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.
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.
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.
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 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.
"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.)
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.
"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)
“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/
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.
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.
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.
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.
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.)
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 :(
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.
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.
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.
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.
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.
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?
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.
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.
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.
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?
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.
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.
"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. "
(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.
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.
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.
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.
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.
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.
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.)
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.
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.
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?
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.
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"
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.)
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.
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.
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.
"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.
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.
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.
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?"
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.!—)
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?
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
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.
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.
>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.
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.
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.
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.
Politically progressive and have strong social safety nets - surely San Francisco's homelessness problem refutes any suggestion the two are correlated?
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.
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.
> 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?
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.
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...
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
> 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.
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.
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.
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.
Yeah, I think in general, if you already know enough of the answer, there are still ways to find it online (though that's usually just as useless as it sounds), but if you're completely lost, you're shit out of luck.
>has enshittified the Internet to borderline unusability.
Amen to that.
Internet searchability, we knew you for such a short time...
I know Gen Zs with very limited search skills, but frankly it doesn't seem to matter all that much anymore, since even good search skills don't yield very good results.
It's hard to see where people will get their information from in the future, since libraries no longer contain many books (and publishing is about as much of a shit-show as search engines are these days anyhow.)
Yes, I know about that. No matter how you phrase a question about means of suicide, all you get out of google is a wall of suicide hotlines etc. I even run into the same kind of problem when I ask google about withdrawal from various psych meds (I'm a psychologist, and often have patients whose MD is taking them off some psych med): I get yards and yards of links to addiction treatment places & the like. On the other hand, there are books about euthanasia available on Amazon that pull no punches when discussing means of ending life painlessly. There are also organizations whose goal is to assist people who need an escape hatch to find one.
I am not in favor of policies that made it hard or impossible to find information about drugs, suicide, etc. I am just asking the people posting here to refrain from talking in detail about the various methods of do-it-yourself suicide. In the present situation I do not think the concerns you have about the difficulty of finding info apply. This group is smart, well-educated, and internet savvy. Even if there actually are a few people posting here who are none of these things, they are likely to have aqaintances who are able to help them get info they need.
I really hope you will consider stepping back and reconsidering about this. I am not opposed to suicide for suffering people whose pain cannot be relieved. If a close friend of mine wanted to end their life and their reasons for doing so seemed valid and unchangeable to me, I would not only give them the info, I would assist them in carrying out their plan if they asked me to.
But that's entirely different from putting up the info in a place where somebody will stumble across it. I almost certainly have more knowledge and experience than you do about this matter, and you should pay attention to my view. I have training in the subject, I have taught myself more about it, and I have known and had long talks about despair and suicide with at least 100 people, most but not all of them patients. I also have had about a dozen people I know fairly well commit suicide. None were patients of mine, though 2 were former patients. One was a a grad school acquaintance who committed suicide while we were both in the program. The others had been patients on a psych ward where I worked, where I had a few talks with them, had them in groups I ran, and heard about them in rounds every day. One of the things I know about suicidal people is that many refrain from learning about the nuts and bolts of how to do it because they see that as the last barrier to going ahead with the act.
"One of the things I know about suicidal people is that many refrain from learning about the nuts and bolts of how to do it because they see that as the last barrier to going ahead with the act."
Could you complete this argument, i.e., how does this (or anything else in your post) make a case against giving information in these comment threads? (I will admit that I am slower and stupider than most people here, which is also why I appreciate potentially useful information wherever I can find them).
I mean, why is this barrier sacrosanct while the fact that there are "books about euthanasia available on Amazon" is not? One is not necessarily selecting for "sensible" people this way, one is only selecting for people who are good at library science or something.
There was a period where I was seriously depressed or bipolar and intermittently suicidal. One time during a mental crisis I got partway through a suicide attempt (I was copying the method of a loved one who died), but I gave up after it became painful. If I’d had a faster and easier method at hand, I might have succeeded. After that, I made sure during my more active moods to avoid learning about easy ways to commit suicide and avoided possessing related tools.
I consider information about easy/comfortable ways to commit suicide to be a kind of info-hazard. I want people like the author of the book here to be able to find it, but I definitely oppose throwing the information around where people who didn’t go explicitly looking for it would find it.
Thank you for a clear and accusation-free articulation of the point, which I appreciate and respect. I am sorry that you went through such a difficult time earlier.
I appreciate your comments here and elsewhere in the thread. Given that the main thrust of the book - as I can tell from the review; I haven’t read it - is that suicide can be morally and practically defensible, I am curious about the underlying assumption for the request not to share practical information online. Anecdotally, it seems that the assumption of (U.S.?) psychologists is that suicide is always or almost always indefensible, or that the psychological motivators for it can and should be overcome or treated. Is that accurate? I don’t mean to be facetious, nor do I necessarily disagree that many or perhaps most suicides can and should be avoided – especially when the situations involve young people who might not appreciate the “permanent solution to a temporary problem” dynamic. I’m just curious whether standard psychological training or ethics rules allow for a “justified suicide,” whether along the lines discussed in the book or otherwise. On a related note, do you think that the suicide hotline warnings that inevitably accompany news articles on suicide are effective? I’ve always suspected they’re more about signaling - that suicide is bad and that treatment or therapy can help the underlying problem – rather than an effective prompt for someone to call a number. Nevertheless, they seem probably harmless, or perhaps “effective” in a broader sense of conveying a message. I do think there is one important exception to the “probably harmless” gloss: I recently saw the standard suicide hotline language on an article about a murder-suicide. (There was, of course, no prompt for those considering murder to call a hotline.) The focus on preventing the murderer from killing himself rather than his partner and kids, seems horrific and perverse.
> I am curious about the underlying assumption for the request not to share practical information online.
There is no underlying assumption for my request. The is a reason for my request and I have stated the reason every single time I have made the request: People who are toying with the idea of suicide often hold back from researching methods. They feel that their relative ignorance about whether painless and easy methods of suicide exist and how to get the materials for them is the last barrier between them and acting. My point is not that everyone else can and should keep them ignorant. It's that we should not toss the info around in places where they can come across it accidentally. I am not trying to hide the info from people like that. It's impossible to do anyhow. The info is easy to find. There are books on Amazon that give it. There are organizations for people who want to be able choose to exit life at a time of their choice-- organizations have websites, newsletters and forums. The chance is nil that somebody who can find this forum would not be able to find excellent info about the options online in a couple hours at most is tiny. So, for approximately the 6th time: I am no trying to keep them from finding the info. I am asking people not to toss it around in a forum where they might run across it. I suspect people keep failing to grasp that because it is much more fun to think of someone who makes a request like mine as a controlling, pearl-clutching advocate of censorship.
As for your questions: Mental health professionals are not taught that suicide is bad, or is always caused by mental illness, or is always treatable or is always indefensible. Mostly we are taught a variety of models of depression & a variety of treatment approaches, and read a bunch of research as a means of thinking clearly about the models and treatment approaches. Even if we were taught that suicide is bad, anybody with any gumption and common sense is going to object to efforts to control their views and will arrive at their own based on their observations and ethics. I, and most mental health professionals I know, have no problem with people whose suffering cannot be relieved being helped to voluntarily end their lives. On the other hand, we know from experience that most depressed people are sure they will never feel better, and most are wrong, so we are not enthused about people being helped to commit suicide under those circumstances. However, any shrink with common sense knows there is no way to prevent a determined person from finding a means of committing suicide. And no mental health professional with common sense thinks the desire to die is in all cases nothing but a treatable illness.
I did notice that. Bear in mind that what I said only applies to the present discussion in the present group. Do you doubt that you, personally, would be able to separate the wheat from the chaff regarding nitrogen if you were lacking in info and wanted it? Or that you could find a book or organization that shared you view that people who want the info should be able to access it -- and that then provided full, accurate info? I am not in favor of anything like censorship of this subject in the media, on google, etc. I am talking about a precaution I think makes sense in this discussion among the people here. I wrote a longer case for my view in my response to Shankar S.
Do you think that, for the argument "why is formal euthanasia using these obviously inappropriate methods?", a review of why the methods are obviously inappropriate makes sense? Would it hurt the argument to disallow it from presenting supporting evidence?
In general, if you make an effort to suppress information, do you expect policies driven by that information to get better or worse? You can always hope that people like Leona are never entrusted with any decisionmaking authority, but the record is clear that that won't work out.
I do not think it should be illegal to post info about means of suicide online, or that people should be prevented from finding it. I am simply asking people not to discuss the efficacy of various do-it-yourself methods on an open forum read by thousands. The information is easy to find -- I know, because I found it, and believe me it did not take any extraordinary cleverness to find it. Even if I was the Sheriff of ACX and could make people STFU about whether and how nitrogen works I would be doing virtually nothing to suppress this information, because it is available all over the place. There are articles in the paper about states and countries that permit doctor-assisted suicide, and mentioning the means of bringing about death. Search google for euthanasia and you get books, some informative about ways and means. There are assisted suicide organizations with web sites, newletters and discussion forums. Stop turning this into a story about me clutching my pearls and trying to keep the little people from getting the facts, while you are being brave and freedom-loving. That is not the story here. As I have said in various places in the discussion, I have studied suicide, I have treated suicidal people, and in my time as a psychologist I have seen about a dozen people circle the suicide drain and eventually go down it. None were my patients, but 2 were former patients and the rest I knew moderately well. People who are thinking of committing suicide often hold back from learning the details about how to do it, because they have the sense that if they know how the will go ahead and take the step. Sometimes they are right about that. It is just not responsible to throw how-to information around in a setting where people can stumble on it.
- We have a significant problem with people who are at no risk of suicide not knowing basic facts.
- We have no significant problem with people who are at risk of suicide knowing the same facts.
The only possible conclusion here is that we need more publicity for the facts.
> I have studied suicide, I have treated suicidal people, and in my time as a psychologist I have seen about a dozen people circle the suicide drain and eventually go down it.
You don't sound like someone with a good grasp on the scale of the problem. You sound like someone who feels the problem is many thousands of times larger than it actually is.
Why should we keep using the wrong methods for euthanasia and execution out of concern for hypothetical people who aren't aware that they can commit suicide? In the first place, there are no such people. Everyone is well aware that they can use guns, knives, and poison to kill themselves. In the second place, how is the remedy supposed to help with the problem?
> I am simply asking people not to discuss the efficacy of various do-it-yourself methods on an open forum read by thousands.
Is your argument that SSC is too big for information about suicide to be appropriate, or that it's too small for the lack of that information to make a difference?
And why did you bring suicide up at all in response to a point about executions?
FWIW, the bottleneck with nitrogen as a suicide method is not the information that a pure N2 atmosphere is lethal. Most people will not have a straightforward way to acquire N2.
But I agree we should probably not have a discussion about the best way to jury-rig a suicide using common household materials without advance preparation.
> FWIW, the bottleneck with nitrogen as a suicide method is not the information that a pure N2 atmosphere is lethal.
No kidding. It's not just nitrogen. An pure atmosphere of any substance other than oxygen will do the same thing. Methane, helium, fluorine, water, sand...
I'm pretty sure this is widely understood. Popular culture already emphasizes two different methods of killing yourself this way using common household items.
While you are correct, these methods vary widely by explosion risk and painfulness. With fluorine, I am not even sure if you would survive long enough to die of suffocation.
Let the record also state that I would expect CO2 to be highly unpleasant given how the body regulates breathing.
I remember looking into this when that first nitrogen hypoxia execution was done (being familiar with exit bags, my first instinct was "sounds good", so articles talking about apparent distress left me wondering), and one thing about it is that if you are executing someone with nitrogen, it's quite different from euthanizing them with it. If you are euthanized, you are consenting to the process, and will breathe normally; if you are unaware, you will breathe normally; but if you are being executed, you may (out of a hopeless desire to live) choose to hold your breath, which *will* trigger your body's asphyxiation responses, just like any other time you hold your breath.
All you need to do to prevent struggling in an execution is to fail to make it obvious when the nitrogen starts flowing. This doesn't seem like a good argument for using other methods; it remains the case that suffocation is as painless and unintrusive as it's possible to be. If those are goals, then they point toward suffocation.
And none of that addresses the concern of "why is euthanasia being done by injection or orally-administered poison?". Euthanasia is definitely not different from being euthanized.
The goobers carrying out the executions seem to be able to fuck up any method, and turn it from a means of knocking someone out painlessly into a new variety of torture.
If you're offered a painless knockout, and you choose not to take it, that's on you. If torture is involved at all, you're the one doing it to yourself.
The emphasis on the "lifelong disabled" seems rather odd considering that the discussion starts with a quote from Stephen Hawking, who, er, wasn't disabled at birth.
Yeah seems like a weird oversight. The review definitely leaves one with the assumption that Hawking was disabled from birth. Given that he wasn't, he actually seems like a potential contradiction to the argument that follows his quote
But his disease was set in gradually, and he knew what was coming at every stage. Furthermore, I'm confident that of the things Hawking valued, his mind was the top of the list and in several places. So his value judgement was surely different from someone with different circumstances: his choice was correct for him, to live, and it may be correct for someone else to choose to die.
The judgement is the important thing. I can see no way to ensure a valid judgement, as some people, with proper mental treatment, might choose to live instead of die. And some may choose others to die rather than live, regardless of the victim's preferences, due to greed, misunderstanding, or other factors. How can someone's choice be validated as their right to choose unambiguously?
That, but also, people vary in the balance of how much of their life is primarily mental vs physical. Compared to Clayton, many more of the things most valuable to my life are doable from a chair, so if we both started at the same level of happiness and then had the same accident, we would most likely end up in very different positions. Now, if this happened to the real me, there is a high chance I would kill myself, but I am also starting from a much lower baseline than he did.
It's very likely (though not certain) that he suffered serious abuse from his second wife - if you're completely dependent on others, you're vulnerable no matter your money, power, etc
Seems like he did philosophy in undergrad as a path to law school? I don't like to gatekeep 'philosopher' usually, but it seems unlikely that he was one in the sense that he had a passion for it, or would have seen making it his life's work meaningful or things like that.
I feel that the description of ableism in the article could be disputed. At least in the autism awareness movement circles I have been in lately (I know other disabled communities like deaf, blind etc may have different framings), there is a strand of people who want to actively emphasise the disability to themselves and wider society and not sidestep it and that this is a mixture of actual loss of function that makes life worse plus a social element that could be alleviated. The ableism in this reading comes in a few forms.
1. Not actually acknowledging the true nature and extent of the deficit experienced (which Clayton appears to have felt was the case, people just don’t want to think about something so uncomfortable); I am suffering and I want my pain acknowledged rather than dismissed as even existing (even if I do not truly know what it is like to be allistic I know that being autistic does cause me some types unavoidable suffering independent of social factors like sensory issues).
2. Society treating those with disabilities (typically subconsciously rather than explicitly unless they are totalitarians) as lesser people in the philosophical sense, as children, as half-humans, not fully capable of any degree of consent, or intellectual autonomy (again with Clayton the inability to accept that suicide was a reasonable response to his circumstances under his judgement of himself).
3. People being assholes and discriminatory to the disabled because they want to push away the other that makes them feel uncomfortable and lump all the “other” together as universally bad = immoral to get Nietzchean about it. This is not just a right wing thing. A live example recently I discussed was liberal people othering the MAGA QAnon crowd as “weird” and that making liberal autistic peope very bothered because the insults felt very autistic coded - and this makes some sense because autistic people are vulnerable to joining high control conspiratorial groups like QAnon - but falling back on such insults rather than targeting beliefs raised a lot of red flags.
4. All the above and a not great history combining to create a lack of trust between the autistic community and the medical community, even as the former really needs the help of the latter.
>This is not just a right wing thing. A live example recently I discussed was liberal people othering the MAGA QAnon crowd as “weird” and that making liberal autistic peope very bothered because the insults felt very autistic coded - and this makes some sense because autistic people are vulnerable to joining high control conspiratorial groups like QAnon - but falling back on such insults rather than targeting beliefs raised a lot of red flags.
But the truth is, "liberal" (I hate this American terminology) autistic people are differently "liberal". George Orwell in The Road To Wigan Pier contrasts obssessive Marxist theorizers and system-builders to "ordinary warm-hearted socialists" who just want to help the working class in some simple straightforward way...
While I definitely recognise the difference you and Orwell describe on the left I would protest that you are painting with too broad a brush if your implication is that all (even most) autistic liberals think one way that is very distinct from allistic liberals. I would acknowledge that a fair few autistic people are more inclined to be very deep into Marxist systematising than the average allistic person BUT I would emphasise that a) there are plenty of autistic people who are not rigid thinkers but pretty flexible (albeit sometime by consciously fighting their rigid instincts, although that can be an intellectual strength to recognise your cognitive weaknesses explicitly) and b) there are a lot of liberals who are not autistic who have such rigid thinking (there are simply not enough autistic people around for it to be otherwise).
All aside from the fact that in the long term you can't consistently get anywhere without a Weltanschauung because sooner or later there will be hard trade offs so some rigidity is inevitable. Even Rawls' conception of Political Liberalism - about the most flexible comprehensive political philosophy framework ever devised - still has some hard edges to protect its own integrity. What Orwell didn't fully acknowledge is that if you don't have an explicit framework there will be an implicit framework still there with the values of previous generations and dead philosophers lying unexamined within it.
I can assure you that the people calling QAnon people "weird" for a lot of autistic people has a very similar vibe to the misogynistic language that some "liberals" seem to slip into when denigrating hard right wing women.
I think it's more on display in the depictions of JD Vance as "weird". Granting that you might not want someone who's off-key in dealing with most people as a politician, it still seems like people who are opposing Vance for that reason are utterly merciless.
Literally just saw a Matt Yglesias piece on the "weird" trend go into my inbox just now. This is probably worth of its own discussion separate from the very relevant topics raised by the main piece that I don't want to derail. I am torn personally because objectively JD Vance (and Trump) are absolutely weird irrespective of their personal politics, but I have also spent my whole life also being called weird or - what is worse - being told not to BE, or more precisely not look/act externally, weird so it is triggering for me.
Now I know that people are calling them weird for different specific reasons (Trump's astonishing degree of narcissism for example, Vance's just total disregard for women's bodily autonomy) than I have always been called weird (autistic social style, not exactly cishet but not "straightforward" gay or a transwoman either) but at a generalised enough level the categorisation is still: normal = natural = socially acceptable = good/morally good; weird = unnatural = socially unacceptable = bad/evil.
More generally, I do genuinely believe Shaw was empirically right that "The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man", but it does cut both ways. So the left pressing for intellectual conformity on the right risks stifling it on the left or any other dimension of politics (the right has been trying to narrow the field of debate and respectability politics for its whole existence!).
I would not have guessed disability advocacy groups to be the greatest enemy of recently crippled (I would have guessed that was the FDA), but they WOULD probably have been in my top three.
Online serial writer Wildbow is hard of hearing, and he's been very vocal about the deaf community forcing and shaming the curable deaf into staying disabled. It seems to just be human nature.
Can you point me to any of his writings on this subject? A google search just directs me to his fiction. My son is hard of hearing, so I'm very interested in hearing what an adult has to say about his experience.
Its a problem caused by a philosophical opposition to natural law theory in favor of social constructivism. If all disability is a social construct, then there is no need to be "cured" because the idea that you have a "disease" is just society's, like, opinion, man; an opinion probably constructed to oppress disabled people by othering them and whatnot.
Natural law, on the other hand, holds that there is objectively such a creature as a "human" and that there is such a thing as a "normal" human and while there is room for deviation some humans are not "normal" in terms of their forms and abilities; a human "should" be able to hear, for instance, or "should" be able to move their legs. Therefore humans that can't hear, or are paraplegics, are abnormal humans with something wrong with them, and it would be a good thing for them if their abnormality could be fixed or mitigated.
Social constructivists would reject the natural law perspective as "othering" and "ableism" whose purpose must be to prop up the existing oppressive social construct of disability in an attempt to benefit oppressors at the expense of the oppressed.
I don't think yours is the typical usage of the term "natural law theory". It is my understanding that it's more about a connection between laws and morality, something like "a law which violates some inherent moral principle is not a true law", and contrasted with legal positivism, which is more "if it's backed up by enough force, sure it is."
Natural law bundles a lot of concepts that are all related to the idea that humans have a particular nature, a way humans “should be” which can be used as a standard of judgement and understanding. Applied to legal theory, laws are compared to the nature of man to see if they fit well with man’s nature or go against man’s nature (a nature that may contain natural rights that the law should not violate). Applied to morality it is used to guide ethical decision making (like “is giving the deaf the ability to hear immoral?). Applied to political theory it requires that system of government are built around man’s nature, and not in the expectation that human behavior can be built around the system of government. Applied to medicine it means that just because someone wants a medical procedure (such as an amputation, or surgically attaching an extra limb) doesn’t mean that providing that procedure would not be doing harm, as harm is understood in context of human nature as opposed to individual preference (a topic very relevant to the review at hand). Natural law has lots of applications and implications.
no; *the* essay "natural law" by spooner isnt simply an apply to nature fallacy, and in fact was arguing that slavery was immoral when other could claim it was natural and inediable
"So long as these conditions are fulfilled, men are at peace, and ought to remain at peace, with each other. But when either of these conditions is violated, men are at war. And they must necessarily remain at war until justice is re-established." -spooner, natural law; i.e. "tit for tat" before game thoery
What, then, is wrong with the natural law outlook? The review has the example of the four-armed alien, but we can easily construct other things.
Suppose we discover a way to make people telepathic. Even if it doesn't work for everyone, would we not want to give this ability to ANYONE because it's an artificial ability? In the same way, for someone born deaf, why would we not give them the ability to hear if we can and they want it?
Someone with a disability shouldn't be shamed by the disability, especially by others. But giving people abilities they want but don't have seems beneficial.
As someone who is very hostile to ableism discourse (and also happens to be hard of hearing and would love a good cure for it) the deaf community's attitude towards cures is an example I find to be more sympathetic than most.
I disagree with them, but... they have a culture. They have schools, they have real communities, and (most of all) they have a language. If deafness were to be suddenly cured en mass, it would be a wonderful thing on balance, but there really would be a true loss, similar in kind to the utter assimilation of an indigenous group
The other thing is that, as I understand it, the best current cure isn't all that good, but it's tempting for some people to insist that deaf people use it.
This is the main issue. If there were *actually* a cure for deafness that allowed people to hear similarly well to someone with natural hearing without significant risks or side effects, it would be easy to evaluate. But the real technology in question is nowhere near as good as natural hearing, comes with significant risks including death or further disability, and has side effects that are not universally tolerable.
A friend worked in a lab developing cochlear implants. She faced protests from the deaf community.
It’s true this technology will greatly reduce the number of people who will learn sign language. There goes a language (multiple actually), and a culture. I can understand the sadness, but not the protest.
With deepest respect, meaning for the masses will not be found in amplifying pity porn. Depravity is a bottomless content trough. There are great opportunities that deserve parity attention from wise and capable ones as yourself, not a humble commenter.
How is this pity porn? In the book, Clayton doesn't ask for pity at all – he says that his life isn't worth living for him, and that he wants to end it. And then he sets out to do that, asking just for people to understand his condition and to make it legal for him to do what he would like. If anything it would be closer to outrage porn about bureaucratic paternalism.
Egregious appeal for understanding and normalization of a condition that feeds the readers internal narrative as a kind and compassionate actor through acquiring testimonial trivia. Did that definition help?
His doctors did not encourage him towards suicide in any way. In fact while he doesn't use the word, he says doctors gaslit him when he talked about his loss of quality of life. Eg, pretending that having sex while unable to move or feel his junk ought to be just as satisfying, or a psychiatrist diagnosing his frustration with his condition as depression.
Were How the War Was Won and Nine Lives intentionally left out? Going by the original list (alphabetival ordering), we should have had these two reviwews already, but they were skipped.
It's *technically* a contest. Starting a few months ago, the commentariat was supposed to read a randomized subset of reviews (or titles that caught their attention), rate them out of 5 stars, and then Scott would officially post the highest-ranked entries. The entries that get officially posted are finalists.
I say "technically", since reading the entries is its own reward. I, for one, would be perfectly happy if Scott just posted everything (within reason). But that's neither here nor there.
I read this in August 2022, all in one sitting, right before I was about to leave for a two-thousand mile motorcycle trip to go to a philosophy conference. I cried at the ending. Clayton really resonated with me, or at least who I was at the time. I later got a tattoo of a knife on my stomach to commemorate his loss, and to remind that both that it's important to do the things that give my life meaning, and to ensure that I don't die or get grievously injured doing them.
Clayton was a reckless, brash fool of a motorcyclist, and his tragedy could have been avoided if he had better respected the danger of motorcycling. In the book, he says that his motorcycle safety course didn't prepare him. That's true – the motorcycle safety courses are a reasonable start but woefully insufficient. But he should have had more heroic responsibility (the concept from HPMOR) or more soloist's mindset (from rock climbing) – my life is my responsibility, and if it's someone else's fault that I die, I am still dead, and having someone to blame isn't super useful to me. So I must make sure I don't die, myself, instead of trusting such an important thing to others.
I recently rode my motorcycle across the country via dirt roads and backroads, and I re-read Two Arms and a Head on my kindle at camp to keep grounded and to remind myself to ride safely. I crashed my motorcycle once or twice, depending on how you count, but I only had minor injuries, because I wore very very good protective gear, I rode fairly slowly, and I slowed down extremely when road conditions were bad. Clayton swerved off the road because he saw a donkey, hitting a tree and getting paralyzed; I routinely went around blind corners to find a herd of cows on the road, and was able to come to a complete stop because I went slow enough that I would be able to stop in time.
Every time I remember Clayton's story I end up not being able to bring myself to ride my motorcycle until I've forgotten about it again. And I don't think I'm a reckless motorcyclists. (I've crashed twice; both time without injury on the racetrack). I just think that no matter how careful I am I might still end up in his position.
I do agree that the MSF is not going to prepare you for the trip he took. He needed a lot more riding with more experienced riders before he should have done a trip like this one. Track days might have saved him. You really learn how much braking you can do on the racetrack.
Last summer, I went out rock climbing in Scotland. I was free soloing. I employed the soloist mindset. Everything went okay.
The next day I went regular climbing with a friend. Ropes, helmets, gear, and decades of experience between us. 6 m from the top of the route all of the rocks collapsed and all my gear failed. I landed on my head, after breaking both my arms and broke my neck. I'm quadriplegic, which is considerably worse than the paraplegia than Clayton suffered.
If you think that you are being safe by slowing down when you go around corners in case the cows are there, and the odds are now tolerably in your favour... I'm afraid it just doesn't really work like that when the chips come down. It's just you're telling yourself to make yourself feel better. Which is fine. Christ, I used to do it constantly. like how I banned myself from motorcycles because they were too dangerous and I didn't want to end up with a spinal cord injury because I wanted to keep climbing.
Just be honest with yourself, that you're not really making anything safer because if it happens, it happens. Just hope that it doesn't.
Hi, that was an astonishing comment. Thanks for that.
Obviously we are all playing the odds constantly and it isn't always clear to what degree (or even in what direction) our choices may affect any outcome.
Your attitude of stoicism or skepticism is healthy, regardless of how many working eyes one has.
I don't judge life's fulfillment upon limbs so I can in all honesty wish you an absolutely fulfilling life.
Thanks again for your comment and have a pleasant day.
Not sure I agree - I think you can make an activity safer by taking precautions but the real lesson is that nothing is ever one hundred pro percent risk free. Plenty of people die at home from preventable causes as well, like tripping on stairs and falling.
I would contend that you are moving them much less than you think you are. To the point where it's often much more negligible than we like to think. We all have a cognitive bias to think we are doing more than we really are when it comes to the odds. Especially when this "allows "us to do something we actually really want to do. I could be wrong. But I'm pretty sure this is a fairly common feature of human psychology. And my guess is that in the grand cosmic scheme of shit you can control versus shit you can't, the latter is so overwhelmingly important that the former (aside from cases in the extreme) doesn't move the dial much, and moves it a lot less than we tend to (like to) think it does.
Yes, slowing down to avoid possible cows that one cannot yet see is better than driving around the corner like a maniac. But if you really want to put them in your favour, don't just don't ride motorbikes at all. Which of course leads to the "well you might as well just stay at home but then people die at home" point. And given that you *like* motorbikes/ rock climbing, you are sure as hell not going to do that. So you do some stuff that tells you you've put the odds in your favour and out you go. And for most people most of the time, that works out just fine.
Yes, I'm fairly sure I move the odds a lot in my favour by _not_ motorbiking. (I agree that slowing down occasionally would move the odds only slightly at best.)
Yes, people die at home, too. But that was a silly 'point' to begin with: your odds *are* much better at home than out on motorbike in the middle of nowhere.
And any climbing I do is in well maintained indoor climbing gyms.
Of course, there are some tradeoffs to be made. I don't spend all my live in my adopted home of Singapore, but occasionally visit less safe countries (ie pretty much anywhere in the rest of the world apart from perhaps Japan or so) for holiday or business.
The main thing I fret about isn't actually accidents, but getting Parkinson's later. Given that I have a few family members on both sides with that.
I'm sorry that a very unlikely but very injurious thing happened to you, but it's plain silly to argue that taking reasonable precautions against much more common, avoidable hazards "doesn't move the dial much." Of course it does. Common things are common.
**Edit** I've now read a few of Paul's posts, and the worst part is how determined he was to make the best of things immediately after the accident, compared to his mental state now. People in these comments accusing him of not trying hard enough to adapt are just factually wrong.
This has actually brought up an unpleasant memory for me: a few years ago, I was scrambling in Glencoe with a couple of friends - employing soloist mindset and many grades below our limit! - when one of my friends slipped and fell about forty metres. We performed CPR on him for an hour until the mountain rescue team arrived, but he'd broken his neck and much else besides and was pronounced dead in the helicopter. One of the things that kept us going was the belief that most newly-disabled people struggle at first but eventually come to terms with their new life and are glad to have survived; but having read Paul's story I'm wondering if we should have just gone for a beer instead.
Reading about the four-armed aliens doesn’t make me feel sad about having only two arms. I already know what it’s like to have two arms: life is good! Instead, realizing how much higher there is to go gives me *envy.* Let’s develop the technology to heal disabled people and also the technology to let everyone go beyond the default!
The four-armed alien analogy doesn't work. Arms are one of many, many things where most of the value comes from the first one. It might be better to have more. But people don't go into crisis when they're reduced from two arms to one, which is worse than going from four to two.
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.
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.
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.
This is a great reply. Thank you for writing it. I’m very glad to have read it.
Excellent comment, I wholeheartedly agree with you.
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.
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.
"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.)
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.
"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)
“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/
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.
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.
You're welcome. I hope others learn how to navigate the crazy clinical-trial system, and, most of all, I hope Congress reforms it.
In case it helps with anything, I'll echo Brian Moore:
That sucks, and you didn't deserve it.
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.
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.
🫡
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.)
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 :(
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.
I’m so sorry you’re experiencing this. No one deserves that.
I'm at a loss for articulate words, so let me just say that I am so very sorry.
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.
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?
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.
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
Never a mention of stem cells, the blind spots with all your blabbering is why EA should be set to pasture.
Well, don't leave us in suspense! What should the 'mention of stem cells' have been?
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.
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.
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?
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.
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.
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.
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?
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.
if you've got a stem cell treatment that works I'm all ears, but I think you probably don't.
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.
All of the ones I’ve seen are shams. If they worked, theyd be able to prove it
Effective stem cell treatments have been known since at least 2003.
https://youtu.be/LNJi0CzfodI
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. "
(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.
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.
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.
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.
No indication the author is an EA. What an odd non sequitur.
Author mentioned replicating nerve cells but not stem cells. Damn you EA!
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.
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.
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.
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.)
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.
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.
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?
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.
'yes it is'
Who are you to decide this?
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.
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"
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.
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.)
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.
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.
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.
"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.
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.
Good cheap exoskeletons would make life better for a lot of people, but I don't think they're all that close.
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.
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?"
'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?
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.!—)
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?
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
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.
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.
>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.
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.
That’s commendable. Thanks.
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.
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.
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
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.
Politically progressive and have strong social safety nets - surely San Francisco's homelessness problem refutes any suggestion the two are correlated?
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.
This is a great review. I did not enjoy reading it, however, but that is not the fault of the author.
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.
You stated it more eloquently, but yeah, it certainly had an impact on me.
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.
> 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?
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.
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...
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.
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
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.
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.
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.
Ugh, hadn't thought of that. Great point.
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.
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.
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.
I don't believe there's evidence for such claims.
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.
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.
"Common sense evidence" is not "evidence". It's just "I think", without evidence.
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.
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.
> 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.
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.
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.
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.
Tangential: https://danluu.com/seo-spam/
Very interesting, thank you.
I was not aware of marginalia.
Yeah, I think in general, if you already know enough of the answer, there are still ways to find it online (though that's usually just as useless as it sounds), but if you're completely lost, you're shit out of luck.
>has enshittified the Internet to borderline unusability.
Amen to that.
Internet searchability, we knew you for such a short time...
I know Gen Zs with very limited search skills, but frankly it doesn't seem to matter all that much anymore, since even good search skills don't yield very good results.
It's hard to see where people will get their information from in the future, since libraries no longer contain many books (and publishing is about as much of a shit-show as search engines are these days anyhow.)
Yes, I know about that. No matter how you phrase a question about means of suicide, all you get out of google is a wall of suicide hotlines etc. I even run into the same kind of problem when I ask google about withdrawal from various psych meds (I'm a psychologist, and often have patients whose MD is taking them off some psych med): I get yards and yards of links to addiction treatment places & the like. On the other hand, there are books about euthanasia available on Amazon that pull no punches when discussing means of ending life painlessly. There are also organizations whose goal is to assist people who need an escape hatch to find one.
I am not in favor of policies that made it hard or impossible to find information about drugs, suicide, etc. I am just asking the people posting here to refrain from talking in detail about the various methods of do-it-yourself suicide. In the present situation I do not think the concerns you have about the difficulty of finding info apply. This group is smart, well-educated, and internet savvy. Even if there actually are a few people posting here who are none of these things, they are likely to have aqaintances who are able to help them get info they need.
I really hope you will consider stepping back and reconsidering about this. I am not opposed to suicide for suffering people whose pain cannot be relieved. If a close friend of mine wanted to end their life and their reasons for doing so seemed valid and unchangeable to me, I would not only give them the info, I would assist them in carrying out their plan if they asked me to.
But that's entirely different from putting up the info in a place where somebody will stumble across it. I almost certainly have more knowledge and experience than you do about this matter, and you should pay attention to my view. I have training in the subject, I have taught myself more about it, and I have known and had long talks about despair and suicide with at least 100 people, most but not all of them patients. I also have had about a dozen people I know fairly well commit suicide. None were patients of mine, though 2 were former patients. One was a a grad school acquaintance who committed suicide while we were both in the program. The others had been patients on a psych ward where I worked, where I had a few talks with them, had them in groups I ran, and heard about them in rounds every day. One of the things I know about suicidal people is that many refrain from learning about the nuts and bolts of how to do it because they see that as the last barrier to going ahead with the act.
I want to thank you for your thoughtful comments here.
"One of the things I know about suicidal people is that many refrain from learning about the nuts and bolts of how to do it because they see that as the last barrier to going ahead with the act."
Could you complete this argument, i.e., how does this (or anything else in your post) make a case against giving information in these comment threads? (I will admit that I am slower and stupider than most people here, which is also why I appreciate potentially useful information wherever I can find them).
It's about trivial inconvenience being a real barrier. It's why sensible people make what they want to do easy and what they don't want to do hard.
Not knowing how to kill yourself easily makes it that little bit harder to be tempted to kill yourself.
I mean, why is this barrier sacrosanct while the fact that there are "books about euthanasia available on Amazon" is not? One is not necessarily selecting for "sensible" people this way, one is only selecting for people who are good at library science or something.
There was a period where I was seriously depressed or bipolar and intermittently suicidal. One time during a mental crisis I got partway through a suicide attempt (I was copying the method of a loved one who died), but I gave up after it became painful. If I’d had a faster and easier method at hand, I might have succeeded. After that, I made sure during my more active moods to avoid learning about easy ways to commit suicide and avoided possessing related tools.
I consider information about easy/comfortable ways to commit suicide to be a kind of info-hazard. I want people like the author of the book here to be able to find it, but I definitely oppose throwing the information around where people who didn’t go explicitly looking for it would find it.
Thank you for a clear and accusation-free articulation of the point, which I appreciate and respect. I am sorry that you went through such a difficult time earlier.
I appreciate your comments here and elsewhere in the thread. Given that the main thrust of the book - as I can tell from the review; I haven’t read it - is that suicide can be morally and practically defensible, I am curious about the underlying assumption for the request not to share practical information online. Anecdotally, it seems that the assumption of (U.S.?) psychologists is that suicide is always or almost always indefensible, or that the psychological motivators for it can and should be overcome or treated. Is that accurate? I don’t mean to be facetious, nor do I necessarily disagree that many or perhaps most suicides can and should be avoided – especially when the situations involve young people who might not appreciate the “permanent solution to a temporary problem” dynamic. I’m just curious whether standard psychological training or ethics rules allow for a “justified suicide,” whether along the lines discussed in the book or otherwise. On a related note, do you think that the suicide hotline warnings that inevitably accompany news articles on suicide are effective? I’ve always suspected they’re more about signaling - that suicide is bad and that treatment or therapy can help the underlying problem – rather than an effective prompt for someone to call a number. Nevertheless, they seem probably harmless, or perhaps “effective” in a broader sense of conveying a message. I do think there is one important exception to the “probably harmless” gloss: I recently saw the standard suicide hotline language on an article about a murder-suicide. (There was, of course, no prompt for those considering murder to call a hotline.) The focus on preventing the murderer from killing himself rather than his partner and kids, seems horrific and perverse.
> I am curious about the underlying assumption for the request not to share practical information online.
There is no underlying assumption for my request. The is a reason for my request and I have stated the reason every single time I have made the request: People who are toying with the idea of suicide often hold back from researching methods. They feel that their relative ignorance about whether painless and easy methods of suicide exist and how to get the materials for them is the last barrier between them and acting. My point is not that everyone else can and should keep them ignorant. It's that we should not toss the info around in places where they can come across it accidentally. I am not trying to hide the info from people like that. It's impossible to do anyhow. The info is easy to find. There are books on Amazon that give it. There are organizations for people who want to be able choose to exit life at a time of their choice-- organizations have websites, newsletters and forums. The chance is nil that somebody who can find this forum would not be able to find excellent info about the options online in a couple hours at most is tiny. So, for approximately the 6th time: I am no trying to keep them from finding the info. I am asking people not to toss it around in a forum where they might run across it. I suspect people keep failing to grasp that because it is much more fun to think of someone who makes a request like mine as a controlling, pearl-clutching advocate of censorship.
As for your questions: Mental health professionals are not taught that suicide is bad, or is always caused by mental illness, or is always treatable or is always indefensible. Mostly we are taught a variety of models of depression & a variety of treatment approaches, and read a bunch of research as a means of thinking clearly about the models and treatment approaches. Even if we were taught that suicide is bad, anybody with any gumption and common sense is going to object to efforts to control their views and will arrive at their own based on their observations and ethics. I, and most mental health professionals I know, have no problem with people whose suffering cannot be relieved being helped to voluntarily end their lives. On the other hand, we know from experience that most depressed people are sure they will never feel better, and most are wrong, so we are not enthused about people being helped to commit suicide under those circumstances. However, any shrink with common sense knows there is no way to prevent a determined person from finding a means of committing suicide. And no mental health professional with common sense thinks the desire to die is in all cases nothing but a treatable illness.
> The information about reliable and painless ways of doing it is not hard to find.
You might notice that I've already picked up one response arguing that I'm misrepresenting the facts.
I did notice that. Bear in mind that what I said only applies to the present discussion in the present group. Do you doubt that you, personally, would be able to separate the wheat from the chaff regarding nitrogen if you were lacking in info and wanted it? Or that you could find a book or organization that shared you view that people who want the info should be able to access it -- and that then provided full, accurate info? I am not in favor of anything like censorship of this subject in the media, on google, etc. I am talking about a precaution I think makes sense in this discussion among the people here. I wrote a longer case for my view in my response to Shankar S.
Do you think that, for the argument "why is formal euthanasia using these obviously inappropriate methods?", a review of why the methods are obviously inappropriate makes sense? Would it hurt the argument to disallow it from presenting supporting evidence?
In general, if you make an effort to suppress information, do you expect policies driven by that information to get better or worse? You can always hope that people like Leona are never entrusted with any decisionmaking authority, but the record is clear that that won't work out.
I do not think it should be illegal to post info about means of suicide online, or that people should be prevented from finding it. I am simply asking people not to discuss the efficacy of various do-it-yourself methods on an open forum read by thousands. The information is easy to find -- I know, because I found it, and believe me it did not take any extraordinary cleverness to find it. Even if I was the Sheriff of ACX and could make people STFU about whether and how nitrogen works I would be doing virtually nothing to suppress this information, because it is available all over the place. There are articles in the paper about states and countries that permit doctor-assisted suicide, and mentioning the means of bringing about death. Search google for euthanasia and you get books, some informative about ways and means. There are assisted suicide organizations with web sites, newletters and discussion forums. Stop turning this into a story about me clutching my pearls and trying to keep the little people from getting the facts, while you are being brave and freedom-loving. That is not the story here. As I have said in various places in the discussion, I have studied suicide, I have treated suicidal people, and in my time as a psychologist I have seen about a dozen people circle the suicide drain and eventually go down it. None were my patients, but 2 were former patients and the rest I knew moderately well. People who are thinking of committing suicide often hold back from learning the details about how to do it, because they have the sense that if they know how the will go ahead and take the step. Sometimes they are right about that. It is just not responsible to throw how-to information around in a setting where people can stumble on it.
Well, the situation looks like this:
- We have a significant problem with people who are at no risk of suicide not knowing basic facts.
- We have no significant problem with people who are at risk of suicide knowing the same facts.
The only possible conclusion here is that we need more publicity for the facts.
> I have studied suicide, I have treated suicidal people, and in my time as a psychologist I have seen about a dozen people circle the suicide drain and eventually go down it.
You don't sound like someone with a good grasp on the scale of the problem. You sound like someone who feels the problem is many thousands of times larger than it actually is.
Why should we keep using the wrong methods for euthanasia and execution out of concern for hypothetical people who aren't aware that they can commit suicide? In the first place, there are no such people. Everyone is well aware that they can use guns, knives, and poison to kill themselves. In the second place, how is the remedy supposed to help with the problem?
> I am simply asking people not to discuss the efficacy of various do-it-yourself methods on an open forum read by thousands.
Is your argument that SSC is too big for information about suicide to be appropriate, or that it's too small for the lack of that information to make a difference?
And why did you bring suicide up at all in response to a point about executions?
FWIW, the bottleneck with nitrogen as a suicide method is not the information that a pure N2 atmosphere is lethal. Most people will not have a straightforward way to acquire N2.
But I agree we should probably not have a discussion about the best way to jury-rig a suicide using common household materials without advance preparation.
> FWIW, the bottleneck with nitrogen as a suicide method is not the information that a pure N2 atmosphere is lethal.
No kidding. It's not just nitrogen. An pure atmosphere of any substance other than oxygen will do the same thing. Methane, helium, fluorine, water, sand...
I'm pretty sure this is widely understood. Popular culture already emphasizes two different methods of killing yourself this way using common household items.
While you are correct, these methods vary widely by explosion risk and painfulness. With fluorine, I am not even sure if you would survive long enough to die of suffocation.
Let the record also state that I would expect CO2 to be highly unpleasant given how the body regulates breathing.
> With fluorine, I am not even sure if you would survive long enough to die of suffocation.
I had wondered about that too.
I think it damages the respiratory tract, so you might still die of suffocation, just in a different way.
HF might be the one you're thinking of, that dissolves flesh and bone.
I remember looking into this when that first nitrogen hypoxia execution was done (being familiar with exit bags, my first instinct was "sounds good", so articles talking about apparent distress left me wondering), and one thing about it is that if you are executing someone with nitrogen, it's quite different from euthanizing them with it. If you are euthanized, you are consenting to the process, and will breathe normally; if you are unaware, you will breathe normally; but if you are being executed, you may (out of a hopeless desire to live) choose to hold your breath, which *will* trigger your body's asphyxiation responses, just like any other time you hold your breath.
All you need to do to prevent struggling in an execution is to fail to make it obvious when the nitrogen starts flowing. This doesn't seem like a good argument for using other methods; it remains the case that suffocation is as painless and unintrusive as it's possible to be. If those are goals, then they point toward suffocation.
And none of that addresses the concern of "why is euthanasia being done by injection or orally-administered poison?". Euthanasia is definitely not different from being euthanized.
The goobers carrying out the executions seem to be able to fuck up any method, and turn it from a means of knocking someone out painlessly into a new variety of torture.
If you're offered a painless knockout, and you choose not to take it, that's on you. If torture is involved at all, you're the one doing it to yourself.
People who are executed aren't offered a painless knockout.
Which execution do you think we're talking about here?
The emphasis on the "lifelong disabled" seems rather odd considering that the discussion starts with a quote from Stephen Hawking, who, er, wasn't disabled at birth.
Yeah seems like a weird oversight. The review definitely leaves one with the assumption that Hawking was disabled from birth. Given that he wasn't, he actually seems like a potential contradiction to the argument that follows his quote
But his disease was set in gradually, and he knew what was coming at every stage. Furthermore, I'm confident that of the things Hawking valued, his mind was the top of the list and in several places. So his value judgement was surely different from someone with different circumstances: his choice was correct for him, to live, and it may be correct for someone else to choose to die.
The judgement is the important thing. I can see no way to ensure a valid judgement, as some people, with proper mental treatment, might choose to live instead of die. And some may choose others to die rather than live, regardless of the victim's preferences, due to greed, misunderstanding, or other factors. How can someone's choice be validated as their right to choose unambiguously?
I'm willing to bet Hawking was getting excellent physical care.
That, but also, people vary in the balance of how much of their life is primarily mental vs physical. Compared to Clayton, many more of the things most valuable to my life are doable from a chair, so if we both started at the same level of happiness and then had the same accident, we would most likely end up in very different positions. Now, if this happened to the real me, there is a high chance I would kill myself, but I am also starting from a much lower baseline than he did.
It's very likely (though not certain) that he suffered serious abuse from his second wife - if you're completely dependent on others, you're vulnerable no matter your money, power, etc
This writer was a philosopher - his mind had plenty to offer if he was interested in using it.
Seems like he did philosophy in undergrad as a path to law school? I don't like to gatekeep 'philosopher' usually, but it seems unlikely that he was one in the sense that he had a passion for it, or would have seen making it his life's work meaningful or things like that.
I feel that the description of ableism in the article could be disputed. At least in the autism awareness movement circles I have been in lately (I know other disabled communities like deaf, blind etc may have different framings), there is a strand of people who want to actively emphasise the disability to themselves and wider society and not sidestep it and that this is a mixture of actual loss of function that makes life worse plus a social element that could be alleviated. The ableism in this reading comes in a few forms.
1. Not actually acknowledging the true nature and extent of the deficit experienced (which Clayton appears to have felt was the case, people just don’t want to think about something so uncomfortable); I am suffering and I want my pain acknowledged rather than dismissed as even existing (even if I do not truly know what it is like to be allistic I know that being autistic does cause me some types unavoidable suffering independent of social factors like sensory issues).
2. Society treating those with disabilities (typically subconsciously rather than explicitly unless they are totalitarians) as lesser people in the philosophical sense, as children, as half-humans, not fully capable of any degree of consent, or intellectual autonomy (again with Clayton the inability to accept that suicide was a reasonable response to his circumstances under his judgement of himself).
3. People being assholes and discriminatory to the disabled because they want to push away the other that makes them feel uncomfortable and lump all the “other” together as universally bad = immoral to get Nietzchean about it. This is not just a right wing thing. A live example recently I discussed was liberal people othering the MAGA QAnon crowd as “weird” and that making liberal autistic peope very bothered because the insults felt very autistic coded - and this makes some sense because autistic people are vulnerable to joining high control conspiratorial groups like QAnon - but falling back on such insults rather than targeting beliefs raised a lot of red flags.
4. All the above and a not great history combining to create a lack of trust between the autistic community and the medical community, even as the former really needs the help of the latter.
>This is not just a right wing thing. A live example recently I discussed was liberal people othering the MAGA QAnon crowd as “weird” and that making liberal autistic peope very bothered because the insults felt very autistic coded - and this makes some sense because autistic people are vulnerable to joining high control conspiratorial groups like QAnon - but falling back on such insults rather than targeting beliefs raised a lot of red flags.
But the truth is, "liberal" (I hate this American terminology) autistic people are differently "liberal". George Orwell in The Road To Wigan Pier contrasts obssessive Marxist theorizers and system-builders to "ordinary warm-hearted socialists" who just want to help the working class in some simple straightforward way...
While I definitely recognise the difference you and Orwell describe on the left I would protest that you are painting with too broad a brush if your implication is that all (even most) autistic liberals think one way that is very distinct from allistic liberals. I would acknowledge that a fair few autistic people are more inclined to be very deep into Marxist systematising than the average allistic person BUT I would emphasise that a) there are plenty of autistic people who are not rigid thinkers but pretty flexible (albeit sometime by consciously fighting their rigid instincts, although that can be an intellectual strength to recognise your cognitive weaknesses explicitly) and b) there are a lot of liberals who are not autistic who have such rigid thinking (there are simply not enough autistic people around for it to be otherwise).
All aside from the fact that in the long term you can't consistently get anywhere without a Weltanschauung because sooner or later there will be hard trade offs so some rigidity is inevitable. Even Rawls' conception of Political Liberalism - about the most flexible comprehensive political philosophy framework ever devised - still has some hard edges to protect its own integrity. What Orwell didn't fully acknowledge is that if you don't have an explicit framework there will be an implicit framework still there with the values of previous generations and dead philosophers lying unexamined within it.
I can assure you that the people calling QAnon people "weird" for a lot of autistic people has a very similar vibe to the misogynistic language that some "liberals" seem to slip into when denigrating hard right wing women.
I think it's more on display in the depictions of JD Vance as "weird". Granting that you might not want someone who's off-key in dealing with most people as a politician, it still seems like people who are opposing Vance for that reason are utterly merciless.
Literally just saw a Matt Yglesias piece on the "weird" trend go into my inbox just now. This is probably worth of its own discussion separate from the very relevant topics raised by the main piece that I don't want to derail. I am torn personally because objectively JD Vance (and Trump) are absolutely weird irrespective of their personal politics, but I have also spent my whole life also being called weird or - what is worse - being told not to BE, or more precisely not look/act externally, weird so it is triggering for me.
Now I know that people are calling them weird for different specific reasons (Trump's astonishing degree of narcissism for example, Vance's just total disregard for women's bodily autonomy) than I have always been called weird (autistic social style, not exactly cishet but not "straightforward" gay or a transwoman either) but at a generalised enough level the categorisation is still: normal = natural = socially acceptable = good/morally good; weird = unnatural = socially unacceptable = bad/evil.
More generally, I do genuinely believe Shaw was empirically right that "The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man", but it does cut both ways. So the left pressing for intellectual conformity on the right risks stifling it on the left or any other dimension of politics (the right has been trying to narrow the field of debate and respectability politics for its whole existence!).
For any like me who went searching for a physical copy: https://www.2arms1head.com/
I would not have guessed disability advocacy groups to be the greatest enemy of recently crippled (I would have guessed that was the FDA), but they WOULD probably have been in my top three.
Online serial writer Wildbow is hard of hearing, and he's been very vocal about the deaf community forcing and shaming the curable deaf into staying disabled. It seems to just be human nature.
Yeah, those were the people I had in mind too, and my impression of disability advocacy groups is generalized from them.
Can you point me to any of his writings on this subject? A google search just directs me to his fiction. My son is hard of hearing, so I'm very interested in hearing what an adult has to say about his experience.
https://www.reddit.com/r/AskReddit/comments/18yphm/comment/c8jfv3t/
Its a problem caused by a philosophical opposition to natural law theory in favor of social constructivism. If all disability is a social construct, then there is no need to be "cured" because the idea that you have a "disease" is just society's, like, opinion, man; an opinion probably constructed to oppress disabled people by othering them and whatnot.
Natural law, on the other hand, holds that there is objectively such a creature as a "human" and that there is such a thing as a "normal" human and while there is room for deviation some humans are not "normal" in terms of their forms and abilities; a human "should" be able to hear, for instance, or "should" be able to move their legs. Therefore humans that can't hear, or are paraplegics, are abnormal humans with something wrong with them, and it would be a good thing for them if their abnormality could be fixed or mitigated.
Social constructivists would reject the natural law perspective as "othering" and "ableism" whose purpose must be to prop up the existing oppressive social construct of disability in an attempt to benefit oppressors at the expense of the oppressed.
I don't think yours is the typical usage of the term "natural law theory". It is my understanding that it's more about a connection between laws and morality, something like "a law which violates some inherent moral principle is not a true law", and contrasted with legal positivism, which is more "if it's backed up by enough force, sure it is."
Natural law bundles a lot of concepts that are all related to the idea that humans have a particular nature, a way humans “should be” which can be used as a standard of judgement and understanding. Applied to legal theory, laws are compared to the nature of man to see if they fit well with man’s nature or go against man’s nature (a nature that may contain natural rights that the law should not violate). Applied to morality it is used to guide ethical decision making (like “is giving the deaf the ability to hear immoral?). Applied to political theory it requires that system of government are built around man’s nature, and not in the expectation that human behavior can be built around the system of government. Applied to medicine it means that just because someone wants a medical procedure (such as an amputation, or surgically attaching an extra limb) doesn’t mean that providing that procedure would not be doing harm, as harm is understood in context of human nature as opposed to individual preference (a topic very relevant to the review at hand). Natural law has lots of applications and implications.
So it really IS just the classic "it's good iff it's natural" view?
Yes, but the word “natural” can be confused a bit, so a more precise formulation would be “it’s good for humans iff it is human”
no; *the* essay "natural law" by spooner isnt simply an apply to nature fallacy, and in fact was arguing that slavery was immoral when other could claim it was natural and inediable
"So long as these conditions are fulfilled, men are at peace, and ought to remain at peace, with each other. But when either of these conditions is violated, men are at war. And they must necessarily remain at war until justice is re-established." -spooner, natural law; i.e. "tit for tat" before game thoery
What, then, is wrong with the natural law outlook? The review has the example of the four-armed alien, but we can easily construct other things.
Suppose we discover a way to make people telepathic. Even if it doesn't work for everyone, would we not want to give this ability to ANYONE because it's an artificial ability? In the same way, for someone born deaf, why would we not give them the ability to hear if we can and they want it?
Someone with a disability shouldn't be shamed by the disability, especially by others. But giving people abilities they want but don't have seems beneficial.
As someone who is very hostile to ableism discourse (and also happens to be hard of hearing and would love a good cure for it) the deaf community's attitude towards cures is an example I find to be more sympathetic than most.
I disagree with them, but... they have a culture. They have schools, they have real communities, and (most of all) they have a language. If deafness were to be suddenly cured en mass, it would be a wonderful thing on balance, but there really would be a true loss, similar in kind to the utter assimilation of an indigenous group
The other thing is that, as I understand it, the best current cure isn't all that good, but it's tempting for some people to insist that deaf people use it.
This is the main issue. If there were *actually* a cure for deafness that allowed people to hear similarly well to someone with natural hearing without significant risks or side effects, it would be easy to evaluate. But the real technology in question is nowhere near as good as natural hearing, comes with significant risks including death or further disability, and has side effects that are not universally tolerable.
A friend worked in a lab developing cochlear implants. She faced protests from the deaf community.
It’s true this technology will greatly reduce the number of people who will learn sign language. There goes a language (multiple actually), and a culture. I can understand the sadness, but not the protest.
> When I finished the last line, I shut down my computer, took a moment to stare off into space...
> ...And went for a very long walk.
There's an XKCD comic that makes me (and one of the characters) feel like this.
https://xkcd.com/667/
With deepest respect, meaning for the masses will not be found in amplifying pity porn. Depravity is a bottomless content trough. There are great opportunities that deserve parity attention from wise and capable ones as yourself, not a humble commenter.
How is this pity porn? In the book, Clayton doesn't ask for pity at all – he says that his life isn't worth living for him, and that he wants to end it. And then he sets out to do that, asking just for people to understand his condition and to make it legal for him to do what he would like. If anything it would be closer to outrage porn about bureaucratic paternalism.
Can we say his opinion was formed in a vacuum outside of his doctors consultations? Where are the doctors responsibilities in this?
I'm not sure what that has to do with my original question. What aspects of Two Arms and a Head, or this review of it, seem like pity porn to you?
Egregious appeal for understanding and normalization of a condition that feeds the readers internal narrative as a kind and compassionate actor through acquiring testimonial trivia. Did that definition help?
The book is not remotely an "appeal for normalization." Just the opposite.
Fair enough, "normalization" is just part of the spiel of the guilty seeking redemption I added for context. I withdraw it.
No. What on earth are you talking about?
His doctors did not encourage him towards suicide in any way. In fact while he doesn't use the word, he says doctors gaslit him when he talked about his loss of quality of life. Eg, pretending that having sex while unable to move or feel his junk ought to be just as satisfying, or a psychiatrist diagnosing his frustration with his condition as depression.
Were How the War Was Won and Nine Lives intentionally left out? Going by the original list (alphabetival ordering), we should have had these two reviwews already, but they were skipped.
It's *technically* a contest. Starting a few months ago, the commentariat was supposed to read a randomized subset of reviews (or titles that caught their attention), rate them out of 5 stars, and then Scott would officially post the highest-ranked entries. The entries that get officially posted are finalists.
I say "technically", since reading the entries is its own reward. I, for one, would be perfectly happy if Scott just posted everything (within reason). But that's neither here nor there.
I read this in August 2022, all in one sitting, right before I was about to leave for a two-thousand mile motorcycle trip to go to a philosophy conference. I cried at the ending. Clayton really resonated with me, or at least who I was at the time. I later got a tattoo of a knife on my stomach to commemorate his loss, and to remind that both that it's important to do the things that give my life meaning, and to ensure that I don't die or get grievously injured doing them.
Clayton was a reckless, brash fool of a motorcyclist, and his tragedy could have been avoided if he had better respected the danger of motorcycling. In the book, he says that his motorcycle safety course didn't prepare him. That's true – the motorcycle safety courses are a reasonable start but woefully insufficient. But he should have had more heroic responsibility (the concept from HPMOR) or more soloist's mindset (from rock climbing) – my life is my responsibility, and if it's someone else's fault that I die, I am still dead, and having someone to blame isn't super useful to me. So I must make sure I don't die, myself, instead of trusting such an important thing to others.
I recently rode my motorcycle across the country via dirt roads and backroads, and I re-read Two Arms and a Head on my kindle at camp to keep grounded and to remind myself to ride safely. I crashed my motorcycle once or twice, depending on how you count, but I only had minor injuries, because I wore very very good protective gear, I rode fairly slowly, and I slowed down extremely when road conditions were bad. Clayton swerved off the road because he saw a donkey, hitting a tree and getting paralyzed; I routinely went around blind corners to find a herd of cows on the road, and was able to come to a complete stop because I went slow enough that I would be able to stop in time.
You can read about my trip here, if you're interested: https://meaningfulagency.substack.com/p/leaving-cambridge
Every time I remember Clayton's story I end up not being able to bring myself to ride my motorcycle until I've forgotten about it again. And I don't think I'm a reckless motorcyclists. (I've crashed twice; both time without injury on the racetrack). I just think that no matter how careful I am I might still end up in his position.
I do agree that the MSF is not going to prepare you for the trip he took. He needed a lot more riding with more experienced riders before he should have done a trip like this one. Track days might have saved him. You really learn how much braking you can do on the racetrack.
Last summer, I went out rock climbing in Scotland. I was free soloing. I employed the soloist mindset. Everything went okay.
The next day I went regular climbing with a friend. Ropes, helmets, gear, and decades of experience between us. 6 m from the top of the route all of the rocks collapsed and all my gear failed. I landed on my head, after breaking both my arms and broke my neck. I'm quadriplegic, which is considerably worse than the paraplegia than Clayton suffered.
If you think that you are being safe by slowing down when you go around corners in case the cows are there, and the odds are now tolerably in your favour... I'm afraid it just doesn't really work like that when the chips come down. It's just you're telling yourself to make yourself feel better. Which is fine. Christ, I used to do it constantly. like how I banned myself from motorcycles because they were too dangerous and I didn't want to end up with a spinal cord injury because I wanted to keep climbing.
Just be honest with yourself, that you're not really making anything safer because if it happens, it happens. Just hope that it doesn't.
Hi, that was an astonishing comment. Thanks for that.
Obviously we are all playing the odds constantly and it isn't always clear to what degree (or even in what direction) our choices may affect any outcome.
Your attitude of stoicism or skepticism is healthy, regardless of how many working eyes one has.
I don't judge life's fulfillment upon limbs so I can in all honesty wish you an absolutely fulfilling life.
Thanks again for your comment and have a pleasant day.
Not sure I agree - I think you can make an activity safer by taking precautions but the real lesson is that nothing is ever one hundred pro percent risk free. Plenty of people die at home from preventable causes as well, like tripping on stairs and falling.
Yes, but I'm not sure that's an important lesson. You are still better off moving the odds in your favour.
I would contend that you are moving them much less than you think you are. To the point where it's often much more negligible than we like to think. We all have a cognitive bias to think we are doing more than we really are when it comes to the odds. Especially when this "allows "us to do something we actually really want to do. I could be wrong. But I'm pretty sure this is a fairly common feature of human psychology. And my guess is that in the grand cosmic scheme of shit you can control versus shit you can't, the latter is so overwhelmingly important that the former (aside from cases in the extreme) doesn't move the dial much, and moves it a lot less than we tend to (like to) think it does.
Yes, slowing down to avoid possible cows that one cannot yet see is better than driving around the corner like a maniac. But if you really want to put them in your favour, don't just don't ride motorbikes at all. Which of course leads to the "well you might as well just stay at home but then people die at home" point. And given that you *like* motorbikes/ rock climbing, you are sure as hell not going to do that. So you do some stuff that tells you you've put the odds in your favour and out you go. And for most people most of the time, that works out just fine.
I wish I was most people
Yes, I'm fairly sure I move the odds a lot in my favour by _not_ motorbiking. (I agree that slowing down occasionally would move the odds only slightly at best.)
Yes, people die at home, too. But that was a silly 'point' to begin with: your odds *are* much better at home than out on motorbike in the middle of nowhere.
And any climbing I do is in well maintained indoor climbing gyms.
Of course, there are some tradeoffs to be made. I don't spend all my live in my adopted home of Singapore, but occasionally visit less safe countries (ie pretty much anywhere in the rest of the world apart from perhaps Japan or so) for holiday or business.
The main thing I fret about isn't actually accidents, but getting Parkinson's later. Given that I have a few family members on both sides with that.
I'm sorry that a very unlikely but very injurious thing happened to you, but it's plain silly to argue that taking reasonable precautions against much more common, avoidable hazards "doesn't move the dial much." Of course it does. Common things are common.
I used to read "Accidents in North American Mountaineering" cover to cover each year, hoping that would help me avoid becoming a victim myself.
It always seemed like I could put them into 3 main categories:
1/3 of the accidents were some avoidable mistake (like rappelling off the end of the rope after failing to find the midpoint)
1/3 of the accidents were happening to people doing extreme climbs I would never attempt.
1/3 of the accidents were just wrong place and wrong time, and there's not a damn thing I could do if I were in the same position.
Sounds like maybe you ended up in the latter group. I'm sorry to hear that, but I appreciate that you're here talking about your experience.
Yes, wrong place wrong time. Climbing many grades below my ability. "Could have happened to anyone" etc.
I genuinely wish I had just died. That way whilst my life would still have been over, at least I would't know about it and have to watch.
Holy shit. I'm so sorry.
**Edit** I've now read a few of Paul's posts, and the worst part is how determined he was to make the best of things immediately after the accident, compared to his mental state now. People in these comments accusing him of not trying hard enough to adapt are just factually wrong.
This has actually brought up an unpleasant memory for me: a few years ago, I was scrambling in Glencoe with a couple of friends - employing soloist mindset and many grades below our limit! - when one of my friends slipped and fell about forty metres. We performed CPR on him for an hour until the mountain rescue team arrived, but he'd broken his neck and much else besides and was pronounced dead in the helicopter. One of the things that kept us going was the belief that most newly-disabled people struggle at first but eventually come to terms with their new life and are glad to have survived; but having read Paul's story I'm wondering if we should have just gone for a beer instead.
Reading about the four-armed aliens doesn’t make me feel sad about having only two arms. I already know what it’s like to have two arms: life is good! Instead, realizing how much higher there is to go gives me *envy.* Let’s develop the technology to heal disabled people and also the technology to let everyone go beyond the default!
The four-armed alien analogy doesn't work. Arms are one of many, many things where most of the value comes from the first one. It might be better to have more. But people don't go into crisis when they're reduced from two arms to one, which is worse than going from four to two.