On cutbacks and dying – Louise Perry in NYT:

‘In June, lawmakers in my native country, Britain, approved plansto legalize assisted suicide. If the bill becomes law, England and Wales will join more than a dozen countries and 11 U.S. states in permitting medically assisted dying.
Every one of these jurisdictions has a total fertility rate below the replacement threshold. I do not think this is a coincidence.
About 30 years ago, P.D. James’s prescient novel “The Children of Men” imagined that a birthrate crisis would induce governments to facilitate the suicides of the elderly in a ritual known as “the Quietus.” Looking at the rush among some low fertility countries to legalize assisted suicide, I fear that Ms. James’s vision is already being realized.
Our fertility predicament is not as extreme as that imagined in “The Children of Men,” but it is nonetheless very real. The global total fertility rate has more than halved since 1950, with those of most countries already below replacement level. The population pyramid is increasingly inverted, not just in the wealthiest Western nations but also in most places outside Africa.
This poses an existential threat to welfare systems, which rely on young workers to fund entitlements and health care for older adults. Those who hope that liberal immigration policies will solve this problem forget that immigrants themselves get old, and their birthrates tend to converge with those of the greater population over time.’

(…)

‘Those who support the legalization of assisted suicide have a bad habit of using a motte-and-bailey style of argumentation. From their easily defended motte, they insist that a person with a terminal illness who fears a painful and undignified death should be able to seek medical assistance and the company of his loved ones if he decides to make an early exit. That argument seems logical enough to most of us, and compassionate.
But then there’s the bailey: what assisted suicide actually looks like in many of the countries that have adopted it.
In 2002, the Netherlands became the first country to deliver death via its universal health care system. Last year 9,958 people in the Netherlands died with the help of that system, accounting for more than 5 percent of the country’s total deaths. One of these was the 29-year-old Zoraya ter Beek, who chose to die not because of any physical impairment but because she suffered from a combination of anxiety, depression, autism and an unspecified personality disorder.’

When Canada first introduced its Medical Assistance in Dying program in 2016, MAID was available only to adults suffering from an incurable and intolerable illness whose natural deaths were “reasonably foreseeable.” But in 2021, that last requirement was removed. Now young people with potentially long lives ahead of them are choosing state-facilitated death. So too are the poor and the desperate, who might want to go on living if only they had enough state support. Roger Foley, a 49-year-old man who was born with a severe neurodegenerative disease, testified to the Canadian Parliament in 2020 that he felt hospital staff members had tried to coerce him into assisted suicide “by threatening to charge me $1,800 per day or force discharge me without the care I needed to live.” The 37-year-old Jennyfer Hatch, who in 2022 was featured in a glossy commercial endorsing the MAID program, told a reporter in the months before her assisted suicide that she wanted to keep on living but was struggling to access the health care she needed.’

(…)

‘If assisted suicide is to be legalized at all — and my view is that it should not be — then the best system to emulate is that adopted by Switzerland, in which patients are legally helped to die through not-for-profit organizations independent of the state. Without this separation, organs of the state that are tasked with solving an impossible financial problem — how to pay for more old people with less money — will be inexorably tugged toward what looks to a mindless bureaucracy like a “solution.”’

Read the article here.

There is a case to be made that assisted suicide should be legal, under certain conditions.

But the danger is real that assisted suicide will end up as a system in which only the affluent can afford to live longer. To suffer longer maybe, but there are people who would rather suffer than die.
The question when suffering has become so severe that it makes life unlivable is real, but it is difficult to answer. We know that the support-systems might play an important role.

We also know that loneliness (it all depends on definitions of course) is as unhealthy as smoking.

Perhaps, that’s why so many people smoke, they prefer the cigarette to loneliness.

The discussion about lower birthrates and assisted suicide has just begun.