I'll start with a question.

If you, your doctors, and your family all agree on an end-of-life healthcare strategy to minimize your suffering, should the government be allowed to veto your choice?

Before you answer, keep in mind that the government's veto might devastate your family's psychological and economic health. Who is onboard with letting the government make those decisions over the wishes of you, your family, and your doctor?

I ask because I've never met anyone who would prefer the government to have veto control over their own healthcare decisions. That's why I think the debate over doctor-assisted suicide is a fake debate.

My hypothesis is that the alleged 49% of the country opposed to doctor-assisted suicide is more like 1% nut jobs and 48% people who got tricked by a poll question that was some form of "Should the government allow your doctor to kill you if it seems convenient?"

But I try to be open-minded. I really do. Can anyone point me to a rational person who would answer yes to the government having veto power over your end-of-life wishes, your doctor's advice, and your family's preferences?

It's no fair rewording my question into something you DO object to. I'm looking for someone willing to say proudly and loudly that the government should make their end-of-life decisions for them over their own wishes, the advice of doctors, and the wishes of their family. Any takers?

I submit that that person does not exist. If I am wrong, I'd like to debate you right here. Please show yourself. Maybe I'll learn something.

In the unlikely event such a person exists, and cannot be swayed with simple information such as the success stories of similar systems elsewhere, that brings us to the second topic on my list.

It turns out that having an outspoken opinion about anything important in this world is very bad for business. The folks who disagree with you on any sensitive topic will use it as a reason to take their business elsewhere.

That leaves no one but the nut jobs to dominate the debate. Sane people stay out of the line of fire.

Now here's the interesting part: I just became an orphan.

Living parents are a huge limiting force on a writer. I was always worried about embarrassing them. They trained me to be that way. I'm now freed from that restriction. (The rest of the family wouldn't much care.)

My remaining reason to self-censor is purely economic. In my unique case, 100% of the money I earn for the rest of my life will be spent for the benefit of others. I already have enough for my own needs. The main reason I keep working is because I am in a rare position to make an oversized contribution to the economy, and perhaps add value in other ways. Apparently I am genetically inclined to find that prospect satisfying if not necessary. I don't want my valuable business engine to clog up just because I was outspoken on an emotional topic. That wouldn't be fair to a lot of people in the value chain who were minding their own business.

So I'm going to offer you (the public) an arrangement. If my new book, How to Fail at Almost Everything..." hits #1 on the NYT non-fiction list I will be freed of my last remaining reason to self-censor. And I will drive a stake through the government's heart on this doctor-assisted suicide topic.

You haven't seen me uncensored. You might enjoy the show.

I'll even sweeten the deal. I guarantee that you know someone who would benefit from the book. That person might be you, or it might be someone in your life who is making suboptimal career and lifestyle decisions and doesn't want your advice. The book is designed like one of those soft dog treats inside of which you hide the dog's medicine. The reader won't even see the useful stuff coming.

If you're counting, that's three potential benefits from one book: The book might help you personally, or at least entertain you. It might help someone you care about (after you read it first, of course). And it might free me to jackhammer some rational thought into the end-of-life debate.

Or you could just buy clothes for everyone on your shopping list. Clothes are fun too.

How to Fail at Almost Everything and Still Win Big: Kind of the Story of My Life.

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Dec 2, 2013
I believe that doctor-assisted suicide should be illegal, even if it coincides with the wishes of the patient and their family. I am not an activist on the issue per se, but some might construe me as such. I have counseled individuals and families in this regard on a few occasions. Further, I have a living will that specifically states in detail that, should I be incapacitated, it is my desire to remain alive by any means necessary. Philosophically, I believe that life is inherently valuable and should be preserved, regardless of the quality of that life. I am a reasonably sane and rational human being, and would be willing to debate the topic if you would like.

P.s. I have read your blog for a while and comment occasionally, so please accept that as proof that I have not come to the blog to engage in this particular fight.

[A belief in magic isn't a philosophy. -- Scott]
Dec 2, 2013
When you got to the "offer" part, I suddenly felt like I was being m o l e s t e d by a family member.
Dec 2, 2013
I think you first need to show that all doctors (and relatives, who might stand to gain financially) always exercise infallible, unquestionable, unswervingly ethical judgement. With that proved, I believe your argument is easily won.

My opinion on the debate doesn't matter, but I don't think you can meet the above burden so the law will probably continue to err on the side of caution (in a matter of speaking).
Dec 2, 2013
Ok, I ordered the audiobook. Hope that counts. If your voice is up to it, you should go on The Daily Show or The Colbert Report. Seems like those shows would hit your target demographic pretty well. You could debate euthenasia with Colbert.
Dec 2, 2013
...Umm...there were folks willing to debate you on this topic in your last post, why didnt you take them up on it? I realize this is a topic you have become very passionate about for good reason, but for some of us its getting old.

[They were willing to debate the wrong question. -- Scott]
+14 Rank Up Rank Down
Dec 2, 2013
Just sharing how this works in the Netherlands, where this problem has been solved long ago.

First, it's called euthanasia. It's not suicide, assisted or not. I could go into the technicalities of the difference, but I won't bother. Words matter though, as they shape opinions.

Over here, the doctor has the final say in the decision. If the patient and/or family are against euthanasia, obviously nothing will happen. If the patient and/or family want euthanasia, the doctor has the final decision, obviously heavily influenced by the family and patient. All three have to agree (actually, the family is technically not needed if the patient is mentally capable). If you feel the doctor is unreasonably rejecting such a request, you can simply go elsewhere, to another doctor. The system as a whole works. It's not perfect, but it works. The only challenge in the system is that patients tend to conclude their quality of life is too low sooner than doctors will.

Note that there is also a difference between active euthanasia and passive euthanasia. Stopping medication for example is passive euthanasia. Conceptually it isn't even suicide, since the heavily medicated state of the body is not a natural state. By stopping medication a natural death occurs. You may think this difference does not matter, but it may matter to religious people.

One important part of why the system works fine here is that doctors have no financial stake in the decision at all. Doctors get paid no matter what, and it is covered by general, partly-socialized healthcare.

Anyway, just sharing that many have gone before you.
Dec 2, 2013
Another vote for uncensored Scott, I'm buying one for each person on my team. (after reading the book I decided I wished someone had given me the book 20 years ago, and being as they're all about that much younger than I am...)

Scott, I'm sorry for your loss and I'm a fan of leaving the control of how one exits this world to an individual and his/her loved ones and trusted advisors.
Dec 2, 2013

[My point was that there are cases, such as abortion, where people believe the government should have veto-power over personal decisions, even though they wouldn't phrase their positions that way.]

That's not the same, because with abortion, the argument is that the fetus has the right to live. With anti-abortionist logic, your argument would be tantamount to saying that outlawing killing your toddler would also be the government vetoing personal decisions.
+1 Rank Up Rank Down
Dec 2, 2013
End of life planning is already common place, the main issue is the focus is on prolonging life rather than ending it at the appropriate time.

Provided the necessary caveats are in place to protect the individual, I fully support "assisted suicide" when it brings about an end to suffering and support that it should be the individuals choice.

My daughter works with a variety of ill and injured people in her role, she has strict instructions from me that if I ever reach where I'm not physically or mentally capable of caring for myself and thus have a totally diminished quality of life, or I'm dying through a terminal illness being kept alive and medicated by machines, pull the plug and hold a pillow over my face.
-2 Rank Up Rank Down
Dec 2, 2013
By the way I agree that assisted suicide should be legal (as long as the patient made the decision when he was of sound mind & not when he is already suffering). My point was that there are cases, such as abortion, where people believe the government should have veto-power over personal decisions, even though they wouldn't phrase their positions that way.

Other examples would be drug use and prostitution.
Dec 2, 2013
Agree with Scott in principle. Agree that his question wording is worse than the original.

However, here is a countervailing scenario.

1. The healthcare system moves further in the direction of capitated contracts, which pay doctors a flat fee based on the number of patients they treat, regardless of the doctors' actual costs. These contracts are used by insurance companies in some cases today with the idea of motivating the doctors to control costs
2. Capitated contracts are instituted for doctors providing end-of-life care, and they are based on the number of patients cared for during the year (vs. current method based on number of active patients at any given time).
3. Patient signed a medical directive years ago permitting assisted suicide if he is unconscious and terminal.
4. Evil stepchildren want the inheritance money. Evil doctor puts otherwise healthy person into an induced coma or other unconscious state, says he is terminal, and kills him off. Step children get money, doctor gets profits, patient gets dead.

Contrived, but not impossible.
Dec 2, 2013
A lot of people believe abortion should be banned. Wouldn't that be an example of the government having veto power over the wishes of individuals and families on a major life decision?
Dec 2, 2013
The sticker is assuring the decision is in fact made by a competent adult (that includes specifying instructions at an earlier time in life against the possibility of not being competent or conscious).

My observation has been that when power of any kind is to be had, somebody will grab it. It's not enough for a government simply to butt out. Somebody has to step in make sure the decision isn't being shaped by others, through force, pressure or manipulation.

There are plenty of possible motives for others to butt in:
-- Relatives or others may wish to maximize an estate or minimize personal inconvenience or expense.
-- Insurers and care facilities have a financial state in either extending a life or ending it.
-- It can be legally useful to people to keep someone "alive" (to avoid a murder charge, to prevent provisions of a will from taking effect, to prolong access to property via power of attorney, etc), or to hasten their demise (to facilitate transfer or sale of assets; to prevent a custodian from assuming the deceased's legal powers, etc.)
-- Interlopers see political, religious or publicity benefits.
-- Sociopaths and/or basic jerks, just because they can (Never underestimate this segment).

The law has intervened when parents endanger their children's lives by denying basic medical care, although adults are perfectly free to deny themselves such care (talking about refusal to treat actual illness, not the anti-vaccine cult). When an adult is senile, unconscious or unable to assert himself, should the law stand aside and leave it to whoever wants make the decision on his behalf -- regardless of what that decision may be?
Dec 2, 2013
Scott, respectfully, I think you are drawing a black and white distinction where there is not one.

I agree with you that the number of people who think that mercy killing people on their very last leg as opposed to giving them treatment to prolong their existence is few. But the question then becomes what is the last leg?

Recently in northern european country, a person was consentually euthanized because they were depressed and didn't want to go on living. What if you are diagnosed with terminal cancer but given several healthy years to live? AN you want to go ahead and go now, because you don't want the mental "torture" of what's to come? What is the point that you should be able to ask to be killed? Immediately? Or only once you've reached a certain health threshold?

I'm not being rhetorical, I'm asking a serious question so I can better understand your position.

[I think the discussion gets derailed if I describe a specific set of rules I might prefer. It makes more sense to look at places it is legal and ask the citizens how it's working out. -- Scott]
-3 Rank Up Rank Down
Dec 2, 2013
I was going to say doctor assisted suicide could start with a law of "we'll donate all the dying persons wealth to charity if we can end their suffering" to curb the main argument, but you sounded like the biggest hack pushing your book at the end of that post, please tell me I haven't wasted years reading the work of a sell out!!!
-3 Rank Up Rank Down
Dec 2, 2013
If Doctors have a moral or philosophical reason for not wanting to be a part of this because of the Hypocratic oath, that's fine - the real hypocrisy though, and caused harm, is maintaining a state of suffering for whatever reason. Whatever the job title is, I'll do it. Not because I want to actually kill anyone, but because I'd want to ease their suffering. I'll have business cards created at vistaprint.com - title "Angel of Mercy"...
+10 Rank Up Rank Down
Dec 2, 2013
I think if somebody wants to die and is in a state of health where that's a forgone conclusion anyway, then that's their business. However, I think a a medical professional who plays a role in death cannot be called a doctor. The doctor's credo is first, do no harm. The most I would ever expect from a doctor is to unhook the machines and allow death to come, be it naturally or self-inflicted.

Scott is framing this in a particular way, but the way I see it, I don't want the government anywhere near the position of giving a thumbs up or thumbs down on whether it's okay to kill a person. Although given the Roe v Wade decision, many would argue they are already doing that. Granted, there's a wide gulf between protecting an unborn child with a lifetime of potential, and an elderly person with theirs behind them, but the casual attitude that inconvenience can be settled by ending a life can be seen as similar in both cases.

Suicide, if done correctly, is an unprosecutable crime. I think it's best kept that way, rather than involving someone who would be bait for potential prosecution. This is one of those things that sounds good in theory, and for a small number of anecdotal cases, but the unforeseen consequences and potential for abuse would not be pretty.
Dec 2, 2013
Uncensored? I wanna see it.

I already have a copy coming to me for Xmas. Maybe I will see what I can do for my friends.
Dec 2, 2013
I totally agree with Scott on everything regarding this specific topic.

... but in light of recent blog posts, it's hard not to see the hypocrisy in Scott's authoritarian position for an omnipotent central government. This is just one of many times when I wouldn't want the central government to veto important decisions in my life. Whereas this appears to be the unique issue under which Scott wouldn't want a central government to have veto power.

[I like the government issuing fishing licenses and setting banking regulations, for example. I don't like them torturing my parents to death. Is that what you call inconsistent? -- Scott]
Dec 2, 2013
Your book is changing the way I think about some things and the way I do some things. Thank you!
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