Noah Smith on Euthanasia: Why I’m Not Convinced

From Noah Smith: The perverse incentives of euthanasia: Suggesting that people die is not a good way of saving taxpayer money.

In his attacks on MAID, Noah trots out the usual, easily-countered arguments.

First, there’s the possibility that people could simply be denied life-saving treatments if health providers consider MAID a cheaper, acceptable alternative. The moral justification for MAID is based on the idea that people should get to choose when to die with dignity. But some people don’t want to choose death. If a health care system makes that decision for them, refusing to pay for non-MAID care, it has violated the principle that death should be a choice.

MAID, or any assisted suicide program, as practiced, has never been about denying care, but about presenting assisted suicide as a more humane option for those who wish to not go through with costly and ineffective end-of-life care, or who otherwise choose to end their lives.

For example, here’s a story from last year about a Canadian woman who was given a poor abdominal cancer prognosis and urged to die with MAID instead of getting surgery and chemotherapy. She refused, and went to the U.S. for treatment. Canadian health insurance refused to pay for the treatment:

This is more of an indictment on the poor quality of Canada’s healthcare, than MAID’s fault; without MAID, she was going to die anyway. Second, MAID was presented as an option in lieu of conventional treatment like chemo, but chemo was still an option. It’s not unheard of for people with terminal cancer to commit suicide, seeing that conventional treatment will only prolong pain and suffering. This is sometimes done ‘accidently’ by the caregiver or doctor increasing morphine to expedite the process. If anything, assisted suicide would make this easier, inexpensive, and less painful for everyone involved.

So I am not sure what this is intended to prove on Noah’s part except that Canada’s healthcare system sucks, which few would dispute and long predates MAID. If more Canadians availed themselves of MAID it would presumably free up resources of Canada’s otherwise strained public system: a win for patients with non-terminal conditions and terminal patients.

This is a lazy rhetorical misdirection on Noah’s part, by shifting the blame from Canada’s poor healthcare system to MAID, as if this is supposed to convince readers, but it’s fallacious. The rest is hand-waiving hypotheticals that MAID could make hospitals less inclined to prescribe conventional treatment, in invoking the slippery slope argument.

This is like the AI-doom arguments, in which there is nothing that can be conclusively tested or proven in a statistical sense, just hypotheticals of things that could go wrong or the possibly of the world ending with a probability of 0% or 100%, which provides no information. This shifts the burden of proof to prove that MAID will never lead to anyone with a curable disease being denied treatment, which is not possible to prove. The inability to meet this impossibly high burden of proof does not automatically invalidate MAID.

Noah also gives a hypothetical of a depressed person being offered assisted suicide:

And having been a depressed person, I can tell you with confidence that depressed people are not fully capable of pushing back against a doctor’s suggestions. Depression — at least, the kind that I suffered — entails a lack of volition, willpower, and motivation. When I was depressed, I would go along with other people’s suggestions, simply because I didn’t have any motivation to do anything other than go along. Fortunately, nobody suggested self-harm to me. But if a doctor had suggested that I’d be better off dead, I can’t tell you with 100% certainty that I would have had the wherewithal to gainsay them.

But everything entails some risk of dying, whether it’s flying, driving, or accidentally consenting to one’s assisted death. It’s also possible that the anti-depressants prescribed by his doctors could have also killed him. Studies have shown that SSRIs are not without possible risks:

These findings suggest an increased risk of presumably new suicidal ideation with SSRIs and other modern antidepressants over placebo among children, adolescents and young adults up to age 24 years and reinforced the initial findings in meta-analyses involving children and adolescents by the UK drug regulatory agency [97] and the FDA [94,96].

It’s possible an exception for assisted suicide can be made for patients with mental health disorders. But even so, similar to terminal cancer patients, depressed people who wish to die and are not being coerced will still find ways to die, like by hanging or gunshot. Noah’s argument assumes the gift of hindsight in that we know beforehand which depressed individuals will recover, and assumes that doctors would be willing to terminate someone’s life at just the mere suggestion of wanting to die, which would violate all oaths of responsibility. Presumably someone who wishes to die would have demonstrate that they can consent and are informed of their choice.