Daniel Kahneman opted for assisted suicide in Switzerland
(bluewin.ch)573 points by kvam 3 days ago
573 points by kvam 3 days ago
Part of the book has been swept up in the replication crisis facing psychology and the social sciences. It was discovered many prominent research findings were difficult or impossible for others to replicate, and thus the original findings were called into question. An analysis[51] of the studies cited in chapter 4, "The Associative Machine", found that their replicability index (R-index)[52] is 14, indicating essentially low to no reliability. Kahneman himself responded to the study in blog comments and acknowledged the chapter's shortcomings: "I placed too much faith in underpowered studies."[53] Others have noted the irony in the fact that Kahneman made a mistake in judgment similar to the ones he studied.[54]
A later analysis[55] made a bolder claim that, despite Kahneman's previous contributions to the field of decision making, most of the book's ideas are based on 'scientific literature with shaky foundations'. A general lack of replication in the empirical studies cited in the book was given as a justification.
I had read so many raves about that book, and heard the author got a Nobel prize for his ideas, so I started reading it.
I just could not digest it. I understood the words but I couldn't make whatever message he was trying to convey... it felt too "dense" for me. Maybe im just stupid, but I could not get past I think the first two chapters.
It’s largely a popsci book for poseurs. To wit: most of these people “into economics” haven’t read a word of Smith or Keynes.
It’s best use is to be announced your favorite book among undistinguished company. Some people need such books. Such as those from Smith and Keynes.
Since you’re giving an edgy take in a thread discussing the death of a respected author, I’ll be pedantic: you’re wrong about those people not reading a word of Smith or Keynes, since it’s impossible to avoid reading at least one of their common quotations if you have even a passing interest in the field.
I suffered through the book and I just think it is a rather boring writing style.
The poseur part is that it doesn't matter if you know what is in the book or not. That is actually the interesting part of the book to me but also why it is largely an exercise in futility.
I would assume someone who says it is their favorite book just has not read that many non-fiction books.
Don't worry, it doesn't matter, because at best a lot of claims in this books just cannot be replicated, and at worst the book is completely useless because it's based on shitty science - depends on your POV.
I really didn't get on with that one. Felt very much like a book that could have easily been shortened down to an essay and suffered for the additional length.
I'm sorry to pile on, since I just replied to you at https://news.ycombinator.com/item?id=45560985, but this is such a bad case that I think two replies are warranted.
You started and perpetuated a completely unnecessary flamewar here, and of all the offtopic things to do that about, someone's use of the word "next" is particularly superfluous.
An isolated comment of that sort is forgivable, but perpetuating the flamewar and crossing into personal attack, as you did below, is not. We ban accounts that do that, so please don't do that.
The sheer irony of your unwarranted pedantic critique of the usage of “next” is that all HN threaded comments, including yours, have a “next” link in their headers which clearly does NOT refer to unwritten future comments.
Not sure why I bothered responding to a troll.
The sad demise of Robin Williams made me a believer of assisted suicide. The option to go out with dignity should be available to everyone.
That said, there is a problem in at least some places where assisted suicide is available where it keeps getting recommended to disabled people who don't want to die. That needs to be solved. Seems like an easy solve. Just don't do it.
There is a cost reduction incentive, though, which is why it happens. Costs can be reduced for abled people by convincing them to exercise and eat more fiber, so the same pressure can do good instead of evil. At some point we have to decide to care about people.
> That said, there is a problem in at least some places where assisted suicide is available where it keeps getting recommended to disabled people who don't want to die.
Where? This is a thing which always pops up in these debates because it is a deep-rooted fear, but are there countries where this is a thing?
> 60% of the patients who died with Kevorkian's help were not terminally ill, and at least 13 had not complained of pain....The report also stated that Kevorkian failed to refer at least 17 patients to a pain specialist after they complained of chronic pain and sometimes failed to obtain a complete medical record for his patients, with at least three autopsies of suicides Kevorkian had assisted with showing the person who committed suicide to have no physical sign of disease. Rebecca Badger, a patient of Kevorkian's and a mentally troubled drug abuser, had been mistakenly diagnosed with multiple sclerosis. The report also stated that Janet Adkins, Kevorkian's first euthanasia patient, had been chosen without Kevorkian ever speaking to her, only with her husband, and that when Kevorkian first met Adkins two days before her assisted suicide he "made no real effort to discover whether Ms. Adkins wished to end her life," as the Michigan Court of Appeals put it in a 1995 ruling upholding an order against Kevorkian's activity.[26] According to The Economist: "Studies of those who sought out Dr. Kevorkian, however, suggest that though many had a worsening illness... it was not usually terminal. Autopsies showed five people had no disease at all... Little over a third were in pain. Some presumably suffered from no more than hypochondria or depression."[27]
This doesn't seem to be an example of assisted suicide being recommended to disabled people who didn't want to die. Mainstream medical practice at the time condemned Kevorkian, and anyone seeking out his services was certainly aware that what he offered was death.
Canada. The critique is that people opt into euthanasia because of poverty, and that the government sees MAID economical alternative to investments in social programs and welfare. https://en.wikipedia.org/wiki/Euthanasia_in_Canada
I don't think things are as bad, but I also think that old age in poverty is a valid reason for euthanasia if there is no alternative. If the society is cruel to the poor, holding poor elderly as hostage to improve situation is cruelty on top of the cruelty.
From the article the safeguards seem fantastic and the biggest issue is the exclusion of mental health grounds.
MAID being inappropriately offered to people who haven't expressed interest in it, and also being extended widely to people without terminal illness, has certainly become a controversy in Canada.
https://thewalrus.ca/assisted-dying/
https://www.ctvnews.ca/politics/article/doesnt-line-up-mps-c...
Why should only terminally ill people get this choice? A 16 year old can decide who to kill in the army but apparently they (and we) aren't competent to choose whether to take one's own life.
Barbara Wagner [1]:
>Her last hope was a $4,000-a-month drug that her doctor prescribed for her, but the insurance company refused to pay.
>What the Oregon Health Plan did agree to cover, however, were drugs for a physician-assisted death. Those drugs would cost about $50.
Randy Stroup [2]:
> Lane Individual Practice Association (LIPA), which administers the Oregon Health Plan in Lane County, responded to Stroup's request with a letter saying the state would not cover Stroup's pricey treatment, but would pay for the cost of physician-assisted suicide.
Stephanie Packer [3] (although in this case she inquired herself):
> Then her doctors suggested that switching to another chemotherapy drug might buy her time. Her medical insurance company refused to pay. She says she asked if the company covered the cost of drugs to put her to death. She was told the answer is yes — with a co-payment of $1.20.
T. Brian Callister, MD, FACP, FHM [4]:
>When I spoke with the insurance medical directors of the patients' insurance companies by telephone on separate occasions, both of the insurance medical directors told me that they would approve coverage for either hospice care or assisted suicide but would not approve the life saving treatment option.
> Neither the patients nor I had requested approval for assisted suicide, yet it was readily offered.
[1] https://abcnews.go.com/Health/story?id=5517492&page=1
[2] https://www.foxnews.com/story/oregon-offers-terminal-patient...
[3] https://nypost.com/2016/10/24/terminally-ill-mom-denied-trea...
[4] https://www.cga.ct.gov/2018/phdata/tmy/2018HB-05417-R000320-...
It's a very odd take to think examples of insurance companies refusing life-extending treatment and instead offering assisted suicide indicates a problem with assisted suicide.
Just to be clear: the insurance companies are the problem here; and more broadly this whole for-profit model of healthcare.
I'd argue that sadly something like this is bound to happen for sure because many (if not most) humans are lazy, greedy and don't like sick people outside of movies. If it is happening systematically and encouraged by the government or insurance companies - that's of course a different matter and has to be prevented.
I think that Hunter Thompson basically did this. Kinda "on-brand" for him, really.
I had a friend that decided to stop treatment (dialysis), when he realized that he'd never get off it (he couldn't get a transplant). He was in his late 60s.
It was both a sad, and joyous experience. He took about a month to pass (renal failure). He was Catholic, and wouldn't do assisted suicide.
During that month, a bunch of us would go over to his house, almost on a daily basis, and we'd just hang out. It was actually a great experience.
You omitted the _most_ on-brand part of this story, which is the part where (per his last wishes) Johnny Depp spent $3m on a party that involved firing Thompson's ashes out of a 150-foot tower in western Colorado.
https://www.nyswritersinstitute.org/post/hunter-s-thompson-s...
>He was Catholic, and wouldn't do assisted suicide.
I thought Jain the perspective shared in this comment is valuable: https://news.ycombinator.com/item?id=45548178
Well, not just the comment, but also the wikipedia article linked to in the comment.
Obviously, Jainism isn't Catholicism, but this part of the wikipedia article got me thinking:
>It is not considered a suicide by Jain scholars because it is not an act of passion, nor does it employ poisons or weapons.
Catholics are probably never going to think suicide is ok, but I wonder if they could come around to a definition of suicide that is more narrow and which excludes death-with-dignity. If they did make that adjustment, I would personally agree with their stance.
There is plenty of precedent for this legislation through definitional scoping in history in general, though I'm not an expert on Catholicism. The book "Legal systems very different from ours" talks about it, and gives examples. It's really the only option for any sort of change when you're dealing with decrees from a supernatural entity or an unchangeable part of a constitution.
No, it will always be wrong to kill an innocent person whether that is yourself or another doesn't matter. Our lives are lent to us by God
That’s the problem. If there’s a financial incentive people will find way to push it.
That’s my biggest concern about assisted suicide for an otherwise healthy person who just wants to avoid the inevitable decline (as in this case). There is a direct financial incentive for families to push people into this.
The only way I can see to remove that would be to require that your estate can’t go to anyone who potentially has influence over you in the case of assisted suicide for with no terminal illness.
Their most expensive customers are not the oldest ones, it’s the ones getting targeted genetic treatment for cancer denied. They don’t need snipers: the patient dies for lack of treatment being paid for.
> There is a direct financial incentive for families to push people into this
What financial incentives are there in killing someone?
Many western countries make dying slowly with Alzheimer’s very expensive, by the standards of normal families.
Between doctors, nurses and lawyers you can burn through a million bucks in five years easily. And most families don’t have a million bucks cash to spare.
On the other hand, if they die after six months, instead of after 5 years? The family doesn’t lose the farm.
We don't talk about it a lot as a society, but some people just like killing people.
The ordinary outlet for them is the military. Sometimes they become serial killers.
A euthanasia industry would attract these people similarly to how police and security work attracts authoritarians and how clergy jobs attract pedophiles.
That's not to say that most people in the industry would enjoy killing people, but it would be a problem. And death is final; it's impossible to fix mistakes. This is the same reason many people are opposed to the death penalty.
I've waffled between support and opposition of MAID a lot, for similar reasons. I think the morality of it depends heavily on social and economic context. In the US specifically, I worry that MAID could serve as a roundabout form of eugenics, even if it wasn't disproportionately recommended to any particular group.
Imagine you're poor, your family is poor, and your friends are poor too. You spend 2 years in and out of inpatient care, and then die. Your family is now saddled with a debt they will never be able to pay. Your medical bills could make them homeless. Now imagine choosing between that, and MAID. MAID is obviously a cheaper "out."
Now remember the demographics of poor people in this country. If poor people end up being more likely to choose MAID, that necessarily means MAID would be used disproportionately on ethnic minorities and disabled people. So you end up with eugenics again, just because of the sorry state of our medical system and class demographics.
Not all assisted suicide is eugenics, to be clear. There's a discussion of Jain practices elsewhere in this comment tree.
But man did I lose sleep at the thought that we could have people volunteering to kill themselves solely because they're poor. You could argue that it's wrong not to give someone the choice to die sooner, given that dying later could cause so much strife for their family. But I hold that the right solution isn't making people die sooner, it's building a medical system where people never have to grapple with this choice in the first place.
I find it really weird. So someone pays CHF 10K to be given a lethal injection then it becomes dignified and the other way isn't? I think it is an insult to the departed if you question the path they choose - because then both the choices can be questioned and judged.
And did you just go to eating more fibre from euthanasia in the same few sentences? :D
This is blogspam of the original WSJ article: https://www.wsj.com/arts-culture/books/daniel-kahneman-assis...
Some of its wording is weird, like mentioning his wife dying in the same context of two other partners with no explanation. The original is a much better read.
I'm surprised and fascinated that this is apparently legal in Switzerland. The Netherlands, famous for allowing assisted suicide, has pretty strict criteria for this[1].
In particular, the physician must "be satisfied that the patient’s suffering is unbearable, with no prospect of improvement", which from this article sounds far from the case here.
[1] https://www.government.nl/topics/euthanasia/is-euthanasia-al...
It is surprisingly hard in NL; we have familiar Alzheimer and had some practice by now, but it is very easy (depressingly so) to arrange your assisted suicide for when you get Alzheimer a long time upfront and still not get it because you did something wrong in the procedures/paperwork and end up going through all the suffering you planned out not to go through. It is not 'oh then they just sit in a home without memories'; it is a devastating process definitely far worse than death.
In the US, in the states that have medical suicide, the problem is that you need to:
1. Administer the medication yourself
2. Be of "sane" mind at the time you do it.
3. Have a doctor certify that at the time you choose to do it, you are in unbearable pain/suffering, and there is no realistic relief from it.
This rules out dementia (especially item 2). So people here who are in early stages of Alzheimers go to Switzerland as well.
Euthanasia in Switzerland ^ has been a notorious profitable practice for years, compared to the Netherlands where it's almost exclusively practiced on those with terminal debilitating disease.
^ Yes, it's "illegal" but it's effectively nulled if the means to it are made legal.
It is illegal to profit from assisted suicide in Switzerland. All organizations that are involved in assisted suicide are nonprofits.
Every assisted suicide is then investigated by the police to ensure no profit motives exist.
Why does one have to pay an extraordinary amount for it then? Does all money go to the facilities and the staff? (which mind you by law isn't mandated to consist of physicians)
Again:
Yes, it's "illegal" but it's effectively nulled if the means to it are made legal.
> Why does one have to pay an extraordinary amount for it then?
I don't know what you mean by "an extraordinary amount." It's about $10,000, which covers multiple consultations, medical assessments, interactions with the government, the nonprofit's operational costs, and so on.
Then I do wonder why no company has come knocking to the door of the hospital room where I'm sitting right this minute waiting for my terminally ill mother to die. Because since years she's member of EXIT, the well-known Swiss institution that is providing assisted suicide services, and it would still take several weeks for us to jump through all the required paper and legal hoops to get the ball rolling. And now she being already unconcious and therefore incapable, most ways are blocked already, as others pointed out, so I'm not sure we could accelerate the process at all.
Sorry, but your comment smells rather about peddling fakery, especially as you have provided heaps of reliable references.
Related, a 5 page page PDF, freely downloadable:
Should assisted dying be legalised?
Philosophy, Ethics, and Humanities in Medicine volume 9, Article number: 3 (2014)
Thomas D G Frost, Devan Sinha & Barnabas J Gilbert
https://peh-med.biomedcentral.com/articles/10.1186/1747-5341...
Abstract
When an individual facing intractable pain is given an estimate of a few months to live, does hastening death become a viable and legitimate alternative for willing patients? Has the time come for physicians to do away with the traditional notion of healthcare as maintaining or improving physical and mental health, and instead accept their own limitations by facilitating death when requested? The Universities of Oxford and Cambridge held the 2013 Varsity Medical Debate on the motion “This House Would Legalise Assisted Dying”. This article summarises the key arguments developed over the course of the debate. We will explore how assisted dying can affect both the patient and doctor; the nature of consent and limits of autonomy; the effects on society; the viability of a proposed model; and, perhaps most importantly, the potential need for the practice within our current medico-legal framework.
A quote from the above:
> It is difficult to reconcile that citizens may have the right to do almost anything to and with their own bodies– from participating in extreme sports to having elective plastic surgery– yet a terminal patient cannot choose to avoid experiencing additional months of discomfort or loss of dignity in their final months of life.
One issue I think about a fair bit is that without legal assisted suicide aside from all the usual issues with unassisted suicide you need to end things even earlier to make sure you do it while still physically capable: with age the risk of physical debilitation increases sharply, a bad fall or a small stroke will see you in the hospital or incapable of moving an arm. Which is on top of the risks of mental debilitation taking away your right to self determination (through simple incompetence).
So he was very old without any significant problems, but he wanted to avoid the inevitable problems?
If you’ve already made it to 90 with no major issues, you’re expected to make it to 95 and you could make easily live to 100. My wife’s grandad is 90 and he still lives alone, drives, plays golf nearly everyday, and regularly sees his 12 grandchildren and many great grandchildren. He even made the 9 hour trip to come see us last year.
I’m very wary of making it legal for doctors to euthanize an otherwise healthy person who just wants to avoid an eventual decline.
It’s relatively common for families to push people into nursing homes, but in this case there’s an even stronger direct financial incentive. I don’t trust the system to adequately prevent this.
> If you’ve already made it to 90 with no major issues, you’re expected to make it to 95 and you could make easily live to 100. My wife’s grandad is 90 and he still lives alone, drives, plays golf nearly everyday, and regularly sees his 12 grandchildren and many great grandchildren.
Counter-anecdote, my partners Granddad is 93. Age 90, we said the same as you. Now he's an old, rude, obnoxious liability - he's still great, and I don't hold it against him, he's earned the right. But I've never known anyone naturally age and die without losing their ability to be civil in some way towards the end.
From the article:
> Kahneman knew that many would see his decision as premature. But that was exactly what he intended, he wrote: If you wait until a life is "obviously no longer worth living", it is already too late.
I personally wish my partners final memories of her Granddad were him at 90, and not at 93. I've known for a good 5 - 10 years I will take the same route as Kahneman. I feel the desire to stay alive long enough to be a liability for yourself and those around you is a decision motivated by ego and fear, rather than compassion or logic.
>I feel the desire to stay alive long enough to be a liability for yourself and those around you is a decision motivated by ego and fear, rather than compassion or logic.
Everyone becomes a liability at some point. By that logic we should just go full Logan’s run and kill people as soon as they stop being productive.
There nothing wrong with saying that you aren’t going to take extreme measures to preserve your life past a certain age.
But I don’t want this attitude of “you should kill yourself so you don’t burden your family” to become the norm either.
What if your partner’s grandad heard you calling him a rude obnoxious liability and felt pressured into killing himself?
>I've never known anyone naturally age and die without losing their ability to be civil in some way towards the end.
But many people die suddenly with no serious mental decline at all. That can happen at 95 or 100 the same as it happens earlier.
If you rule out everyone who didn’t die of some nebulous cause as the result of a slow decline you are selecting for people who mentally decline.
> Everyone becomes a liability at some point. By that logic we should just go full Logan’s run and kill people as soon as they stop being productive.
That's ridiculous. People can be unproductive, but not a liability.
> But I don’t want this attitude of “you should kill yourself so you don’t burden your family” to become the norm either.
I can see that, but you haven't explained why. Personally, I don't want to burden myself, my family and those I care about, that's important to me. There must be something more important to you that justifies burdening loved ones with a hard painful death of a loved one. Help me understand: what's that thing for you, if not ego/fear?
> What if your partner’s grandad heard you calling him a rude obnoxious liability and felt pressured into killing himself?
The alternative is he's unnaturally kept alive in a perpetual state of suffering for him and the people around him. If he hadn't suffered mental decline, I know he'd never consciously choose that, another reason why I'd like to make sure I'm gone before serious decline kicks in.
> But many people die suddenly with no serious mental decline at all. That can happen at 95 or 100 the same as it happens earlier.
That doesn't change anything. I agree with Kahnemans point that becoming a burden is too late. If I accept that, without being able to predict the future, it then becomes a game of risk. Kahnamen decided the risk of him becoming a burden was greater than the risk of him continuing to live what he would consider a productive (edit: "valuable" is probably a better word here) life.
My nan made it to 92 without any mental issues, but then deteriorated significantly over the course of 18 months, forgetting she'd ever been married, had kids, etc, just reverted to believing she was a teenager who wanted to go home to her parents (in a house which was destroyed in ww2)
She couldn't look after herself was was forced into care by the courts. Since going into a home she's physically never been fitter, but mentally she's not the person she was 10 years ago -- it's not that she's changed personality, it's as if her memory of the last 80 years was wiped.
That’s terrible, but you never know when or if the decline is going to happen, so if you pick an arbitrary cutoff you’ll have killed people who had plenty of good years left.
Many people die suddenly with no decline at all.
It's an interesting thing. Aside from the constant complaints she's being held prisoner she's far happier now than she was 10 years ago, but the person she was no longer exists. How does that factor in to how wishes can be expressed. What is important - the mind or the body?
Your assertion
> If you’ve already made it to 90 with no major issues, you’re expected to make it to 95 and you could make easily live to 100
Doesn't really hold up, either in my anecdote (life) or in data
In the UK 70% of men aged 90 today will die before being 95. Most will die before turning 94. Women have about 40% chance of making it to 95.
If the society treats people badly, that's not a reason to deny them the ability to do final exit with dignity. We must fight to fix the problem cases, not take dignity away from those who suffer from it.
> It’s relatively common for families to push people into nursing homes,
So you are rejected by your family and punished even more by taking away a dignified exit strategy?
Nothing is being taken away. Medically assisted suicide to prevent old age has never been a right anyone has had under any legal framework until very recently. And it’s not a right anyone has anywhere but a few countries.
You can argue that more countries should grant that right. But if you’re going to do so, you need to have an answer for the incentives it creates.
I agree with your legal assessment and still think of the case as very interesting. The article explicitly talks about how any such decision could have only been premature, for the slow cognitive decline is typically only noticed when it is too late, and because the change is continuous, there can be no good commitment to "I no longer consider this life worthwhile once condition X is no longer satisfied".
Took care of someone with Alzheimers for six years until they passed away. No one should have to exist like that, for that long. A biological shell simply of automatic inputs and outputs.
Robin Williams had to hang himself.
There should be easy medical options in the US.
I think Alzheimer's is a particularly difficult case. Before diagnosis, many of us imagine that we wouldn't want to exist in a highly deteriorated state with no ability to care for ourselves. But as you start to decline, you still feel like yourself, just a very forgetful version of yourself. On which day do you decide that what remains of your mind isn't enough to make your available future days better than no future days?
The instinct for self preservation is strong. Knowing what will come requires foresight and clarity. You may lose the capacity for informed decision making before the point where it's clear that there's not much to live for.
Many of us lack the insight that Kahneman perhaps had that in order to take control of the end you may need to leave some good days on the table.
I’m young, but I’m at the age where I’ve seen many grandparents pass away and I must say, I support assisted suicide. The helplessness of the last stretch of your life, something that can last a couple of years, where you often need to help to even stand, doesn’t seem like a period of time worth living. Further modern medicines, in my opinion insane focus on extending life of the very old, compounds this situation to something much worse. I know of a relative who had 5 surgeries, 2 ICU admits in his final year, he was 84. First they were convinced his kidney was failing, then his liver, then they thought cancer and on an on that I couldn’t help but suspect whether this was a money grabbing scheme.
I do not know if this was ever widely practiced, but I think the ancient Indian ritual of going to the forest and starving to death in your last days is basically fine. It gives a dignified, sacred end to a life, while the modern medical sciences constant battle against the inevitable ends up distorting and deforming the last days of your life and forces you to leave without dignity clinging to the last vestiges of your humanity that’s left.
Ever since I watched my father waste away in agony and die in a veterans home, it has become my greatest fear in life to suffer until the bitter end. I choose euthanasia because I don't want to put my family through that, and the last thing I want to do, if you'll pardon me, is to waste away in my own urine and feces in what will likely be a sub optimal care situation.
Same with my grandmother that had dementia.
You can get into a state of living death where the brain is mush and who you were is completely destroyed. That's hell for the family.
I saw my grandmother forget her daughter (my mother) it was heartbreaking. Seeing my mom realize her mom forgot everything about their life together was just painful.
It was just a sad existence to observe as well. Grandma lived for quiet a while with dementia and spent years trying to return to her childhood home. We'd constantly have to trick her into accepting help from us "strangers". Re-convincing her to come inside that these "strangers" wouldn't mind having her for a bit. Watching her read over the same page of a book for hours on end.
That's not an existence I want for myself or my family.
Lots of discussion of the morality of assisted suicide in this thread, and the circumstances under which it should be legal.
In the cryonics community, it's a common complaint that they have to wait until the patient is legally dead in order to cryopreserve, which can make it difficult to cryopreserve under ideal circumstances.
I like the idea of allowing individuals to opt for cryopreservation over end-of-life care. End-of life care costs so much money, it could even be neutral from a financial perspective.
Since cryopreservation lacks the finality of other forms of death, it could also address some of the ethical dilemmas around assisted dying. After all, a lot of end-of-life care seems to be motivated by a futile attempt to somehow delay the inevitable. From my perspective, cryopreservation seems slightly less futile.
If medical technology continues to advance, maybe in the year 2500 there will be people walking around who were born in the 1900s and can give talks about their experiences. Wouldn't that be cool? It would help a lot if just a single country to made it possible to get cryopreserved before you're legally dead.
You're talking about cryonics as if it were an established, scientifically proven and effective technology, but it doesn't work and is widely considered to be pseudoscience.
And mentioning the cost of end-of-life care is risible when your alternative is paying paying indefinite rent to a company for freezer space to keep a corpse frozen.
>You're talking about cryonics as if it were an established, scientifically proven and effective technology
I don't believe that. I do believe it is a hair less futile than delaying the inevitable and then burying yourself 6 feet underground.
>it doesn't work and is widely considered to be pseudoscience.
The cryonicist claim is something like: "If we save your brain in a way that preserves its information content, it may be possible for future technology to reconstruct that information content, and effectively revive you." No cryonicist is claiming that cryonics "works" with existing technology.
Consider the state of medicine in the year 1925 vs the state of medicine in the year 2025. Now extrapolate that advancement trend forwards until 2525. Is extrapolating trends forward a form of pseudoscience? If so, what do you say about global warming?
>And mentioning the cost of end-of-life care is risible when your alternative is paying paying indefinite rent to a company for freezer space to keep a corpse frozen.
Keeping a closed canister filled with liquid nitrogen is not especially costly.
Alcor charges $80K out of pocket for neuropreservation: https://www.alcor.org/membership/pricing-and-dues/
The Lancet says a typical American accumulates $155K in healthcare costs during the last 3 years of their life: https://www.thelancet.com/journals/lanam/article/PIIS2667-19...
Long-term care costs are rising fast: https://www.nytimes.com/2025/05/24/business/retirement-long-...
(BTW, I appreciate that you made a falsifiable claim here, since that helps readers evaluate the credibility of your other claims. A sort of within-comment Gell-Mann effect.)
> And even at the end, when asked what he would like to do, he said: "I would like to learn something."
Don't have an exact word to describe how I feel after reading above. Find it beautiful that such an accomplished person wanted to learn something even towards the end of his life.
Everyone talks about Alzheimer's and dementia, but Daniel Kahneman has neither. He chose to commit suicide because he wanted to avoid “natural decline.” That's an unexpected statement from a 90-year-old. I'm more surprised by his lack of will to live and that he just “gives up” and throws away the most valuable thing he has.
We definitely need a better culture around dying. My mom is 95 and slowly everything she likes is being taken away from her. Going for a walk is difficult because she has unpredictable falls, husband is dead, all friends are dead, eyesight is so bad she can't read anymore, memory is failing. Really nothing to look forward to. Just existing and waiting for things to get worse.
Mentally she is still pretty clear and she often says it would be best if she doesn't wake up in the morning.
I think it would be better for everybody if we had a way to have a ceremony where we all say goodbye and then end it.
”Daniel Kahneman did not want to make a statement or start a debate. "I am not ashamed of my decision," he wrote, "but I don't want it to be discussed publicly either."”
Seems like we should close this thread to honor these wishes
This is one reason why as I’ve entered my 50’s, I’ve decided to take every advantage of modern medicine including hormone management and performance enhancing drugs. I started three years ago at 47 and now I’m living my best life at 50, in the best physical condition that I’ve been in since my early twenties. Although I’d certainly like to live a lot more years, I care more about my quality of life than the quantity of years. If I make it to my 80’s, it’ll be with the testosterone of a man in his 20’s and muscle mass on my body.
I think it's beautiful he got to go out on his own terms, when he felt it was the right time to do so.
I'm often reminded about a case in my own country: a young person had decided it was time to end her life after struggling for many years, without a sign of improvement. She was denied the right to euthanasia. After multiple failed suicide attempts, she went for the nuclear option and jumped in front of a train.
Everyone deserves to die in a dignified and humane way, not in multiple pieces or with a mind deteriorated beyond recognition. Forcing prolonged suffering is unnecessarily cruel. I wish more countries were as progressive with euthenasia as Switzerland.
Coincidentally, today there was an article in a Belgian newspaper about a 25-year-old woman who will undergo euthanasia in a few weeks due to severe psychological suffering with no prospect of improvement. After years of suffering and 40 failed suicide attempts, I indeed think it's much more dignified to have euthanasia as an option.
Euthanasia has some strict rules in Belgium, especially for cases involving psychological suffering. In 2014, the age restriction was dropped (except for psychological suffering). Since then, 6 minors have received euthanasia.
I saw someone interviewed who had set the criteria of being able to enjoy some ice cream with his children and grandchildren at the regular family dinner on Sunday late afternoons.
He said that alone made life worth living, for him and them, but once any deteriorating conditions rendered him permanently unable to participate in this weekly activity then he felt it was time to go.
Maybe having a pre-set condition like this is less arbitrary, and also allows everyone involved to understand as the time comes closer.
I think this is a fair measure of any life -- are there enough positives to offset the negatives? And that includes the cost (and the benefit) of your suicide on others. No one but you should be able to make that call. All that remains then, legally, is to ensure you are well informed about the de/merits of your choice and sane enough to make the call.
Of course, even if you lack legal permission, suicide doesn't strictly _require_ legal or medical assistance. An autonomous exit is always an option, though generally less painless than assisted.
My dad is in the early stages of Alzheimer's and it's made me think of what I'll do if I find myself in the same situation
Assisted suicide sounds like a fine option until you think of its impact on your loved ones. Imagining putting my wife and kids through my deciding to die, and the process of them bringing me to the place where it happens - or imagining one of them doing the same thing - just fills me with horror
Death comes for us all. It’s okay to cultivate emotional fortitude to die on own terms, at the place and time of our choosing, with grace. Would you rather them remember you as a shell of who you were, long dead mentally while the body continues on? Death is a part of life we cannot avoid, nor should we.
> If you wait until a life is "obviously no longer worth living", it is already too late —- Kahneman
Live your life in a way that it is worth living until you no longer can, I suppose. To exist is hard, do your best.
One of my friend's parents had a neurological disorder in his later years and was considering suicide. I don't know the details, but I know he had mentioned it to my friend. I believe he was convinced to try one more procedure that the logistics never lined up for. He ended up dying anyway a short number of years later.
He kept to himself, so I didn't know him well. I did know that he was an independent and thoughtful man who hated that his tremor got so bad he couldn't feed himself. I remember talking with his family about if those self-balancing Google spoons might help.
There are two kinds of people for whom suicide sounds appealing: those in poor health who don't want to experience it getting poorer, and those for whom the difficulty of being alive outweighs the joy of it. If you're in the former camp, that pain is coming for them anyway. If you're in the latter camp and still make the decision, maybe you don't have those close bonds that make you want to persevere.
Death happens to all of us. I’m 51 and as far as I know have no terminal illness. I stress to everyone that I focus on “living a good life. Not a long life”. My wife and I balance living every year like it might be our last and saving for a long life. We don’t put off traveling, concerts, hanging out with friends and other experiences so we can “retire rich”. If we can’t afford expensive travel in our 60s because we spent our younger healthier years traveling - so what? Statistically we won’t be healthier in ten years than we are now and we are both gym rats.
I “retired my wife” at 46 in 2020, eight years into our marriage so she could enjoy her passion projects and I have turned down more lucrative jobs that would have required me to work harder and be in an office so I could work remotely from anywhere - but realistically in US time zones.
Everyone who knows me, knows that I would die with no regrets. As far as my wife who loves me and my grown (step)kids who I know also love me, I don’t owe physical suffering to anyone. Assisted suicide because of Alzheimer’s is more tricky than something like cancer though. What can you do? Sign something in advance where once you can’t pass a cognitive test three months in a row - kill you?
I'm totally in favor of assisted suicide, and I think it's a good mechanism for those suffering, if voluntarily chosen.
That said, I think the same, and there are some non-obvious second-order effects around it being the menu, especially regarding life extension incentives and if people started to feel guilt-tripped by it.
The first thing that comes to mind is a reduction in commitment to the elderly. As soon as health care costs ramp up, people will start to make more decisions based on the economic aspect of the people's support instead of thinking in life extension mechanisms as a natural first choice.
Second, it is related to the public health services. From my experience in some parts of EU/America, if you have a disease until your 50s, you will get treatment. However, after that, there are probably some parts of the public/private health system that throttle down the treatments.
The 2-week interval between a return if you are 30s/40s, will become 6 weeks if you are over 60s.
The next one, the "inheritance social contract," will be changed. As long as folks know that assisted suicide will be placed on the menu, I do not doubt that folks terrified with the possibility of loved ones "not doing enough to keep them alive" will dilute everyone who lifts the gas.
And as a second-order, I can see the securitization and life insurance industry will demand insane premiums to cover elderly persons, given that potentially people can lift and coast the treatment for their loved ones, and this can break part of their actuarial models, which, yes, expect people to exhaust resources to keep their elderly alive and not to choose together to pull the plug in a single-digit number of years before.
And maybe a third-order effect (in Germany there are some cases) where people with resources (single-digit million real estate + assets) exercise liquidity on it and live the best of their lives after 70 or in some cases, legally marry 30+ nurses to take care of them in the last 3 years and offer a chunk of inheritance, post-death pension, or insurance premium.
Good account of his reasoning. Off topic, but my Dad’s last girlfriend before he died two years ago was a co-founder of the Hemlock Society/International Right To Die organization - huge effort to get assisted suicide made legal in different tax jurisdictions around the world and different states in the US.
assisted suicide bears risks similar to adding benevolent backdoors to software. The policy rests on the assumption that policies and those enforcing them will always be benevolent.
We're opening up tremendous abuses of power by allowing the state to kill people for non-criminal behavior.
Sure the first iteration is presented as "voluntary", but the next edition will be for the greater good. And how about sinister / malevolent abuses of "voluntary" suicide -- similar to abuses over guardianship.
at least with guardianship the person can be set free, because they are still alive.
This is a bit of an aside but I wonder if people who possess greater intellectual capacity are more resilient - at least outwardly - against old-age mental decline, as even their mental function diminishes, they have an excess buffer so that they are slower to cross the 'threshold' where their inability to mentally function in everyday life becomes apparent?
I see a lot of comments here expressing disapproval about assisted suicide.
I'd like to quote from the HN guidelines:
> Don't be curmudgeonly. Thoughtful criticism is fine, but please don't be rigidly or generically negative.
With that said I urge you those who disapprove to ask whether you are being "rigidly negative" about this.
1. Is this disapproval perhaps coming from your religious context? If so, please pause and consider why that may not apply to the rest of us. And also whether you really think that your religious beliefs must be forced on the rest of us.
2. Is this disapproval coming from a sense of deep unease that this post causes? If so, know that this unease is shared by most of us. But try and muster the fortitude to go past that unease and consider the decision from a place of compassion.
My mum died earlier this year. In hospital, she was approved for assisted dying. There is a mandatory waiting period as part of the process.
Many/most of the nursing staff are Filipino and strongly Roman Catholic.
As she lay dying and unable to speak, one of the nurses undertook to convert her at this last minute to their religion. At night, alone, after all visitors had left, she would come into mum's room and press mum, a very committed atheist, to pray for her salvation.
It's hard to describe how vulnerable someone is who is stuck in their bed and dependant on the nursing team for everything, even sips of water.
I will say this was not representative of her care, but it opened my eyes to the lengths religious believers will go to to push their views on others.
Sorry to hear that, that is completely unacceptable behavior.
That was a heartrending account. Am so sorry for your loss. Both she and you deserved to be treated better.
"His decision seems to have been based less on his famous scientific thinking and more on a very personal feeling. He wanted to retain his autonomy until the end and to shape his own end."
So you could say it was more system 1 thinking rather than system 2.
I would've expected the opposite given our survival instincts.
Death with dignity must be more accessible to more people who, by their rational choice, wants to use it.
I find it somewhat fascinating that the article has a giant "Suicidal thoughts? You can find help here:" footer.
I don't think it's a link to an assisted suicide/dying with dignity center.
Society's relationship with intentional end of life decisions is fraught, to say the least.
There's a Star Trek episode with this exact plot https://en.wikipedia.org/wiki/Half_a_Life_(Star_Trek:_The_Ne...
An interesting choice. It's fascinating that even for very ill or injured people the will to survive is so strong - I wonder if at a certain age this instinct diminishes making a choice like his easier?
> I wonder if at a certain age this instinct diminishes making a choice like his easier?
It's less likely to be "a certain age" and more surrounding factors: if most of your friends have passed and you don't have much chance to do things that interest you because you could pass at any moment yourself there comes a point where life has limited worth.
Essentially, hope runs out, and when it's run out entirely you either wait for death, or ... don't wait.
> It's fascinating that even for very ill or injured people the will to survive is so strong
Sometimes. Chronic illnesses are a massive contributing factor to suicide rates for instance: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7...
My grandparents stuck around too long, so I have the opposite fear of burdening my descendants with having to (if not legally, then via social pressure) spend too much time, money, and energy caring for me.
I think it would be valuable to get your parents opinion on whether the burden was worth it or not. Or, unfortunately, to see if your opinion changes if you have to bear the burden of your parents in the future. It's easy to assume the burden isn't worth it when we have a bit more distance (e.g. grandparents) but I think people are more open to it than we realise - even if it comes with immense amounts of stress. Saying that I think it varies person to person. Often in families you have people who are willing to carry the burden and others who aren't and that brings even more stress and disagreement to the situation.
I had real time feedback from my mom (the daughter in law) while growing up. I would never ask or want my wife to live the quality of life my mom did for her parents’ in law.
And I don’t want that for my kids, or even from the rest of society.
There’s a solution to this you can start on right now: structure your life and experiences such that you become an awesome grandparent with hilarious stories, humility and appeal to your grandchildren.
I probably won’t ever meet my grandchildren if there are any, because I am over fifty and single; I probably will never be a parent. So I will have to go a lot sooner if I am not to be a burden on society. But if you think you are going to be a grandparent, you can work on being an irreplaceable and useful one.
I am referring to being so old that you are dependent on others everyday such that the caregivers cannot go on vacation. One set of my grandparents both lived to 100, and they had a 15 year age gap, so that was the first 30 years of my life that my parents sacrificed time with their kids, professional life, and personal life.
Very few people are independent after age 80, and a miniscule amount after 90.
Maybe at a certain age other instincts strengthen making a choice like this easier? We all have to come to terms. And if you are older than 70 then it is just a fact that every day can be your last without any accident or noteworthy medical complication. And the guy has been probably thinking about this fast and slow for at least two decades then.
Are you sure you understand how painful pain can be? Especially when you experience it daily and there is no hope for recovery?
For every Daniel Kahneman case, there's a case where the victim doesn't give consent, is coerced, or pressured from caregivers. It always rapidly expands from terminal illness to mental illness or non-terminal conditions. There's also weak oversight and misaligned profit motives. The examples in the Netherlands, Switzerland, Canada, and Oregon are shocking.
It's another thing to not give palliative treatment to prolong life for a little more and another to provide poison to accelerate death. My opinion is to continue palliative care when the benefit outweighs the harm in the QUALITY of life (not necessarily quantity) and infuse some morphine 1 or 2 days before death in order to skip the last stage.
Not going to express an opinion, I'll just leave this except from the Hippocratic Oath [1], which reflects society's primary beliefs on this topic approximately up until the 19th century:
> οὐ δώσω δὲ οὐδὲ φάρμακον οὐδενὶ αἰτηθεὶς θανάσιμον, οὐδὲ ὑφηγήσομαι συμβουλίην τοιήνδε
In English:
> Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course.
The modern hippocratic oath has no mention of poisons, also doesn't require the oath to be sworn before the gods of the pantheon. Up until the 19th century, physicians didn't believe in germs either. Attitudes change with the knowledge we accumulate.
That's likely to be a consequence of prevailing religious norms of the time.
I will, ahem, take steps to ensure I never get dementia
To me, Daniel Kahneman humiliated himself by choosing suicide (if he was in a sound state of mind to make that decision). He was a scared, little old man. He made an assumption that his life was "obviously no longer worth living", how little he thought of life is pathetic.
Now he could have been depressed after his wife died and was just lying to himself that this was his own, autonomous, decision. Depression can do that to you, it can make you think suicide is the most rational decision.
Assisted suicide is not how a healthy society should respond to serious mental health conditions.
As a person who lost my life partner six years ago to a brain tumor I completely understand what he did. After seeing things first hand I too don't intend to wait for old age and illness to devastate me. I'm barely over half of his age with no serious health issues that I know of so it's not the time for me yet. But I can fully understand his reasoning.
Seems like a good way to go out, "my choice, my body" . I realize some psychological exam should be necessary before such things but it really should be self-determined within reason. I hate that USA is so far behind the curve on this, but eventually we might catch up on it with Europe and not have to resort to more ugly methods.
I used to be for assisted suicide but I have changed to be against. The things that changed my mind is seeing how it has gone in countries that have implemented it like The Netherlands and Canada with what I consider to unethical assisted suicide of people with mental disorders and disabilities. It smacks of state sanctioned killings disguised as charity. The second one was what kind of psychopath assists in the killing and why is that person allowed to keep practicing. Finally if we can kill ill people what really is the difference in implementing the death penalty and justifying it by ending the criminal insane’s suffering?
A psychopath that reads stuff like this https://www.theatlantic.com/magazine/archive/2023/06/canada-...
You have to somewhat lacking in critical thinking if you look at assisted suicide and its implementation and still back it.
I mean...is there anyone here who isn't on this bandwagon?
This always comes up with this prize, but it’s generally considered one of the Nobel prizes, although it’s not one of the original prizes. Your opinion on whether it should count is up to you, but to call it media manipulation is reading a lot of malice into it.
Argument is that economists knew exactly what would happen when they got linked with Nobel Prizes and help solidify economics as hard science like physics, medicine or math in eyes of the public. Begin debate around how scientific is some economics.
That sounds a bit harsh - probably more simplification than manipulation.
Your quote says Nobel Memorial Prize or what am I missing?
In a piece about life and death, about the will to live a full life, you choose pettiness.
> Now this is ironic.
Ironic is the opposite of what you mean, don't you think? By your explanation, Kahneman acted according to his life's work.
> The guy who spent his life researching how to live rationally chooses suicide at age 90, upon seeing “increasing metal lapses”, presumably in order to not ever live irrationally.
That was possibly part of his motivation. But also the pain, suffering (goes broader than physical pain), confusion, and cost -- to him and his family.
It's not unsettling for me, but I have a similar feeling. On the other hand, maybe he did have a medical issue, just chose not to disclose it. In any case it is his choice, as is the wish not to discuss it. I think this will be difficult to enforce, but I will personally respect it.
Daniel wrote one of my favorite books, Thinking: Fast and Slow (https://www.amazon.com/Thinking-Fast-Slow-Daniel-Kahneman/dp...). If you haven't read it, and you're into economics, behavioral psychology, and thinking about thinking then I'd highly recommend it. The first half of the book is especially compelling.
You will be missed! Sad to hear he passed, but glad he was able to go out on his own terms.