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As a recent quadriplegic who is in the process of attempting to secure assistive suicide in another country, thank you for putting it so well and so eloquently. Some of them more puzzled commentators above should read this comment.

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I think you should be allowed to pursue suicide if you want it, of course — I just don’t understand how physical disability / discomfort could offset all the good you could still do on earth to other people.

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I have two possible answers to that.

First, everyone is allowed to be selfish to some extent. I would probably be willing to suffer a bit to do a lot of good to others. I would probably not be willing to suffer a lot just to cause a tiny bit of good. As a concrete example, I have not donated one of my kidneys, and have not seriously considered it, even though that kidney would likely be more useful to someone else than it is to me. I'm selfish enough to not want to go through that hassle and to not want to take the risk something goes wrong, even if that means someone else will die. That level of suffering to me is apparently not worth doing a lot of good to others, and it is the point of view that I think is most common on the topic of kidney donation. If you can believe that to be a reasonable position, you might try to view this situation as analogous to that (albeit with a flipped sign, ending personal suffering at a cost to others versus inflicting personal suffering to the benefit of others), even if you would draw the line elsewhere.

Second, there might be a serious question as to how much good you can do to other people; many struggle with this question, and quadriplegics (especially recent ones) might find it easier to find a negative answer as compared to before they became one. Your job options as a quadriplegic are rather more limited, and even jobs you can do in principle might take more effort in terms of required infrastructure. Bluntly speaking, becoming quadriplegic reduces your ability to do good for society as a whole, and adds some costs to take care of of you. I'll hasten to say that this should not be seen as a moral judgement of any kind. Society (in whatever form you wish to read this) made a decision to care for quadriplegics, and they don't need to feel bad about that (or even feel bad about not feeling bad about that). The level of good one can do for friends and family is different, and a quadriplegic can still do a lot of good for them just by being around. However, even then, some of that value can be lost since some shared hobbies might no longer be accessible, and relations with other people can change. Rightfully or not, I think some quadriplegics might argue that their friends and family might be better off in the long run; having the grief now, but getting closure right away. I am not sure I agree with this in the case of quadriplegics, but I have some experience with people who slowly withered away physically and mentally, to the extent that when they finally did pass away my relief that their suffering was finally over almost certainly outweighed whatever minor bits of happiness I would have had over their continued existence. 'Merely' being a quadriplegic would not cause me to believe that (many quadriplegics are happy with their lives, and I would wish for anyone who is happy to live to be able to live), but if someone told me that they were suffering significantly yet staying because of the good they can do for me... Well, I'd have trouble answering that without pushing them in either direction, but internally, I would probably value my happiness less as compared to their suffering; they should not be forced to live just for the sake of my happiness. In this sense, I would be unselfish.

My answers above might be mis-aligned with what you think about doing good on earth to other people, and I might be missing some significant things that you think of as good. I do think there's value in giving anyone a perspective that helps them find a reason to live. All else equal, I would prefer someone finding a reason to live and then living over them dying. Still, in the end, I think that one can reasonably draw a line on the axis of 'how much am I suffering' versus 'how much good can I still do', and decide they have ended up on the side of that line that makes their life not worth living.

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This is a great reply. Thank you for writing it. I’m very glad to have read it.

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Excellent comment, I wholeheartedly agree with you.

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I read this book in a single sitting about two years ago during my sophomore fall quarter. I thought motorcycles were pretty cool and was investigating accident statistics when I somehow stumbled upon it.

Once I started reading, I couldn’t stop. It gripped my undivided attention for ~6 consecutive hours. I immediately think about it anytime I encounter paraplegia.

Clayton is painfully intelligent. He outright begs the reader on multiple occasions to just *take him seriously.* That he isn’t insane, depressed, psychotic - that the only thing “wrong with him” is his disability.

The final pages are the only time I’ve encountered a live, real-time recounting of suicide. I just kept reading them over and over again. Unlike the common narrative of “I regretted suicide in my last moments” - I do not remember that being the message he expressed. What I do remember was looking for a sign that may be the case, and acknowledging its potential, but I couldn’t conclusively draw the line.

Before I read this, I had never truly internalized “be thankful for your health.” It was just a vague “sure is nice to not be blind/deaf/paralyzed/immobile.” I now routinely am.

I’d recommend this to anyone. He has a way of making you laugh, cry, find gratitude, and look unflinchingly into what it might really mean to lose your body.

I ended up deciding not to buy the motorcycle.

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I read it recently. Regarding the end, he's determined at first, then feels a moment of panic and regret before settling into happiness and even euphoria, and recommends other paraplegics considering suicide to not be afraid of it.

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"Happiness and even euphoria" sounds a lot like the endorphin rush after a serious injury. When I snapped my tibia I was texting people "guess who just broke his leg LOL" for about two hours afterwards, at which point the endorphins wore off and it stopped being funny. Which is not to invalidate Clayton's decision, but to say that I personally place more weight on the two or so years of thought that went into his decision than on his body's immediate reaction.

(This is not an argument against anything you said, just me trying to tease out how I feel about his case, and explore what it might feel like to have the endocrinology of a "living corpse" affect my thinking.)

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Very wise on that latter. I am a defense attorney, and we mainly defend motor vehicle accidents. All the worst injuries I've ever seen have been to motorcyclists (or pedestrians, which kind of can't be helped, but I also wouldn't recommend that either, fwiw). I've had two cases where guys have had their legs amputated below the knee. Not worth it.

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"Before I read this, I had never truly internalized “be thankful for your health.” It was just a vague “sure is nice to not be blind/deaf/paralyzed/immobile.” I now routinely am."

....we do not become conscious of the three greatest blessings of life as such, namely health, youth, and freedom, as long as we possess them, but only after we have lost them. (Schopenhauer)

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“He is lingering in that liminal space between life and death, going through the motions.”

This is essentially where I am right now: https://jakeseliger.com/2024/07/29/more-isnt-always-better-death-and-over-treatment-as-a-downside-of-agenticness/. I'm dying from cancer, though, rather than being paraplegic. Since getting a dose of radiation therapy on June 12, my life has been hellacious, and has consisted primarily of 1. pain management, 2. mucus / slime / saliva management, and 3. not sleeping, due to #2. I'm technically alive but my life isn't worth living.

A horrible pseudomonas pneumonia infection appears to be contributing or causing much of the misery. I'm on my third antibiotic in an attempt to treat it, and am likely to switch to a fourth. But it doesn't matter that much: I'm too sick to travel to another clinical trial, and I've crossed the threshold from "tolerable quality of life" to "not tolerable quality of life:" https://jakeseliger.com/2024/01/23/will-things-get-better-suicide-and-the-possibility-of-waiting-to-find-out/

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I mean this in the simplest, most direct way: that sucks, and it breaks my heart that you are suffering this. I hope - again, in the simplest, most direct way - that you find and can utilize a treatment that will alleviate that misery. Everyone deserves to be able to do so.

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I've been following your writing and I don't really know the best way to say this, but, it's been a really amazing, horrifying, enlightening gift to be able to get the slightest glimpse into what you're going through. Obviously nothing could ever be worth having to go through that, but I want to thank you and Bess for writing all of that down and letting people see it.

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You're welcome. I hope others learn how to navigate the crazy clinical-trial system, and, most of all, I hope Congress reforms it.

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In case it helps with anything, I'll echo Brian Moore:

That sucks, and you didn't deserve it.

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Oh wow, I'm amazed you're still alive. I thought the next time I heard about you would be your death.

I really hope that miracle comes for you, because you really fucking deserve a happy ending. But either way, you really tried your best. I can only hope I'll be as brave if I ever face that level of hardship.

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I'm amazed I'm still alive too. I won't be for long; the turn after getting spot radiation on June 12 has been horrible. My wife and I won a bunch of treatment gambles, but we really lost with the spot radiation, followed by the savage pseudomonas pneumonia.

Once a sufficient number of things go wrong, they tend to keep going wrong, and I'm caught in that doom spiral.

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🫡

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Jake,

I've been following your story since the glossectomy post was linked to in /r/medicine. (Though I think I've missed a few posts, unless the last one was the first mention of Bess being pregnant.) I'm very sorry the misery has been compounded by tumultuousness. ("Tumultulty?" The spell-checker doesn't recognize "tumultuousness.")

1. In addition to your writing about the invisible graveyard and difficulty of navigating clinical trials, are there any themes or subtext in the way you depict your experience of illness that you care to highlight or make explicit?

2. Any regrets over pursuing the strategy of leapfrogging from trial to trial?

3. In /r/medicine, we discussed whether or not it was reasonable for your surgeon to switch from a hemi-glossectomy to a total glossectomy, without a new consent from your medical proxy, especially since it was unclear how much he expected it to change your prognosis (given that the cancer he was removing was itself a recurrence of an aggressive and frequently-recurring cancer). What do you think?

I hope you have the least unpalatable outcome possible. (Pun intended, since you're a writer.)

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The last one was the first public mention of Bess being pregnant!

Don't think there are more themes or subtext, or, if there are, I'm too ill to imagine or articulate them now.

Given the current constraints on e.g. distributed clinical trials, the strategy of going from trial to trial seems reasonable. But ideally one would have a better and more humane system.

I think the problem is that once Dr. Hinni (the ENT at Mayo who led the glossectomy) discovered that the cancer had compromised the lingual arteries, it was too late to intelligently back out. I was warned that there was a possibility of a total glossectomy. He thought he was maximizing the likelihood of the cancer not returning. After the total glossectomy, Bess and I (mostly Bess) did a lot of research and consulting to figure out whether I should do chemo in an effort to prevent further recurrence, and most oncologists said good data doesn't exist, and the choice would ultimately be mine. I elected to pursue to chemo, but, by the time we started, a bunch of new tumors had already grown.

Multiple head and neck oncs have independently said mine is among the most aggressive cancers they've ever seen :(

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I think you've made a difference, especially as seems probable that your wife will carry on with activism or awareness-raising y'all have done. I know I will think about you whenever I hear about the difficulty of accessing trials and making use of one's own research into one's illness.

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I’m so sorry you’re experiencing this. No one deserves that.

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I'm at a loss for articulate words, so let me just say that I am so very sorry.

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I hope this isn't too late.

Please read this with the frame of mind that I care very deeply for you and your family, though I don't know you.

Rather than having crossed the threshold from "tolerable quality of life" to "not tolerable quality of life," you've crossed from "being able to believe that your quality of life is tolerable when it really isn't" to seeing things clearly because now you are deprived of any health or comfort to your body. Everything in this world is temporary and worthless, with the exception of the souls of every person. All that is done by anyone in this life that doesn't work towards the good of your soul or anyone else's is worthless. One day, everything in our universe will be completely destroyed and forgotten. All that will be left will be the souls of man and God and the angels, and we all will be judged for every way God's commandments have been broken. That is, unless we have faith in Jesus Christ, who sacrificed himself to take our place in punishment and then resurrected himself to prove that he had the power to conquer death.

God created mankind in order to love us, but there is a penalty for anything we do that is contrary to God, and that penalty is death. Living righteously is the baseline that God requires, so there's no amount of righteous living that can bring us back to a place where we stand justified with God once we have acted against God in our hearts or minds or actions. God still loves us even when we are against him, and that's why he came as a human to suffer as a human and die in the place of all humans, because he lived perfectly righteously as a human. Anyone who accepts what Jesus did and has faith in the saving power of his love and what he did will be pardoned for all that he or she has done wrong, and on that day when Jesus judges all of creation, he will pass over us and accept us to be with him because we accepted his love for us.

I won't argue with you about the fact that you have done any wrong against God, or that he has the absolute authority to create and judge in the way that he has and will. You know that it's true and can't deny it to yourself, even though you may be able to deny it and argue against it to everyone else.

I urge you to see the wrong in yourself and see how truly evil it is. Look around at how much evil there is in the world is around us. Any amount of slightly bad or less wrong from us has contributed to it. Admit to yourself and to God that you know that you have done evil and cannot redeem yourself on your own, and believe in Jesus that he will save you and redeem you himself.

I am praying now for God to heal you physically, but more importantly that he will heal you spiritually and your wife and family as well. I'm praying for you all. Jesus loves you and wants to save you, he has suffered so you can be free from evil and righteous with him.

Edit: To anyone else who may be reading, this applies to you as well.

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Do you think people would be immortal in their current bodies if they didn't do anything God was against?

Do you think people who are healthier and longer-lived are in better compliance with God?

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For your first question, the Bible says that death entered the world as a punishment for sin (going against God), so if mankind had never sinned then I think yes we would have been immortal in the bodies we were born with. But my speculation doesn't really have any effect on reality, and there is death in the world and our bodies aren't immortal.

For your second question, no.

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Jake Seliger died in the week following this discussion. I regret that I never got to meet him.

https://marginalrevolution.com/marginalrevolution/2024/08/jake-seliger-is-dead.html

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Well, don't leave us in suspense! What should the 'mention of stem cells' have been?

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The appeal of stem cells, as you likely know, is that they can theoretically be developed into any other type of cell.

This would make them redundant with mentioned strategy #1, cultivating nerve cells from an olfactory bulb or mucosa. Since that strategy appears to already work, stem cells don't have much to add to it.

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This seems unnecessarily unkind. What mention of stem cells would have redeemed EA? I can't think of what it'd be.

Why not just add a nice paragraph or 3 of how mention of stem cells would have improved the book review, or at the very least, improved our understanding of the situation?

You seem to have a passion about stem cells. Could you imagine for just a moment that other people have other passions, and haven't been able to fill the gaps the same way you have? Help us grow together, please.

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Redeeming this article is beyond the point, it is about the choice in subject matter. How many articles from the EA community can you find about stem cells versus assisted deletion?

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One about assisted deletion. This one we're commenting on.

What is the "EA community"? Lesswrong.com? https://www.google.com/search?q=stem+cells+site%3Alesswrong.com - I see a lot of results, although it's tough to say which are really about stem cells, since one is about ChatGPT, for example. But Google seems to indicate there are many many pages of results. I clicked to see the 100-110th results, and there were still articles that seemed to talk about stem cells proper.

So not only are you being kind of an a--hole, you appear to be factually incorrect as to your reasons why. A massive number of articles from EA community about stem cells.

Seriously... just give us something, anything, besides ironically angry veiled insults. Can you write an article about stem cells? If you have anything interesting to say about them from the past few years, I'm sure it would be well-received.

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It's difficult searching for assisted deletion, isn't it? You get limited search results replaced with guidance to harm reduction. My apologies if I can't hide my distaste for the EA community anymore. Thank you for the diligence in providing exactly the materials that deserve amplification, you did a better job than this humble commenter could.

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There's absolutely nothing wrong with "assisted deletion" as you call it. Whether you agree or not, I have the right to "delete" myself whenever, for whatever reason.

I understand there's implementation difficulties, and that the true will of a person can't be elicited just by asking them, especially when mental illness is involved.

All that said, this has very little to do with EA. There are tons of EAs pushing in all sorts of directions; you can be an EA working in one cause area even if you disagree with other EAs in other areas. Insofar as EAs cluster around specific beliefs and causes, assisted suicide is very, very far from the top.

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I don’t understand why that matters. Is the issue just that you would rather read about stem cells and have disdain for anyone who doesn’t cater to your preferences?

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I assume the criticism is that the EA community is putting effort into legalising assisted suicide for disabled people when such effort would be better spent researching cures for the disabilities in question.

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if you've got a stem cell treatment that works I'm all ears, but I think you probably don't.

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There are a handful of stem cell therapy options available to the rich and have worked for athletes. I wonder what sort of consultation Clayton would have gotten after law school.

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All of the ones I’ve seen are shams. If they worked, theyd be able to prove it

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Effective stem cell treatments have been known since at least 2003.

https://youtu.be/LNJi0CzfodI

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To anyone interested, here is a review from April 2024 going over research in spinal cord regeneration:

https://journals.lww.com/nrronline/fulltext/2024/04000/regenerative_medicine_strategies_for_chronic.26.aspx

"As described above, cell transplantation alone has proven to be limited in its ability to improve function, especially in complete chronic SCI, it is essential to improve the spinal cord microenvironment with scaffolds, neuroprotective factors, and scar reduction agents prior to cell transplantation, as well as to develop transplanted cells with enhanced efficacy or new developmental treatments.

Furthermore, neural cell tissues induced from human pluripotent stem cells are typically insufficiently mature and cannot imitate the morphological features completely, there are some potentials for tumorigenesis and inadequate efficacy of improvement functions. "

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(the infamous) Ray Peat mentioned some research where they severed the spines of mice, and then implanted Progesterone soaked ropes, which resulted in healed spines.

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Whose blabbering? This is an anonymous book review. What makes you think the author is an EA.

It looks to me like you are reading in context which isn’t actually present.

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This is the kind of comment that is less than worthless. You offend people, suggest that you have some important information, but you don't provide it. In case you are right, the comment is still worthless for a reader. And in case you are wrong, the reader will have to spend some time, only to find out that there is no useful information at the end.

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I have no guilt for not wasting time on a discourse on your terms as a deflection from my point. The commenters interest shows there's an appetite for beneficials solutions that deserve amplification.

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No indication the author is an EA. What an odd non sequitur.

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Author mentioned replicating nerve cells but not stem cells. Damn you EA!

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Banned for this post.

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The anti euthanasia advocates I encounter are more nuanced than this article presents. The fundamental problem with this style of euthanasia is it absolves people of finding better options.

If Clayton had better social care and tools to live, might his quality of life have tipped over into livable? Maybe not in his case, but there are many cases where the life of the disabled is unlivable not because of the impairment, but because of the lack of support, inadequate housing and heating and care.

With euthanasia on the menu, it's a much cheaper option than fixing the broken system (or discovering new cures) and demand for improvements goes down.

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Clayton does devote a chapter in the actual book to discussing this. IIRC, He rejects it out of a combination of pride and pragmatism. Says basically it's fine the independently wealthy accident victims want to hire a giant team to take care of them, but that in his opinion people in severely disabled conditions similar to him will absorb tremendously amounts of resources for relatively little improvement, such that support for him wouldn't be a reasonable public expenditure. He further adds that he doesn't think "society" owes him that level of financial expenditure and, more or less, that being a burden rather than a producer is a major injury to his pride/dignity/meaning anyway.

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It sounds from the review that Clayton’s life would have sucked less with someone who wasn’t particularly trained coming over to help with tasks a few hours a day. This wouldn’t help with toileting but also isn’t wildly expensive.

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Help multiple hours every single day doesn't seem that cheap to me. Strictly in terms of time, it's around 15% of someone's waking hours. Would it improve Clayton's life enough to be worth sacrificing 15% of someone else's? Maybe, but I would say it's expensive.

(Obviously in practice the burden would be spread across multiple people but it doesn't meaningfully change the total cost I don't think.)

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If you pay them, it's not "sacrificing" their hours. If they love you, or see you as a god in disguise, or made it their mission to clean feces for Christ, it's not wasting their time. If we accept that only the individual gets choose the meaning and value of their life, then surely we should also accept that sometimes others value our lives more than we do and are willing to share and lighten the burden. Asking for their help is not an imposition. Refusing their help is negative sum, i.e. irrational.

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If we're paying them, then the money is coming from somewhere. One way or another we as a society are sacrificing the value of their time.

If you can find someone who's willing to help for the sheer joy of it and has nothing else they'd rather do, then sure, that would be great and a win for everyone involved. But I think empirically the supply of saints doesn't match up to the demand.

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Can't the money come from the disabled person's supply, in the cases where they are employed? Clayton planned to become a lawyer; in that case, he certainly would have been able to trade his time working for someone else's helping.

And when they are not, shouldn't their family be able to do this on their behalf, if the family values the person enough to do so?

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I remember that, but it was a logical fallacy. Comparing numbers that seem sensible to compare but really aren't. "OMG taking care of a disabled person requires more than 100% working hours from an able person, and is therefore net-negative"... This doesn't matter one bit! What actually matters: is our society rich enough to be able to provide extensive care to disabled people without collapsing? yes, it is. Do we actually want to do that? Well, now we have to get into the nitty-gritty, but at least we're asking the right question.

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'yes it is'

Who are you to decide this?

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I'm saying it's feasible, not that it's a good idea or that we should do it. As I said in the very next sentence.

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From a progressive perspective, to have an opinion on this they should be a voting taxpayer. From a libertarian perspective, they should be a customer of a disability insurance company. Either one makes sense, and involves the same calculation of "odds of this happening to me" and "cost of this care" and "value to me if I need it"

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I don't think that's a progressive perspective. I think one of the premises of progressivism is that care shouldn't have to be earned.

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Maybe the situation is different in the US, but AFAIK you cannot buy private disability insurance that provides you with long-term extensive 24/7 care, indefinitely. This type of combined medical & nursing care (with no time limit) is so hideously expensive (& difficult for insurance companies to calculate in advance) that it is not offered as an insurance product - the market is not there. (Also due to the severe adverse selection problem you have as an insurer.)

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A voter, and thus entitled to a fraction of the power to allocate society's resources.

I'm not a big fan of the libertarian argument according to which voting for something to be done at the taxpayers' expense is theft, but even if you believe it, you must recognize in our (and evety other) society any adult citizen is factually entitled by law to do so.

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Just voting does not permit you to 'allocate society's resources'. It allows you to decide who will run the government. There are (or should be) very strong checks on the power of government to 'allocate society's resources', precisely because of this problem - voting to allocate resources requires no effort to be put in to generate those resources in the first place, reducing the incentive for society to improve.

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This seems like an oddly limited scope for voting. There are many votes taken in the United States beyond just electing representatives. Citizens vote on ballot measures affecting taxes and spending here. I believe that is true in many other countries as well.

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"is our society rich enough to be able to provide extensive care to disabled people without collapsing? "

Well, apparently we're not doing it now (assuming the author found it too expensive, rather than say being too proud to get the help or something).

What does that say about the job of taking care of a disabled person? That compensation and working conditions are not attractive enough that enough people do that job. So disabled persons can't find carers.

How would we fix that? You could increase pay, but that I'm not sure if that's the sticking point. I'm not certain that you could make working conditions better.

For instance, I have alternative employment, and you would have to force me to work as a carer, or it would have to be for family. Money doesn't actually enter into it.

"Society is rich enough to do this" is just a call for someone else to fix it. Be more specific on the measures you would take to do so. Otherwise we cannot judge whether this is indeed true.

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Page at https://www.sci-info-pages.com/spinal-cord-injury-facts-and-statistics/ mentions a number of about 291,000 people in US who are either paraplegic or quadriplegic, costs of living with paraplegia after the first year was estimated at $68,821 annually according to a 2017 Washington Post article at https://archive.ph/wip/EfUfZ so even if this was paid entirely by a specialized government program as opposed to by insurance premiums from healthy people, cost in 2017 dollars would be in the neighborhood of 20 billion a year, overall government spending on health care in 2017 (state and local as well as federal) was around 1580 billion according to p. 6 at https://www.ama-assn.org/system/files/2019-04/prp-annual-spending-2017.pdf

In Clayton's case I also wonder if he was uninsured or if his insurance failed to cover things that would have made daily tasks significantly easier, like a colostomy bag (mentioned at https://www.spinalcord.com/blog/when-should-people-with-sci-consider-a-colostomy as a common medical intervention for people with spinal cord injuries) or some medical devices that can help with tasks like bed/wheelchair or car/wheelchair transfers. The Washington Post article I linked above also talks about robotic exoskeletons as emerging alternative to wheelchairs, as home robotics develops hopefully the price tag on those will keep dropping.

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Good cheap exoskeletons would make life better for a lot of people, but I don't think they're all that close.

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I just finished reading the book. In Atreus' case, it wasn't about needing care. He mentioned several times how wonderful his social circle and school were with whatever assistance he needed, and he was on track to make a bunch of money as a lawyer. But he thought society's cached responses about life still being just as good were bunk when applied to spinal-injury paraplegics, and that he preferred not to be alive.

His thoughts about neck-down quadriplegics were different, and pretty clearly colored by his disdain for Not Dead Yet. That's where he goes on about being a drain on others.

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I think this is a valid object, but I would condition it on the judgement of the individual, rather than you or me. If *they* believe that the cause of their misery is lack of reasonable care, then we should give it to them. If *they* believe that the cause of the misery is not that lack, but rather the objective impositions of their condition, and that (like Orion says below) that they do not want (for whatever reasons) feel that care would alleviate them meaningfully, then I think we should defer to them there as well.

If you or I believe "If Clayton had better social care and tools to live, might his quality of life have tipped over into livable?" then that is fine, but the judgement of whether that is true or not needs to be in his hands.

"With euthanasia on the menu, it's a much cheaper option than fixing the broken system (or discovering new cures) and demand for improvements goes down."

Sure, incentives exist, but:

1) you are describing benefits for society that might demand torturing a real individual to acquire. I think perhaps we've decided that isn't a good idea. This feels too much like hostage taking.

2) there are lots of other diseases/conditions that straight up kill people - and yet I think we're just as incentivized to come up with cures? If Clayton had died in his original accident, would we say "well, why would we prevent donkey crashes, because look how cheap just burying him was?"

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'If *they* believe that the cause of their misery is lack of reasonable care, then we should give it to them.'

Why? Do they have something to give in return?

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Quite possibly.

I'm not a big fan of deciding how we treat people — in the medical domain, I mean — based solely upon a measure of their Contribution to the Collective™, though...

Sure, /in general/ I've become more and more in favor of the libertarian/Libertarian position, having developed a touchingly childlike faith in The Power of the Market(®) — due in no small part to, until recently, actually being in a position wherein I could organize & test ways to handle various tasks that were (apparently) amenable to both a top-down & market-centric solution, and then seeing that the latter really did tend to do extremely well (when I could get others to play ball; a few ideas, unfortunately, needed—say—larger scope, to give a "marketized" approach a fair shake¹) — but...

...stuff like "medical care that literally means the difference between life & living death & then actual death"...?

I don't know, man, I'd kinda rather a floor for how far we let people fall, in at least this arena.

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¹: (sure, sure: yes, as it turned out, my famous Roustabout-Truck–Exchange–Pool suffered from liquidity issues that — in retrospect — maybe should have been obvious when we're talking "like a half-dozen spare units, max, at any given moment"...

(...but III maintain that it was merely ahead of its time! Someday, ALL fleet-owning companies will "internally securitize" their rolling stock & force... er, allow... project managers to self-allocate units & justify equipment needs based upon participation in both the internal toy market AND the external actual market at the same time!

(...I mean, sure, maybe it sounds a bit like I was just creating extra work for the PMs, in an arena that already had a pretty direct relationship to & feedback from real-world economic considerations — what with the standard way projects are billed back to the company & client anyway... — but... there were inefficiencies there, man, I'm telling you! Why, ones upon ones of people told me they'd been able to re-assess crew-truck needs thanks to the R.T.E.P.!—)

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You, and others like you (including myself btw) are quite welcome to give up as much of your income as you voluntarily want to support these people. Why force others to do so?

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Because this ends up in an equilibrium where the most selfish have the most power because they aren't burdened with paying for the common good. A level of common responsibility stops your saints all running out of resources entirely, and produces many dividends in public health, reliable care for you when you become old and disabled, etc

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Taking care of the disabled is not 'the common good'. It is good for them, and it is good for those very few people who would pay to take care of them. It carries no benefit for anyone else, and hence should not be paid out of tax money.

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Yeah, the way we'd treat any illness. They pay with their money, insurance or state-provided $. My comment was not so much about "how would they pay" and more "if lacking an obviously reasonable standard of care" was pushing them to no longer wish to be alive, then we could try doing that first! Definitely I could imagine a scenario where someone said "the standard of care I think I need" is far too much, but "reasonable standard of care" has a general (if debateable) meaning.

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>If Clayton had better social care and tools to live, might his quality of life have tipped over into livable? Maybe not in his case, but there are many cases where the life of the disabled is unlivable not because of the impairment, but because of the lack of support, inadequate housing and heating and care.

If this is the argument against euthanasia, then until this proposed remedy can be readily provided to everyone, and it can be demonstrated that it eliminates people’s desire to end extreme suffering, please allow people to end their extreme suffering by some other means. If someone is mortally miserable and you say you can imagine a situation in which it doesn’t have to be that way, that is not a solution.

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Yes, personally I believe we should be providing doctor assisted euthanasia and just trying very hard to improve provision (and culture around the stigma of being dependant) so it is needed in fewer cases, much like I believe we should provide abortion services but also strive very hard to make provision for alternatives as good as possible so it is needed in fewer cases.

I just felt the article position was a bit of a straw man compared to the position I'd heard.

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That’s commendable. Thanks.

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Is there evidence for this in practice? It seems to me that the places with legal euthanasia are generally politically progressive and have strong social safety nets. I would be surprised to find that Oregon is less dedicated to providing for disabled people than Washington, or the Netherlands less so than Belgium. Maybe that is the case; it still seems unfair to the Claytons of the world, who would opt for euthanasia regardless, to tell them that they aren't allowed to have it because other people need better social services.

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I don't think there are any comprehensive statistics, but there are anecdotes like https://www.independent.co.uk/voices/assisted-dying-maid-suicide-canada-homeless-b2233845.html and you'd expect most people affected to a) be dead and b) not be keen on talking about it beforehand because it might make their families etc feel guilty.

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There are cases like this one, where a Canadian veteran allegedly spent five years unsuccessfully trying to get a wheelchair ramp installed in her house, only to be offered MAID instead: https://www.ctvnews.ca/politics/paralympian-trying-to-get-wheelchair-ramp-says-veterans-affairs-employee-offered-her-assisted-dying-1.6179325

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Can you see how the framing of the headline designs the way you're supposed to react to this? Or the way you say "only to be offered" translates to "and therefore the intent was to save money on having to install a ramp." It makes it sound like the same person they called for the ramp install was like "you know, it's too much work for me to build the ramp, have you considered dying instead?" I can certainly imagine problems or abuses in this system, but this is a news story that is designed to create a point of view, not inform.

If you've ever dealt with the gov agencies (at least in the US) that handle things like this, you know that "hey let's save money on this patient by euthanizing them" is - as bad as that sounds - honestly above their competency level. If they couldn't manage a wheelchair ramp for 5 years, undoubtably because of red tape forms not being filled out in triplicate, they couldn't manage this. Obviously the case worker shouldn't have said it, especially when the person was obviously expressing a desire to live, and in fact the gov says in the article "they shouldn't have done it, it's not how the policy works, it's absolutely a conversation with a doctor". I am the last person to apologize for the government, but this is just propaganda.

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Politically progressive and have strong social safety nets - surely San Francisco's homelessness problem refutes any suggestion the two are correlated?

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As mentioned above, with regards to euthanasia, the Netherlands are trailblazers in the world. Also, government support for the disabled is very good. Still, the great support here doesn't stop people from wanting euthanasia.

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This is a great review. I did not enjoy reading it, however, but that is not the fault of the author.

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The reviewer chose wisely. It's got enough effective altruism in it to be remembered as positive-valence for this community, and enough punch in the content that nobody will forget it. The title is evocative and sticky. I've already forgotten whether or not the review was well-written, but I won't have forgotten the title or the power when it comes time to vote. Admittedly, most of the readers here who vote at the end are far more conscientious than I am, but if more of the electorate were like myself this one would win first or second place for sure.

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You stated it more eloquently, but yeah, it certainly had an impact on me.

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I decided to not read it, which is my usual choice given a body horror content warning. The comments have been sufficient food for thought.

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> In most places that have legalized it, the patient’s condition must be considered terminal (i.e. death is expected within six months) to be eligible for MAiD. The procedure itself is typically either an IV injection administered by a nurse, or a prescription cocktail of benzodiazepines, digoxin, and opioids which patients drink themselves.

Reason magazine has recently been demonstrating their total lack of journalistic, intellectual, or moral integrity by running a bunch of columns claiming that suffocation by nitrogen is a horrifying, inhumane death.

In reality, we know that people who die this way fail to notice that anything is wrong, which is why, where there's any risk of funny atmospheric conditions, there are warning signs and cumbersome safety protocols and strict directives like "if you see your partner collapse, do not attempt to save him, no matter what".

Nitrogen suffocation ("hypoxia") is also the way we euthanize pets.

Why would we euthanize humans by injection? What's going wrong here?

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All those columns seem to be by the same person. Yes, I agree that allowing them to be run demonstrates deficiencies in "journalistic, intellectual, or moral integrity", but I wouldn't go so far as to describe it as a "total lack" thereof.

Yeah, it's an interesting fact that the suffocation under normal conditions is torturous not because of a lack of oxygen but rather because of an increase in carbon dioxide.

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https://www.democracynow.org/2024/1/30/nitrogen_gas_execution

https://www.theguardian.com/us-news/2024/jan/26/alabama-nitrogen-gas-execution-torture

https://www.bbc.com/news/world-us-canada-68085513

https://www.cbsnews.com/news/alabama-execution-nitrogen-gas-kenneth-eugene-smith-tortue-united-nations-human-rights-warns/

You seem very confident that nitrogen hypoxia (at least, as implemented by Alabama and soon Ohio as well) is a basically unimpeachable way to kill someone, for all the diversity of sources disagreeing with you. Reason Magazine is not the only one, it's also...the eyewitnesses...

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This is all so dumb because hanging, beheading & firing squad are all time-tested means of executing people that we just don't use for no good reason.

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the mechanism of death for those are (a) definitely not fast, humane, or reliable ways to kill, and (b) they look vindictive, which for good reasons we've moved away from

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Not reliable? Who is surviving them? I suppose if you have complete incompetents carrying them out they could drop people from a short height, fail to hit a vital organ, or use a dull blade with little force, but we've had plenty experience in figuring out what conditions will cause successful executions.

As for speed, I believe they're all faster than gas or injection.

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Long drop hanging where the object is to snap the neck rather than suffocate is one of the quickest and most painless ways to kill. Meanwhile, there are multiple stories of the "humane" cocktail of drugs given for modern executions resulting in severe pain upon injection.

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Regarding long drop hanging: is it though? I attempted to find arguments in favor of it on the webs and my impression was that it's all wishful thinking, contemporary cope, and current edginess.

Breaking your neck doesn't stop your heart from beating. It stops you from breathing, so you will slowly suffocate over several minutes.

*If* you're lucky, the noose will compress your neck arteries and you will pass out painlessly in seconds, but in my searches I've never seen it proposed as the primary mechanism of death.

So from these first principles and not seeing any credible discussion I have to conclude that long drop was adopted because it was certainly more efficient than short drop, but then the claim that it's painless and humane was invented from the whole cloth, as a cope. Of course you can't see that someone is in pain if they are paralyzed below the neck and there's a sack on their head.

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Ugh, hadn't thought of that. Great point.

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They should look vindictive: that's the point. Executing a man will not bring back his victims, but it's what he deserves for the crime he's committed. If we've moved away from "vindictive" punishments, then why do we try to fit punishments to the crime? Why don't we lock up rapists, thieves, and muggers until we're confident that they're rehabilitated? Why do we punish attempted murder less than murder? Because the purpose of the justice system is to mete out ordered and proportional retribution, in which wrongdoers are punished proportionally to the harm they have committed, regardless of whether such a proportional punishment would serve the purpose of rehabilitation or deterrence.

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John Hinkley Jr., a man who shot the President, is no longer locked up, precisely because it appears that he has been rehabilitated and deterred.

Maybe he will try again to shoot the President. If he does this, I will admit I was wrong.

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When TGGP mentioned beheading, I assumed that he was thinking of the guillotine which is very fast, humane and reliable.

As an opponent of the death penalty, I think that if a society decides to kill one of theirs against his will, sugar-coating that by emulating medical procedures is positively obscene.

If you can't handle the head in the basket and all the blood (I probably could not), then you should not watch executions.

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I think there are some decent reasons not to use them: Because they kill by damaging the body in grotesque visible ways, they probably cause more anticipatory terror for the person who is going to be executed. And if you view that as an acceptable part of the criminal's punishment, consider the distress of their family and friends. Hanging, beheading or shooting the condemned are probably more distressing to those who carry out the execution, more likely to produce ptsd and other anxiety disorders, then are gassing the person or giving them a lethal injection.

Also, these punishments desensitize the public to images of mutilation. Seems to me useful to have a lot of people who are horrified by the idea of mutilating bodies. It's plausible that being horrified by mutilation reduces the chance of someone violently assaulting someone else.

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I don't believe there's evidence for such claims.

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Well, certainly nobody has tested them in executions, comparing gory kill subject to non-gory kill ones. But do you think there is no indirect evidence, and/or not enough common sense evidence to make these ideas worth testing in a targeted way? I am confident that if I was going to be executed I would have more fear of death by beheading than of death by gas, and that if a loved one of mine was going to be executed I would be find the prospect of their being beheaded more distressing than the process of them dying in a less gory fashion. I may be wrong, of course, but my experience about this sort of thing is that I anticipate accurately how much something is going to horrify me. For instance, if I am considering watching a certain horror film, I find out ahead of time how gory it's going to be, just so I'll be prepared. My expectation of how much especially gory scenes are going to bother me is generally quite accurate.

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Long drop hanging isn't gory except in the rare cases where the head pops off. The British used to give reprieves to people with the wrong sort of neck so this didn't happen. In Canada, I think we did have a head popping off case in the 1950s. Albert Pierrepoint, who did more judicial hangings than anyone else in history was a mild gentle person who did not seem to suffer psychologically from his vocation as an executioner.

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"Common sense evidence" is not "evidence". It's just "I think", without evidence.

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Hanging isn't gory, particularly if it's long-drop hanging, which snaps the neck and kills the victim instantly.

As for the desensitising the public angle, there's no reason executions have to be held in public. Britain stopped public hangings during the Victorian era, for example, but still kept hanging itself for a century or more.

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This is exactly why the Nazis invented gas chambers. It does seem that the choice of execution methods is more for the benefit of the executioners than for the executionee. If I had to go, I’d take the guillotine. Or maybe a shotgun directly to the head…something foolproof and instantaneous. I’ve heard hangings didn’t work plenty of times… I guess you could solve that by making the drop long enough. But wouldn’t that just make it a less clean method of beheading? I think definitely for fat people. Either way…seems like it would less stressful to not have to be dropped first.

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> You seem very confident that nitrogen hypoxia (at least, as implemented by Alabama and soon Ohio as well) is a basically unimpeachable way to kill someone

This isn't a difficult question. Welcome to the "total lack of journalistic, intellectual, or moral integrity" club.

Do you just not have any concern for whether the things you say might be true?

> for all the diversity of sources disagreeing with you.

There is no end of people willing to declare that they are idiots in the service of an ideology. Mostly they're less transparent than this.

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I think we should avoiding discussing methods of do-it-yourself suicide in this discussion. In a group this size there are guaranteed to be people unhappy enough to be seriously considering suicide. The information about reliable and painless ways of doing it is not hard to find. If people considering suicide have not found it, it is because they have held back from doing so. It's not a good idea to post it someplace where they will run across it accidentally.

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I disagree. If you're old enough to be internet-savvy, perhaps, but it's now non-trivial to find useful information, with (arguably well-intentioned) people actively taking it down everywhere they can, which includes almost all the "normal" places one would look for information, and recommending the fucking hotline instead. Worse, there is active deception, either to make attempts unsuccessful such as about the direction to slice wrists (For reference, "Sideways for attention, long way for results"), or from trolls hoping to make it slower/more painful.

I would definitely appreciate finding information useful to me serendipitously, and would resent people trying to prevent that arguing that because if I really wanted to, I could go through the effort to find it elsewhere. I see no reason information about how to commit suicide is an exception.

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Sadly, it's not just controversial topics. It's hard to find useful information on almost any topic now'days. Even making good use of site search, keyword subtraction, and multiple engines. The combination of increased tech censoriousness, SEO-ification, and money-and-fear-motivated hostility to the userbase has enshittified the Internet to borderline unusability.

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