Daniel Kahneman opted for assisted suicide in Switzerland
(bluewin.ch)575 points by kvam 3 days ago
575 points by kvam 3 days ago
Thank you for sharing this. My grandpa passed away earlier this year at the young age of 97. We discovered a kidney cancer and decided not to treat him and bring him back home.
During his final days, he became unresponsive, only sleeping. The doctors gave us the option of feeding him through a tube. We made the hard decision of not doing it. Gave him all the medicine to help his body heal, but no invasive procedures.
We stayed by his side for the next 5 days. Playing songs that he enjoyed. Audiobooks that he loved. And just taking care of him.
Finally, his breath became slower and slower until it stopped and he passed away. I had the opportunity of being beside him during his last breath.
The passing of loved ones is always difficult, but I am grateful for how he went. He lived a full life and was incredibly healthy until the end.
Without knowing, we decided on a sallekhana-like process for him. It was the right thing to do.
Thank you for showing me this.
Right. It's a not-so-well-kept secret that hospice care is actually assisted suicide in disguise. It's done with a wink and a nudge, hiding behind the principle of double effect, but it's a mercy everyone knows is happening. It's sad that it has to be done covertly.
This is a misconception—research has found that people entering hospice often live longer than those who do not:
https://www.sciencedirect.com/science/article/pii/S088539240...
There are many who will raise their hands with anecdotal counters to this, but I think much of that is borne from misunderstandings about end of life generally, which is a charged and difficult topic lots of people would rather not learn more about.
I highly recommend the book Being Mortal by Atul Gawande for anyone who wants to explore the topic further—or really for anyone who has loved ones at all!
Which is highly illegal, especially as a form of monetizing pain and lack of agency from elders incapable of decision making but flush with money and inheritors
Thank you I just learned about it. Seems compatible with atheism.
It absolutely does not. Jainism is even stricter than Hinduism, to be co-opted with a faithless belief system
In a similar vein India also has/had Thalaikoothal, which is more of a traditional method of homicide than suicide.
"They are given an oil bath and made to drink glasses of coconut water"
I'm surprised that someone can be killed in this way. Is it the electrolyte imbalance? There's a lot of potassium in coconut water.
Yup—too much potassium.
Apparently you can (almost) do it unintentionally if you play tennis in the heat—though 88oz (2.6L) seems like a lot!
Here’s a case report:
Hakimian, J., Goldbarg, S. H., Park, C. H., & Kerwin, T. C. (2014). Death by Coconut. Circulation: Arrhythmia and Electrophysiology, 7(1), 180–181. https://doi.org/10.1161/circep.113.000941
How did they medicate for pain for millennia before the advent of painkillers?
Are we pretending opioids do not exist in nature? What's next, how did people hallucinate before LSD?
Before the early modern period, large portions of the world did not have any wild or cultivated opium poppies or any other strong painkillers.
Jainism developed in India which did have access to these. Regardless, until the early modern period painkillers and other medical treatment was blanket disapproved of as it was considered likely to be damaging some part of the body. (My non-expert understanding).
People were probably suffering a lot. I can't imagine being a migraine sufferer in 1500. It's miserable enough now.
Hard fast (e.g. hunger strikes) usually take about 2 months to kill a healthy adult.
On the one hand according to the wiki this is more progressive removing food by degrees which would make the process a lot longer.
On the other hand being a mostly ascetic practice I'd assume it's done by people who have a lot less reserves (body fat and muscle) which would shorten the process significantly (the 207kg Angus Barbieri famously fasted continuously for 382 days[0] breaking his fast at 82kg, although he supplemented his liquids — water, tea, and coffee — with vitamins, electrolytes, and yeast extract, the latter for essential amino acids).
[0]: technically he was put on a recovery diet of salting then sugaring his water for 10 days, so ate no solid food for 392 days, breaking his fast with a boiled egg and a slice of buttered bread
The earliest was under a day. The latest was about 2 weeks. I've heard of about 45 days one as well.. but thats unusual.
I was curious about how he actually died and found an [1] article describing it:
> Kahneman used the services of Pegasos in the village of Roderis in Nunningen, Switzerland. In the death room with a view over green hills, wearing a suit and tie, he lay on the bed and turned on an infusion of sodium pentobarbital himself. A companion held his hand and told him they were holding it on behalf of his loved ones. Kahneman's last words were "I feel their love."
[1]: https://www.aargauerzeitung.ch/schweiz/suizidhilfe-weltstar-...
Is this https://pegasos-association.com the one?
> Pegasos, a non-profit based in Basel, Switzerland, believes that it is the human right of every rational adult of sound mind, regardless of state of health, to choose the manner and timing of their death.
I found this bit "regardless of state" really interesting.
I wonder what their views would be for someone who wouldn't have a family and nothing much to do or explore after a certain age? Does it matter what nationality they are from? What if someone's reason is - they had savings and now they have run out of it and area already 55-60 or more and have no intention or plan to work anymore and don't want to go through the struggle of life? (Of course they would have had paid the euthanasia fees)
How does it all happen?
I had an old teacher who died almost a year ago.
Great guy, very sociable, knew everyone in the little town he lived in. Kept in touch with a lot of students. Good neighbour, friendly guy who'd talk to everyone.
He got Alzheimers. He started forgetting stuff, and it frustrated him. He got caught driving dangerously, and cursed the doctor who took away his license.
He argued with me about the state of some chicken he wanted to cook. I told him "this is pink all over, you have to cook it more". He got angry. I understood he'd become like this to everyone.
He pissed off everyone on his street, and all police, medical and social workers sent to help him. The disease made him blow up every relationship he had with anyone that he didn't know well, like me and a couple of colleagues.
He got found in his house, having left the gas on, endangering the whole street. He ended up in a care home, not knowing who he was, or who I was.
If he'd been run over by a car, or died of a heart attack at the age of 80, people he knew would remember him as that nice old guy who had a dog and made a lot of art, and was friendly to everyone. Instead he was that 83 year old guy who pissed off everyone, nearly blew up the neighbourhood, and drove like a maniac.
You really don't want to end up with dementia and related illnesses, it totally sours everyone's view of you.
It doesn't seem pleasant for the person themself either. Constant frustration, gaps in your memory growing ever larger, disorientation, loss — periodically augmented by brief flickers of recollection of what you used to be — and yet no one can legally end your misery, because you can likely no longer unequivocally consent to euthanasia or assisted suicide, even if you explicitly signed a declaration that you did not want to end up like this — legally, the current husk of your former self must consent, and it can't.
Some places permit consent in advance, the person specifies the conditions but hands the evaluation of whether they have been met to the doctor.
It’s still absurd despite what you say that we are implying that we should euthanize another human because they have become difficult to manage due to illness. Where do we draw the line?
> we should euthanize another human
You are shiftinf the topic. This is about self-euthanization, assisted suicide. Not others.
> Where do we draw the line?
As written elsewhere, having to draw a line does not mean that the only reasonable conclusion is to make it illegal in general. It's a hard topic without easy answers. "Don't allow it" is an easy answer that doesn't do justice to the topics complexity.
A good friend of mine passed away a year ago with an incurable disease, diagnosed 3 months before his death, and it was essentially guaranteed that he'd have to endure unbelievable suffering during the last weeks of those months. He didn't have the choice to end it early. It was heartbreaking.
I for my part hope that I can choose myself when the time has come.
I am not implying that at all. People should be free to choose when to die, and people should be free to set conditions for their future wherein they no longer wish to live even if they could not express that at point.
That's a personal choice. Anyone not interested in that won't have to do anything and can just wait for the end.
You can quite easily draw a line that society does not get to force someone to live a tormented existence in spite of their prior declaration that they do not want to be tormented.
“It shouldn't be that way” is not an excuse to torture people through your moralizing indifference to the fact that it is that way.
This is such a cruel perspective, implying that he'd be better off dead, for what, 3 years of inconvenience to his community, despite the previous 80 years being spent contributing positively to it?
You even literally show that he isn't solely remembered for those last 3 years of his life. We owe people like that care and understanding, not murder framed as mercy.
It's always so painful to see old people around who are clearly living alone, forced to do everything themselves, having to ask strangers for help because they're afraid of being a burden, and their actual children can't find time for them. Only to now see people actually supporting murder because old people become a burden for a couple of years near the end of their life.
Thank you for saying this. It's not a popular view, but it is the correct one.
> You really don't want to end up with dementia and related illnesses, it totally sours everyone's view of you.
I don't think I've read a wilder defense of euthanasia in my entire life.
This is a "great guy" who committed his life to teaching kids, being a good neighbour, and his reward is one of his former pupils arguing he ought to be killed because he's grown unwell, he's unable to maintain his optics, and the community he gave his life to has therefore 'soured' on him. How very inconvenient for you, that this man is unwell.
What message is this supposed to send to anyone? "Don't get invested in trying to be nice to the neighbours, they're all ghouls who'll have you shipped to the glue factory as soon as you stop seeming useful." And once everyone internalises this level of social atomism, where do you expect these 'great guys' to keep coming from?
He’d be dead either way, the question is if having those three years were a net improvement to his life
By that logic we should invoke the death penalty for everyone who has been sentenced to life in prison and has exhausted all their appeals, or any seniors convicted of a crime.
Their life probably won't improve anymore, and in the latter case they're going to die in a few years anyway, so might as well just lighten the load on society?
3 years living vs dying is a 3 year net improvement on life. Such silly statement.
By your logic we should kill everyone at their peak.
But this guy wanted to die right? Bit different. Agreed that 'how others view you' is such nonsense. People are cruel that way and also: those children who couldn't be bothered visiting or helping out, will be standing at the funeral sniffling and telling 'such great dad stories'. Makes my blood boil.
> You really don't want to end up with dementia and related illnesses, it totally sours everyone's view of you.
This seems like such an absurd conclusion to this, as though the opinions of other people of you are what matter when you functionally lose your personhood and then die.
Maybe a better focus would be that there often isn't a good way for a community to manage a person who suddenly becomes irrational because of an illness.
The parent described someone who went above and beyond the norm of other members in his community in his constant positive interaction with his neighbors, collegues, and former students. It is highly likely this kind of person would give a considerable shit if he knew he would become a nightmare for the same community.
There may be others reading in the thread who also can relate to the personality of the teacher and may care about their affect on others when they are "not themselves".
In my experience having had a parent suffer this way, you lose them before they are dead and you grieve along the way. I can understand the "souring" phrasing - in that there is less affection for the altered person in the present even while feeling a duty for their care and a deep love for who they were.
I'm grateful for this story - it's powerful to see examples of autonomy at end of life - and contrasts starkly with the experiences many of us have with aging parents. End of life, at least in the US, can be deeply flawed and misery for all.
Valuing how others remember you is definitely a motivation in life for many. I respect that it is not your own, respect that it may be mine. It is by no means "absurd".
It is absurd because it places subjective opinions over objective goods. This is the vice of “human respect”. Human beings do not have a final say about others. They can opine, but opinions are like buttholes, everyone has one.
Sure, it is nice to be remembered well, if you deserve it, but I do not live for the opinions of others. This is slave mentality and pathetic. I care about being good, and if I am hated for that, then so be it. Sad, but better to be hated for being a good person than loved for being a mediocrity or a knave.
And to off yourself out of concern with how people remember you is a condemnation of our society, our lack of charity, our lack of magnanimity, and our selfish prioritization of convenience. Full throttle consumerism.
My brother had schizophrenia. No one thought well of him. I guess he should have killed himself as well by the logic some are professing on here. Oh, he tried, but he ended up dying of heart disease.
> Maybe a better focus would be that there often isn't a good way for a community to manage a person who suddenly becomes irrational because of an illness.
Yes, this is the focus. Science has stalled when it comes to neurological disorders. But the response is love and understanding. I do not understand how someone would "sour" on a person because they have an illness. A very absurd conclusion indeed.
Dementia and Alzheimer is not something that can simply be managed throught treatment. It is an inexorable descent into suffering for both the person and its entourage with absolutely zero hope of getting better. At best in the last stages you get very short glimpses of normality within hours of confusions, frustrations, anger and pain.
If I am ever diagnosed with one of those, I absolutely want the chance to end my life before I reach a stage I become a burden to my loved ones and can't give a trustable consent. I'd rather go too soon than too late.
the conclusion is true, though obviously the worst part is that this guy spent at least a year in varying states of despair, anger, and even worse psychological terrors.
you don't want dementia because it damages and hurts you and everything and everyone around you
(my grandpa physically attacked grandma multiple times in his last year)
>This seems like such an absurd conclusion to this, as though the opinions of other people of you are what matter when you functionally lose your personhood and then die.
They do matter.
Being concerned with how your behavior affects your family or your community, and the opinion they have of you, above your own self-interest, is how good parents, good friends, good citizens, and so on, are made.
> Being concerned with how your behavior affects your family or your community, and the opinion they have of you, above your own self-interest, is how good parents, good friends, good citizens, and so on, are made.
You've changed the meaning behind the original comment in a subtle but important way. The original commenter wasn't concerned about their effects on other people, they were concerned about how the disease would ruin their public image. Maybe they didn't mean that but it's what they wrote.
This distinction matters because those people whose top priority is their public perception (i.e. social status) are never "good people". It's normal to care about your social status to some degree but it shouldn't be the first thing you consider.
My wife's grandma passed some years back due to dementia/Alzheimers. Her final memories of her were of struggling to change her diaper because she insisted "she didn't need a change" and being really racist.
I really don't want my family's last memories of me to be that. Yeah my wife remembers when her grandma was of sound mind, and has some good memories with her back then, but they stopped due to the disease.
Everyone should be entitled to their own opinions on how they want to be remembered. I would rather be allowed to pass in sane mind.
It's not so absurd. The only afterlife that exists (in a materialist sense) is what other people think of you. The only part of 'you' still around us quite literally just a memory in someone's head. That's not nothing.
Whether we should care about that or not is a philosophical conversation, I suppose. I would take the side of if we care about what people think about us when we are alive, surely we should care what they think of us when we are dead. Otherwise, we only value their opinion of us as a function of what they will do for/to us, which seems not great.
This is a maximalist view, in reality not feasible or scalable. Of course this is what we need to strive for, but aiming to decrease 'total unhappiness' with what we have, is a rational, if somewhat cynical, aim.
But even at aface value, more rational long-term approach would be to treat it, surely
This. Life is such a precious random occurrence that failing to protect it in the face [dementia|physical disabilities|etc] is the real tragedy.
It's not like life stops when someone (with a grave an irreversible condition that causes suffering) dies. It goes on with the young generations (i.e. the billions of them!). I think too much clinging to a single life causes the whole (which is more important) to suffer. That's not to say we shouldn't value and respect elders, but clinging to life excessively is ignorant and potentially cruel, in my humble opinion. I defend the right to die in the face of incurable diseases that cause a lot of anguish and suffering.
I think clinging to life is partially rooted in an egoist/solipsistic metaphysics that you yourself are all that matters (to yourself at least, of course). Relax, we're just a small part of the cosmos. Ancient and immortal :)
As I mentioned in a another comment, framing it as "how one is remembered" is leading to pointless tangents in this thread.
The important point is this: are you causing emotional, psychological, physical distress in the real world to those you care about when you have this disease? Yes or no. That's what I care about. Whether they are able to remember me well despite that, or poorly because of that should be completely secondary.
What does protecting life look like when one is literally losing everything about themselves that they value?
idk man whether the people I love hate me matters to me...
Jason Zweig, Kahneman's friend, wrote about this and many other thoughts Kahneman would have gone through in making the decision.
As Barbara Tversky, who is an emerita professor of psychology at Stanford University, wrote in an online essay shortly after [Kahneman's] death, their last days in Paris had been magical...
One afternoon, according to her online essay, she asked what [Kahneman] would like to do. "I want to learn something," he said.
Kahneman knew the psychological importance of happy endings. In repeated experiments, he had demonstrated what he called the peak-end rule: Whether we remember an experience as pleasurable or painful doesn't depend on how long it felt good or bad, but rather on the peak and ending intensity of those emotions. "It was a matter of some consternation to Danny's friends and family that he seemed."
I have to wonder if they could have had one more magical day. Or maybe two.
Maybe in a different city, or with different friends.
If he did “learn something new”, could he have incrementally improved upon it, using his brilliant mind? Could he have made one more wise observation?
It seems he likely left something on the table.
You know how the story is going to end if you stick around for it. I would make the same choice he made. And I would do it before I was ruled mentally incompetent to do so. My wife and I have already had conversations on doing exactly this having watched multiple family members succumb to dementia. It's horrific and the state salivates at institutionalizing you for the final lap.
No cure for getting old and no cure for dementia on the useful horizon. Having made it to 90 intact, he had knocked living out of the park already. I completely understand his thinking here and support it. He likely could have gone a little longer, but he also might have had a stroke or some other nonfatal cataclysmic event that took away his options.
Kahneman's family & friends who knew beforehand apparently did object.
You should read the piece by Jason Zweig, if you haven't. The decision was deeply personal and was most certainly not an endorsement of euthanasia.
... Kahneman's final email said: "Not surprisingly, some of those who love me would have preferred for me to wait until it is obvious that my life is not worth extending. But I made my decision precisely because I wanted to avoid that state, so it had to appear premature. I am grateful to the few with whom I shared early, who all reluctantly came round to support me."
Kahneman's friend Annie Duke, a decision theorist and former professional poker player, published a book in 2022 titled "Quit: The Power of Knowing When to Walk Away." In it, she wrote, "Quitting on time will usually feel like quitting too early."
She is frustrated by his decision. "There's a big difference between it feeling early and it actually being too early," she says. "You're not terminal, you're fine. Why aren't you taking the outside view? Why aren't you listening to people who will give you good objective advice? Why are you doing this?"
Paul Slovic, a psychologist at the University of Oregon who befriended Kahneman more than 50 years ago, says, "Danny was the type of person who would think long and hard about things, so I figured he must have thought about it very slowly and deliberatively. Of course, those of us who spend our lives studying decisions, we think a lot about the reasons for those decisions. But often the reasons aren't reasons. They're feelings."34M. I live with my mom who's had it for a few years.
It sucks. It's so easy to forget who they were before the disease. This is them now and it's hard as hell.
Simple things that take 1-step for us take 50+ steps for her. She doesn't readily communicate that she's hungry or thirsty or needs to use the bathroom, we have to constantly ask. She's always exhausted and walking around in circles but reacts aggressively to most suggestions to go to bed or take a nap (no matter how we word it). She can't focus for more than a few seconds, so she has no hobbies to occupy her time, and even the TV loses her interest after a minute at most. Her speech is one unbroken babble, and she gets annoyed if someone starts a conversation near her but doesn't let her interject.
Not sure how much more my dad and I have left in us. The disease stripped everything from her and it's stripping everything from us. In-home care is the likely course but she hates all strangers and is always paranoid about anyone other than us being in the house. There's no good solution.
Tell your parents you love them.
Yeah but if you are in that state, you probably don’t give a shit and everybody else seems to be the problem. So how do you solve this? When dementia isn’t too far progressed, your life seems to be still worthwhile to live and once the dementia gets worse, it’s too late to realize this.
I read that in some societies, if you ended up not being able to feed yourself, they would bring you to your favorite tree and leave you there.
If you ended back in camp you’d be welcomed. If you didn’t, that was your end. I found that remarkably comforting and peaceful.
I have this childhood memory of my neighbour's dog, that grew old and one day decided to go out in the woods and die peacefully. They found it a few days later.
I wish to remain so lucid when the time comes, that I can go sit under a tree and let myself go like that old dog. Perhaps I should leave a note.
Or they'll treat you with a daily oil bath and feed you tender coconut water ... until few days later your kidney's blow out.
Death from hunger (esp. when you're frightened and don't understand what's happening) is neither comfortable nor comforting
You could express your wishes about how you would like to be treated in advance, while you are still clear in the head. That’s already possible for other situations, like when you are braindead and entirely dependent on machines to keep you alive, with no chance of recovery.
Having a living will is a great idea in general. My dad got a brain tumor and had no documentation on what he wanted do with his estate, in the event he became vegetative, etc. By the time he realized he needed one, it was too late for "sound mind judgement" and my mom had to go through this ridiculous legal process to ensure she held on to his assets and whatnot while she was directly caring for a dying man.
Save your loved ones some grief, create a living will with a trusted lawyer, update it about once a year. It's worth it. There are so many insane snafus one can get into with estranged family members, the state/gov't, medical institutions, etc that make the situation even more difficult and stressful to deal with. Don't expect anyone coming out of the woodwork to act according to honor. They are vultures and know no such kindness.
Even if you express this in a wish, but you probably don’t remember it when you are deep into this, how does it get executed? I’m curious about this, so does the court overrule the current you with the previous you?
I get it’s easy with other diseases such as cancer, though.
> You could express your wishes about how you would like to be treated in advance, while you are still clear in the head.
You can't express in advance that you want to have assisted suicide.
Your former self might express wishes, but what if your later self doesn't feel like this anymore? In a way, we can all get the same feeling when doing another round of "lose weight this year" new year's resolutions just to realize a couple weeks later that the former self wasn't that trustworthy to begin with (or was it the other way around, the future self can't be trusted?)
Point is: you can wish for whatever you want, but dementia is probably a tough case and it shifts your priorities, making everything before obsolete and I'm not sure that people beginning to suffer from dementia ever find the right point in time to end life early.
> how do you solve this?
You don’t. You try to take care of yourself before you’re gone. If you miss that opportunity, you and your loved ones suffer. Same as it is for everyone now.
Give me a timer. Like the previous discussion of a red button it verifies identity. I can set the timer for whatever I want, if it reaches zero it peacefully kills me. Dementia, set the timer for say 1 month. If my mind is too far gone to reset it it will run down.
I read your comment and it strikes me as a cautionary tale that can be used by bad people to justify or push for eugenics: "they took him; they said he developed Alzheimer's".
As we're currently seeing happen: whatever is left unsaid in the body of the law can and will be abused by evil people to concentrate more power (even if the spirit of the law advocates for something kind).
So, we have to normalize some sort of stress tests for laws... because you sure don't want to be dragged against your will because you're poor.
Yes, there is a danger of that in general. I think someone made a movie in Japan about the subject, specifically because there is a culture of the elderly not wanting "to be a burden on the younger generation." Some said it hit closer to reality than science fiction because of that specific cultural characteristic in Japan. It also supports Kahnemen's position of pulling the plug when "the going is good" from a ethical point of view, since it leaves no doubt of intention.
This was also mentioned in the debate about euthanasia in the UK; that it could lead to pressuring elderly relatives to off themselves. I can imagine the pressure might not even be explicit, it could be implied, and maybe not even consciously, but through behavior.
Like a more subtle form of Shakespeare's "Will no one rid me of this meddlesome priest?".
> I read your comment and it strikes me as a cautionary tale that can be used by bad people to justify or push for eugenics: "they took him; they said he developed Alzheimer's".
Isn't the point of eugenics to influence population genetic trends? Not a very effective strategy to kill people when they already have probably 2 generations of descendents.
I think you are right — definitionwise. But I think you're not thinking about the impacts it can have when grossly misused as I hinted, and how this might be one tool in the cruelty toolbelt of oppressive regimes.
By targeting their support networks, the "baddies" effectively end up making the new generations risk for impoverishment greater (can't let the kids at grandma's, have to pay for daycare, lose access to nutritious inexpensive meals, etc).
This comment really bothers me. I am not put off by the idea that the memory of a person is worth protecting, what I am put off by is the suggestion that death is a good option here, or that death is better than having lived those 3 years of life. The idea that when someone loses the capacity to retain their reputation and dignity it would be better for them and others that they were dead and that they have nothing good to offer is such a dangerous one and is just wrong. It applies to many people who are not near their end of life too. I am really pro assisted suicide as a way of shortening suffering when made as a conscious decision by people of sound mind, but comments like these make me very very uneasy.
I don't think the average amount of suffering for people with Alzheimer's and their families is sufficient to warrant euthanasia as a solution. I don't doubt there are some cases where it could be warranted, but I find it very difficult to get behind the idea that consent should pass from the individual. I obviously see that people with Alzheimer's and their families do suffer, the degree to which depends on the availability of proper care. We're essentially debating whether euthanasia is a better option to high quality care, and that's where the life of a person becomes a pretty gross economic equation. High quality care deprives families of assets. That tension between selfish (or so called "practical") interests and prioritising the interests of the dying is non-trivial, particular where the dying can't reasonably consent. The gentleman mentioned in this scenario would have had a more dignified death had he been provided the correct facilities, and probably shouldn't have been left to run riot in the community. It pains me that this is a story about how some guy became an asshole in his final years and not one of how a guy was deprived of a dignified death by the structures of society. I suspect to some degree people see euthanasia as a simple way to offer compassion and dignity in death, but I do think it's highly informed by ableist prejudice. There is a wide spectrum of dignity and life left to live in an end of life pathway and jumping to euthanasia as the solution is a pretty dangerous one in my opinion.
>You really don't want to end up with dementia and related illnesses, it totally sours everyone's view of you.
I completely agree that the disease is horrible, but your conclusion is bizarre. When you are in that condition, how anyone views you is the least of your worries.
Framing it as an obsession of rememberance or legacy distracts from the more crucial point: the fact that you will be causing chaotic emotional, psychological and physical distress in the real world to those you cared about. Again we should stop framing it as some weird obession with legacy and instead stick to the facts on the ground.
Is your position that you don’t personally care how people remember you?
Many people think badly about the mentally ill act when they are suffering through an episode. Should they be allowed to die by suicide because what people think of them after they come out of psychosis? Should embarrassment be the bar we are setting for suicide?
What you say is "you don't want to end up with mental state because people will hate you" but TBH mental illness, though really harsh on environment, shouldn't be viewed differently than any other illness like broken leg. When person is riding a wheelchair you don't tell them "hey you're a pain in the ass because you drive so slow and cannot jump on the stairs" - we tend to give them hand, help by building ramps and lifts. The same should be with mentally ill. Places safe for them, mabe remembering aids software in a watch?
> it totally sours everyone's view of you.
That's just as much failure of everybody as it is of him. This was dementia speaking and society needs to learn that.
You wouldn't tell somebody with a broken leg to get it together and it's just their personality that they can't walk. Nor should you treat dementia like that. Yes, people seem to shift personalities and anger others. But those others need to understand that it's a medical condition, an untreatable and fatal one, so should have even more sympathy than with somebody who broke a leg (cause that will likely just be temporary). Not alienate the person and speak ill of them.
Imagine that the illness in question was unremitting and excruciating (unlike a broken leg), not only for you and the your loved ones, but everyone you come into contact with. And there's no hope it will ever get any better. That's what dementia usually becomes, and that inhuman level of misery can last for years until you finally slip away.
No animal other than man would consider perpetuating that state of decline. An elephant would simply wander away to die, freeing their community from their struggle to simply keep breathing.
I agree with Kahneman, at least that we all should seriously consider the cost of allowing that level of degeneration to consume us -- and more, the pain it inevitably will inflict on our loved ones -- and plan for it while we're still compos mentis.
We are human. Unfortunately all of our experiences with others change our perception of them, no matter how much awareness of their motivations and our history with them. We can try to ignore it and have patience. Apologies can help but relationships will constantly change.
It's certainly a failure point within us and something to be aware of to make effort towards understanding our own impact as you suggest. Sadly a problem with no full solution over long enough time periods.
I agree with you, I would not want people to remember me that way.
Folks I know who have passed on also wanted to be remembered when they were strong, not when they were ill.
A society that sours on you due to an illness that’s totally out of your control seems a little inconsiderate to put it mildly.
Well sure — I’m not talking about euthanasia, I’m talking about compassion towards the aging. An 80 year old who has dementia needs community more than ever. If you’ve been there for your community and their opinion of your turns when you age, what is the purpose of community?
>Instead he was that 83 year old guy who pissed off everyone, nearly blew up the neighbourhood, and drove like a maniac.
I find the people who remember him as this guy somewhat contemptible though, so I guess my theory would be he wasn't remembered badly by anyone whose opinion mattered.
But on the other hand I guess that's the way the world works.
>> You really don't want to end up with dementia and related illnesses, it totally sours everyone's view of you.
I don't think this is fair. I know several people who died with Alzheimer's and although their final years were very difficult for them nobody has a bad opinion of them. It's certainly a strain on the family but intimating that if you have dementia you better kill yourself or your legacy will be ruined is not ok.
I think the suggestion needs more thought, but I don't necessarily disagree with the idea of making my exit before the dementia really sets in. I've directly cared for two family members who suffered from it (collective 5 years of my life, which I'd like to think gives me a pretty good view of what the disease can actually do to people) and I decided for myself that I'd rather be quietly killed than put my loved ones through what I went through as a caretaker. While also trying to work a full-time job and maintain my own sanity while I watched people I'd known all my life be destroyed, becoming tortured versions of themselves like something out of a body-snatchers horror film.
We, the loved ones, made the decisions to keep them going and I wonder how fair that was to them. We tend to not want to let people go, choosing to sacrifice quality of life for the sufferer and those around them for, what, a few fleeting moments of possible clarity? The opportunity to say goodbye to someone who may or may not even understand what is happening?
The events I went through with my family hurt us in ways that will not likely ever heal, despite effort on at least a few of our part, and it did leave me wondering if I would put my son or wife through that should something similar ever happen to me. I decided against it, seeing as I am at the age where these are very real possibilities. In the US, we have DNRs ("do not resuscitate") and living wills that offer prior directives, but something like assisted suicide is not allowed here unless some very extreme circumstances are met, because insurance companies and hospitals make more money from suffering people than dead ones. I'm a strong advocate of the right to die, but it is a decision that needs to be made some extensive consideration and documentation before one actually needs it.
Sorry if I'm missing something but how do you plan to exit on your own terms if it's not allowed, and your only legal tools are DNRs and living wills?
It seems like DIY methods could be risky to your family if you're already impacted by the disease, and your own competency is called into question.
Not to mention that you won't really care what people think of you because you'll be dead.
> If he'd been run over by a car, or died of a heart attack at the age of 80, people he knew would remember him as that nice old guy who had a dog and made a lot of art, and was friendly to everyone. Instead he was that 83 year old guy who pissed off everyone, nearly blew up the neighbourhood, and drove like a maniac.
I've really thought about this a lot after seeing a number of family members and friend's family members go through dementia, and it seems like it can go two ways: like this, which is how it went with my grandmother (whose hoarding behavior increased aggressively, and she started slapping people), or how it went with my grandfather on the other side (he became quieter and quieter, watched tv every day while understanding less and less of it, and when you caught his eye would repeat how much he loved you and how much seeing you "made an old man feel good.")
It has something to do with how you feel about the nature of people in general, and whether you feel they are all suspicious and possibly conspiring against you, or that you think they are basically good and want the best for you. When you have all of your mind, you can beat the demons or the angels back with your reasoning enough to have the personality that you want. My grandmother was very loving, and my grandfather was very shrewd and practical. But when that higher function can't regulate you, what shows is if you were someone who taught yourself how to see the good in people, or someone who taught yourself how to see the bad in people.
I suspect I'll end up like my grandfather, as much as I think of myself as like my grandmother. Deep down, I've always been crippled by the feeling that everyone is a wonderful person. My aggression and judgemental nature on a lot of things can really, embarrassingly, be interpreted as me looking for excuses for everyone's behavior.
This leaves a bad taste in my mouth. I see that the man was Israeli in the original story and I don't want to presume a religious perspective, but I can share some thoughts from my own based on his story and yours. I've read the New Testament within a Jewish framework and one of the things it says, Rabbi Shaul says in 1 Corinthians 12:23 that those people in the community who are most embarrassing or cause us to blush, like the parts of our own body who are honoured or dignified by being clothed with underwear, likewise in the community are owed a special covering and to be afforded dignity by the other parts of the same body/community. Just something to think about in light of this story!
Not all Alzheimers patients get aggressive/angry. I know it happens, I’ve known one person who did almost exactly what you describe above. He lived with his partner of many years, and seemed superficially very cogent and together. It was just that he started to see insults and conspiracies against his person everywhere around him. Not until later did the cognitive and memory decline become apparent, giving him a diagnosis that explained his bad behavior.
But my personal anecdata puts that man in a minority. None of my older relatives with Alzheimer’s have become aggressive or troublesome. Worry, anxiety and confusion seem to be much more common states of mind, which admittedly also doesn’t seem like such a fun way to spend your days.
> You really don't want to end up with dementia and related illnesses, it totally sours everyone's view of you.
Yes, the sixty-fifth worst thing about degenerative brain disease. Good observation.
I agree alzheimers turns everything to shit in every meaning of the word.
I disagree it’s up to you to conclude it would have been better if he had been killed 3 years earlier (which you imply).
In general you don’t have the right to such a statement.
Now, if you were discussing _your own_ condition this would be a totally valid consideration IMHO. But you (almost) _never_ have the right to conclude from someone elses part when it’s their time to go.
Assisted suicide is a humane option but ”I hope he had died with some dignity years ago instead of pissing everyone off” tarnishes the entire concept and is exactly the type of argument which stops assisted suecide becoming a more widely accepted option.
It’s basically getting rid of somebody when they become an inconvenience to others. Outside the bubble of HN, I suspect most people that talk about it as humane for the person actually mean humane for them.
Many countries hesitate to execute criminals despite very clear criteria that could be used to justify it. (Many countries banned entirely.)
Why would we have a lower bar for someone who hasn’t committed any crimes?
My issue is, anyone with half a clue should know that a formerly nice respected man doesn’t automatically turn into a mean guy that “pisses them off” because he wants to be. They should have known that he had dementia and it wasn’t his fault.
I’ve never been close to anyone who had dementia. My grandparents on both sides died with their mental facilities in tact and my parents who are 83 and 81 are independent and just as of 6 months ago passed a cognitive test. I can imagine if they started acting out of character and being mean to me or forgot who I was that I would be hurt, overwhelmed etc. But not pissed.
I think you are bit wrong. Once someone close to you dies you remember them by their legacy. Also, you just have to laugh at some of the chaos these elderly cause. They call you in the middle of the night being lost somewhere and you have to guide em home. Or help the cops guide em home.
I am pro assisted suicide. Not sure about Switzerland but some countries allows it for young people with mental health problems. That I can't accept that.
> it totally sours everyone's view of you.
That's the part that doesn't matter at all. Your life isn't contingent on others having a specific view of you - the rest of the world can, for lack of better words, go fuck themselves.
What matters is if you want to live a life where you can't drive a car, you might poison yourself with your cooking, you lose your mental facilities, etc. That is the relevant choice here.
I think the takeaway should be you really don't want Alzheimer's regardless of what people think of you.
Think about what is happening from his point of view. The condition has fundamentally changed his perception of reality. You are trying to tell him that this perfectly cooked chicken is pink all-over when it clearly isn't. Everyone else has gone mad and he doesn't know why.
I hear quite a lot of these stories from my parents. Are these kind of personality shifting diseases, like Alzheimers becoming more common? And if so, is it because we take better care of our hearts and don’t die as early as?
Yes, I think that's right. The average age of death due to old age has climbed for over a century, probably due to greatly improved public health and personal medicine.
https://ourworldindata.org/life-expectancy
Because dementia and other neurodegenerative diseases take decades to manifest they've been especially hard to diagnose early and prevent or treat early, while cognition is still intact. Alas, I think that hasn't changed much in recent years, despite many scientists and businesses working toward that end.
Partly that's because few academic researchers can pursue a theory long enough in time to fully assess its potential, especially in combo therapies. Nor can the big pharma corporations who not only suffer from the same difficulty in long-term funding, but prefer the ROI of continuing treatments for disease to that of quick cures (or lifestyle advice). These are nowhere near as profitable a pill the patient must take for decades.
This is a heartbreaking story to read. But I think that pushing for assisted suicide as a "fix" like you're suggesting misses the bigger picture. We have a responsibility as a society to support people through these diseases, not cut their lives short because it's tough on everyone else.
The real issue is our broken systems for handling dementia and underfunded homes, overworked staff, no real community nets. Fixing that honors the full life someone led, instead of saying their value drops when they need help. Assisted suicide opens doors to abuse, like pressuring people who feel like burdens.
We owe better to people like your teacher.
Sounds like LinkedIn story to me. Written by claude trying to drive a point home.
Not sure how to react. This is the second time in a month that someone thinks I used AI to write an HN post.
All I can say is that I didn't, and thank you for implying that it was so well written that it could only have been authored by a machine that has all of humanity's cultural output to hand.
Sorry about that, will be more considerate in the future
This sounds like a big and somehow convincing but still rationalization.
If you apply at scale the same logic with more sensibility you will also be able to rationalize a genocide because someone felt bad about something.
What defines demonic inspiration?
And here I don't say "demonic" metaphysically but philosophically.
I would say that this is a societal problem, not an individual one. Society needs to do better in taking care of people who do slip by the wayside, with mental illness and diseases like Alzheimer's.
So you're telling me Alzheimers is a death sentence? Also, what is the minimum nuisance that should lead to someone's death? Because that is the problem with the euthanasia obsession.
At some point everything indirectly leads to euthanasia and society is not built for that at all. Everything you do might or might not lead to someone's euthanasia, which means you are liable for their death.
Let's say we can predict school shooters before they shoot and give them an euthanasia to save lives. If bullying or encouragement causes someone to start shooting up a school, then the latent shooter will die before they do their shooting, but it also means that the instigator is a murderer themselves, because in the absence of instigation, no crime would be committed and no euthanasia would be necessary.
Since it is probably not possible to assign liability of a euthanasia to a single individual, because multiple people contributed to the outcome, the liability will be shared. Ten people being involved means each has committed 10% of a murder, meaning that they should receive 10% of a life sentence. Are you ready to serve a cumulative year in prison spread throughout your life to account for indirectly causing euthanasia?
Note that this problem isn't necessarily unique to euthanasia. The problem applies to any cure all solution. (Think of series like "Common Side Effects")
If you punch someone's face in, but cure it with a blue mushroom, was it really a crime, since their face is intact? And yet, more punching happens as a result of the existence of the panacea, which is why there needs to be a punishment for making someone dependent on the panacea.
I'm part of the Jain community in Bangalore, and the version of this in society exists, called Sallekhna [1], a tradition that's developed over millennia, and this is venerated and celebrated.
The philosophical underpinning is giving up of materialness. The practicality of the 5 instances that I witnessed over the past year - typical terminal individuals choose this. They pass away surrounded by loved ones (they typically medicate for any pain, and the body starts shutting down when food and water stops). This is observed with somberness, but celebrated as very positive act.
When someone starts this process, it's a unique experience speaking with them, as there's usually nothing that comes up, and the moment does not really lend itself to small talk :)
[1] https://en.wikipedia.org/wiki/Sallekhana