you’re right. It is too complex for a thread like this. But instead of literature my opinion is informed by my own firsthand experience with terminally ill people and my own fear of dying in an uncontrolled way. But you’re so right that the complexity of these things must be appreciated.

This comment is very black and white for a complicated topic. Personally I think people should have the right to die in a carefully regulated and administered fashion, after they have received appropriate counselling and support. The support is essential. However in real world application there are only relatively few cases where euthanasia is arguably the 'best' option. I am very much at the coalface of this issue if you are concerned I am an armchair commenter.

Doctors and nurses don't generally euthanize people. Pallative care are actively against the concept and do research showing that various strategies for symptom management do not shorten life. If someone is suffering a lot from pain or shortness of breath, they will receive escalating doses of drugs which can cause death, but the reason for administering them is not to cause death. The distinction is important.

When someone is suffering a lot, they should receive good symptom support and unnecessary investigations and interventions should be avoided. This means that all the blood tests, blood pressure checks, X-rays, nutritional support people would normally undergo don't get done. Is that a form of (perfectly legal) euthanasia, if an easily correctible but otherwise fatal problem doesn't get fixed?

There are underground euthanasia practitioners for sure. These are doctors or nurses who take it upon themselves to administer fatal doses of medication to people who want to die. Invariably this is done at home. I've heard terrible stories about when it goes wrong.

I live somewhere where there is legalised voluntary euthanasia or assisted dying as they call it. Patients go through a process where they are assessed by two doctors (who have been trained specifically) and then when it is approved they receive medication they can take themselves. It works well generally. But is not a fast process. Patients with cancer certainly die during the process. And they don't die in agony. Modern palliative care is excellent, if you live somewhere where it exists, particularly for cancer.

The part missing from your analysis is that the health care system has limited resources, and properly assessing patients for and administering euthanasia takes a lot of resources. It is not much of an exaggeration to say that it is easier to die than to see a psychologist where I live. The doctors who do the assessments are not seeing other patients. The money used to pay for the assessments etc is not being spent elsewhere (it's a socialised healthcare system). Even if the patient pays for everything, you are still using up time and expertise.

The 'easy' cases for euthanasia are people with degenerative neurological conditions where there is no treatment available, just gradual slow descent into disability. Cancer is more complicated - patients can be very well until close to the end, and they are often having ongoing treatment. It is hard to be considing euthanasia while hoping the next clinical trial will work. Cancer patients also tend to die quickly.

For major organ dysfunction like heart failure, kidney failure, liver failure, it is possible to withdraw active medical support and therapy and patients will die fairly quickly, while also receiving symptom support.

Euthanasia for mental illness I find would be almost impossible to implement. Euthanasia for chronic pain I think would also be very difficult. Euthanasia for dementia has obvious problems too, although we all tell our partners to push us off the pier when we can't do the crossword anymore.

Some people just want to die because they are too old, fed up etc despite no serious medical problems or overt mental illness. I don't know about this. I am not sure a medical system can support this kind of choice, it is 'out of scope' to my mind, a kind of medicalisation of the human condition. There is a complicated spectrum from 'Completely well and wanting to die' and 'Severe imminently fatal illness and wanting to die.'

> although we all tell our partners to push us off the pier when we can't do the crossword anymore.

Wow. Let's not generalise. We "all" definitely not tell that to anyone.