I don’t have much anxiety about death. One day you’re here, next day you’re not. Big deal. I wasn’t around during the Roman Empire and it wasn’t that bad. I do worry, however, that one day I’ll have a stroke, or a blood vessel will pop or something, and I’ll be rushed to the hospital. I’ll be incapacitated, turned into a vegetable, and then our nice Christian society will for decades keep me hooked up to machines. When an adult comes into my room, it will be to change a diaper or move me so I don’t get bed sores. My enemies on Twitter will laugh. I’ll be nothing but a burden on the taxpayer, and maybe my children, who make their lives smaller and perhaps forgo opportunities to form families of their own in order to take care of me.
One thing I’m going to stress to them when they’re old enough is that they definitely should not do that, and if they decide differently I would consider that a failure to transmit my values, which say that if and when I get to be too much of a burden I should be put on the proverbial iceberg and allowed to drift off to sea.
To be reduced to such a state of dependency would be the worst imaginable fate. I feel the same way about other people’s lives. Hearing that someone I liked or respected died is much better than hearing that they’re in constant pain and unable to take care of themselves.
Opponents of euthanasia often invoke the idea of “human dignity.” I find the way they use the term very odd, and frankly repulsive to how I understand the concept. To me, human dignity means things like being an autonomous agent, with the freedom to make my own choices in life; not being a burden on those I care about, or the rest of society; having a sense of privacy, in the form of say not needing to wear diapers and be changed by other adults; and not losing the essential features of my intellect and personality.
I believe that paternalism in all its forms robs people of their dignity. This is why I almost always oppose it, even though I’m sure that there are some things you can force people to do for their own good. Giving you the choice to ruin your own life grants you respect. Forcing a cone on a creature’s head so it doesn’t harm itself is befitting a dog, but not a human being. If I was going to spend my life prioritizing the well being of creatures who can’t be trusted to take care of themselves, I’d rather we focus on factory farming instead of people who are stupid and weak.
The anti-euthanasia position is of course much worse than normal paternalism. It not only seeks to take away a choice, but demands government have final say over the most fundamental question an individual can face — whether he should, given his circumstances, continue to exist or not. Putting such a decision in the hands of the state is a much more serious offense against human dignity than something like stopping people from eating trans fats.
Making matters worse is that one of the recurring arguments of the anti-euthanasia position is that people might choose to kill themselves because they don’t want to be a burden on others. But not wanting to burden others is virtuous! To invoke paternalism to stop people from acting immorally is one thing, to do so in order to mandate forced parasitism is another. It’s like if one justified taking away people’s money by saying they might feel pressured to give it to charities, or make the lives of their children better.
An academic paper from last year cites this newsletter for the claim that “[s]ome commentators have lauded the Canadian system for endorsing that citizens opt for MAID to avoid being a burden on their families or society.” I haven’t seen any indication that the Canadian system actually does endorse this idea, whatever that means, but it should. Nonetheless, professors usually prefer to cite peer reviewed journals rather than newsletters, so the fact that they had to refer to my essay indicates that this is an argument very few people are willing to make publicly. I find this very odd. If I knew someone who was completely indifferent to how much suffering they brought to others around them, I would think this person was immoral. Yet critics of euthanasia take the fact that people sometimes consider the greater good in their decision-making process as a reason to restrict the practice, and this point is supposedly so obvious that they don’t feel the need to explain why.
What these types are saying is that you have to wear diapers and get them changed twice a day for your dignity. You have to transform from a proud man in control of his own destiny to a drooling mess spending your days soaked in feces for your dignity. You will go from living a life in which you put your children and family first to being in a state of existence that ensures they will always remember you as an emotional and financial drain for your dignity.
For people who oppose euthanasia in all circumstances, from my perspective there is nothing that can be said to them. The chasm in values is too vast. I try not to hate people for their political views, but feel tempted to create an exception in this case. What opponents of euthanasia want to do to their fellow humans after they grow old is generally worse than what they would experience if they fell into the hands of ISIS, and they should be ashamed of themselves.
More common is the moderate position that grants the right to euthanasia in extreme situations but argues that places like Canada and the Netherlands have gone too far. To me, it’s worth defending euthanasia even in the most difficult cases, like when a person is suffering solely from mental illness, for the same reason we defend free speech rights for NAMBLA. Sure, free speech can be abused and have negative consequences. But the principle is too important to allow government to decide what to ban on a case-by-case basis. Once the state can restrict some speech, the temptation to keep going is too great.
Yes, this is a slippery slope argument. But unlike the anti-euthanasia position, it’s one that clearly understands the characteristics of Western societies. Our culture cares a great deal about stopping people from dying, and not too much about individual liberty. This means that we are way too biased against death to trust the state to decide when euthanasia is appropriate. What kind of slippery slope you find plausible should depend on cultural context. If we lived in Tokugawa-era Japan you might be worried about going too far in glorifying suicide or making it seem like an acceptable option.
I wish there was a kind of testament I could leave that says that if I’m ever in a position where my mind is so gone that I can’t be treated as an adult in the eyes of the law, I want to die. As far as I know, such a document wouldn’t be enforceable anywhere, at least in the United States. I’d probably be much quicker to kill myself if I ever get diagnosed with an illness that might eventually leave me incapacitated than I would be if I lived in a society that I was sure would honor my wishes.
A few years ago in The Netherlands, there was an elderly patient who declared she wanted to be euthanized, but then later developed dementia. Her doctor put a sedative in her coffee to render her unconscious and fulfill her wishes. The woman woke up, so she had to be held down by her husband and daughter while the doctor administered the lethal drug. This was controversial even in the Netherlands, so the doctor ended up in court, although she was thankfully cleared. The press in the US and UK ran with the story as a kind of cautionary tale about what happens when you legalize euthanasia. A doctor simply honoring the wish a woman had when she had been of sound mind became an international scandal, showing that we have a long way to go before we accept an approach to end of life issues that is centered around human dignity.
In other words, the moderate anti-euthanasia position worries about mistakes in the wrong direction. In Canada in 2021, for example, only 2% of euthanasia deaths involved someone without a terminal condition, or about 200 cases. Most of those were likely in unbearable pain. Meanwhile, 368,000 people in Canada have dementia. If you figure even 10% of them would not have wanted to live in that state if you asked them earlier in their lives, which I think must be an underestimate, then that’s almost 37,000 cases of assisted suicide that should have happened by now but didn’t. And this is only one disease. I support the least restrictive euthanasia regime possible because practically all modern societies are prone to err on the side of life, and the costs of keeping too many people alive in terms of suffering and lost dignity are much higher than those that might result from giving mentally ill people too much autonomy.
I think that if you make the most basic assumptions of how many people who have terrible illnesses would reasonably want to die and compare them to how widespread euthanasia is, you would find it difficult to come up with numbers that indicate that even countries like Canada and the Netherlands are too liberal on end-of-life issues. When you read anti-euthanasia articles you’ll often be transplanted into an alternative reality where Canada is ruled by the spiritual descendants of Nazism intent on ruthlessly culling the weak, instead of being a modern welfare state that is at best ambivalent towards personal freedom and prides itself on how much it can do for the most helpless members of society.
As Scott Alexander once wrote, relying on his experience working in hospitals,
And now every time I hear that phrase I want to scream. 21st century American hospitals do not need to “cultivate a culture of life”. We have enough life. We have life up the wazoo. We have more life than we know what to do with. We have life far beyond the point where it becomes a sick caricature of itself. We prolong life until it becomes a sickness, an abomination, a miserable and pathetic flight from death that saps out and mocks everything that made life desirable in the first place. 21st century American hospitals need to cultivate a culture of life the same way that Newcastle needs to cultivate a culture of coal, the same way a man who is burning to death needs to cultivate a culture of fire.
An opponent of euthanasia of course might say that one can’t treat false positives and false negatives as equivalents here. Preventing one death that shouldn’t happen is more important than letting a thousand people make an informed decision to commit suicide. This is a plausible argument if you consider death the worst possible outcome. But it’s hard for me to think of a value system more antithetical to a noble conception of man’s existence.
