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Why the ‘Right to Die’ Will Always Be Controversial

What is the right to die? To put it simply, it’s a moral argument that a person should be able to die on their own terms — that is, to commit suicide. The conditions necessary to exercise this right (if it exists at all) vary drastically from country to country.

Countries that have a legal right to die often have a few stipulations in common — that the individual must suffer unbearable pain, that their illness be incurable and that the decision is made within the individual’s full consciousness. Cases in which these stipulations are not met are likely to be treated as homicides rather than suicides.

The right of a terminally ill patient to choose when their life will end would seem, at least at first, to be a not-too-terribly controversial topic, but recent US history belies this. Thanks to a number of high-profile cases, right to die and death with dignity are more contentious than ever before — thanks in part to America’s status as one of the world’s premier conservative nations.

The current state of the debate—as well as where the controversy goes from here—is very much uncertain. Let’s get things rolling with a look at one of the fundamental problems with right to die laws: The subjectivity of pain.

The Physiological Basis of Pain Is Not Well Understood

No discussion of suffering is complete without an understanding of the way pain affects us, and really, what pain itself actually is.

Some pain has a physiological basis, like when you burn your finger on a hot stove. The tissue-damaging heat activates nerve endings within your finger. These nerve endings produce an electric signal that is transmitted via the nervous system to the spinal cord, where the electric message is converted into a chemical message, which activates pain-transmission neurons.

These neurons send their message to the brain stem and thalamus, which then project to different parts of the brain, which results in the sensory experience of pain. The process, as you can see, is incredibly complex. No one knows how heat or other stimuli like a pinch, smash or chemical burn activate the nerve endings — it’s hard to find these nerve endings at all, let alone research them in a laboratory.

Chronic and psychological pain are even more complex. Even enduring the unpleasant feeling of pain can trigger changes in mood, leading to anxiety and depression. Stress and anxiety can lead to muscle contractions and trigger the sympathetic nervous system, which worsens any current pain or creates new pain in itself. Pain is a vicious cycle.

The feeling of pain is always subjective. Physicians may use a pain scale to assess the amount of pain perceived by a patient, but everyone has a different pain tolerance. What is tolerable to one person may be completely unbearable to another.

Pain can leave its sufferers disabled and socially isolated. Symptoms absolutely require treatment. Treatment usually involves opioid drugs, which are the most effective drugs available for pain treatment. Opioids are synthetically manufactured drugs designed to inhibit pain. They originate from naturally occurring chemicals found in the opium poppy, which also produces drugs like heroin and morphine.

So what is someone suffering from pain to do?

For rape victims, particularly child victims of sexual abuse, litigation may help to obtain some compensation for the emotional distress endured, cover the costs of hospital visits and prevent this type of trauma from happening to others.

There are non-medication based therapies available, too, but their results are mixed and mechanisms not fully understood. In the way of treatment with highly addictive drugs, conducting a risk-benefit assessment for the use of opioid drugs is a difficult task for physicians and policymakers, let alone a patient without formal training in medicine. Pain management is still subject to intense debate and will continue to be a pressing issue in our time.

But will we ever recognize suicide as a “pain management tool” on a societal level? Lots of people are hoping we do — and soon.

The “Right to Die” and the Moral High-Ground

The fact that there is no scientific way to prove someone’s pain — which can be mental as much as physical — means the issue of the right to die is fraught with ethical and moral debates. From some rationalist perspectives, the right to die is obvious. The astrophysicist Stephen Hawking has said, “To keep someone alive against their wishes is the ultimate indignity.” If you were in excruciating pain and knew you would die soon, would you rather end it all or continue to suffer?

One young woman answered this question with a heartfelt yes last year when she moved from California to Oregon to take advantage of the latter state’s enlightened “right to die” laws. Brittany Maynard, who had been diagnosed with a stage 4 brain tumor, decided that she’d greatly prefer ending her life on her own terms, rather than waiting around for the tumor to finish her off, which would’ve cost her a great deal of time, dignity, and physical pain.

But there’s a reason why our United States are a hodgepodge of contradictory death with dignity laws: We live in a country where both the fear of death, and religious conservatism, hold sway in the courts of public opinion. From the perspective of two of the world’s largest religions, Christianity and Islam, killing yourself is a sin against God. Religion is one of many factors that makes the right to die, morally and legally, extremely complicated.

Even from a humanist perspective, the right to die is fraught with ethical implications. If, for example, a perfectly healthy and financially secure adult male wanted to legally pay someone to kill him simply because he was tired of living, should such a “radical choice” be permitted? That man could argue that his mental pain — the fatigue of his existence — was just as real as a cancer patient’s.

With this example, there is no clear “right” or “wrong” answer when it comes to the right to die — just a variety of perspectives and a multitude of legal experiences. The potential spectrum ranges from outright legalization to a total ban of the practice.

A decent starting point in the euthanasia debate is distinguishing between “active” and “passive” euthanasia. Historically, “passive” euthanasia was favored by doctors as the more ethical solution.

An example of this would be a terminally ill 92-year-old woman suffering enormous pain after a critical injury. Knowing that the patient had no chance of recovery, doctors would simply let the patient die in a hospital bed without actually treating her, aside from some pain medication. Medically speaking, there are a number of ways to let someone die: Calling off another major surgery for example, or scaling back non-pain medication.

“Active” euthanasia, however, is different. An example of active euthanasia would be the case of another terminally ill patient, like Brittany Maynard and her brain tumor. A patient like this suffers excruciating pain on a daily basis due to her disease.

Letting her die “naturally” (if such a label applies here) of this affliction would be an enormously cruel sentence. She would die eventually, this much is true, but she would suffer enormously all the way through. Even doses of the strongest pain medication would not stop this woman from suffering. Therefore, “active” euthanasia would call for directly ending the patient’s life — killing her — upon her request. Lethal injection can knock someone unconscious and kill them within an hour. Some patients in this circumstance would prefer an injection to days of agony with no cure in sight.

In a famous 1975 essay, American philosopher James Rachels argued that active and passive euthanasia are indistinguishable. After all, both forms rely upon a decision made by a doctor leading directly to the death of the patient.

The ‘Right to Die’ Is Not Straightforward Legally and Varies Drastically Between Countries

Legally speaking, the distinction between active and passive euthanasia continues to exist. In India, for example, passive euthanasia was legalized in 2011. However, the active form is still considered murder. Interestingly, Japan allows both forms of euthanasia under strict terms. For example, for a doctor to administer active euthanasia, the patient must be proven to be suffering enormously and provide consent. No direct consent is needed from the patient in a case of passive euthanasia — if the patient is bedridden and barely sentient.

The Netherlands is similar. In 2002, it passed a law allowing direct euthanasia as long as strict conditions, overseen by physicians and the patient’s family, were passed. That hasn’t come without pushback or controversies, though.

Just this month, it was revealed that a Dutch woman in her 20s legally ended her life because she could not bear the mental pain of her PTSD resulting from childhood sexual abuse. The case greatly angered anti-euthanasia activists across the world, who cited the woman’s death as the inevitable consequence of legalizing euthanasia — an argument often called the “slippery slope.” The woman’s case yet again highlighted the importance of knowing what pain really is.

In the United States, active euthanasia is illegal in every state. However, physician-assisted suicide is legal in five: Washington, Oregon, California, Montana, and Vermont, and all of these laws are meant to cover people suffering enormous pain or living in vegetative states. Assisted suicide means that a physician provides the tools for patients to kill themselves — the physician never administers any form of euthanasia directly.

The right to die remains enormously controversial in the US, particularly due to its status as one of the developed world’s most religious countries. Most famous was the case of Terri Schiavo, who became a figurehead of the debate when her family decided to remove her feeding tube (passive euthanasia) after she was in a coma for years. Religious and politically conservative organizations mobilized in reaction, arguing that despite Schiavo’s non-sentient status, she was still alive and anything which was not designed to keep her that way was essentially murder.

Although Schiavo’s family was ultimately successful in cutting off her feeding tube, resulting in her death, the debate has hardly been settled. This is most evident by the growing number of states passing right-to-die laws, often termed “dying with dignity” laws by their advocates. In 2009, for example, Montana’s Supreme Court deemed that a doctor aiding a terminally ill patient to die was not illegal.

The Right to Die Is Ultimately a Personal Choice

While we wait and see what kind of legacy the Brittany Maynard and Terri Schiavo cases will have, it’s already clear that this debate is raging on across the developed world, and may soon become a mainstream, household political issue.

But because pain and suffering cannot be quantitatively determined, and political tensions surrounding this issue are contentious, the argument for the right to die becomes a morass of moral, legal, and personal issues. People decide on major, personal life decisions all of the time, regardless of political norms, like the decision to get an abortion or gender reassignment surgery.

Moreover, the religion-based argument holds less and less water with each passing day. While religious folks believe with all their hearts that their soul is destined for eternal life, they cling to earthly life with something approaching fanaticism. Indeed, formal and informal research suggests that Christians awaiting death in hospice fear death more than their unbelieving counterparts do.

One thing remains clear: For believers and unbelievers alike, these are deeply personal issues and their interpretation varies depending on culture, religion, and personal beliefs. Like many personal choices, the right to die may continue to be controversial for decades to come.

What has become necessary is this: Both sides need to recognize that mobilizing the Federal Government to enshrine personal beliefs — whatever form they may take — in the language of the law is not the proper function of bureaucracy in this country or any other. Government exists to allow us the means to reach a consensus on difficult topics — or, at the very least, to approach a common understanding of phrases like “victimless” and “a cessation of suffering.” Your morals might chafe at the thought of state-sanctioned suicide, but a dignified ending to another mammal’s suffering ought to be universally recognized as a morally acceptable outcome.

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Holly Whitman is a writer and journalist based in Washington DC. She loves to share her thoughts on the intersection of politics and culture, and writes on everything from feminism and human rights to climate change and technology.

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117 thoughts on “Why the ‘Right to Die’ Will Always Be Controversial

  1. The right to die is grouped under the broader concept that “it’s my body and I can do with it what I want”. Sell a kidney, sell a lung, have an abortion, take my own life. It’s MINE. “You” as in gov’t, the group, society, the state, in the US, has no authority to tell me what I can do with it, as they are my servants, not the other way around. Sadly most people believe that using these elements to force other people into doing “what’s best for them” is all to common, and revolting.

    Obviously there needs to be some safeguards for individuals wanting to die; sound mind, no coercion, etc. As to the religious aspects, that’s between the individual and their own god, and maybe their church, and isn’t my call, nor none of my business, nor anyone else who doesn’t have a personal state in the matter.

    Nice post Holly.


      • Governments have been telling people what to do with their money for a long time, ours included. Pay this tax. Don’t buy this product. Don’t sell this product to this person. Pay this tax as a form of forced retirement savings. Health insurance isn’t fundamentally different than that.

        Your money and your body may have qualitative differences rendering governmental compulsion more legitimate in one arena than another.


        • But wouldn’t the the ideal reflex — in both cases — be as minimum intrusion/restriction/compulsion as possible? Obviously, the devil is in the details of how much is necessary/warranted and to what ends.


          • I’m not sure that follows, for two reasons.

            First, in a modern western democracy atop a complex industrialized economy, citizens demand certain kinds of services from their government. These services are principally economic: old age pensions, physical and transactional infrastructure, consumer product safety. And these economic concerns creep into nearly everything.

            Second, in a large, pluralistic democracy, a variegated palette of morals and personal decisions must be addressed, triggering an inevitable balancing of majority preference against individual autonomy. If a democratic majority is going to matter at all, sometimes the majority’s preference will prevail.

            Those things suggest to me that an impulse to govern with the lightest possible hand at all times, in all situations, with respect to all subjects, is unlikely to reflect actual governmental behavior.


            • A fair counter. It felt like I was being overly simplistic. I think the section of the OP that several people have quoted below is probably a better distillation of the sentiment I was seeking to express here.


    • @north

      Yeah no. The “my body, my choice” argument seems intuitive enough and like all intuitive seeming arguments has a certain base appeal but it is ultimately too simplistic and seems to be designed to avoid grappling with really difficult questions.

      Maybe “my body, my choice” works better with some issues more than others. Let’s look at a difficult one: organ sales. Do we have a need for donated organs? We already sort of have a market for donations in the United States with female eggs. Go to any top college or university and you will see advertisements asking young women to donate their eggs. Officially compensation is not allowed but through clever loopholes and phrasing, a woman can easily make a solid five figures if she donates her eggs. The requirements are usually very narrow tailored: you have to have the right grade and SAT ranges, being athletic helps, couples want as close an ethnic match as possible usually too (which generally means that the couple seeking an egg donation are wealthy and white, though I have seen ads looking for young Jewish women specifically.)

      Donating eggs is hard. You need to pump your body full of hormones and it is invasive surgery with significant recovery time. Why do women do this? Because college costs are through the roof and this is a way to get a lot of cash something like a good middle-class annual salary or close to it.

      The other possible word to describe this situation is financial and stress duress. Why would anyone sell an organ? The need for a lot of money quickly. Who is going to do that? The poor and desperate.

      Why is this a good thing to allow? Why not work to creating a society where people are not in such duress filled situations where they have to turn to selling their organs for the cash. Some people might be in this situation because of financial recklessness. Others through no fault of their own. An untimely layoff coupled with some other unfortunate events.

      A society where people and/or the state can say “Why don’t you sell a kidney or lung, Mr or Ms. Smith? That can get you six figures easy. No need for charity or welfare” is not a world I want to live in.


      • Now there might be other good reasons to legalize drug use and sex work like the utter futility of prohibition and that legalization makes it safer for drug addicts and sex workers but “my body, my choice” strikes me as inherently morally and ethically blase.


      • Yeah, no.

        The left has used “it’s my body my choice” for abortion for decades. Oh, you can say that but not be able to sell a kidney? Square that circle using only the protest line to ensure abortion rights. If it’s a right, it’s applicable to other activities.

        “Why is this a good thing to allow?” Good has nothing to do with it. “Allow”. Sorry, that’s not your call. You allow women to have abortions? That’s big of you. State the right you have to prevent someone to sell their eggs or organs. You don’t have one. You just want to use the power of gov’t to prevent certain activities you disagree with because they offend your moral sensitivities. The same applies to the right.

        The poor and desperate may choose to sell organs. I’m not either but I’d sell mine, likely at the time I was about to die. Why? Because I could add, or have, an estate with a beneficiary. That’s why I’m not an organ donor now. I’m not going to allow someone else to profit from a “free” donation-the doctors, the organ transporters, the hospital, etc. Why shouldn’t I get a slice of the action? It’s MY organ that’s wanted.


        • One difference that distinguishes abortion and euthanasia on one side from sex work and organ selling on the other is that while all the issues have an aspect of “freedom to sell”, the ones on the other side have a counterbalancing “freedom to not be sold” that has to be juggled.

          There are vanishingly few cases where family members find a rogue doctor to force an abortion on an unwilling woman, but sex trafficking is definitely a thing. Waking up in an ice bath the morning after to find yourself with one kidney is just an urban legend – largely because the market is black. If there were “Max Headroom” style chop shops, there would quite possibly be “Max Headroom” style violence to serve them.

          I don’t know where to draw that line, how to enable people while still protecting the vulnerable from exploitation. I don’t have that issue with euthanasia – I think we can set up a legal structure to enable that.


          • Muneco,
            “Waking up in an ice bath the morning after to find yourself with one kidney is just an urban legend – largely because the market is black”

            what actually occurs is far worse.

            But we’re astonishingly okay with selling women’s wombs to bear other people’s babies.


          • Well of course you have the “freedom not to sell”. As to “not to be sold” that’s already covered in the law. Individuals, and independent types have the innate right for bodily integrity, so trafficking etc. is wrong.


    • The laptop-based solution a doctor in Australia came up with might be a decent start. It puts the process entirely in the patient’s hands. The process is complex enough to provide at least a limited assurance of “sound mind”. The process is rigorous enough that it takes multiple efforts to get through, presumably preventing accidents. There are multiple decision points with failsafes, allowing the patient to change their mind up until the last decision point. The physician who sets it up isn’t even in the room when the process is going on, limiting the opportunity for coercion. Without examining it from an engineering perspective, I don’t know how it deals with equipment failure – but since it runs from a laptop, I’d expect the process to terminate catastrophically (which in this case actually means that it doesn’t kill the patient!).


  2. Let us somehow figure out some legislation that will allow for The Government to get a piece of any given estate, automatically. No appeal, no probate, no nothing. You die? The state gets a third.

    We’ll figure out a way to normalize euthanasia.


    • So if I’m reading you right you’re asserting here that the reason “Right to die” policies aren’t widely in place is because the Gummint doesn’t get to wet its beak?


      • No, not really. The reason that the reason that there isn’t a more normalized set of arguments that are pro-euthanasia is because government doesn’t wet its beak.

        This isn’t about the policy, it’s about the existence of arguments in service to the policy.

        I imagine we’d have something like arguments focusing on “selfishness” or something of people who no longer are able to produce goods/services and are reduced to appetites who are hoarding wealth or some crap like that.

        We’d see some dark reflections of some of OWH Jr’s arguments surface.

        (And if you’d like to argue that those silly arguments date back to the 20’s and 30’s and our society has antibodies against them (something that I, myself, would have argued a decade ago)… well. I’ll just say that I now think you’ll be surprised by what bubbles up over the next decade or so.)


        • Hmmm I remain skeptical that pro-euthanasia arguments haven’t been developed simply because there’s no payola for the state to allow it. Viewed that way the state should already pro-euthanasia simply because euthanized sick or dying poor or elderly patients would impose fewer costs on the state which typically ends up footing the bill for them.


          • It’s not about who is imposing costs. Nobody cares about that.

            It’s about who has something worth taking.

            We’re not going to hear pro-euthanasia arguments in service to talking about the 90 year old in a social-security old folks’ home (or, we will, but not at first as that won’t be the focus at first).

            It’ll be in service to talking about the people who retired with millions.


            • Money is fungible. A penny saved is a penny earned.

              The premise is: Government isn’t supporting/pushing assisted suicide because there’s no financial incentives in place for them to do so.
              I observe that there is financial incentive already. They’re not pushing assisted suicide. I think that puts the original premise in significant doubt.


              • I’m not talking about “Government supporting/pushing assisted suicide”.

                I doubt the Ad Council will be throwing some bits together.

                I’m talking about the social/cultural normalization of arguments in service to euthanasia. So we’d see these arguments blooming in the wild.

                Discussions about euthanasia in service to a larger society (as opposed to a libertarian level of selfish emphasis on the individual).

                The government doesn’t have to do anything but set up the program. The arguments about how it’s important for people to use the program will bloom naturally.


                • The government doesn’t have to do anything but set up the program. The arguments about how it’s important for people to use the program will bloom naturally.

                  I more or less agree with this. Corollary: the arguments about how it’s important for the government to stop doing this program will also bloom naturally.


                  • They’ll be variants of arguments that we’re giving now, though.

                    The best ones will be based in the deontological arguments and the ones talking about measurables will prove, at first, to be overwrought.


    • Let us somehow figure out some legislation that will allow for The Government to get a piece of any given estate, automatically. No appeal, no probate, no nothing. You die? The state gets a third.

      We already have that legislation. It’s called the “Death Estate Tax.” In the beginning it was viewed as serving the vital function of maintaining America’s valued commitment to meritocracy…

      We’ll figure out a way to normalize euthanasia.

      Just like “we” have normalized Death to maximize the inheritance tax, yeah?


  3. “Cases in which these stipulations are not met are likely to be treated as homicides rather than suicides.”

    Isn’t this limited to physician (or other person) assisted suicide? If someone who doesn’t meet those criteria takes his life all on his own (e.g., self-inflicted wound, OD), is it considered a homicide?



      If I give you the gun with which you shoot yourself, what does the law say?

      If I didn’t know you were going to shoot yourself, what does it say?
      If I *DID* know you were going to shoot yourself (and, indeed, that’s why I gave you the gun), what does it say?

      I don’t know but I am willing to guess that there might be something out there like “accessory to suicide” or “conspiracy to commit suicide” that could be thrown at me at the criminal level and the sky is probably the limit for the civil side of things.

      Could one of the law-types who know something about this chime in?


      • I, personally, would not say that the person who provided the gun had any moral culpability (beyond that which he assumes himself) and, as such, should have no culpability legal or otherwise. The only issue I’d take is if the provider knew or had good reason to believe that the individual in question was not of sound mind. Though “having good reason” is a phrase I am very intentionally going to refuse to elaborate on!

        But now I wonder… how would I feel if he provided that gun to someone who went and killed someone else? I don’t know. Is that sufficiently different such that we could then assign moral (and perhaps legal) culpability? My gut says yes but we probably shouldn’t make laws based on my gut.


          • Oh, yes, I’m curious as well.

            My hunch is that the law doesn’t explicitly address this situation but that the state has all sorts of ways of assigning guilt/culpability which are probably wildly inconsistent but which mean the practical answer is, “Anything is possible.”


  4. Actively ending a life, any life, probably should always be controversial and subject to debate.

    War, execution, euthanasia- all of there have a tremendous potential for abuse and corruption, and the stakes are high enough that there isn’t any way hat I can see that the issue could possibly become so settled as to be normalized.


  5. Describing pain as “subjective” to me is interesting. Maybe that term has a different use in the scientific/medical communities than the general colloquial usage, but when I hear that something is “subjective”, it implies to me a certain amount of agency or choice in the matter. My understanding of variations in sensory integration/processing is that much of this is hard-wired. I am not an expert but as a teacher of younger children (and now parent of two), I’ve read up on the matter and can attest to variations being physiological and not “subjective” as I understand that term. But maybe I’m just misunderstanding the term. The link seems to support my understanding of the phenomenon even if we differ on vocabulary. But if others interpret that term as I do, I think it risks making people less-than-empathetic to others individual experiences.


  6. Overall, I am with above on what the gov’t can/cannot dictate about my body. If I want an abortion, if I want to shoot heroin, if I want to smoke a cigar, if I want another piece of chocolate cate, it’s my decision as it is my body. In many ways this is the foundation of my disagreement with the idea of gov’t being involved with health care.

    “Both sides need to recognize that mobilizing the Federal Government to enshrine personal beliefs — whatever form they may take — in the language of the law is not the proper function of bureaucracy in this country or any other.” This is an increadibly important point, and thank you for making it.

    Excellent post Holly


    • @aaron-david

      “the gov’t can/cannot dictate about my body. If I want an abortion, if I want to shoot heroin, if I want to smoke a cigar, if I want another piece of chocolate cate, it’s my decision as it is my body.”

      I agree with the core of this sentiment, but I am also sympathetic to those who would argue that not all or your examples are things you are just doing to your body. Abortion obviously has an effect on one other body, and smoking done in public does as well.

      (I have less sympathy for many things that go beyond that, however. I am in agreement with you that you should be able to help yourself chocolate cake, or have a cigar — though I suspect that we would disagree on the subject of whether or not the government should be allowed to inform the public about the health risks of those activities.)


      • Also, as we get closer and closer to universal insurance coverage, we may find that we have compelling interests in the bad habits of others. It’d be one thing if you wanted to shoot heroin but I’m going to have to pay for your Naloxone…


        • I am also somewhat sympathetic to those arguments, but not nearly as much.

          Because I don’t see public policy as ways to measure ideological purity, I am OK with having a sliding scale when it comes to indirect effects.

          Being in an office building with little ventilation and a large number of chain smokers (which, btw, I am old enough to have been the status quo during my early post-college work years) has a fairly large indirect impact on me.

          On the other hand, knowing that a quarter of a tenth of a cent of my annual tax burden went to pay for Naloxone, on the other hand, seems to have such an extraordinarily low indirect impact on me that without a demand for ideological purity, I cannot fathom objecting too much. (Which is not to say that it would be that little, just using a number I pulled out of my butt to make the point. If it cost me $1,000 a year in taxes, then that indirect effect has far greater impact, and I wold adjust my reasoning.)


          • It won’t be ideological purity, I don’t think. Not down in the trenches, anyway. It’ll be the moral busybody impulse manifesting.

            I’m interested in seeing whether the “Body Positivity” people will hold the moral high ground over the “Obesity Epidemic” people or vice versa… and the extent to which the PPACA stirs that particular pot.


            • Yeah, here’s a blast from the past. Shazbot put it better than I could:

              Your actions are costing other individuals in society whom are paying to help you, thereby making it harder to help others, therefore you have a moral obligation to act so as to need less of that help, amd the state will sometimes write that obligation into law when doing so is possible without draconian violations of individual autonomy.

              We live in a world of mutual obligations to help each other and to not misuse that help. Unless you are a hardcore, Nozick-style libertarian who thinks that the only factor we should look at when deciding what is good and just policy is to ensure that we don’t violate individual rights.

              At the time, I argued against this (sputtering!).

              I failed to see that he was, functionally, right. Not in the moral sense of Right” but in the… engineering, I guess?… sense of “correct”.

              This *IS* how it’s going to play out.


            • It won’t be ideological purity, I don’t think. Not down in the trenches, anyway. It’ll be the moral busybody impulse manifesting.

              Question: How is moral busybodying not ideological?


            • I’m interested in seeing whether the “Body Positivity” people will hold the moral high ground over the “Obesity Epidemic” people or vice versa… and the extent to which the PPACA stirs that particular pot.

              The PPACA won’t have anything to do with that mess.

              When I was first getting back in shape and losing weight, I saw this debate from the perspective of the weight loss community. Since then and getting more hardcore with lifting and training, I’ve seen this debate from the fitness community side. From the fitness side, there’s nothing at all positive being said about the Body Positivity movement, and some of the worst fat shaming I’ve ever seen came from the people that were overweight, transformed and now take it upon themselves to make the fit lifestyle a moral issue.

              I’m going to leave it at that.


              • The debate, as far as I can tell, is gendered and one side is much more… sympathetic… than the other.

                But I take your point that the PPACA will probably not be used as a cudgel by those whose parents passed along good muscle genes.


                • Why do we assume that “body positivity” and “obesity epidemic” are somehow mutual exclusive positions to hold? I don’t think anyone should be shamed for how they look. However, if good medical science tells us that it is healthier to be 180 pounds than 300 pounds, we shouldn’t ignore that fact. We shouldn’t beat 300 pound people over the head with it but we also shouldn’t stick our head in the sands.

                  The problem is these ideas become ideologies and then movements and everyone stakes out an extreme position and holds fast to it.


                  • On an individual level? Of course they can both be held by the same people.

                    It won’t play out that way once it reaches the level of culture war, though. We won’t have a “let’s be reasonable about this!” side, except for in the comment sections of certain blogs.


                    • How much of that is…

                      A) Because each side stakes out an extreme position (i.e., “It is evil shaming if you ever comment on anything related to weight and health!”; “Anyone who doesn’t look like they belong on the cover of a fitness mag is a moral degenerate who is choosing to be unhealthy and suck of the teat of others!”)
                      B) Because each side reads the other as staking out an extreme position (i.e., “They said that saturated fat is linked to heart disease… BODY SHAMING!”; “They said don’t call them fatty-fat-fat-fats… THEY WANT TO BE UNHEALTHY MONSTERS!”)

                      My hunch is that both happen and cause the other via a feedback loop. Which is unfortunate.


        • Relevant.

          “Roughly half of cancer deaths in the United States could be prevented or forestalled if all Americans quit smoking, cut back on drinking, maintained a healthful weight and got at least 150 minutes of exercise each week, according to a new report.

          These same measures would also reduce the number of new cancer diagnoses by 40% to 70%.

          For men, universal embrace of this lifestyle could avert or delay 67% of cancer deaths and prevent 63% of new malignancies each year, researchers calculated. If all of the nation’s women did the same, their yearly cancer mortality rates would fall by 59% and new cancers would drop 41%.”


      • Well, I think they are pretty simple, and require very little governmental action. You don’t want smoking in your bar, then don’t allow it. Post a sign out front, and all is good. You want smoking in your bar, then allow it. Post a sign out front, and all is good. I know, I know, then we get to the tragidy of the commons. Hey, lets have a vote, on the common areas! That sounds like a good way to decide it.

        If the gov’t wants to inform the people on the health risks, fine. Just pay for it, don’t make someone else pay for it.

        If the gov’t wants to assume the burden of something, then it needs to pay for the burden. From no-smoking in public area signs, to health warnings or calorie info in restaurants. Pay for the signs and pay rent on the space they occupy.

        /gets down from libertarian soapbox…


        • “You don’t want smoking in your bar, then don’t allow it. Post a sign out front, and all is good. You want smoking in your bar, then allow it. Post a sign out front”

          Out west you see a lot of these signs, but “smoking” is replaced with “firearms”. So you can tell folks you want or don’t want guns in your establishment but you can’t tell them you do want smoking in your establishment.


  7. Great piece, Holly. I’m probably somewhat radical in that I think every individual has the right to dictate the terms of his/her death. I recognize that the choice is not without externalities (a father of four killing himself will almost undoubtedly impact his children and almost certainly negatively) but I don’t know that any of them suffice to deny this right.

    But I think this must be coupled with an explicit understanding that no one can be compelled to facilitate, cooperate, support, or otherwise be complicit in another’s death. If that father of four wants to pay me to shoot him, I can say no.

    I suppose a question would arise around the role of physicians. Do they have any ethical obligation to provide a course of treatment, even one which kills the patient (with his consent) and/or which they find morally repugnant? I’d be curious how this functions currently, as there are undoubtedly procedures that current exist and are legal which doctors may object to for one reason or another (I immediately think of abortion but also plastic surgery done on minors or risky procedures); I don’t believe that a doctor is beholden to a patient’s wishes but maybe I’m wrong. Regardless, even if there are ethical responsibilities to provide procedures-on-demand, I’d carve out an exemption here.

    Another complicating factor is gaining and confirming consent. If you walked in on me with a smoking gun in my hand and a dead man on the floor, could I simply insist, “No, really, he wanted me to!” We’d probably want some sort of formal legal mechanism to ensure that consent was given and was actually reflective of the individual’s wishes. And even then we’d probably need some sort of oversight. Suppose the guy dotted his i’s and crossed his t’s but at the last minute said, “No, no, don’t do it! I’ve changed my mind!” What then? If I still shot him, would it be murder?

    Complicated, no doubt. But ultimately I think the goal should be to reserve as much rights within the individual as possible.


  8. In the United States the irony is that we care more about the comfort and dignity of those convicted of capital crimes in a death penalty state than we do the comfort and dignity of those suffering from a terminal illness.

    Imagine a form of judicial execution that replicated, say, all the agonies of terminal cancer. Who but the most psychotic sadist could even imagine such a thing? The courts have repeatedly blocked executions because the methods or procedures used were thought to impose cruel and unusual punishment. At the same time, the courts have insisted that the functional equivalent of a cruel and unusual punishment must be administered to those whose sole crime was to fail to commit a suitably heinous capital crime.

    Anyone who has been with a terminally ill family member or friend has heard them wish for the end. Should we really continue to say, sorry, no, a dignified and painless exit is reserved only for our most violent criminals?


    • While I agree with where you end up, there’s a distinction between what we affirmatively impose as the just and appropriate infliction of violence by the state and what we allow to happen. Plus the evidence that capital punishment is painless and immediate is far less conclusive than I would like.


  9. What has become necessary is this: Both sides need to recognize that mobilizing the Federal Government to enshrine personal beliefs — whatever form they may take — in the language of the law is not the proper function of bureaucracy in this country or any other.

    A statement that needs to be heard more often.

    Hell, it should not only be inscribed above the door to congress, but on the desk of ever legislator, everywhere.

    PS Good post!


  10. If you believe force should be used to prevent someone from making a rational choice to end their own life, you’re functionally totalitarian.


    • It is a weird dynamic. At least to me. And I agree. But I think the worry is more about complicity in helping a person end their life more than the bare fact, or morality, of their having done so.

      Slippery slopes and all. (Reality, for humans, is a very slippery place!) At least for folks who think along those lines.


    • As someone who recently called the just-in-time artisanal euthanasia folks, I can easily see where Scott Adams is coming from in his controversial “I hope my father dies soon” essay. (Hey! We talked about it here!)

      I tend to think that there are a lot of changes that will attend us switching from a “Officially No Euthanasia (but, unofficially, there are a lot of things that happen and we don’t talk about them in public)” to “Okay, We Will Officially Allow Euthanasia”.

      Are the changes that we’ll get worse than the policy now?

      As I said, I recently called the just-in-time artisanal euthanasia folks… but I sincerely suspect that the changes we’ll get will not all be rainbow bridges and terra cotta handprints. If we’re down with that, we’re down.


        • I missed that post in real time, Tod. I’m sorry I missed it. Nothing in my own life approaches the feelings you must have experienced during that event. My condolences not only for the loss of your mother but the circumstances as well.

          Death sucks. Death is inevitable. The the sooner we get a grip on reconciling those two things the better off we’ll all be.


        • I forgot about that one. That still sucks.

          You’re a lot closer to Oregon than I am. Have you noticed any shifts in how things are done?

          If we, as a country, had something like Measure 16, would you be allowed to bring cups of water today?


      • Have to say, I just don’t understand you Jaybird. Like, at all. (You seem to be driven by a combination of reflexive contrianism coupled with an Unintended Consequence/Slippery Slope Leading Towards Ruin Paranioa.

        As a bare fact – morally, ethically, pragmatically – a person SHOULD have the right to terminate their own life when they rationally determine doing so is in their best interest, and yet you – of all people! – find the PERMISSION of people to act on their individual rights more problematic than maintaining a coercive regime under which such acts can’t be assisted by trained professionals.

        Ie., I don’t think you’re worried about gummint over-reach at all – since eliminating government from individual decisionmaking is a good thing, yeah? – as much as a moral impulse that codifying assisted suicide is “gut level” wrong.


        • OR maybe here’s a better way to say it:

          Alternatingly, you’re persistently worried about either government OR society riding a slippery slope to our ruin, irrespective of whether the slope is created by restricting or enhancing the gumints or individuals freedom to act. But that ends up being a worry about a tautology.


        • I’ve come to think of Jaybird as a spaghetti argumentlist (toss a pot of maybe-ready arguments against the fridge, see what sticks). As such, unless he has made a pretty concrete statement that he believes X, I wouldn’t hold him to any argument he puts forth, he may just be trying it out to see if it works, or if it gets shredded like a rabbit in a cougar pen.


          • While this isn’t an invalid approach, there is an air of inauthenticity or insincerity to it, especially when done without transparency.

            If you want to play a form of Devil’s Advocate, you sort of have to own it. Otherwise you’re not engaging the other person on equal terms and that can quickly become frustrating. I’m not here to put other people’s ideas-about-ideas to the test. I want to put my ideas in conversations with their ideas. When talking with Jay (who I really like, mind you!), I’m sometimes unclear if I’m talking to Jay or some mask Jay has temporarily assumed to challenge me. I don’t mind the challenge; just let me know your plan.


          • Well, this is most uncharitable. I’m not an Atheist Feminist Libertarian so we’re hardly on the same team so to speak, but I see Jaybird’s comments as among the most consistent here. I appreciate his keeping folks honest by asking many uncomfortable questions from within y’all’s framework and his ability to get beyond the simple result and into possible implications.

            From my perspective, many of his rabbits beat the shit out of the cougars around here…


            • @marchmaine

              I don’t think Jaybird is being dishonest or just playing Devil’s Advocate, I think he is honestly exploring the given domains of ideas to try and suss out where he wants to settle (given he’s had something of a disruption of his ideologies as of late). Sometimes he does that by turning things on their head.


              • But at that point he is essentially using others to pursue that end. Which isn’t wrong, but he should make that known. Because participating in conversations like that can be incredibly frustrating for the other person and we should be able to enter into them (or not!) with a sense of the other person’s intentions.

                I see the value in what Jaybird does. But it isn’t without cost and the lack of transparency makes the costs greater or involuntarily taken on.


                • Pretty sure Jaybird made two big posts about how his trip to Qatar shook things up for him, and he’s made reference to it numerous times in comments and other posts.

                  He’s been pretty transparent about it.


                  • But within individual threads and conversations, I’d like to know if I’m talking to Jaybird-expressing-Jaybird’s-thoughts or Jaybird-using-the-conversation-as-a-petri-dish-for-ideas.


                    • Seems to me, those aren’t exclusionary states. Assume both are at play at any given moment. It makes parsing his thoughts a bit more challenging, but on the whole, I find it a worthwhile bit of mental exercise.


                      • But if someone asks me a question not because they are actually seeking the answer but because they want me to ponder the question and what its answer means for me, they aren’t really being genuine in asking that question. And that is often how it feels when talking with Jaybird. I often will say to him, point blank, “What is your point here?” and get little in return. But maybe that is on me for continuing down that path with him.


                  • As we know, folks get very attached to their ideological commitments. They are often internalized so completely that they constitute a part of a person’s self-identity, a component of who (they think) they are. So I give Jaybird a lot of credit for not only being personally honest enough to reject his old views when he realized they weren’t doing the work he thought they were, but for doing so publicly here at the OT, where such an admission could be used by others as an “I told ya so!” moment.

                    (And to be honest, I very much like the way he described his current state: that he’s wandering through a post-atheist gnosticism. Not only is that eminently fair and reasonable, but it seems like a pretty good place to be!)


                  • I’m pretty much with Marchmaine above. Jay is pretty good at walking with someone along the path of their ideology and asking questions at the ends.

                    Sometimes there is substance, or lessons there, sometimes there aren’t, but that doesn’t necessarily reflect or diminish his position.


        • I am downright certain that, in any given case that we, as highly educated folks (who primarily hang out with other highly educated folks) would share as an example from our own lives would get me to reach for some Kleenex and tell them that what happened was something that should not have happened and we should have had a process to make sure that something better happened and we’ll all have a good cry.

          Me and mine are steeped in thick, buttery privilege.

          What happens when you take some cultural norms created by and for thick, buttery privileged people and start applying these practices to other parts of society?

          I’m trying to not be hung up on government anymore. Government is just another word for the things we do together. It’s just another word for culture… but moving from “unofficial” to “official” indicates a shift in the culture… and when this culture starts oozing from the nice part of town to the more authentic part of town, it’s going to have handmaidens.


          • when this culture starts oozing from the nice part of town to the more authentic part of town, it’s going to have handmaidens.

            Sure. Just like if the cultural shifts were reversed. Cultural oozing has handmaidens!

            What happened to the deontological Jaybird I’ve argued with? Is that only a stance when it serves your (entirely subjective, at this point) goals to prevent privilege-culture from oozing outward? Seems to me that if culture’s evolve, then a hypersensitivity to Unintended Consequences is really, in bare terms, a fools game since it leads to paralysis. The best of us do the best we can given the evidence directly in front of us, based on dispassionate reason applied to a spectrum of options. Then we move forward, fully understanding that things will inevitably change over time.


            • My deontology got shaken hard by a huge dose of hard cultural relativism.

              I’m becoming much less interested in moral fabric than in the evolution of culture and systems and the things most likely to result in sustainability and the things most likely to result in high trust/high collaboration and whether they overlap at all.

              I’m beginning to suspect that they don’t.

              So I suppose I’m wandering through a post-atheist gnosticism for a while.


              • If by sustainability you mean the kinds of policies that will result in 10 billion people living on this planet without destroying it for the people living in the 22nd century, then no, probably not.

                Even without the issue of ghg being a pollutant, the American lifestyle needs a lot of land, a lot of water, and a lot of energy. As China and India shake off their socialistic / command economies and develop a robust middle class their citizens want what we have. Are the resources even there?

                And, of course, ghgs are changing the planet around us. As people moved into cities, the cities built sewers and people had to pay the cost as to stop polluting. As the EPA got going, businesses had to stop polluting soils and groundwater, and had to pay to for the cost of cleanup of their prior practices. And now as people around the world are emitting CO2 by the megaton and that practice is changing the world we live on, people are going to have to stop doing that, and pay for the alternatives.

                No, I don’t see current American conservative politics ever getting around to trusting liberals on paying to capture these externalities.


                  • The Chinese government is not exactly known for listening to its constituents. And as for the Indian government, Indian and Pakistan had temperatures exceeding 122 degrees last week. See, for example, here (somewhat of an extremist website, but still, that’s really hot).

                    So if Pres Hillary starts talking about taking on America’s share of its responsibility for dealing with global warming, so that we don’t have food riots, instability, civil war and refugees on an ever-growing scale over the next 20 years (not to mention the years thereafter), how does that sit with you?


                    • I suspect that the small-scale food riots, instability, civil war, and refugee crisis we have coming will have global warming as one of their causes, but I also suspect we’re more likely to have other, more immediate, causes being claimed by the major players.

                      As such, I see Pres Hillary’s appeals to Global Warming in the face of such a calamity as likely to fall on deaf ears and her quotations will be taken out of context in surprisingly effective attack ads.

                      (Though I think I’m on record as thinking that Trump is getting elected.)


                      • 1 in 4 chance of civil unrest in America.
                        Civil War ongoing in Syria because of Global Warming.
                        Civil Unrest in Egypt.

                        Global warming is already causing severe distress.
                        We haven’t started seeing massive population dieoffs, but India’s not that far away (it’s NOT the heat, it’s the humidity — they’re pretty close to “kills everything” levels).


                • And by “sustainability”, I mean something closer to “recognizable across multiple generations” rather than “environmentally sustainable”.

                  One of the things that impressed me in Qatar was that they still read the religion of their forefathers in the original language and the extent to which their religious views were similar to the religious views of their grandparents (which were similar to the religious views of their grandparents (which were similar to the religious views of *THEIR* grandparents)) and I was fascinated because, if you asked me, behind the veil, whether Islam would have staying power, I’m not sure that I would have thought it would have. I think that I would have thought that it would have died in the desert.

                  But no. Even with something like Ramadan, it’s sustainable. For centuries.

                  As someone who comes from a culture where it’s considered shameful to have opinions similar to those of one’s grandparents, this is very interesting. (This part of the comment is not intended to inspire stories where “my grandparents were totally progressive! The reason they were willing to work on the atom bomb was in service to gay marriage!” or something like that. Even though I’m sure your grandparents were totally misplaced transplants from 2015 who happened to be in 1945, my point is about society in general rather than your grandparents in particular.)

                  Given what we see going on with the high trust/high collaboration societies of Europe in the face of the refugee/immigrant crisis, I very much wonder about what the new equilibrium will look like after the uncertainties in the system resolve themselves.

                  That’s what I mean by sustainability in this context.


  11. , A good way to reduce co2 emissions would be to move most of the industries back to America. That cuts emissions in two ways in that America has much stricter epa rules and we would not have all those large ships emitting more co2 than the airline industry.


    • agreed! And a great way to motivate companies to do so is to start levying a carbon tax at the federal level. If foreign countries won’t match our tax or disclose the carbon use associated with the goods in question, we will just calculate (make up) the likely carbon emission associated with foreign made goods and levy it at the point of entry. That should thrill Trump.


  12. Two things:

    1. When it becomes easier to avoid homicide charges if the right forms are filled out, you will see homicides disguised as suicides.

    2. When suicide is normalized, you will see more socially sanctioned suicides for reasons we would not sanction today. (See how euthanasia laws are driving disabled people to suicide in Europe die to social pressure.)

    A world where euthanasia is legalized and notmalized will result in more people getting away with murder and more people being pressured into suicide for the sin of physical non-conformity. This is not speculation. It is what happens.

    Weird to me how neither advocates or critics of legal euthanasia talk about this, but there you go.


    • Thanks for making this comment. Disabled people do talk about it. There’s a wide range of opinion, but one of you basic points “and more people being pressured into suicide for the sin of physical non-conformity” I think is well accepted in this community.

      One activist organization is Not Dead Yet.

      After my brain injury more than one “friend” said to me something along the lines “If what happened to you happened to me I’d kill myself.”

      The other issue not covered here is parents murdering their disabled children and getting sympathy for it.


      • Thanks for making me aware of this organization. I think they’ll have my support.

        I used to be a “progressive” on this issue until I learned how often disabled people are basically murdered in places where assisted “suicide” is legal, and how devalued the lives of the disabled are in Europe.


    • One of the things about a high trust/collaboration society that it’s easy to overlook is the level of collaboration required for a society to embrace the differently abled. Some differences are more easily embraced than others, of course, but as the collaboration levels go down somewhat, the less easily embraced will find themselves embraced less.


  13. I’ve read almost all the comments and I don’t think anyone has said this explicitly (although Heisenberg and a few others above do talk about what types of norms a more “liberal” regime would validate), so I will.

    The “right to die” will “always” be controversial not because the US is uniquely conservative or because people are clinging irrationally to their religion in an “aw shucks, don’t they realize they’re just postponing heaven?” way. It will always be controversial because we’re talking about helping people die, which could mean that we’ll be helping people die who might not really want to die, or who if they wait five minutes or five days or five years might have second thoughts.

    I’m not saying we shouldn’t help people die. I really don’t know where I come down. And regardless of where I come down–and regardless what country we live in or how “enlightened” we are–it will remain controversial.


  14. Thanks so much to everyone for their comments, I love seeing the conversation and discussion that this topic generates. It’s so important to be openly talking about this, regardless of what side you come down on, so thank you!


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