I don't follow the author's logic. They seem to assume anyone choosing MAID has been failed by the healthcare system. While that's certainly possible for some of cases, every single person eventually reaches a point where their health is failing. Many know in well enough advance, and in Canada you can choose to decide when/how to end things.
The health care system can and should be improved, but there will always be people choosing MAID regardless. We should use a different measure for how to improve healthcare, and not falsely correlate MAID as a failure metric.
This is completely dismissive. People are choosing to kill themselves and the government is helping them do it. The question is why?
"We should use a different measure for how to improve healthcare, and not falsely correlate MAID as a failure metric." No this is actually a perfectly legitimate question. Are people choosing to kill themselves due to a lack of available healthcare?
Is the government using assisted suicide as a mechanism to relive a overburdened medical system? Legit questions. Dont dismiss them.
The anti-MAID brigade has been asking "legit questions" for ages and has yet to come up with anything resembling actual data supporting their view. At some point the burden is on people pushing to eliminate the program to actually argue their point rather than "just asking questions."
I think people should be allowed to exit when they wish.
I just dont know if they government should be involved with this to the point of counseling people to kill themselves. It leads to all sorts of perverse incentives.
Neither the government nor anyone else is "counseling people to kill themselves," medical professionals are counseling people on the option with strict regulations on who they can provide the option to and how they can present the option.
Careful. The reporting in The Atlantic says otherwise:
"Perhaps the now-suspended Veterans Affairs caseworker who, in 2022, was found by the department to have “inappropriately raised” MAID with several service members had meant no harm. But according to testimony, one combat veteran was so shaken by the exchange—he had called seeking support for his ailments and was not suicidal, but was told that MAID was preferable to “blowing your brains out”—that he left the country."
That's followed by an anecdote in which a Vancouver patient in a suicidal crisis claims a hospital clinician said there were no beds available, but that MAID would be a "more peaceful" option than suicide.
No idea how widespread these cases are, not making any claims, just saying there's reporting around this.
> Perhaps the now-suspended Veterans Affairs caseworker who...
They were immediately fired, referred to the RCMP for investigation, and a systematic review launched that found 4 incidents[1] - all by the same employee. There have been no further incidents reported since this happened. Since 2022.
> That's followed by an anecdote in which a Vancouver patient in a suicidal crisis claims a hospital clinician said there were no beds available, but that MAID would be a "more peaceful" option than suicide.
This was in 2023. It was covered a bunch at the time until it was revealed that it was a standard question asking if she had ever considered MAID before[2], since she had a history of depression and suicidal thoughts.
The Atlantic reporter you're referencing is themselves anti-MAID due to her religious convictions and wishes to remove choice from individuals. It is not an unbiased source of information. The MAID system is _routinely_ criticized from the religious base here in Canada for the last 9 years, and yet not even a hint of systematic abuse of the system has ever been found.
No one dismissed asking a question. I'm pushing back against a logical hole in the argument. Even with better healthcare, everyone's heath eventually fails. Using something that happens to 100% of people as an indication of anything is a mistake.
You introduce several forms of asking "why" as a reaction to my comment, but that's exactly what I argued for: a better metric with the actual possibility of causation.
I only personally know one person who has chosen MAID. He was a close family friend and was very ill. He decided that once he got to the point where he could no longer walk that he didn't see any further point in living. There was nothing more any medical system could do for him. He reached that point and he died on his terms.
I also had family member die recently; he was 95 years old. At 85 he said it was time to go into a home and went and did that for a few years. But at 95 he just decided he was done. He told everyone and then he just stopped eating. Within in a week he was gone.
according to chatgpt, 25% of people die of cancer in canada; presumably dying of cancer is a lot worse than MAID so one might expect this number to grow beyond 5% unless there are just that many people that object to it for themselves on philosophical grounds
According to StatsCan it is actually a bit more, but varying year-to-year. Pre-Covid it looks like it was closer to 27% or 28%, now closer to 26%. So a lot of room to grow, if we made the assumption that all those dying of cancer would prefer to choose their date of passing. Personally, I think the more immediate source of growth in the number of MAID administrations should come from those who died after requesting MAID but before MAID was able to be administered, which would give an increase of 19% in administrations.
As a physician, I can tell you that euthanasia has been always around in every society and at all times. MAID just made the arrangement formal. Before MAID, it was implemented by withdrawing life-saving treatments (usually due to side-effects), rising doses of narcotics (for painful conditions) or even "terminal sedation" (the most explicit form of euthanasia before MAID-like laws).(And of course, patients always had the option of taking their own lives). In any healthcare system, there has to come a point where patients (and their families) and their doctors decide to terminate efforts aimed at extending life. In most cases, MAID is just a way to shorten the unpleasant interval between that decision and death. Given all that, it is not that surprising that 5-7% of deaths are attributed to MAID. The debate about MAID is another example where a lot of otherwise rational people fall prey to misguided sloganeering.
I don't think it's that misguided. The incentives are so perverse here that, if the government isn't abusing it, they are acting incompetently. it would almost be better if they just had the actuary provide an expected life and expected cost chart and we agreed to pay the potential MAID recipient's estate 10% of the savings remaining on the day the chose to go, if they choose MAID.
How are incentives perverse? Would it be better to have a system that only incentivizes life extension, no matter the suffering it causes, no matter that it will still ultimately end in death?
It's not about whether the person should live or die, it's that the Canadian government has vested responsibility to provide healthcare in itself while making other options illegal. I can't make my own choice to, for example, buy my own medical insurance to ensure I live for as long as possible with the most effective (and likely expensive) treatments. The government has said they got this and limited everyone's choice to government only.
They screwed this up via multiple mechanisms, because that's what government seems to do, and now there is a pretty decent shortage of healthcare up here. This makes the incentives highly perverse because the government can't provide the world class health care it promised even if it wanted to, which leads to political pressure to bring in MAID and chop tens to hundreds of thousands of dollars of medical liability off the end of many patient's lives (which I would actually support if the underlying incentive structure was different, or if the government was at least honest about what was happening and compensating the MAID recipient's estates for forgoing treatment the government is obligated to provide but would be better for said government if they didn't). The most concerning bit here is the lack of provision of other life improving services like joint replacement, the latest experimental drugs, etc. and the likelihood that that is funneling people into a situation where MAID is the obvious best choice sooner than it otherwise would be. This is certainly happening with cancer treatments (although probably not intentionally, just incompetently) as people get detections for cancer and then find a months long wait list instead of days to weeks long wait list to see someone who can progress their treatment.
> which leads to political pressure to bring in MAID and chop tens to hundreds of thousands of dollars of medical liability off the end of many patient's lives
So this is an assertion that requires some evidence. The political pressure was instead from a majority of Canadians (across political lines) who want there to an an end-of-life option in situations when life becomes intolerable. People do not want to be forced by the state to stay alive and suffering via extensive medical interventions. Nor do they want to have to suffer through the alternative of slow and debilitating conditions that science is powerless to stop. This is the where MAID came from. Thinking of it in purely economic terms is already acting in bad faith.
> compensating the MAID recipient's estates for forgoing treatment
If you paid for private medical insurance, would you expect the same from them? To compensate your estate if you choose to end your life early rather that receive invasive and expensive treatment to temporarily forgo the inevitable? Even if you did expect that, insurance companies would never go for it. An even by the widest stretch they did, it would a discounted rate, and then you're still back to the same economic incentive but now with private industry. This is even worse I would say, because now people would be given a cash bonus to commit suicide (either by the government or private insurance, the same applies if people were compensated for foregone treatments). People with families in financial trouble may even consider this a way out to help loved ones. That is a crazy perverse incentive if you ask me.
On the side of offering better services, you have my whole-hearted agreement. Even something as simple as mandating an increase in the number of available seats at medical schools that corresponds with the population growth would be a start. Lots more to that list.
> The debate about MAID is another example where a lot of otherwise rational people fall prey to misguided sloganeering.
This is the same level of argument as saying that people who vote for the other guys must have been tricked by FOX News / MSNBC / Russia / Tik Tok / transtrenders / tradwives, and if only they truly understood their actual self-interest they would agree with you on all things. It's a bad style of argumentation, albeit very popular in academia ('why do the poor keep voting wrong?').
There are legitimate reasons to oppose Canada's euthanasia program on its own terms, and it's not surprising the Canadian government has very carefully shielded MAID from any sort of public input or oversight, since it's deeply unlikely it would pass a majority vote in its current form. There is consistent public opposition to euthanasia being available to anyone but late-stage terminally-ill people (and even then, it's divisive at best). There is strong public opposition to euthanasia solely on the grounds of mental health.
More broadly, I think people are increasingly sick of the misuse of the term 'healthcare' (or 'public health') to sneak unpopular or controversial policies past the electorate, and the idea of 'death as healthcare' is probably the most extreme example of this trend. When people cannot express democratic opposition to policies they deeply oppose, don't be surprised if you get pushback and populism.
> Only 12.1% correctly answered ≥4 of 5 knowledge questions about the MAID law; only 19.2% knew terminal illness is not required and 20.2% knew treatment refusal is compatible with eligibility. 73.3% of participants expressed support for the MAID law in general, matching a nationally representative poll that used the same question. 40.4% of respondents supported MAID for mental illnesses. Support for MAID in the scenarios depicting refusal or lack of access to treatment ranged from 23.2% (lack of access in medical condition) to 32.0% (treatment refusal in medical illness)
Most Canadians express support for MAID but cannot correctly answer questions about it. When Canadians are actually told what's in MAID, they oppose it.
It's also worth noting that quite a lot of polling on this question is done by, or on behalf of, pro-euthanasia organisations; there is often a huge mismatch between the questions asked and the actual legislation proposed and passed (in a very motte-and-bailey kind of way).
People stated they supported the policy after reading a full description of the policy. If you don't trust the paper (whose researchers are anti-euthanasia), the Canadian government found the same results. https://researchco.ca/2023/05/05/maid-canada-2023/
Nobody ever correctly answers questions about legislation, to put it glibly. Any piece of legislation newer than 10 years and more complex than a sentence is not going to pass such a test with the general public. 19.2% knew that terminal illness is not required? I would be shocked if 19.2% could correctly answer a few basic questions about the definition of "terminal illness."
About 18 months ago in Quebec, my aunt, who was terminally ill with cancer, had to go to the hospital for severe pain. I had a phone call with her just before she went in, and while the idea of suicide had come up occasionally, usually during bouts of sundowning, it wasn't her focus at that moment. Once she was in the hospital's care, she was offered a permanent solution to her suffering. After a seemingly normal visit with her sisters that night, she died by assisted suicide the next morning. Her sisters were shocked and devastated.
While I think people should be free to choose, I don't know how much information hospital staff should be able to give.
Difficult.
Edit: I'm not 100% certain as to the timeline. She may have been in the hospital for 2 days.
You have to have 2 independent medical assessments at a minimum as well as written consent that is witnessed. So its not like you can just say you want to do it and then they just off you right there. She could have had all sorts of reasons for not telling anyone including her sisters. There's nothing in your anecdote that disputes she could have planned it long in advance and just not told anyone.
"There's nothing in your anecdote that disputes she could have planned it long in advance"
It seems implausible.
She lived with her sisters and while she was quite capable of many tasks, I think that long term subterfuge was beyond her. She was well into mental decline.
"You have to have 2 independent medical assessments at a minimum as well as written consent that is witnessed"
Well its impossible for us to know her state of mind, anything would be speculation.
Yes, it could have happened at the hospital but do you think they have people sitting around waiting to do medical assessments and be witnesses just so they can push MAID onto people? At most hospitals the doctors and medical staff are extremely busy.
It has little to do with religion. There are lots of examples of MAID being pushed upon people that do have other options and made to feel like it's the only one.
It's also a way for collapsing government-run healthcare to save money.
If you're being serious, I'd like to see actual data on what percentage of MAID-eligible patients are having MAID "pushed" on them, along with a clear definition of what "pushed" means.
Well you're not going to get it, because the only institutions with the ability to create that data would not do it in that way.
What we do have is the words of people saying they do not wish to die, but are taking MAID due to necessary supports not being offered instead. What percentage would you consider too high for that?
> What we do have is the words of people saying they do not wish to die, but are taking MAID due to necessary supports not being offered instead. What percentage would you consider too high for that?
What you do have is a handful of anecdotes, to put it in more honest terms.
What's fascinating to me is that the discussion of these anecdotes revolves around wanting to eliminate MAID rather than -- gosh, I don't know -- offering those necessary supports instead? The anecdote (in the article) about it being easier for "some people" to get MAID than to get a wheelchair makes for a great soundbite, but the people who quote it always seem more interested in eliminating MAID than in providing wheelchairs to those in need, for some odd reason.
Well see I've been part of this conversation longer than maid has been a thing. And it used to be "oh that won't happen, it'll only be for terminally ill people and with a high level of medical and psychological oversight." And so my position was that maid shouldn't become a thing until eg "providing wheelchairs" is fully accomplished.
And now here we are. Maid is a thing, and people are being encouraged to do it while not being provided the alternatives they are asking for. And the numbers for how many are totally illegible but also somehow too low for you to be concerned with.
My activism has long been more focused on getting people the care they need than opposing maid. But regardless people still don't always get the care they need and we have maid for them instead. We said it would be like this and it is like this.
> And so my position was that maid shouldn't become a thing until eg "providing wheelchairs" is fully accomplished.
Without having actual data, this is nothing more than an excuse to eliminate MAID indefinitely pending an imaginary system in which no one slips through the cracks; in the meantime, you will force countless more to suffer months or years of needless agony on the off chance that one of them might be one of your anecdotes.
> And now here we are. Maid is a thing, and people are being encouraged to do it while not being provided the alternatives they are asking for. And the numbers for how many are totally illegible but also somehow too low for you to be concerned with.
The only "numbers" I get from anyone like you are a handful of anecdotes that add up to a tiny fraction of a percent of people who elect MAID, and a vanishingly small percent of people eligible for MAID. If you genuinely mean well, I want you to understand: you are being manipulated by people who will do nothing to help those in need, and on their behalf you are campaigning to immiserate thousands upon thousands every single year.
Please respect the site guidelines when commenting here and don't cross into personal attack, no matter how wrong someone else is or you feel they are.
I genuinely am not clear on how that crosses over to a personal attack? I'm factually describing the outcome of eliminating MAID, nothing more.
Edit: By the way, great job singling my post out for speaking factually about the consequences of someone's beliefs while ignoring a post[0] that explicitly calls MAID eugenics. I wonder: if I'd spoken in abstract terms rather than referencing @giraffe_lady specifically would I be in the clear? What a wonderful policy you have, dang.
"one who wishes months or years of suffering and misery on the terminally ill solely to assuage her own conscience" was a reference to the person you were arguing with and an attack, hence a personal attack.
I didn't see that other comment. If you see a post that ought to have been moderated but hasn't been, the likeliest explanation is that we didn't see it. You can help by flagging it or emailing us at hn@ycombinator.com. (https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...)
> What we do have is the words of people saying they do not wish to die, but are taking MAID due to necessary supports not being offered instead. What percentage would you consider too high for that?
But these are separate issues, no?
I mean, if we don't have MAID, the existing failings of our healthcare system won't just go away; they won't just magically get the support they need. Instead, they'll die anyway, probably in a painful way.
Of course, for this discussion to be worth anything, we'd need more details. What does "support not being offered" mean, precisely? ..How many people is this actually happening to? And no, we can't just believe accounts posted on social media. And even if we did, are we going to get the other side of the story?
Well, some sort of source of any kind would be a start if you’re actually posting this in good faith. Right now this is “pulled out of my butt with no evidence whatsoever” and simply not credible.
> There are lots of examples of MAID being pushed upon people that do have other options and made to feel like it's the only one.
I'm not really surprised. It looks like Canada's healthcare costs are growing exponentially, and are outstripping growth in GDP. These costs are mostly driven by hospitalizations. If a government can carefully promote the message that hospitalization means suffering, suffering is hard, a life with suffering is not worth living, and that relief is quick and easy, then a route is charted to a reduction in healthcare expense. It would certainly help if the large physician organizations are on board, and the nation's major broadcasters lean into euthanasia-friendly messaging.
What is the source that the healthcare costs are growing "exponentially" and are outstripping growth in GDP? I would accept that its increased but definitely not exponentially.
As well, I live in Canada and have not seen any such messaging that you have said.
Neither of those links give us evidence of "exponential" growth as one would normally define exponential growth. I did agree that it definitely has increased, just not exponentially. As well, the first link demonstrates that the GDP has increased greater than the healthcare expenditure. Only in the "forecast ed" area does it outstrip GDP as an annual percentage.
If you search the CBC, they have articles both for and against MAID. I think its kind of silly to say that all positive news articles about MAID is government propaganda as there is likely to be a non-zero amount of positive experiences with it. Should the government not allow the press to make any comments on MAID to avoid biasing anyone for, or against it? For example, here is a negative video the CBC posted about MAID: https://www.cbc.ca/player/play/video/9.6521196
Are those "other options" going to be "sitting here and dying naturally, maybe drowning in your own vomit, maybe dying of starvation"?
I have a hard time believe things are going down like, "You have cancer. We can treat it and you'd be fine, but you know what you should do instead? Kill yourself"
On the other hand, I do believe (and want) doctors to be like, "You have cancer. We can treat it and you might get a few more months with very poor quality of life. You may wish to consider these other options"
It's not always the way you imagine it will be. I've posted this in this thread already but it seems most people haven't seen it.
https://www.youtube.com/watch?v=gG3AJ3W_sbI
This veteran seeks help and isn't able to get what she needs. What she is offered is MAID. That's the reality; sick people who aren't getting medical care are offered the comparatively cheaper option of death and it's very insulting for them.
Video news is a poor source of information, highlighting outliers when full data distributions are needed to analyze the dynamics at play.
One person’s account of what happened against an entity who is not allowed to discuss their side of the story is useless. And even if the whole account is accurate, it is not sufficient to stand in as proof of a nation’s protocol.
This evil Track 2 still requires that a recipient of MAID have "grievous and irremediable medical condition". It requires informed consent and primary capacity. It's not a law to bump off demented old people.
Limiting euthanasia to people with imminently terminal conditions is how you keep people in pain. The very best palliative care can still accompany suffering beyond anything a well and able person can begin to perceive.
Mental healthcare and social care and all these perpetually under-funded margins do need to be improved. MAID is not the preventative healthcare that we all need throughout our lives, but we need to be honest about the balance. Is it worse to end life prematurely for the "wrong" reasons, or to make someone suffer for the "right" reasons? This is dirty ethics. Get out the way and let people decide for themselves.
"One of the things it means to be Canadian is to honour the rights and wishes of other people. That’s part of what makes it a wonderful place to live: most people genuinely believe in equality and respect for others, including people who don’t look like them."
In my opinion, this drives the narrative in this article, and is at the root of why there is little stigma in Canada surrounding MAID.
I think any article that cites assisted suicide statistics without breaking it down by Track 1 vs Track 2, should not be taken seriously.
The author cites 5% as the “number too high” but as someone who’s had a family member who’s been through the MAiD system, Track 2 is pretty difficult to get so I would t be surprised if most of that 5% is Track 1, but we wouldn’t know from this article.
The vast majority of MAID provisions (95.9%; n=14,721) were for individuals in Track 1; 4.1% (n=622) of MAID provisions were for individuals in Track 2. (See Section 2) [1]
The vast majority of people choosing maid are those who enter hospice and wish to go peacefully before their terminal illness degrades their life to a state of loss of bodily control and pain.
What does that have to do with the post you replied to? Is your implication that young people can’t enter hospice or have terminal illness? Or are we just quoting random statistics without any regard to relevance whatsoever?
As a Canadian, I’ve witnessed a perfect polarization of opinions among the people I’ve talked to about MAID. So far, every Christian I’ve talked to about MAID is against it while every non-Christian is either for it, or has a neutral attitude about it.
Interesting. There are certainly different streams/versions of Jewish faith. I was thinking more about Orthodox Jews. To me "Christian" is a lot more diverse so I'm surprised this is somehow so fundamentally Christian vs. other religions.
Canadians who identify as religious are overwhelmingly Christian (53.5%)[1], with most of that being Catholic. The next most common religion is Islam at just 4% and Judaism is a paltry 0.9%. You're simply more likely to get anecdotes from the religion that is the vast majority.
In general, even the religious in Canada aren't very religious, so those who actively identify as it are likely to be _very_ religious. I have not a clue what religion any of our close friends are.
Canada becomes about 10% more agnostic/atheist every 10 years, which is a fun pattern[2].
In my experience, the line is between "people who have seen a family member die a horrible, painful, prolonged death" and those who haven't. The former group tends to be very passionately in favor of it.
It's really not that simple in my experience. Younger disabled people are generally against it as well, they rightfully have their guard up about things that look like eugenics.
> It's really not that simple in my experience. Younger disabled people are generally against it as well, they rightfully have their guard up about things that look like eugenics.
Apologies for sounding like a broken record here, but do you have anything other than anecdotes to support the claim that younger disabled people are generally against MAID?
Really? I'm surprised, many secular people on the left are against it because they see it as the state running it badly. Take this video someone posted higher up;
https://www.youtube.com/watch?v=gG3AJ3W_sbI
A paraathelete get injured and it's suggested MAID. Insulting and ridiculous. It only takes a few of these before people decide even if they like the idea the government botches the execution and there's little recourse if they go too far.
If you've ever seen someone die slowly in hospice or in hospital having spent the last 5-10 years in misery, of a chronic diseases with cures beyond our ken, you question will be....
Legalizing medically assisted suicide is fine. w/e
Forcing others to contribute to funding and carrying it out through taxes is not.
It should only be offered when patients ask for it. Some sick people are already depressed and feel like a burden we shouldn't put ideas in their heads.
If you mean, what would stop a random healthy person from walking into a hospital and getting MAID, the procedure is described in another post on this thread: https://news.ycombinator.com/item?id=45021339
I don't follow the author's logic. They seem to assume anyone choosing MAID has been failed by the healthcare system. While that's certainly possible for some of cases, every single person eventually reaches a point where their health is failing. Many know in well enough advance, and in Canada you can choose to decide when/how to end things.
The health care system can and should be improved, but there will always be people choosing MAID regardless. We should use a different measure for how to improve healthcare, and not falsely correlate MAID as a failure metric.
This is completely dismissive. People are choosing to kill themselves and the government is helping them do it. The question is why?
"We should use a different measure for how to improve healthcare, and not falsely correlate MAID as a failure metric." No this is actually a perfectly legitimate question. Are people choosing to kill themselves due to a lack of available healthcare?
Is the government using assisted suicide as a mechanism to relive a overburdened medical system? Legit questions. Dont dismiss them.
The anti-MAID brigade has been asking "legit questions" for ages and has yet to come up with anything resembling actual data supporting their view. At some point the burden is on people pushing to eliminate the program to actually argue their point rather than "just asking questions."
I think people should be allowed to exit when they wish.
I just dont know if they government should be involved with this to the point of counseling people to kill themselves. It leads to all sorts of perverse incentives.
Neither the government nor anyone else is "counseling people to kill themselves," medical professionals are counseling people on the option with strict regulations on who they can provide the option to and how they can present the option.
Careful. The reporting in The Atlantic says otherwise:
"Perhaps the now-suspended Veterans Affairs caseworker who, in 2022, was found by the department to have “inappropriately raised” MAID with several service members had meant no harm. But according to testimony, one combat veteran was so shaken by the exchange—he had called seeking support for his ailments and was not suicidal, but was told that MAID was preferable to “blowing your brains out”—that he left the country."
That's followed by an anecdote in which a Vancouver patient in a suicidal crisis claims a hospital clinician said there were no beds available, but that MAID would be a "more peaceful" option than suicide.
No idea how widespread these cases are, not making any claims, just saying there's reporting around this.
> Perhaps the now-suspended Veterans Affairs caseworker who...
They were immediately fired, referred to the RCMP for investigation, and a systematic review launched that found 4 incidents[1] - all by the same employee. There have been no further incidents reported since this happened. Since 2022.
> That's followed by an anecdote in which a Vancouver patient in a suicidal crisis claims a hospital clinician said there were no beds available, but that MAID would be a "more peaceful" option than suicide.
This was in 2023. It was covered a bunch at the time until it was revealed that it was a standard question asking if she had ever considered MAID before[2], since she had a history of depression and suicidal thoughts.
The Atlantic reporter you're referencing is themselves anti-MAID due to her religious convictions and wishes to remove choice from individuals. It is not an unbiased source of information. The MAID system is _routinely_ criticized from the religious base here in Canada for the last 9 years, and yet not even a hint of systematic abuse of the system has ever been found.
[1] https://www.veterans.gc.ca/en/about-vac/reports-policies-and... [2] https://www.theglobeandmail.com/canada/british-columbia/arti...
No one dismissed asking a question. I'm pushing back against a logical hole in the argument. Even with better healthcare, everyone's heath eventually fails. Using something that happens to 100% of people as an indication of anything is a mistake.
You introduce several forms of asking "why" as a reaction to my comment, but that's exactly what I argued for: a better metric with the actual possibility of causation.
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I only personally know one person who has chosen MAID. He was a close family friend and was very ill. He decided that once he got to the point where he could no longer walk that he didn't see any further point in living. There was nothing more any medical system could do for him. He reached that point and he died on his terms.
I also had family member die recently; he was 95 years old. At 85 he said it was time to go into a home and went and did that for a few years. But at 95 he just decided he was done. He told everyone and then he just stopped eating. Within in a week he was gone.
according to chatgpt, 25% of people die of cancer in canada; presumably dying of cancer is a lot worse than MAID so one might expect this number to grow beyond 5% unless there are just that many people that object to it for themselves on philosophical grounds
According to StatsCan it is actually a bit more, but varying year-to-year. Pre-Covid it looks like it was closer to 27% or 28%, now closer to 26%. So a lot of room to grow, if we made the assumption that all those dying of cancer would prefer to choose their date of passing. Personally, I think the more immediate source of growth in the number of MAID administrations should come from those who died after requesting MAID but before MAID was able to be administered, which would give an increase of 19% in administrations.
Statistics Canada. Table 13-10-0392-01 Deaths and age-specific mortality rates, by selected grouped causes https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=131003...
https://www.canada.ca/en/health-canada/services/publications...
Do you have an actual source? I'm not saying these numbers are wrong, but anything started with, "according to chatgpt" has already lost the plot.
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Or it’s a way for people to make a choice for themselves.
Amen. Let us all out of the torment nexus on our own timeline and terms.
As a physician, I can tell you that euthanasia has been always around in every society and at all times. MAID just made the arrangement formal. Before MAID, it was implemented by withdrawing life-saving treatments (usually due to side-effects), rising doses of narcotics (for painful conditions) or even "terminal sedation" (the most explicit form of euthanasia before MAID-like laws).(And of course, patients always had the option of taking their own lives). In any healthcare system, there has to come a point where patients (and their families) and their doctors decide to terminate efforts aimed at extending life. In most cases, MAID is just a way to shorten the unpleasant interval between that decision and death. Given all that, it is not that surprising that 5-7% of deaths are attributed to MAID. The debate about MAID is another example where a lot of otherwise rational people fall prey to misguided sloganeering.
I don't think it's that misguided. The incentives are so perverse here that, if the government isn't abusing it, they are acting incompetently. it would almost be better if they just had the actuary provide an expected life and expected cost chart and we agreed to pay the potential MAID recipient's estate 10% of the savings remaining on the day the chose to go, if they choose MAID.
How are incentives perverse? Would it be better to have a system that only incentivizes life extension, no matter the suffering it causes, no matter that it will still ultimately end in death?
It's not about whether the person should live or die, it's that the Canadian government has vested responsibility to provide healthcare in itself while making other options illegal. I can't make my own choice to, for example, buy my own medical insurance to ensure I live for as long as possible with the most effective (and likely expensive) treatments. The government has said they got this and limited everyone's choice to government only.
They screwed this up via multiple mechanisms, because that's what government seems to do, and now there is a pretty decent shortage of healthcare up here. This makes the incentives highly perverse because the government can't provide the world class health care it promised even if it wanted to, which leads to political pressure to bring in MAID and chop tens to hundreds of thousands of dollars of medical liability off the end of many patient's lives (which I would actually support if the underlying incentive structure was different, or if the government was at least honest about what was happening and compensating the MAID recipient's estates for forgoing treatment the government is obligated to provide but would be better for said government if they didn't). The most concerning bit here is the lack of provision of other life improving services like joint replacement, the latest experimental drugs, etc. and the likelihood that that is funneling people into a situation where MAID is the obvious best choice sooner than it otherwise would be. This is certainly happening with cancer treatments (although probably not intentionally, just incompetently) as people get detections for cancer and then find a months long wait list instead of days to weeks long wait list to see someone who can progress their treatment.
> which leads to political pressure to bring in MAID and chop tens to hundreds of thousands of dollars of medical liability off the end of many patient's lives
So this is an assertion that requires some evidence. The political pressure was instead from a majority of Canadians (across political lines) who want there to an an end-of-life option in situations when life becomes intolerable. People do not want to be forced by the state to stay alive and suffering via extensive medical interventions. Nor do they want to have to suffer through the alternative of slow and debilitating conditions that science is powerless to stop. This is the where MAID came from. Thinking of it in purely economic terms is already acting in bad faith.
> compensating the MAID recipient's estates for forgoing treatment
If you paid for private medical insurance, would you expect the same from them? To compensate your estate if you choose to end your life early rather that receive invasive and expensive treatment to temporarily forgo the inevitable? Even if you did expect that, insurance companies would never go for it. An even by the widest stretch they did, it would a discounted rate, and then you're still back to the same economic incentive but now with private industry. This is even worse I would say, because now people would be given a cash bonus to commit suicide (either by the government or private insurance, the same applies if people were compensated for foregone treatments). People with families in financial trouble may even consider this a way out to help loved ones. That is a crazy perverse incentive if you ask me.
On the side of offering better services, you have my whole-hearted agreement. Even something as simple as mandating an increase in the number of available seats at medical schools that corresponds with the population growth would be a start. Lots more to that list.
> The debate about MAID is another example where a lot of otherwise rational people fall prey to misguided sloganeering.
This is the same level of argument as saying that people who vote for the other guys must have been tricked by FOX News / MSNBC / Russia / Tik Tok / transtrenders / tradwives, and if only they truly understood their actual self-interest they would agree with you on all things. It's a bad style of argumentation, albeit very popular in academia ('why do the poor keep voting wrong?').
There are legitimate reasons to oppose Canada's euthanasia program on its own terms, and it's not surprising the Canadian government has very carefully shielded MAID from any sort of public input or oversight, since it's deeply unlikely it would pass a majority vote in its current form. There is consistent public opposition to euthanasia being available to anyone but late-stage terminally-ill people (and even then, it's divisive at best). There is strong public opposition to euthanasia solely on the grounds of mental health.
More broadly, I think people are increasingly sick of the misuse of the term 'healthcare' (or 'public health') to sneak unpopular or controversial policies past the electorate, and the idea of 'death as healthcare' is probably the most extreme example of this trend. When people cannot express democratic opposition to policies they deeply oppose, don't be surprised if you get pushback and populism.
73% of Canadians support MAID https://pubmed.ncbi.nlm.nih.gov/38910003/ 71% of Americans believe doctors should be "allowed by law to end the patient’s life by some painless means if the patient and his or her family request it" https://news.gallup.com/poll/648215/americans-favor-legal-eu...
These policies are supported by a strong majority of people.
Literally the abstract of that very study:
> Only 12.1% correctly answered ≥4 of 5 knowledge questions about the MAID law; only 19.2% knew terminal illness is not required and 20.2% knew treatment refusal is compatible with eligibility. 73.3% of participants expressed support for the MAID law in general, matching a nationally representative poll that used the same question. 40.4% of respondents supported MAID for mental illnesses. Support for MAID in the scenarios depicting refusal or lack of access to treatment ranged from 23.2% (lack of access in medical condition) to 32.0% (treatment refusal in medical illness)
Most Canadians express support for MAID but cannot correctly answer questions about it. When Canadians are actually told what's in MAID, they oppose it.
It's also worth noting that quite a lot of polling on this question is done by, or on behalf of, pro-euthanasia organisations; there is often a huge mismatch between the questions asked and the actual legislation proposed and passed (in a very motte-and-bailey kind of way).
People stated they supported the policy after reading a full description of the policy. If you don't trust the paper (whose researchers are anti-euthanasia), the Canadian government found the same results. https://researchco.ca/2023/05/05/maid-canada-2023/
Nobody ever correctly answers questions about legislation, to put it glibly. Any piece of legislation newer than 10 years and more complex than a sentence is not going to pass such a test with the general public. 19.2% knew that terminal illness is not required? I would be shocked if 19.2% could correctly answer a few basic questions about the definition of "terminal illness."
About 18 months ago in Quebec, my aunt, who was terminally ill with cancer, had to go to the hospital for severe pain. I had a phone call with her just before she went in, and while the idea of suicide had come up occasionally, usually during bouts of sundowning, it wasn't her focus at that moment. Once she was in the hospital's care, she was offered a permanent solution to her suffering. After a seemingly normal visit with her sisters that night, she died by assisted suicide the next morning. Her sisters were shocked and devastated.
While I think people should be free to choose, I don't know how much information hospital staff should be able to give.
Difficult.
Edit: I'm not 100% certain as to the timeline. She may have been in the hospital for 2 days.
Here is the procedure for MAID: https://www.canada.ca/en/health-canada/services/health-servi...
You have to have 2 independent medical assessments at a minimum as well as written consent that is witnessed. So its not like you can just say you want to do it and then they just off you right there. She could have had all sorts of reasons for not telling anyone including her sisters. There's nothing in your anecdote that disputes she could have planned it long in advance and just not told anyone.
"There's nothing in your anecdote that disputes she could have planned it long in advance"
It seems implausible.
She lived with her sisters and while she was quite capable of many tasks, I think that long term subterfuge was beyond her. She was well into mental decline.
"You have to have 2 independent medical assessments at a minimum as well as written consent that is witnessed"
Could this not have happened at the hospital?
Well its impossible for us to know her state of mind, anything would be speculation.
Yes, it could have happened at the hospital but do you think they have people sitting around waiting to do medical assessments and be witnesses just so they can push MAID onto people? At most hospitals the doctors and medical staff are extremely busy.
Here is the 2023 (latest) government report on MAID in Canada.
https://www.canada.ca/en/health-canada/services/publications...
It has little to do with religion. There are lots of examples of MAID being pushed upon people that do have other options and made to feel like it's the only one.
It's also a way for collapsing government-run healthcare to save money.
> There are lots of examples of MAID being pushed upon people that do have other options and made to feel like it's the only one.
How many examples? What percentage of patients eligible for MAID receive such treatment?
how many would you like?
If you're being serious, I'd like to see actual data on what percentage of MAID-eligible patients are having MAID "pushed" on them, along with a clear definition of what "pushed" means.
Well you're not going to get it, because the only institutions with the ability to create that data would not do it in that way.
What we do have is the words of people saying they do not wish to die, but are taking MAID due to necessary supports not being offered instead. What percentage would you consider too high for that?
> What we do have is the words of people saying they do not wish to die, but are taking MAID due to necessary supports not being offered instead. What percentage would you consider too high for that?
What you do have is a handful of anecdotes, to put it in more honest terms.
What's fascinating to me is that the discussion of these anecdotes revolves around wanting to eliminate MAID rather than -- gosh, I don't know -- offering those necessary supports instead? The anecdote (in the article) about it being easier for "some people" to get MAID than to get a wheelchair makes for a great soundbite, but the people who quote it always seem more interested in eliminating MAID than in providing wheelchairs to those in need, for some odd reason.
Well see I've been part of this conversation longer than maid has been a thing. And it used to be "oh that won't happen, it'll only be for terminally ill people and with a high level of medical and psychological oversight." And so my position was that maid shouldn't become a thing until eg "providing wheelchairs" is fully accomplished.
And now here we are. Maid is a thing, and people are being encouraged to do it while not being provided the alternatives they are asking for. And the numbers for how many are totally illegible but also somehow too low for you to be concerned with.
My activism has long been more focused on getting people the care they need than opposing maid. But regardless people still don't always get the care they need and we have maid for them instead. We said it would be like this and it is like this.
> And so my position was that maid shouldn't become a thing until eg "providing wheelchairs" is fully accomplished.
Without having actual data, this is nothing more than an excuse to eliminate MAID indefinitely pending an imaginary system in which no one slips through the cracks; in the meantime, you will force countless more to suffer months or years of needless agony on the off chance that one of them might be one of your anecdotes.
> And now here we are. Maid is a thing, and people are being encouraged to do it while not being provided the alternatives they are asking for. And the numbers for how many are totally illegible but also somehow too low for you to be concerned with.
The only "numbers" I get from anyone like you are a handful of anecdotes that add up to a tiny fraction of a percent of people who elect MAID, and a vanishingly small percent of people eligible for MAID. If you genuinely mean well, I want you to understand: you are being manipulated by people who will do nothing to help those in need, and on their behalf you are campaigning to immiserate thousands upon thousands every single year.
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Please respect the site guidelines when commenting here and don't cross into personal attack, no matter how wrong someone else is or you feel they are.
https://news.ycombinator.com/newsguidelines.html
I genuinely am not clear on how that crosses over to a personal attack? I'm factually describing the outcome of eliminating MAID, nothing more.
Edit: By the way, great job singling my post out for speaking factually about the consequences of someone's beliefs while ignoring a post[0] that explicitly calls MAID eugenics. I wonder: if I'd spoken in abstract terms rather than referencing @giraffe_lady specifically would I be in the clear? What a wonderful policy you have, dang.
[0]: https://news.ycombinator.com/item?id=45021189
"one who wishes months or years of suffering and misery on the terminally ill solely to assuage her own conscience" was a reference to the person you were arguing with and an attack, hence a personal attack.
I didn't see that other comment. If you see a post that ought to have been moderated but hasn't been, the likeliest explanation is that we didn't see it. You can help by flagging it or emailing us at hn@ycombinator.com. (https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...)
> What we do have is the words of people saying they do not wish to die, but are taking MAID due to necessary supports not being offered instead. What percentage would you consider too high for that?
But these are separate issues, no?
I mean, if we don't have MAID, the existing failings of our healthcare system won't just go away; they won't just magically get the support they need. Instead, they'll die anyway, probably in a painful way.
Of course, for this discussion to be worth anything, we'd need more details. What does "support not being offered" mean, precisely? ..How many people is this actually happening to? And no, we can't just believe accounts posted on social media. And even if we did, are we going to get the other side of the story?
More than zero and enough to demonstrate it's a systemic problem, say > 5%?
Well, some sort of source of any kind would be a start if you’re actually posting this in good faith. Right now this is “pulled out of my butt with no evidence whatsoever” and simply not credible.
> There are lots of examples of MAID being pushed upon people that do have other options and made to feel like it's the only one.
I'm not really surprised. It looks like Canada's healthcare costs are growing exponentially, and are outstripping growth in GDP. These costs are mostly driven by hospitalizations. If a government can carefully promote the message that hospitalization means suffering, suffering is hard, a life with suffering is not worth living, and that relief is quick and easy, then a route is charted to a reduction in healthcare expense. It would certainly help if the large physician organizations are on board, and the nation's major broadcasters lean into euthanasia-friendly messaging.
What is the source that the healthcare costs are growing "exponentially" and are outstripping growth in GDP? I would accept that its increased but definitely not exponentially. As well, I live in Canada and have not seen any such messaging that you have said.
> What is the source that the healthcare costs are growing "exponentially" and are outstripping growth in GDP?
See here, in particular the first figure: https://www.cihi.ca/en/national-health-expenditure-trends-20...
And here (slightly dated, but still valid): https://www.fraserinstitute.org/studies/sustainability-of-he...
> I live in Canada and have not seen any such messaging that you have said.
Here's a not-particularly-subtle example: https://www.cbc.ca/news/canada/new-brunswick/maid-medical-as...
Neither of those links give us evidence of "exponential" growth as one would normally define exponential growth. I did agree that it definitely has increased, just not exponentially. As well, the first link demonstrates that the GDP has increased greater than the healthcare expenditure. Only in the "forecast ed" area does it outstrip GDP as an annual percentage.
If you search the CBC, they have articles both for and against MAID. I think its kind of silly to say that all positive news articles about MAID is government propaganda as there is likely to be a non-zero amount of positive experiences with it. Should the government not allow the press to make any comments on MAID to avoid biasing anyone for, or against it? For example, here is a negative video the CBC posted about MAID: https://www.cbc.ca/player/play/video/9.6521196
Are those "other options" going to be "sitting here and dying naturally, maybe drowning in your own vomit, maybe dying of starvation"?
I have a hard time believe things are going down like, "You have cancer. We can treat it and you'd be fine, but you know what you should do instead? Kill yourself"
On the other hand, I do believe (and want) doctors to be like, "You have cancer. We can treat it and you might get a few more months with very poor quality of life. You may wish to consider these other options"
It's not always the way you imagine it will be. I've posted this in this thread already but it seems most people haven't seen it. https://www.youtube.com/watch?v=gG3AJ3W_sbI This veteran seeks help and isn't able to get what she needs. What she is offered is MAID. That's the reality; sick people who aren't getting medical care are offered the comparatively cheaper option of death and it's very insulting for them.
> There are lots of examples of MAID being pushed upon people that do have other options and made to feel like it's the only one
The only pushing I’m seeing is that by religious people onto non religious people, as usual.
Do you consider CBC "religious people"?
https://www.youtube.com/watch?v=gG3AJ3W_sbI
Video news is a poor source of information, highlighting outliers when full data distributions are needed to analyze the dynamics at play.
One person’s account of what happened against an entity who is not allowed to discuss their side of the story is useless. And even if the whole account is accurate, it is not sufficient to stand in as proof of a nation’s protocol.
This evil Track 2 still requires that a recipient of MAID have "grievous and irremediable medical condition". It requires informed consent and primary capacity. It's not a law to bump off demented old people.
Limiting euthanasia to people with imminently terminal conditions is how you keep people in pain. The very best palliative care can still accompany suffering beyond anything a well and able person can begin to perceive.
Mental healthcare and social care and all these perpetually under-funded margins do need to be improved. MAID is not the preventative healthcare that we all need throughout our lives, but we need to be honest about the balance. Is it worse to end life prematurely for the "wrong" reasons, or to make someone suffer for the "right" reasons? This is dirty ethics. Get out the way and let people decide for themselves.
"One of the things it means to be Canadian is to honour the rights and wishes of other people. That’s part of what makes it a wonderful place to live: most people genuinely believe in equality and respect for others, including people who don’t look like them."
In my opinion, this drives the narrative in this article, and is at the root of why there is little stigma in Canada surrounding MAID.
I think any article that cites assisted suicide statistics without breaking it down by Track 1 vs Track 2, should not be taken seriously.
The author cites 5% as the “number too high” but as someone who’s had a family member who’s been through the MAiD system, Track 2 is pretty difficult to get so I would t be surprised if most of that 5% is Track 1, but we wouldn’t know from this article.
The vast majority of MAID provisions (95.9%; n=14,721) were for individuals in Track 1; 4.1% (n=622) of MAID provisions were for individuals in Track 2. (See Section 2) [1]
[1] https://www.canada.ca/en/health-canada/services/publications...
The vast majority of people choosing maid are those who enter hospice and wish to go peacefully before their terminal illness degrades their life to a state of loss of bodily control and pain.
34% are between 18 and 65
Being between 18 and 65 does not mean you're in good health, sadly.
The median age for MAID recipients is over 77.
50% is not a vast majority, so that's a red herring
Both can be true, I think.
What does that have to do with the post you replied to? Is your implication that young people can’t enter hospice or have terminal illness? Or are we just quoting random statistics without any regard to relevance whatsoever?
I always thought the desire to bring a doctor in on suicide revealed a lot about how the person must really feel about it.
I also remember that poor woman in Canada who died after being refused a kidney transplant because she wouldn't take the covid vaccine.
Canada has got a lot of problems.
As a Canadian, I’ve witnessed a perfect polarization of opinions among the people I’ve talked to about MAID. So far, every Christian I’ve talked to about MAID is against it while every non-Christian is either for it, or has a neutral attitude about it.
I would imagine Muslim or Jewish people to also be opposed. I think both consider this to be a sin.
Or maybe you meant religious vs. secular people?
As I've learned from Jewish friends, Judaism is rarely that simple. Here's an article about Judaism and MAID in Canada:
https://thecjn.ca/opinion/how-jewish-nursing-homes-approach-...
Interesting. There are certainly different streams/versions of Jewish faith. I was thinking more about Orthodox Jews. To me "Christian" is a lot more diverse so I'm surprised this is somehow so fundamentally Christian vs. other religions.
Canadians who identify as religious are overwhelmingly Christian (53.5%)[1], with most of that being Catholic. The next most common religion is Islam at just 4% and Judaism is a paltry 0.9%. You're simply more likely to get anecdotes from the religion that is the vast majority.
In general, even the religious in Canada aren't very religious, so those who actively identify as it are likely to be _very_ religious. I have not a clue what religion any of our close friends are.
Canada becomes about 10% more agnostic/atheist every 10 years, which is a fun pattern[2].
[1] https://www12.statcan.gc.ca/census-recensement/2021/dp-pd/pr... [2] https://en.wikipedia.org/wiki/Irreligion_in_Canada
> maybe you meant religious vs. secular people?
Nope. I meant Christian vs. Non-Christian. Granted, I haven't discussed MAID with any muslims before.
In my experience, the line is between "people who have seen a family member die a horrible, painful, prolonged death" and those who haven't. The former group tends to be very passionately in favor of it.
It's really not that simple in my experience. Younger disabled people are generally against it as well, they rightfully have their guard up about things that look like eugenics.
> It's really not that simple in my experience. Younger disabled people are generally against it as well, they rightfully have their guard up about things that look like eugenics.
Apologies for sounding like a broken record here, but do you have anything other than anecdotes to support the claim that younger disabled people are generally against MAID?
I'm a younger disabled person (severe visual impairment, autism, ADHD, and some other things) that is very much in favor of it.
Thinking this is akin to eugenics is silly and not doing anyone any good.
Really? I'm surprised, many secular people on the left are against it because they see it as the state running it badly. Take this video someone posted higher up; https://www.youtube.com/watch?v=gG3AJ3W_sbI A paraathelete get injured and it's suggested MAID. Insulting and ridiculous. It only takes a few of these before people decide even if they like the idea the government botches the execution and there's little recourse if they go too far.
If you've ever seen someone die slowly in hospice or in hospital having spent the last 5-10 years in misery, of a chronic diseases with cures beyond our ken, you question will be....
only 5%?
Legalizing medically assisted suicide is fine. w/e
Forcing others to contribute to funding and carrying it out through taxes is not.
It should only be offered when patients ask for it. Some sick people are already depressed and feel like a burden we shouldn't put ideas in their heads.
> Forcing others to contribute to funding and carrying it out through taxes is not.
How else is it supposed to work?
> Some sick people are already depressed and feel like a burden we shouldn't put ideas in their heads.
You sound like you think there isn't an entire system of checks and balances around this but, of course, there is.
People pay for the $5 pill themselves or find a tall, tall bridge.
> How else is it supposed to work?
Like literally any other good or service.
I think it's best that we keep any profit motive out of this. It certainly doesn't work for health care.
This is not health care. Not in any sense that Hippocrates would cosign.
Hippocrates didn't actually write the Hippocratic Oath, which, if this matters to you, also forbids abortion.
We consider it health care for our pets.
So... like sewage service, or the fire department?
What prevents someone from committing suicide this way?
If you mean, what would stop a random healthy person from walking into a hospital and getting MAID, the procedure is described in another post on this thread: https://news.ycombinator.com/item?id=45021339