Find comfort in choosing your own death

boing
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What I’m saying is that the philosophical issue you raise is irrelevant in the real world. If I decide, while I’m still thinking clearly, that I want to die when my mental abilities reach a certain point of decline, whether or not I am thought by other people to be “happy”, rather than waiting for agony and mental anguish, then that should be honored. Your evaluation of a demented person’s “happiness” is irrelevant.

If the state of dementia was reversible, and if there was any hope of a full recovery, and a resumption of a healthy, thinking life again, you’d have a point. But that’s not how this ever works. At the point in life we’re discussing, there’s no road back, and death is inevitable. The question is, who gets to decide on when I die? You or me?

Whatever your concern about my agency as a future demented person, it is clearly not within the ambit of YOUR agency to make decisions about when I may or may not die if I have in the past made my considered decision clear.

If you say “But, I am able to think clearly, and in your state of dementia you are not able to understand these things. I think you are happy, so I will make the decision to override your previously expressed desires” - you are, in fact, supporting my assertion that when I believe I am thinking clearly, and I decide under what conditions my life should be ended, MY desires, not yours, should be honored.

If anyone is going to second-guess my future self, it should be me, not you. I promise you, if I get it “wrong”, that’s ok with both me and my future self. If my clear-headed early decision denies my later demented self one more tasty piece of pie or a laugh at the antics of a cat, that’s ok. If he could think clearly, and he could understand what was coming, he’d know I was doing it for his sake, and he’d be fine with it.

As an experiential note - have you ever gone to a nursing home and heard the old demented people strapped in their wheelchairs wailing? For hours? Or, in other facilities, seen them strapped in, slumped and silent, drugged so that they will not wail? That is the “agency” you are worried about violating. Can they ask for death at that point? Most of them can’t. And under your philosophical regime, they would be condemned to months or years of anguish before they die, because their past selves’ expressed wishes are not valid and they can no longer say “I don’t want to live like this any more”. That’s good for the nursing home profits, but I would assert that it’s bad for the old folks who are screaming and moaning or drugged into insensibility as they slowly dwindle towards their inevitable death.

I look forward to your response to these considerations.

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46

There’s some historical discussion of how suicide has been viewed by society in a video I’ve seen. However… the philosophical discourse is mainly the first two parts of the video; the rest is very personal, and deserves a strong Content Warning. If you don’t want to see that, I’d recommend shutting it off when Dr. Rozenkrantz confronts Olly about his choice of sources (you’ll be able to recognize that when you see it. at the end of Act I; hit stop at Act II.)

The video itself has plenty of content warnings, but I feel it’s irresponsible to link it without adding my own. It’s very intense, and given the subject matter, could be upsetting, even triggering… so please don’t watch if it might be harmful to see it. But I do think it’s relevant to the OP, and the conclusion is, IMHO, a hopeful, uplifting one.

Edited to clarify when the personal content begins.

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47

We routinely make every day decisions that are binding on our future selves. Whether to buy that house or not. Whether to go to university or not. Whether we want fries with that. Etc., etc.

While you can argue that these decisions can be revisited, that isn’t true. I can never have bought that house today if I decide not to today. Future me may curse because the next day the person who did buy the house finds a billion dollars hidden in the walls, but they won’t get that money, because I bound them by deciding not to buy that house right then.

I don’t see that this is any different. Future me always owes present me the circumstances of their life (or non-life). Hey, I know, I’ll go skydiving! Does future me get any say in that, even if it’s possible my parachute does not open?

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48

Cognitive decline is a special case, but a common one, and it’s a good example of why we can’t tackle euthanasia without being able to think about “regular” suicide in a more nuanced way.

If we tried to completely medicalise the distinction, in the case of dementia that would have to mean something like, I file a declaration saying that once I fail a given cognitive test I want to be euthanised. But then, what, do I end up trying desperately to remember “person woman man camera TV” while a nurse hovers over me with a pillow? Or do I have to lose the power of speech first? I could be more of a vegetable than I ever hope to be, and still say that I wasn’t ready to die if someone asked.

Ideally, if I see that on the horizon, I want to be in a position to decide “OK, today is my last day”. That means having a legal way to do it, possibly with help; but it also means having a way to arrange it so I’m not found on a park bench by a toddler, and it’s not traumatic for my survivors, and I can set it all up without using advanced spycraft to avoid getting caught.

So at a minimum I would want the kind of general-purpose suicide infrastructure described in the OP. But the bigger obstacle right now is, whose friends and family would ever accept being told about this in advance? It’s much more than just a narrow question of medical law.

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49

There’s a very real pragmatic issue here. If you declare that future self should be assisted with suicide when reaching a certain level of cognitive decline, presumably there comes a point when you actually administer the assistance, and I would have serious ethical issues with that being done against the will of the person there and then.

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Most old people and seriously ill people I have known have quietly arranged ways to end their lives if they decide that it is time to do so. The ones who have died mostly haven’t used those plans - but their last years, months and days were much easier for them because they knew they were in control of the timing of their end, if they chose to be.

Some have included their families in their plans, because they knew their families would support their choice - others have hidden it, knowing that they would have to act with no notice.

What we need is a simple, clear, legal framework for suicide that does not require psychologists or religious counselling or the approval of doctors - people have their own lives, their own motives, their own beliefs, and it’s not really up to other people to decide for them if they are “making a mistake”.

One friend jumped from a tall building, because his previous attempts at a less dramatic suicide were stopped by relatives and doctors. He gamed the system that was set up to stop him, and succeeded, but they put him through a lot of trauma he could have avoided in a saner world. Was he wrong? Not my place to say. He was convinced that death was his next step, and I have to assume he did what was right for him. I miss him, but that’s not relevant to his decision about his own life.

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52

In various discussions about it over the years I find that the people (mostly young) who haven’t seen someone close to them dying in a slow way are against it. Those who have seen such a death tend to be for it.

While still able-bodied most people can deal with it themselves but there’s always the chance of it going wrong and there’s the problem of who finds your body. However, many people would choose to live longer than their ability to reliably kill themselves–when you’re on heavy pain drugs a mistake is easy.

I favor a system where you can declare your wishes in advance. Some in this thread have brought up the issue of irrevocable decisions–but why does it have to be irrevocable? So long as your mind is still functioning you can change your decision at any time. It only becomes irrevocable when you are no longer in a state to make such a decision.

Also, I would like to see a different approach to who qualifies. Where it’s permitted it usually requires a terminal diagnosis with a limited lifespan left–but the worst ways to go don’t actually kill you. Instead, I would like to see a system based on what the doctors can do, instead. You apply, a psychiatrist (picked from a pool, not one of your choice) determines that you are of sufficiently sound mind to make the decision and looks at what medical options exist to make life better for you. If specialists in the relevant area(s) say there’s nothing you get approval in say a week. If there is something to be done to help you must reasonably cooperate with their efforts (perfect compliance is not required, we are not infallible) until either they conclude it won’t help, or a year has passed which gives an automatic approval assuming you have been cooperating.

Once approved you have access to professionally-handled means of suicide and physical assistance if you can’t do it yourself.

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53

Of course you would. That’s clear from your hand-waving and wittering on about your philosophical angst. The distinction here is the phrase “against the will of the person there and then”. You would question the future me with dementia, and try to interpret their response in some way that made sense to you in that moment, on the assumption that whether or not to end their life was your decision, not my past, clear-thinking self’s decision.

I would not do that - I would ask, when my mind was clear, that I be given a sedative and then death at a certain future point, without consultation with my remaining husk. That would not prevent me from living forever - my death is inevitable. It would just let me decide on the timing of my death. THAT would be the kind thing to do, for ME.

You’ll damage your knuckles with all your hand wringing, but please stay away from ME if you’re ever in a position of power in a hospital or nursing home.

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54

Because the discussion is going that way

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And who decides that?

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I don’t think anyone in this discussion is feeling suicidal right now - no one sounds like that. That link is always a good thing to post, of course, so people know there’s someone to talk it over with if they want to.

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58

this is good but it should require more doctors and more social workers and cost more money

we can’t be leaving any dollars on the table here

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61

Love it.

Our male cat (RIP) was pretty ornery so we called him “Nuisance.” Every now and then we’d stick an S at the front and call him Snuisance. You see where this is going. He used to try to mate with the girl cats (despite being “fixed”), so once we saw that episode of Futurama we started calling him Snu-Snuisance.

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62

It’s not just religious people, but clinicians too have to be somehow convinced. When my MIL had a stroke and went into a coma, we couldn’t find her living will at first. Surgeons put in a feeding tube. We found the will that clearly stated, maybe in not these words: “NO PROCEDURES TO KEEP MY ALIVE IF I"M IN A COMA.” Surgeons said, well we can’t take it out now that it’s in, and we have to keep her alive. Fortunately there the social workers there put us in touch with a very nice bioethicist (about 85 years old) who was able to get the policy changed. After a week or so, she went into hospice care. Even there an idiot physician said “oh it’s the law we have to start feeding her.” The hospice nurses (clearly smarter) were able to convince him otherwise.

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63

Obligs.
Get out your hankies.
We miss you, Sir Pterry, every day.

Warning: this link (Terry Pratchett: Choosing to Die | Full Documentary | Reel Truth) has actual person actually dying in it.

https://www.youtube.com/watch?v=LviHXDp8SHk

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64

Would you believe that this is that?

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They are still working on that. Apparently, death is easier.

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Society? So for example the same society that failed to protect the child from being abused by a parent has any right to prevent abused person from ending their suffering due to PTSD? Or the taxpayers rights to their investment are more important than ending absolutely unbearable suffering? I guess you are right though, society has right to do anything it wants, it makes up laws after all.
The society has no moral right to anything, especially since it’s the same society whose politicians are currently calling for stoning to death of some of us only due to our sexual orientation.

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It’s a bit too macabre for my taste but apart from that this would look great framed on a wall.

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