California Legalizes Assisted Dying for the Terminally Ill

    Regular readers of this blog know I have some history with the topic of doctor-assisted dying.

    My father died in 2013. That experience left my emotions raw, and prompted me to write this blog post.* It went viral.

    At the time, a Gallup poll said 51% of Americans favored doctor-assisted dying. That seemed low to me. Indeed, when the question was asked in a more positive way, Gallup showed support in the high sixties.

    A year later, according to Gallup, support for doctor-assisted dying law in America had jumped from 51% to 58%. Using positive phrasing for the same poll question, support was as high as 69%.

    On October 5th, 2015, Governor Brown signed a bill legalizing doctor-assisted dying.

    Polls say 76% of Californians are in favor of having the option.

    I support the new law. But under the circumstances, celebration of its passing seems inappropriate.

    Instead I would like to show some appreciation to the folks who opposed the law for reasons of human dignity, or because of risk to the differently abled. And special thanks to Jimmy Akin for artfully explaining his views for my blog readers. While I support the new law in California, I keep in mind that others are fighting for the value of human life, and fair treatment to all. I think the world is a better place for your voices, and they form the right kind of balance. I wouldn’t want to live on a planet where questions of life and death are treated casually. So thank you, sincerely, for that.

    Scott Adams

    *Find the persuasion techniques in my post about my father, linked above. Regular readers should recognize them by now.

Morally Acceptable Behavior

    According to this poll, a majority of Americans now find physician-assisted dying to be morally acceptable behavior.

    That doesn’t mean the practice should be legal, obviously. There are lots of practical considerations. But the majority no longer sees it as a moral failing.

    On a related matter, I have been noodling on the question of how best to reduce the number of coerced physician-assisted deaths in places where it is legal. There is no perfect solution, but I think social media could someday be part of it.

    Coercion in this context means an unscrupulous family member or perhaps a rogue medical professional manipulates grandma into choosing death over a chance of recovery. How would that sort of bad behavior be detected?

    One potential avenue for a solution could be Facebook. Let’s say I am worried about being coerced someday after my mind declines. I could put into my health directive today that physician-assisted death is off the table for me unless I have advertised it for sixty days on Facebook. In other words, everyone close to me has to hear of it in advance. Shine the brightest light on it.

    The idea, poorly formed at this point, is that the more people who are watching, the less likely the bad people will have full control. And let’s say the doctors involved have to review your Facebook comments before agreeing to anything. 

    I would expect dissent in most situations. Family members could have lots of reasons for being opposed. But if the objections are based on morality or dignity, the doctor would be free to align with the patient’s view. If the objections look like “I think the daughter is trying to kill grandma to get the inheritance” then doctors would be able to opt out or require a more rigorous third-party review.

    As someone here pointed out, a relative can coerce grandma to change a health directive too. But I think health directives should always show the chain of decisions, not just the current document. Any change to the physician-assisted dying directions should be automatically reviewed by third-parties for signs of coercion.

    There is no way to drive the risk of coercion to zero. But the biggest risk is a rogue relative or two operating in the shadows. A Facebook requirement could fix some of that.

    I think the coercion risk is real, and it might increase over time as more seniors enter the final years and overload the system. But I also think we could be more clever about reducing that risk with these two tweaks:

    1. Flag any changes to a person’s health directive.

    2. Post on Facebook your intent to pursue physician-assisted dying, 60 days in advance.

    3. Automatic third-party review if the directive on physician-assisted dying has changed, the Facebook option is ignored, or there are questionable comments from friends and family.

    I believe anyone could put a Facebook requirement on their health directives today. All it needs to say is that you want the doctor making the decision to review the relevant posts to look for evidence of coercion. 

    This idea is slightly less than half-baked. I’m hoping you can improve it. 



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Death with Dignity – Claims Phase

    In my prior post, Jimmy Akin provided the seed argument against physician-assisted death that I will pass through what I call the Rationality Engine

    I have reduced Jimmy’s extensive arguments, along with other notable thoughts on the topic, into “claims” which I will soon evaluate for a verdict. 

    Today I hope you can check my work and make sure the claims are clear, bias-free, and complete before I start with verdicts.

    A lot of my readers here are big-media writers and editors, along with politicians and other thought leaders. So what we do here does influence the real world. And I think it is important because literally nowhere else is anyone even attempting objectivity on this topic.

    Before we get to the draft of claims, let’s look at the bias in the participants. When you spot more bias as the debate progresses, please call it out.

    Bias spotlight:

    Rationality Engine Host (me): I have personal experience with six relatives who suffered in the final months of their lives. I do not want to go that way. And I do not want you to go that way either, unless it is your preference.

    I am a non-believer in souls and deities. But in recent years I have become pro-religion because I see it as a benefit to people’s lives. We are all different, and religion fills a need in some folks. I’m a fan of anything that works.

    Debate Participant (Jimmy Akin): Jimmy is affiliated with the Catholic Church but does not work for it. His personal experience with the topic includes his wife passing from cancer while pressure was being put on her by others to not use treatments that could extend her life. 

    The point of the Rationality Engine is to use public scrutiny to scrub out the bias in the debate over time. Some bias has already been identified (by readers and by Jimmy) and I attempted to remove it in this draft. When you see more bias, call it out in the comments. This is a living debate.

    I remind you that the verdicts here are always preliminary. If the data changes, or better thinking is presented, the intent is to improve the argument as we go.

    The truth filter used for the Rationality Engine attempts to find at least two pieces of support for every claim. Reliable data and replicated science will always be the top filters for truth, along with logic and reason. But if any of that conflicts with our personal observation, or the observations of others, that too has to be factored into a verdict.

    Claims – First Draft

    Claim: Well-meaning doctors, family, and friends will have a natural desire to end the suffering of a patient because we feel empathy and we imagine we would want death in that situation. This primes all people involved to be coercive even if only in a subtle and unconscious way.

    Claim: The AMA, the Catholic Church, and disabled rights groups oppose physician-assisted death. Even if you disagree with their position, collectively they form a useful counter-force against society slipping into a death culture.

    Claim X and Y: The common good is not served by allowing people a legal option to harm themselves, for two reasons among others:

    • Claim X: We have lots of laws that limit personal choice for the common good. For example, you can’t drive at night on the freeway with your headlights off because your choice could kill someone, including yourself, and we are all components of the common good.
    • Claim Y: Our sense of the value of human life (and dignity) is influenced by the actions of individuals and by laws. Legalizing physician-assisted death, along with widespread use, would decrease the value we assign to life by treating it the way we treat food that is past its expiration date.

    Claim: The so-called Slippery Slope argument is real, and intentionally engineered in some issues. Proponents for gun control, medical marijuana, pro-life, and bans on smoking all took small steps (because that’s all they could get) with a strategy of getting people used to the new situation before going for more. 

    Claim: Proponents of physician-assisted death in California are limiting their focus to terminal patients in pain who have a sane preference for death. 

    But if that right is established by law, it will make it easier for proponents of even greater euthanasia rights to push for more. This would be a threat to the disabled and the elderly. 

    Claim: A Dutch study of their physician-assisted suicide laws showed that in 28% of cases the strict criteria were not fulfilled. This suggests a high potential for abuse of the law beyond its intended boundaries. 

    Note: Jimmy Akin does not rely on the slippery slope argument but in response to my question he does call it out as a legitimate concern. Jimmy’s objections are to the proposed law on its own merits, not simply a concern that things could worsen.

    Claim: The Common Good can include a situation that is bad for one member of the group and good for another. The relative weight of the individual concerns matters. For example, an inconvenience to one person would be ranked lower than physical harm to another.

    Claim: There is no objective standard for the Common Good, so once we leave the realm of the obvious (death versus inconvenience), humans can be expected to disagree, especially when self-interest is involved.

    Claim: When reasonable people disagree about what constitutes the Common Good, there is no objective standard to break the tie. 

    Claim: A mind that is “trapped” in a non-functional body is just one of many forms of pain and need not be treated differently for the discussion of physician-assisted death. Pain is pain.

    Claim: A brain without consciousness, that is still functioning to keep the body alive, has human dignity. 

    Claim: A brain that has no consciousness and is not capable of keeping the body alive without medical intervention no longer possess the dignity of a living person. (But it would maintain the dignity we accord to corpses.)

    Claim: It is rare for a person to experience pain in the final months of death. Most deaths are either sudden, involve pain for a short period, or involve manageable levels of pain using medications. And as stated, improvements in pain management, including induced coma options, could reduce the issue of pain management to a trivial number of cases.

    Revised per Jimmy Akin on 5/5/15 to:

    Claim:  It is rare for a person to experience extreme, untreatable pain in the final months before death

    Claim: It would not make sense to pass a law that benefits only the rare exceptions (as horrible as they are) when you consider the wider impact on human dignity and other practical matters (discussed further down).

    Claim: Old people are not good advocates for their own pain relief. 

    Claim: When mentally weak patients are not good advocates for their own pain relief, the most reasonable solution is to give them better advocates, not make it legal for them to take their own lives.

    Claim: From a Catholic perspective, pain and suffering before death do not decrease human dignity. 

    Claim: From a Catholic perspective, ending your own life decreases human dignity. 

    (Note: Jimmy’s views on life are obviously informed by his faith, but in this case he is putting forth an argument based on reason as he sees it. (He also agrees with the AMA and they are not a religion.) That said, no differences of opinion between Jimmy and the Church have been noted.)

    Claim: The only arguments against physician-assisted death are based on religion. (The implication is that atheists would call it magical thinking.)

    Claim: As a society we should not settle for doctor-assisted death because we can do better.

    Claim: Legal options for assisted death would decrease the efforts put into finding cures. Why find cures when you can just get rid of patients?

    Claim: Pain can be completely removed by drug-induced coma. Therefore, no one needs to suffer before death.

    Claim: In California it is illegal to aid or encourage another to commit suicide, therefore the legislature of California appears to believe it promotes the common good.

    Claim: It is not accurate to say a citizen of California is being “denied the right” to physician-assisted death because rights are created by laws and that right has not been created.

    Claim: There is no “moral right” that supports the idea of allowing physician-assisted death. 

    Claim: The “common good” standard is the most reasonable standard for deciding on the legality of physician assisted death.

    Claim: The “common good” includes both the good of individuals and the good of individuals in a group. Both are important.

    Claim: Physician-assisted death violates “innate, intrinsic, human dignity.”

    Claim: For the purpose of discussing physician-assisted death, it does not matter if human dignity is the product of a “soul” or an emergent property of a complex system.

    Claim: Human dignity (whether soul-based or an emergent property of a complex system) is real, and has consequences for how people must be treated.

    Claim: Because humans have innate “dignity,” their lives “mean something” and they “must be respected” to a higher degree than we respect inanimate objects, for example.

    Claim: No one has less right to life based on how near or far they are to death.

    Claim: Dignity applies to ourselves as well as others, and it is possible to disrespect yourself.

    Claim: We “deserve” love and respect because each of us has human dignity worthy of that love and respect.

    Claim: Because of the near-universal belief in human dignity (or a similar concept) throughout history, and across societies, there has always been a stigma on suicide as something that is bad and wrong.

    Claim: Physician-assisted death is never a desirable outcome in a world in which human dignity matters and pain can be totally eliminated by medications (which might include an induced coma.)

    Claim: Putting a terminal patient into a pain-free coma until death preserves human dignity.

    Claim: There are practical barriers to full pain-elimination in the real world, for a variety of reasons, but our efforts are better served by fixing that situation as opposed to promoting physician-assisted death with its human dignity issues.

    Claim: Helping a patient find pain relief better corresponds to the requirements of human dignity than letting them die, even if they prefer death.

    Claim: A medical professional would debase herself by being part of a system that assists in the killing of innocent people. This too is a violation of human dignity for the professionals involved.

    Claim: Violating the dignity of another is a violation of one’s own dignity. In other words, if I kill you, my dignity suffers as well.

    Claim: Asking a professional to violate your dignity (in any way) does not make the violation acceptable because human dignity is bigger than personal preferences.

    Claim: The American Medical Association opposes physician-assisted death, explaining that it would cause “more harm than good” for three given reasons:

    •  It is fundamentally incompatible with the physician’s role as a healer.
    • Difficult or impossible to control
    • Would pose serious societal risks

    Claim: Legalizing physician-assisted death would put pressure on patients to kill themselves.

    Claim: Patients are more likely to be abandoned once it is thought a cure is impossible.

    Claim: People might someday be denied insurance payments for medical treatments when physician-assisted death is an option.

    Claim: Medical progress will slow because there is no point trying to solve a problem already “solved” by assisted death.

    Claim: Human dignity is better served by giving grandma enough pain medication to eliminate suffering, not allowing her to suffer and giving her only the option of death.

    Claim: There are reported problems with Oregon’s laws on physician-assisted death

    Claim: It is impossible to know how many problems Oregon has had with their physician-assisted death laws because it is unlikely all problems are reported.

    Claim: If a family member coerced grandma to seek assisted death for personal gain, no one would know of this crime. Grandma would soon be dead and the perpetrator would not talk.

    Claim: It is irrelevant to the discussion whether Oregonians are happy with their law because they are not likely to be well-informed about how it is working for individuals. That sort of data is not tracked, and it would be impossible to obtain data on whether family members were being coercive.

    Claim: A poll of Oregonians regarding their experience with physician-assisted death would be unreliable because the way you ask the question will influence the result.

    Claim: In the context of this discussion, psychological anguish is considered pain, not just physical pain.

    Claim: An advanced medical directive (in which you state your end-of-life preferences while still healthy) would eliminate some but not all concerns about a patient being coerced into choosing death.

    Claim: Some folks will not set up an advanced medical directive, so that is a problem.

    Claim: A person can be coerced to change their advanced medical directive while still mentally capable but susceptible to manipulation.

    Claim: There is no objective standard for deciding if someone is mentally incompetent, so some people will be making advanced medical directives under coercion.

    Claim: Including a physician-assisted death instruction in an advanced healthcare directive would devalue human life by reducing it to a check box on a form.

    Claim: Complete pain relief is medically possible, as demonstrated by anesthesia during surgery.

    Claim: The assisted death pills used in Oregon have not worked every time, especially when they cause vomiting. No data is available on how often complications arise.

    Claim: Complete pain relief in the form of induced comas is not common practice today, probably for a variety of reasons.

    Claim: A rational person can decide to live in pain until the end of life for a variety of reasons.

    Claim: Physicians are reluctant to induce comas in today’s world.

    Claim: Insurance might not cover induced comas for pain relief. (Speculation.)

    Claim: According to the American Medical Association, physicians are reluctant to be aggressive in pain medication and they believe education can help.

    Claim: Patients suffer less when they have a sense of control over their own suffering. So one path for improvement is allowing more patients to regulate their own pain meds as is sometimes the case now.

    Claim: We have no data to tell us how many people might want a physician-assisted death. The number could be in the hundreds-of-millions someday as science continues to improve at keeping people alive long after their bodies have become useless.

    Claim: It is possible that someday our skills at pain relief (without coma) and mood regulation will be so good that dying will rarely be preferred. In that case, a law allowing physician-assisted dying would create far more risk than benefit.

    Claim: In some cases a person might choose death right before an incurable condition finds a cure. That situation is rare now, but could change as the rate of cures advances.

    Claim: We have no data on how many folks would be encouraged to take their lives if physician-assisted death were legal in more places, but it would probably be “lots of people” because even in today’s world we see dying people pressured to forego potentially life-extending procedures toward the end of life.

    — Added Claims since first posted —

    Claim: Doctors might encourage people toward assisted dying to free up organs to help the living.

    Claim: Doctors are human, and their opinions of what constitutes a “life worth living” could influence what they recommend to patients.

    Sources: (Incomplete)

    For the proposed text of the California law, see here.

    For a critique of the California law, see here:


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