Very Interesting Kathleen Stock article

[TempestTost]

I found this article one of the best I have read about assisted dying. It is the only one I've seen articulate so clearly the concerns around how it might change people's ideas about what counts as unbearable suffering.

She clearly draws a lot from her experience looking at what has happened with gender ideology, both legally and socially and psychologically. And her philosophy background clearly helps her frame this in a way that is clear and exact, which is so hard to find.

Anyway, I thought people might find it an interesting comparison. It's from Unherd, so you might need to register to read it but you can do so for free.

https://unherd.com/2024/10/theres-no-dignity-in-assisted-dying/

I think that Kathleen’s point was that what politicians were saying is not exploring the issues in ant depth, just soppy childish sound bites

I think it's important to understand the logic with the arguments on this.

The most basic premisees are a) that some lives are so full of suffering, and there is no hope for improvement, and it is cruel not to let people die, and b) people have the right to end their life. The rest follows logically.

You can see the way it plays out where these laws have passed. It starts that there are protections, people need to be approaching death, they need to be able to communicate their own decisions, they need to be mentally competent.

So the next step is that lobbyists say, well, what about the poor people who want assisted death but become demented or incapacitated? They need to be able to make provision ahead of time.

Then they say, well what about people who are suffering, there is no clear way to relieve it, but aren't going to die in the foreseeable future? Isn't that a terrible thing? So then that rule is removed, along with rules about not allowing it for mental illness, because after all, that is real suffering.

Then, what about people without capacity? Don't we have an obligation to help them if they are truly suffering? So then they start looking at allowing parents, guardians, or others to act on behalf of children or people with intellectual disabilities.

And if that sounds unlikely, consider that in Canada, a group of doctors reviewing these rules recommended that assisted death laws be extended to infants.

Here is an article - for context, the group, the College of Physicians and Surgeons is the group that manages doctors licencing, regulations, standards, etc, for the province of Quebec.

https://www.cbc.ca/news/politics/assisted-dying-carla-qualtrough-1.6625412

Basically, once you allow for those premises, it's very difficult to stop the protections being eaten away.

But that is the level of the comments that we hear from MPs and most social commentators on this.

It's completely emotionally manipulative. Even from people like Starmer who should know better. And the lobbyists are even worse.

I think it is also possible to understand that the law proposed is like the one in Oregon rather than the free for all in Canada. Oregon has allowed assisted dying in people with less than 6 months to live for over 20 years and has resisted attempts to loosen it. Why do people immediately rush to Canada rather than considering the multiple jurisdictions around the world where something much more limited is in place and appears to be working.

The question is, how do you know that you will be able to keep a law like the one in Oregon?

The initial law proposed in Canada was more strict, what passed a little less so as people argued it would be too strict.

Immediately lobbyists started trying to gain sympathy for changes, mainly by using emotive stories. At the same time, they started challenging the protections in the courts.

In other jurisdictions you can see similar trajectories. Because when you have protections in place, it;s limiting, and people don't want to accept those limits.

And people are not thinking about it in a systemic way, they are thinking, shit, I don't want to suffer, and I don't want to have to get help with bodily functions, or they think about their sick aunt.

I think we all know how overwhelmed people can be from these emotional appeals, and how difficult many people find it to think of system effects.

Why has Oregon manages to avoid any creep? That's the question I guess. Just good luck? The population over all not inclined?

It's an interesting piece by Stock, and to some extent I agree with her. But I don't completely.

I think what this issue boils down to is principle vs pragmatism. Unlike Stock (if I've understood her correctly), I do believe in assisted dying in principle. That is, I think if someone has an incurable illness that they find unbearable, they should be allowed to end their life with medical help. In practice, however, I agree that we have massive problems with defining unbearable, intolerable, pain and suffering etc, and there is a very strong danger of a slippery slope.

For me, I would absolutely hate a degenerative disease such as MND, where you gradually lose control of all your functions. It's not just the incontinence, it's the fact that you lose the power of speech, the power to use your hands or your legs and that you can't even swallow properly so risk choking. That kind of life feels intolerable, and I would want to end it. And at the moment, if you decided you wanted to end it you would have to travel to Dignitas in Switzerland before the point where it became intolerable, because after a certain point you become too ill to travel. So the current law against assisted dying is arguably counter-productive.

But how would you frame a law that allowed someone in that situation to end their life without running into all the problems that Stock outlines? I really don't know.

It's straighforward for me. Is it possible to create policies that have adequate protections and safeguards? Yes. Would we end up with these policies? Maybe.

Look at the way children have been prescribed puberty blockers and the way the elderly were treated by government in the early days of Covid and it's clear that neither the UK medical profession nor the UK government (the Tories will get back in at some point) can be trusted to do assisted dying properly.

So what we have isn't a choice between the status quo and the perfect system. What we have is a choice between the status quo and a system where people who could be helped to live a life they are willing to live end up dead instead.

the way the elderly were treated by government in the early days of Covid

'Let the bodies pile high' said by the leader of a government that let COVID run rampage through care homes. Compounded by members of the public who said that the elderly and vulnerable were going to die anyway so there was no point in protecting them.

The naivety of those who don't see any problems regarding this bill is astounding.

That is a very good article which articulates very eloquently the problems inherent in passing this legislation. I have been very uneasy about the speed with which it is being addressed by the new government and the way that its supporters seem oblivious to the wider consequences. The comparison with the GRA is very apt. Both cross a line of legalising something which previously was unthinkable within the law: falsifying your birth certificate or doctors killing their patients. In both cases the focus was purely on those who would want to take advantage of the legislation with the wider impact on society ignored or minimised because of the safeguards built into the legislation (in the case of the GRA the tiny number of people who would use it). There is no way that anyone can be certain that the UK wouldn't go down the Canadian route or even further. The equivalent of self-ID would be the demand that it's a human right to be helped to die. It's interesting that Wes Streeting is apparently reconsidering his previous support for the legislation because of the poor state of end of life care and the pressure this might put on the vulnerable. I would much rather discussion was had on how end of life care can be improved and the vulnerable supported than legislation passed whose consequences we can only guess at at present.

@CitrineRaindropPhoenix
My grandmother deteriorated very quickly. She went from bad arthritis to sepsis in every organ with 24 hours. Unfortunately the medical support didn't recognise this and failed to either treat her or give her painkillers. It took her nearly a week to die, screaming in pain until we finally managed to persuade the hospital to sedate her. They'd resisted even that and were scathing about how feeble we were for being unable to cope.

That is so shocking. Was that in a hospital in UK?

I read the piece with interest, because the topic is one of several on which I've modified my views in recent years (see also prostitution etc). but whilst it's tempting (and easy) to give a good kicking to politicians seeking deeply sincere and empathetic sound-bites 😀, it seems to me the difference here is that views are sincerely held on both sides, often for the most harrowing of reasons. DocStock seems close to saying that people who support euthanasia are bad actors or gullible fools, and I don't think that's true at all. That said, I do conclude the risks are too great. And there will be cock-ups. And worse. It's not unfair to say, though, that if MPs have given this topic as much serious thought as they apparently did before they took leave of their senses and decided that men could change into women, God help us.

@duc748 nails it.

I agree with you on this. Irrespective of any debate on assisted dying, people should not be left in pain. Where is the compassion that leaves ill people (certainly at end of life) in pain like that?

Dr Stock is highlighting the use of language that is framing this debate precisely because it is the language that is doing all the heavy lifting here.

Dying with dignity. Gentle death. Peaceful death. Going to sleep. When in actuality killing someone whose body is not ready to die is much harder and less ‘gentle’ than being implied by the use of that language. Sometimes it is quite brutal. I don’t have faith that all these MPs have done their homework on this topic and in all likelihood are being swayed by these pillowy phrases as she puts it.

How can it be right that people should suffer in this way rather than be helped with extra painkiller?

It is precisely because we have medical professionals who don’t offer adequate pain relief (and women in particular are woefully underserved by doctors with respect to pain management) and an abysmal end of life care in the UK that we are faced with these calls for assisted dying. I’ve got doctor friends in Canada who see MAID being requested by pensioners without adequate incomes who don’t have enough to eat or can’t afford heating. How on earth is that right?

We all fear a painful death but better and more informed care for people dying would be a more humane approach in my view.

But Blackbird, your argument assumes medication can always relieve the pain and suffering. My understanding is that this is not correct.

My own view is that assisted dying should only be offered at end of life, to shorten pain and indignity, when the dying person clearly and repeatedly requests it. I know Canada is apparently out of control in this (as in other things!) but assisted dying should not (of course!) be offered to the homeless, poverty stricken, mentally unwell etc.

Should not according to whom?

As soon as you make a legal principle that people have a right to die with medical help if they deem their life insufferable, how do you propose you can control that? Once something is a right it is very hard to parcel it out to some and not others, particularly once people start to press the point in court.

And if they are people without capacity, how does it not become the responsibility of those who are their guardians to make those decisions in their best interests? Because what society is saying is that death is in the best interest of some people.

You'll see some fairly wide differences of opinion on the pain question, even from medical professionals, though IME most would say it is possible to control in pain in almost all cases - so long as you are willing to deal with the other effects. I think some of the rhetoric around this comes as much from others who find it uncomfortable to watch their loved ones dying. There's a real thread in our culture that seems to believe it's better to kill and not witness death rather than go through a natural death which is not always as sterile and quiet as people imagine.

Because often they aren't suffering when they have agency, and by the time they are suffering they no longer have the physical capability to act.

My father had a degenerative illness, so under your argument perhaps he should have ended his own life while able to do so. But he was a long way from the end stage when he got sepsis (unrelated to his main illness) and went from partially limited mobility and OK quality of life to none at all overnight. He begged to go to Switzerland but was far too unwell to travel and certainly had no ability to organise the trip. The only ability he had was to refuse food, which he did for almost a month.

My grandmother was apparently completely healthy and walking back from the shops when she had a stroke. She recovered enough to be able to very slowly and painfully write a few words, but there was no way she could walk, leave hospital, or move from her bed. She refused food too, but they put in a feeding tube. She lived for another 6 months.

My friend had minor stomach pain, then within hours was immobile in hospital. She lived almost 3 months - sometimes conscious enough to speak, sometimes in a coma but still screaming in pain. Not for lack of treatment - there is some pain that no medicines will alleviate.

Anyone who can ask that question clearly has limited experience of illness and death.

I suspect that you and a few others are missing the point.

The question was, how can we not allow people the agency to end their own lives.

Well, they have it. People can kill themselves, generally if someone wants to do it, they can.

What they are asking for with assisted death is for other people to be involved, and the law. At which point there are all kinds of other issues to consider aside from their agency. It's no longer just a personal question.

I used to be all for assisted dying, until MAID in Canada was expanded and the expansion into mental health cases in Europe. Mental health can improve, I wanted to die for something like 20 years, with the appropriate help I’m now worried about my mortality rather than rushing towards the exit.

I’ve shifted to a position of “I simply don’t know”. People do suffer, it’s difficult to measure another persons agony, it does seem reasonable that people have some agency over their lives and deaths. But people are vulnerable, I can imagine pressure to call it a day could be applied quite subtly to encourage someone to euthanise themselves.

I don’t actually think the article was that convincing tbh, I do see her point about the drip drip of expanding what is considered suffering. Equally if someone feels they are sufferIng is it really humane to expect them to carry on, is it really humane to help them kill themselves?

It’s so difficult, I think most people engaged in the conversation are well meaning. I think eventually it will be passed anyway, the question is whether we keep qualifying conditions tightly controlled.

I do think we also have to have a conversation about extending life as well. If I had dementia or alzheimers and was confused and miserable I would hope someone would have the good sense to let me slip away at the first opportunity.

I just can't agree. My much-loved FIL is dying right now in a country that allows assisted dying, he will go very soon, he is in terrible pain, he doesn't want to become incoherent, he wants to pick his moment with his family around him. They have travelled a long way, have commitments, can't stay indefinitely. Why the hell shouldn't he have this. It's mercy. In his case it's unambiguously mercy. We should at LEAST allow that much here.

From this article in the Telegraph, there are already calls to widen the criteria before the initial bill is even introduced:

www.telegraph.co.uk/politics/2024/10/05/widen-access-to-assisted-dying-say-labour-mps/

"Dozens of Labour MPs are pushing for more people to be eligible for assisted dying, The Telegraph understands.

Kim Leadbeater, the Labour MP, will table legislation on Oct 16 to legalise assisted dying after her Private Member’s Bill was selected for debate. Her decision to propose the law change means there could be a free vote by MPs before Christmas.

The bill is expected to give terminally ill adults the right to choose to shorten their lives if they wish.

As many as 38 Labour politicians, including 13 who hold government roles, are understood to back proposals for the bill to go further and to apply not just to the terminally ill, but more broadly to those “incurably suffering”.

They are among a cross-party group of 54 MPs calling for the scope of the bill to be widened, according to Humanists UK, which has long called for a change in the law. It is likely to raise fears over introducing ambiguity into who would be eligible for state-sanctioned euthanasia."

The question was, how can we not allow people the agency to end their own lives.
Well, they have it. People can kill themselves, generally if someone wants to do it, they can.
What they are asking for with assisted death is for other people to be involved, and the law. At which point there are all kinds of other issues to consider aside from their agency. It's no longer just a personal question.

That's not always the case by any means. Once someone is in hospital, weak and in pain, near the end of life, how would they kill themselves? And why should they do it without support, and with the risk of getting it wrong and injuring themselves?

I have a family member who shot themselves - as they didn’t want to be a burden and DHs unmarried aunt who’d been a nurse all her life just didn’t eat once admitted to hospital as she couldn’t manage at home and had had another fall.Died in a few weeks.
is this a better option?

The question is, how do you know that you will be able to keep a law like the one in Oregon?

I guess one answer is you build a really good, sturdy schelling fence (Schelling fences on slippery slopes — LessWrong) and you put it near the top of your slippery slope in exactly the place where you want it to be. And you make sure its really well fixed to the ground so no-one is inclined to start moving it for very hard, individual cases. It would require that the law is drafted by people who are both really aware of the dangers AND not inclined to sneak in extra legislation or loopholes to get what they really want further down the line. I am more suspicious of legislators since seeing the way in recent times "extra" things were tacked onto changes to abortion law in places like Ireland or have been attempted to be tacked onto things like conversion therapy bans. And wherever you stand on trans rights V women's rights, the GRA is a complete mess that doesn't make anyone happy.

So, in theory I think you could do it. I just don't know if the current government for example would be capable.

Most very ill and old have dementia so wouldn’t be allowed to decide to go to Switzerland.