Life-and-death choices

A particularly problematic angle on various reductions in choice* is a potential removal of the right to live resp. make own decisions about living and dying,** be it outright or through taking or not taking certain risks, taking or not taking certain precautions, etc.

*Cf. [1] and various follow-ups.

**Beyond the restrictions that arise through natural mechanisms, including aging, accidents, and fatal diseases. (But note that some of these still have a component of choice, e.g. in that a chain-smoker has a disproportionate risk of lung cancer and other health issues, and can choose to smoke or to quit. Cf. the later part of the above.)

For instance, over the last few months, I have heard repeated claims of excessive pushing of “assisted suicide” (likely all relating to Canada). Assisted suicide might seem like an increase in one’s own self-determination. When done correctly, it might even be so.* However, when suicide becomes a “solution” actively offered by e.g. the government or a hospital (as opposed to something requested by the patient), maybe even one pushed as “the best option” (or similar), this fast ceases to be the case—especially, when the concerns of others are given priority.**

*As a Libertarian, I originally had a positive attitude to the availability. From what I have seen over the twenty-or-so years since the topic became mainstream, I have begun to suspect that the harm will be greater than the benefits. (More generally, Libertarianism often needs a pragmatic brake.)

**Consider thinking like “if this patient dies, we have a free bed for someone else and maybe an organ or two to transplant”, “if this pensioner dies, there is more pension money to go around”, “if this prisoner dies, society is free from the costs of keeping him incarcerated and he is guaranteed not to commit further crimes” (also see excursion), and note the fate of Boxer in “Animal Farm” and many in “Soylent Green”. (Also note how often the dystopic works of old appear to be used as instruction manuals today—not as deterrents.)

We might even, in the long term,* see scenarios where someone is offered an unconscionable** solution (or “solution”) to a problem, turns this down, is then offered assisted suicide, turns this down, and is then told to take a hike. (Often with the effect that the unconscionable solution is begrudgingly “accepted” as the lesser of three evils.) At the far extreme, beyond what might be realistic, a scenario is conceivable where anyone who raises complaints against the government is offered death as a “solution” and, if turning this “solution” down, is told that he has no right to complain—as he has rejected the “solution” and thereby chosen to live in society as it is.

*Here and elsewhere, note that I am not necessarily saying that this-and-that dystopian scenario is right around the corner. I am merely pointing to what might happen at some point, if current government mentalities, current societal tendencies, whatnot, go unchecked.

**What this might be will vary so strongly from situation to situation, person to person, and level of desperation/need/urgency/whatnot to level of desperation/need/urgency/whatnot that it is hard to give specific examples. However, a less drastic real-life example with an unconscionable alternative is Karl Lauterbach’s (failed) attempt to force vaccinations in German by a fines-or-injections scheme.

For instance, there have been cases where abortion extremists have suggested a mother’s “right” to take the life of an already born child, in some variation of the old parental threat “I brought you into this world; I can take you out of it again”. If we were to accept this, where is the line to be drawn? Could we e.g. have a first-grader killed off for letting mommie dearest down by not being the genius that she had expected? What happens when this intersects with the previous paragraph? Consider scenarios like a social worker denying welfare payments to a mother unless she does her utmost to cut unnecessary costs—including by euthanizing that kid. Or take an NHS-style scenario of “it is too expensive to treat that chronically ill kid for several years, so we will not do that, but we can euthanize him for you” (with variations like “the waiting list for the right operation is two years, but we could euthanize him for you later this week”).

For instance, other recent reports include patients being denied operations and other treatment—unless they accept a COVID-vaccine. This even for patients who are not in a risk group, have already had COVID, or otherwise belong to a group for which not getting the vaccine is the rational decision. This can then result in situations like “either you take the vaccine or you die an excruciating death from a burst appendix”. The former is, by a very considerable distance, the lesser evil, but it does involve an additional and entirely unnecessary risk of death. (Not to mention (a) the risk of non-lethal side-effects, (b) the violation of choice in other categories than life-and-death.) In quality, if not quantity, it is the same as if someone was told to play a round of Russian roulette “or we just shoot you”.*/** In a longer term, the same type of approach might be used for a more harmful*** or otherwise unconscionable alternative, maybe up to such extremes as “either you accept this digital implant for governmental monitoring or we let you die” and “either you agree to donate a kidney or we let you die”.****

*Normally, I make a clear distinction between active action (e.g. harming someone) and passive inaction (e.g. not helping someone). The Russian-roulette example involves an active action (or threat thereof), while the failure to treat is a passive inaction; however, I view medical professions as a special case, as, within reasonable limits, a duty to render medical aid should be assumed, which nullifies the difference. (The overall topic is for a dedicated text, but I note that contractual obligations, debts of gratitude, and similar can also nullify the difference through creating a duty to act.)

**I am slightly reminded of a case of a criminal dentist that I encountered many years ago. Apparently, he would make an agreement about some type of dental surgery for some amount of money, put the patient in a daze through drugs, perform half the procedure, and then demand more money to complete it. The dazed patient had two options: pay or be kicked out on the street with his mouth a complete mess.

***The COVID-vaccines are highly problematic when we look at aggregates over a large number of recipients, but, with reservations for future revelations and what I might have missed, pose a (in comparison) tolerable risk for any given individual.

****Off topic, there are other severe complications that can arise from such arbitrary denials, e.g. that someone who has the “wrong” skin-tone or “wrong” political opinions might be denied treatment. (It might even be argued that current vaccine requirements are sufficiently poorly founded in science that they should be seen more as a matter of demanding political compliance than as a medical issue.)

For example, there are reports of unvaccinated patients being forced to accept blood transfusions from vaccinated donors against their will, which implies an additional risk.* Blood transfusions are, again, an area where the benefit of treatment often outweighs the risk, but it is also, again, a potentially unnecessary risk and a violation of free choice. And: if the treatment outweighs the risk in this case, things could be different the next time around. Correspondingly, any intervention of the kind and/or size of the COVID-vaccinations should lead to a great amount of caution, and it should have been par for the course to (a) strongly prefer unvaccinated donors, (b) strictly separate blood from vaccinated donors from the unvaccinated donors—just like any major intervention in any area should be cause for caution and precautions.**

*I have heard the claim that this should not be a concern, as the vaccine does not enter the bloodstream. Empirical evidence shows this to be either false or misleading. If in doubt, there is no guarantee that the shots are given with sufficient skill and precision to make even a “true on paper” claim hold true in real life. (E.g. in that an injection intended to be given solely in muscle still occasionally ends up directly in a blood vessel. Generally, such “sunshine” assumptions are an endless source of problems, e.g. in politics and software development.) It could not even be ruled out that someone like Karl Lauterbach would push the deliberate addition of COVID-vaccines to the transfusions to ensure that as many as possible are exposed to the vaccine, no matter the cost, the consequences, the efficiency, and the violations of self-determination.

**Note e.g. thalidomide and freon, how they are perceived today vs. how they once were perceived, and how long it took to discover the problem.

Excursion on capital punishment:
From a general view point, the death penalty is a relevant example for this text, in that it removes the convict’s right to live and in that there are many current or historical regimes that abuse[d] the death penalty to e.g. get rid of dissidents—but, unlike most the above, it is neither a current development, nor something that the typical reader would be unaware of.

However, the aforementioned calculating attitude of “if this prisoner dies, […]” is fundamentally different from the normal motivations for the death penalty, and the presence of the one does not necessitate the presence of the other. Indeed, looking at the U.S., assisted suicide could end up being far cheaper and taking place far faster than an execution, as the years or decades of appeals and whatnots disappear.

An interesting middle-ground is formed by various rumored fake suicides, rumored instigated-by-management prisoner-on-prisoner murders, the possibility that some prisons might view prisoner-on-prisoner murders as positive (even without own instigation) and not look too closely at the issue, etc.

Excursion on COVID and the elderly:
I do not believe that similar thinking has been behind the mismanagement of COVID; however, I have from very early on noticed a considerable convenience for over-burdened welfare societies, especially those with a “pay it backward” pension system: Deaths from COVID disproportionately hits the elderly, and the elderly tend to be a burden on the government, the welfare system, or whatnot through paying smaller amounts of (especially, income) tax, drawing pensions, and incurring greater medical expenses. (To which, maybe, some other factors can be added, e.g. that they might consume less and thereby stimulate the overall economy less.) Especially in Left-leaning countries and countries with a demographic strongly skewed towards the elderly (relative the historical norm), COVID might have been a great boon for the politicians by clearing out the retired Boxers.

(COVID has also been a great boon for them as an excuse to blame for this-and-that and as an excuse to implement this-or-that policy that might otherwise have been blamed on the politicians resp. rejected. Here I do assume considerable deliberate action.)

Excursion on “Quitters, Inc.”:
Mentioning smoking resp. quitting smoking above, I am reminded of Stephen King’s “Quitters, Inc.”, which shares some common ground with this text series. I do not wish to dwell too long on King (cf. [2]), so I merely recommend a thoughtful reading.

Disclaimer on references:
As none of the individual encounters left me with a strong wish to write something, I did not keep references at the time.

Advertisement