The problem isn't maid per se. It's the utter failure of the welfare state from catching people sinking that's to blame.

Canada’s welfare state is pretty good though. Healthcare is paid for. I would be interested to know what percentage of people using this maid program are doing so specifically for economic reasons.

"Paid for" does not necessarily mean "good" just as "expensive" doesn't necessarily mean "bad."

I'm not trying to opine on the Canadian health care system, as I've never experienced it nor given it much thought, but arguendo, if a part of the calculus for wellness is "is it cheaper to kill them?" that would be a deal-breaker.

(Again, not saying that's what is happening, but I am always skeptical of the payor's ability to dictate the treatment for reasons you can infer)

There's such a sliding scale of what is good and right here, and I think reasonable people can draw their lines at different places. Plot these as points on a line, and I think everyone will draw a line somewhere:

  * suicide should be allowed
  * medically assisted deaths are different from suicide and should be allowed
  * people assisting in death should be prosecuted
  * if it is hard for law enforcement to distinguish assisted suicide from murder, prosecutions are allowed
  * it is okay for your doctor to prescribe death
  * it is okay for the state to encourage death as the most cost efficient means of care
  * it is okay for the state to withhold care if it is too costly to administer
  * it is okay for the state to kill anyone they deem burdensome

A definition of "good" may still contain characteristics that cross a line that a reasonable person has drawn, and I can't imagine how someone might convince another grown adult to draw their line somewhere other than what feels intuitive.

Incentives are different between state and private actors. The state has many tools at it's disposal to encourage or even force suicide (aka, murder in the latter case). The state is the ultimate arbiter of whether or not someone is mentally incapacitated, thus they can determine who lives and who dies.

I can't think of anything more shameful than encouraging a non-terminal person to kill themselves.

There is already a calculus of cost per annum applied to medical interventions in the Canadian health system -- eg, we wouldn't give a heart transplant to a 96 year-old, generally speaking.

Also, suicide hasn't been illegal in Canada for 50 years!

"Canada’s welfare state is pretty good though." It's not. Not at all! If you have a positive experience please share it. Also please provide a comparison, even anecdotal one.

My wife gave birth to our three children. Here are the costs:

First child: $10.00 Second child: $10.00 Third child: $2.50

These were the parking fees for 24 hours (there were no complications necessitating longer stays) in the two different cities she gave birth (the third child was born in a much more rural area with cheaper parking). I cannot stress enough that it cost us $0.00 beyond these amounts.

These costs include the use of a midwife in all three instances, with around 12 visits in advance of birth, then 2 midwives or 1 midwife and 2 nurses for the actual delivery, then 4-6 visits with the midwife post-birth, several of which were in our home.

I would say that’s a positive experience.

I don't follow really. You are comparing $10 to what? I can't think about a lot of countries with 'paid' childbirth. Also while childbirth falls under the health care I wouldn't think about it if asked. Also, lumping parking there? Why? In the poor country I'm originally from ambulance riding is free, and yes, one additional person can ride it too. I would think about illness treating first and foremost if asked about health care. Your comment is just sad to me.

I think the majority of HN readers seem to be American, so the costs are drastically different where births can be 10s of thousands of dollars, even with insurance. That’s why I brought it up.

Any country that does free childbirth and ambulance rides and appointments with doctors and specialists, I would suggest has an excellent healthcare system, even if not perfect.

Nearly all legal residents of the US are either eligible for Medicaid or covered by insurance. The average out of pocket cost of child birth is under $3,000 for people with insurance and free for people on Medicaid.

Births to illegal immigrants accounts for about 5% of child births in the US. These are not covered by Medicaid, but are covered by some state health systems. To my knowledge, Canada does not extend healthcare to illegal immigrants either. https://nationalpost.com/news/canada/illegal-immigrants-have...

My brother just had a quadruple bypass and he's recovering nicely. Cost $0.

I had many positive experiences with it when I lived there. It wasn't perfect, but it was far better than what the US has.

I can't comment on welfare etc but the healthcare system is good. I've had mostly good experiences. Probably the worst part is getting a GP.

Healthcare can encompass a lot of things. The NHS is supposedly good on paper but stereotypically it doesn't cover dental.

Similarly, I meant welfare. I think it goes much beyond just healthcare. Unemployment insurance, state help to access the job market, disability help, etc.

It would be nice (though likely impossible) if everyone could have unlimited assistance to make their life manageable. But even if that were available, we need to keep in mind that others may not want to continue their life for various reasons. Just because it is theoretically possible to keep someone alive doesn't mean they want that. Living life feeling like a burden to others, being in constant pain, or drugged out completely to avoid pain is not a life everyone would choose to live.

So if someone chooses to die, don't always look at that as a problem that could have been fixed with enough resources. Sometimes it's not fixable and we all need to compassionately accept that.

I usually find this reasoning to be fallacious. Sure this hypothetical person in an hypothetical setting might hypothetically exist in an hypothetical future. However, bringing it up doesn't provide value to the topic at hand.

Your point doesn't refute what I said, or answer a point I made -- I never said it was always a problem. At best I said it very much was now.

You've apparently never been in a precarious health situation. I have, my mother has, and she chose to end her life because her daily living situation had deteriorated to the point where she could no longer take care of herself. And no amount of money or increased healthcare would have changed her circumstances.

> So if someone chooses to die, don't always look at that as a problem that could have been fixed with enough resources. Sometimes it's not fixable and we all need to compassionately accept that.

There are different forms of acceptance. Yes, accept that some cases are not fixable. On the other hand, we should also be looking at what led to it being not fixable. There is a huge difference between seeking assisted suicide due to deteriorating physical and mental health from medical causes and seeking assisted suicide due to a lack of medical, psychological, and financial support from the outset.

There's a word for people who think health care is very good.... "healthy". There is nothing like illness to dissuade you of that belief. I'm not talking about the cost, or administration of healthcare, which of course is often lousy (esp in the US). I'm talking about it's capabilities, which is a universal problem.

> It's the utter failure of the welfare state from catching people sinking that's to blame.

You can blame policies and programs, but in reality the issue has always been the value of human life.

If human life isn't valuable then ending it is easy.

How does "valuing human life" help people who would be deaths of despair under a program like this? That just sounds like idealism.

Life is ultimately valuable, that's why allowing people to have complete ownership over their own destiny is good.

Forcing people to die in pain, misery, and utterly debased is a misplacement of values in my opinion.

And this is often than not a symptom of capitalist valuation. The value of a life is too often viewed as economic [1].

[1] https://www.researchgate.net/publication/354671644_VAluing_L...

> pain, misery, and utterly debased

I think this is because we often see pain and misery as "bad things" that must be avoided at all cost. This tends to lead to the assumption that people who have pain and misery in their lives don't have "good lives" and that the only real option then is to end it.

Pain and misery have purpose and meaning. It can cause people to look beyond themselves. Some very beautiful things have come from people who were in deep pain.

> Some very beautiful things have come from people who were in deep pain.

Could it be cruel to put it this way? I'm imagining people living in pain and misery having their suffering distilled into some sort of artistic achievement or pretty "chicken soup for the soul" anecdote that you can consume from the comfort of your home office or living room.

It's almost like saying that their suffering causes you enjoyment, albeit in a roundabout way.

I grew up Southern Baptist in the rural South where "chicken soup for the soul" type fare was very popular and until I was about 12 I would sit with the women in my family after church listening to them swap stories and many of them would have this sort of flavor. Of talking about people's misfortunes and sharing how sorry you felt for them, or how their struggling led them to do something heroic or noble or caused them to get "saved." Sometimes I would be so moved that the hairs on the back of my neck would stand up and then I would feel bad about the enjoyment I was obviously getting. Like we were emotional vampires sitting around relishing all this bad stuff in our little circle.

Is it bad to share stories of people's suffering and bond over them? I suppose not. It just feels off and I don't know why.

It would be a cruel person indeed that would suggest that someone must suffer in agony because it suits their definition of morality.

Tthe health care system works like that sometimes.

An old person had late stage skeleton cancer, extreme pain, drugs didn't help. He wanted to die. The health care system kept him alive against his will for as long as they could

In that case I suppose the reason was instead covering one's own back.

Even the Catholic church firmly defends such people's right to refuse further treatment, and even to terminal sedation (painkillers that will shorten your life by a lot as a side effect). If the health care system actively kept him alive against his wishes, that's on the health care system.

You are using death as a panacea that makes all other treatments pointless.

It depends on the kind of pain, the kind of misery, doesn't it?

Temporary deep pain, that's one thing.

Permanent never ending deep pain and you're old and just waiting to die, that's different.

Or Alzheimers.

> we often see pain and misery as "bad things" that must be avoided at all cost ... only real option then is to end it.

I never heard anyone say anything remotely like that. I believe you're mistaken?

Did you hear someone say that or you're hypothesizing

With that said, the doctors in the article seem crazy, and this: “MAiD is the new society safety net”

Your judgement that my life has purpose and meaning should not be final if I don't agree. I'd rather not suffer just because you find it meaningful or think I should.

But euthanasia laws require a lot more than him getting out of the way with his belief (common to everyone who stood up from bed today) that life is worth living.

It requires, if he is a doctor, that he gives approval to your choice, and in compassion's name try to relieve you from the burdens of guilt and doubt you might have from your choice.

It doesn't just mean accepting that you say "my life is not worth living", it requires them to say, "Yes, your life is not worth living".

Opponents said this was a can of worms, and it seems harder and harder to deny from what's happening in Canada.

(And to repeat, terminal sedation, treatment that hastens death as an unfortunate side effect of trying to relieve pain, as well as refusal of life-prolonging care, is defended even by hardline opponents to euthanasia laws).

What if the increasing welfare state is what leads to people sinking en masse as we see here?

No. Killing poor depressed people isn't a failure of the welfare state but a deliberate choice by the people behind this program

I once attended a memorial lecture on euthanasia at Oxford university. It started with euthanising people who are in great pain and are obviously going to die in the next 24 hours, and by the end a psychologist in the audience was arguing for euthanising depressed teenagers.

It felt like we hadn't just slipped down the slope, we basically rocketed into the ground. I will never support this movement.

In US the government is allowed tk kill you - as apparently capital punishment is constitutional.

Yet you are not allowed to kill yourself? I don't think that morally defensible

If you wanna eat a bullet I'll buy you the bullet. That's your initiative.

My issue is when the medical system, which has a pretty crap track record when it comes to dealing with people who's suffering is curable, starts offering suicide to people as an out. These institutions can't put people on the right pills and we're supposed to trust them to suggest (or not) that people end their lives?

I can't eat wheat. I don't know if it's the gluten or if I'm celiac. Nobody diagnosed me.

Wheat bloats my stomach and clogs my intestines almost gas tight and sometimes the pain can be extreme because it feels like your intestines are being torn apart.

This makes you feel like your own body is conspiring against you because society has decided to put wheat everywhere and everyone else is fine and the doctors tell you it's not the wheat. From this perspective the "sane" choice against generic unexplainable suffering because of randomly occuring physical pain would be to get a different body but that isn't possible so suicide it is.

Except, my solution is peppermint tea and avoiding wheat at all costs. I don't care how many people tell me that I don't have celiac disease or that I should be able to eat wheat. I can't, I know my body better than the doctor or you or the industrial complex that puts wheat everywhere.

Suicide is not euthanasia. Assisted suicide is not euthanasia either. Forbidding people from killing themselves is just weird. Who are you to decide what I can do with my life?

At the margin it creates an incentive to not commit suicide, or to make damn sure you succeed if you do. In a time when suicide was viewed more negatively, I can see why such laws would exist.

>Slippery slope is no longer a fallacy, I guess.

It is validly one of the 15 logical fallacies used to illustrate parts of arguments.

I think this might be historical revisionism. The idea that all conversations about assisted suicide 20 years ago were solely about the extremely disabled seems unlikely.

In a society that does not give any value to people's lives beyond their productive output, this will inevitably be an outcome of euthanasia. It merely provides a more dignified alternative to the existing paths to what we call "deaths of despair".

People who were forced to starve, to subsist, to suffer empty, meaningless lives of toil and/or misery, now have an alternative to the continuation of their suffering. This does not mean the alternative is good, but neither is its absence.

One would hope that seeing how many people would rather choose to die in their own terms, as opposed to continuing to toil to enrich their landlords while they have to choose between food and heating, would steer us towards building a better society, one where people have not only freedom, but autonomy over their own lives.

And if it doesn't, well, then I suppose I'm glad we have an alternative to the society we're building.

>People who were forced to starve, to subsist, to suffer empty, meaningless lives of toil and/or misery, now have an alternative to the continuation of their suffering.

Hope you don't find yourself in that demographic at some point of your life.

Suicide has always been an alternative, as is just suffering quietly for decades and ending your life naturally with no lessons or meaning to your suffering.

My wife was very suicidal in her teens and early twenties. She tried to kill herself a number of times and even ended up in one of those infamous padded rooms. Long story short, she's no longer suicidal and is happy she wasn't successful. I don't agree with expanding scope to "mature minors": life is change but life as a minor is breathless transformation we can't even cognize for ourselves until years later looking back.

Thank you for sharing this. I do not know the specifics of the Canadian law on this matter, so I will not comment on those. I understand the concerns raised about it -- the topic requires the sort of nuance that is so often absent from bureaucratic processes.

I also struggled with depression and suicidality in my twenties. My life also got better, and I am glad I did not succeed at killing myself. I do not advocate for assisted suicide as a solution for most problems -- just for those health situations where no real solutions exist.

My mother, however, is approaching her sixties. She's been depressed, like, really, majorly, manically, clinically depressed, for as long as I can remember. She's tried to kill herself many times, twice in the last year alone. She's tried every medication under the sun, some which have temporarily made things better, many which have permanently made things worse.

All she's heard from her loved ones, over the last thirty years, is that she has to keep trying. Always, forever, keep trying, through an endless trough of misery with no end in sight. Do yoga, sign up for courses, move away, move back, try CBT, try CBD, try SSRIs, try benzodiazepines, try anti-psychotics.

Try and then try again, forevermore getting nowhere, until you finally get to die in a way that your loved ones find socially acceptable. Because otherwise us, your loved ones, we'll keep rescuing you -- hell, legally speaking, we're forced to rescue you, again and again, unless you eventually get desperate enough to die that you don't even call to say goodbye.

I also hope that assisted suicide can be a revulsive for our profoundly sick society. Maybe if instead of letting people freeze, starve, be lonely and sick and sad, "fade out" in a way that looks like a "natural death" or an "accident", maybe if we counted them, if we kept a tally of the people who have gone to their doctors begging for death because their existence was untenable or unworthy of living, maybe that would force us to acknowledge them, to listen to their stories, to transform our society so that there's a place in it for them.

Or maybe it would just be another number to become desensitized to.

> People who were forced to starve, to subsist, to suffer empty, meaningless lives of toil and/or misery, now have an alternative to the continuation of their suffering

They virtally always had, though. Suicide is legal. Even when it isn't, it's always been an option, and people have always used it. Short of that, even hardliners like the Catholic church are explicitly fine with terminal sedation (medical treatment that is intended to relieve pain, but is expected to hasten death as a side effect) and refusing life-prolonging treatment when that is understood as only postponing the inevitable.

The culture war polarisation makes it sound like the alternative is keeping you alive in agony against your will and confiscation of your family's assets if you commit illegal suicide.

Nobody is proposing that! Everyone wants to respect people's autonomy. It's just that we feel denying you official approval for your suicide doesn't interfere much with your autonomy, and things like the feeling that you're a burden to your loved ones or wasting hospital time that could be better spent on others - can interfere a lot more.

That life is worth living is no small assumption. It's a huge one, and one of those which it is questionable if can ever be justified on anything resembling "objective" grounds. Please, don't even try.

It is nonetheless the assumption that is the basis for everything we do, from getting up in the morning to voting to obeying traffic rules to calling an ambulance if we see someone collapsing to the ground. Do we really have a meaningful alternative that involves not affirming it?

Suicide is not legal in many places, though it is correct that this is rarely enforced in any meaningful way. There are cases, however, where family members have been prosecuted for assisting terminally ill people in committing suicide. Technically, in many legislation, you have a duty to assist someone whose life is in danger, and neglecting this duty is a crime.

What you brush off as "official approval" can be the difference between a person's family members getting to say goodbye to their loved one before they die peacefully on their own terms, or them getting home one day to find their brains scattered all over the garage. It's about whether you get to make this painfully difficult decision about your life on the open, with the support of those around you, or whether you are forced to hide it from them, out of shame or to avoid legal repercussions. It's about whether your loved ones are able remember you as you were in life, or as the trauma, guilt and shame that followed your death. It matters a lot.

Life is worth living, yes. On the abstract, and on a personal level, I wholeheartedly agree. But I do not get to impart that judgement on other people's concrete lived experiences, to decide that their life is worth living on their behalf. Just like I alone decide whether mine is.

The real horror of suicide, for survivors, is not really about the mess, even though it doesn't help. If it were only that, I guess we could educate people about methods. But no, the real horror is that their loved one wanted to kill themselves, and did. We're not getting away from this horror with suicide, no matter how clinical and "clean" it is.

If you want to make the decision in the open with the support of those around you, involving them in your decision, I think you have to accept that they must be allowed to say "no, please don't do it", too. If you want their support, but don't give them that option, then it's downright cruel.

And assisted suicide laws impose that obligation, not on relatives, but on doctors. They're not just stepping aside for someone else's decision, they are demanded to accept it, support it and actively assist in pursuing the objective of death (unlike in terminal sedation and cessation of treatment, where death is not the goal). They have to do this even for people who are not terminally ill, who we know from statistics in many cases would have abandoned their wish to die and lived long lives.

I've known doctors from very different backgrounds (including non religious people, just so that's clear) who have been very disturbed by the prospect of being expected to do such things.

I think the options of terminal sedation and refusing life-prolonging treatment should be the extent of what we demand from doctors. That's no small deal, it is important that no one's life is prolonged by medicine against their will at the cost of suffering. But doctor's and the health system's obligations should stop there.

I think you severely underestimate the horror of knowing that your loved ones wanted to kill themselves, and didn't. Suffering is a state of being; death is an instant.

Of course those around them are allowed to say "please don't do it" -- but the person who's making the decision might still choose to do it. This is true, independently of whether assisted suicide is on the table. Regardless, getting to have an open conversation about it will be a better starting point for healing, for everyone involved. You can't say "please don't do it" to a suicide note, or ask it further questions so that you can better understand why they made that decision.

You have a profound misunderstanding of how most assisted suicide laws around the world work. Doctors are not demanded to do anything, and certainly are not held to any obligation to end the life of anyone who asks them to. They evaluate whether the request has validity based on medical criteria, and deny it or accept it on that basis. Doctors who object for religious or moral reasons are usually exempt from participating in it altogether. They definitely don't have to do it for people who aren't terminally ill -- although in some legislations, they might be allowed to.

I'm also unsure what you believe terminal sedation and cessation of treatment are. Death is definitely the expected result. Or rather, death is the means to achieve the desired goal, which is ending the patient's suffering -- just like with assisted suicide.

You speak of statistics where people have abandoned their wish to die and lived long lives. Did they live good lives? Can you, personally, promise to everyone in the world seeking assisted suicide, that if they do not follow through, they will live good lives? That their continued suffering will eventually end, or that it will be worth enduring?

I think it's the least you can do, given that you've talked to a dentist once or whatever, and that apparently gives you the moral high ground to make that decision, on behalf of all doctors and of all people who seek assisted suicide alike.

> You have a profound misunderstanding of how most assisted suicide laws around the world work.

I got into this debate through reading and engaging with four doctors, over many years. One of them, the one I knew best, is a professor of medical ethics now. I borrowed Rawls' "A theory of justice" from him. Managed to return it too. Don't know how this is relevant, but since you speculated about "talking to a dentist" I guess it is?

Can't say I know what laws are on the table at every point, but I think I got a reasonable overview.

The right to conscientious objection is certainly important, but I really can't entrust it to people who don't understand the difference between "accepting an outcome" and "seeking an outcome as a means to an end". You won't let us keep it for long.

> Or rather, death is the means to achieve the desired goal

That's exactly what it is not. The sedatives relieve pain, they shorten the patient's life as a side effect. An easy way to see is, imagine if the painkillers killed the pain, but the patient miraculously didn't die. Would you be happy? Of course. Both of you, generally.

If the patient was genuinely suicidal and wanted to die, they might not be. Not even if they recovered and went on live a long life.

So no, I can't promise them that they'll find out why life is worth living. But I can promise them a nonzero chance that they someday will. And if that chance isn't enough to make them stop actively seeking to end it, I honestly think they're not thinking straight.

> That's exactly what it is not. The sedatives relieve pain, they shorten the patient's life as a side effect. An easy way to see is, imagine if the painkillers killed the pain, but the patient miraculously didn't die. Would you be happy? Of course. Both of you, generally.

Let's set aside that neither the patient and the doctor would be happy about this at all, since the patient would still be in pain after the painkillers wear off, and the doctor would have failed to achieve the actual purpose of the procedure, which is to kill the patient. Sure, they're both happy about their shared failure because, I don't know, baby Jesus is smiling at them from the heavens or something, whatever.

So you're saying that, by applying terminal sedation, whose only possible outcome both in theory and in practice is the death of the person, the actual objective is to relieve the pain without causing the death of the person? The obvious conclusion of taking this absurd argument seriously is that every single doctor who applies terminal sedation is committing medical malpractice, because apparently they're all too stupid to not kill the person, as this procedure, according to you, does not actually intend to.

Please think about the bullshit you spew for a second before you press send. It's embarrassing.

> So no, I can't promise them that they'll find out why life is worth living. But I can promise them a nonzero chance that they someday will. And if that chance isn't enough to make them stop actively seeking to end it, I honestly think they're not thinking straight.

Wow. So everyone who doesn't agree with your blatantly pro-continued-suffering agenda is "not thinking straight", and therefore you get to force them to continue suffering, actively taking their agency from them, because... maybe magic? Hey, who knows, your suffering might miraculously vanish tomorrow, so suck it up, buttercup. Life is good, baby! Life is good! Except, well, for you it isn't, but why would I let reality get in the way of my pro-forced-misery ideology? And maybe, most likely, almost surely, this miracle will never happen. But what do I care? You're the one suffering, and I'm just grandstanding about borrowing books from fancy doctors on the internet. All's good on my end, anyway.

Truly spoken like an entitled know-it-all who has never suffered for a single second of their life. Embarrassing and shameful. All of those debates with so many doctors over so many years, and you still haven't figured out that the topic requires empathy for other human beings.

> The right to conscientious objection is certainly important, but I really can't entrust it to people who don't understand the difference between "accepting an outcome" and "seeking an outcome as a means to an end". You won't let us keep it for long.

Don't have the fucking nerve to tell me that I won't let you keep your rights for long. You're the one openly advocating against other people's right to end their suffering, their rights over their own minds and bodies, with no real basis except magical thinking and abysmal misunderstandings of law and medicine. Have some fucking respect.

I suppose this is an unpopular opinion, but when I am old or if I have a severe incurable disease, I want to choose how I die. And if a doctor has the grace to give me a dignified death, I do not want them to be prosecuted for it or to have to do it in secrecy (as medics already do).

Whether it's a slippery slope or not, I think it is progressive not to gatekeep medically assisted suicide too much. Modern medicine should offer a choice for each individual - to live or to die, not a prescription to live through suffering and pain at an immense economic and societal cost. Death is a normal, natural part of life that will come for all of us. The amount of suffering before death should be each person's choice.

Hard cases make bad law.