As a physician, I can tell you that euthanasia has been always around in every society and at all times. MAID just made the arrangement formal. Before MAID, it was implemented by withdrawing life-saving treatments (usually due to side-effects), rising doses of narcotics (for painful conditions) or even "terminal sedation" (the most explicit form of euthanasia before MAID-like laws).(And of course, patients always had the option of taking their own lives). In any healthcare system, there has to come a point where patients (and their families) and their doctors decide to terminate efforts aimed at extending life. In most cases, MAID is just a way to shorten the unpleasant interval between that decision and death. Given all that, it is not that surprising that 5-7% of deaths are attributed to MAID. The debate about MAID is another example where a lot of otherwise rational people fall prey to misguided sloganeering.

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snapplebobapple 14 hours ago | parent | next [-]

I don't think it's that misguided. The incentives are so perverse here that, if the government isn't abusing it, they are acting incompetently. it would almost be better if they just had the actuary provide an expected life and expected cost chart and we agreed to pay the potential MAID recipient's estate 10% of the savings remaining on the day the chose to go, if they choose MAID.

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Eddy_Viscosity2 8 hours ago | parent [-]

How are incentives perverse? Would it be better to have a system that only incentivizes life extension, no matter the suffering it causes, no matter that it will still ultimately end in death?

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snapplebobapple 7 hours ago | parent [-]

It's not about whether the person should live or die, it's that the Canadian government has vested responsibility to provide healthcare in itself while making other options illegal. I can't make my own choice to, for example, buy my own medical insurance to ensure I live for as long as possible with the most effective (and likely expensive) treatments. The government has said they got this and limited everyone's choice to government only.

They screwed this up via multiple mechanisms, because that's what government seems to do, and now there is a pretty decent shortage of healthcare up here. This makes the incentives highly perverse because the government can't provide the world class health care it promised even if it wanted to, which leads to political pressure to bring in MAID and chop tens to hundreds of thousands of dollars of medical liability off the end of many patient's lives (which I would actually support if the underlying incentive structure was different, or if the government was at least honest about what was happening and compensating the MAID recipient's estates for forgoing treatment the government is obligated to provide but would be better for said government if they didn't). The most concerning bit here is the lack of provision of other life improving services like joint replacement, the latest experimental drugs, etc. and the likelihood that that is funneling people into a situation where MAID is the obvious best choice sooner than it otherwise would be. This is certainly happening with cancer treatments (although probably not intentionally, just incompetently) as people get detections for cancer and then find a months long wait list instead of days to weeks long wait list to see someone who can progress their treatment.

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Eddy_Viscosity2 5 hours ago | parent [-]

> which leads to political pressure to bring in MAID and chop tens to hundreds of thousands of dollars of medical liability off the end of many patient's lives

So this is an assertion that requires some evidence. The political pressure was instead from a majority of Canadians (across political lines) who want there to an an end-of-life option in situations when life becomes intolerable. People do not want to be forced by the state to stay alive and suffering via extensive medical interventions. Nor do they want to have to suffer through the alternative of slow and debilitating conditions that science is powerless to stop. This is the where MAID came from. Thinking of it in purely economic terms is already acting in bad faith.

> compensating the MAID recipient's estates for forgoing treatment

If you paid for private medical insurance, would you expect the same from them? To compensate your estate if you choose to end your life early rather that receive invasive and expensive treatment to temporarily forgo the inevitable? Even if you did expect that, insurance companies would never go for it. An even by the widest stretch they did then you're back to the same economic incentive but now with private industry. This is even worse I would say, because now people would be given a cash bonus to commit suicide (either by the government or private insurance, the same applies if people were compensated for foregone treatments). People with families in financial trouble may even consider this a way out to help loved ones. That is a crazy perverse incentive if you ask me.

On the side of offering better services, you have my whole-hearted agreement. Even something as simple as mandating an increase in the number of available seats at medical schools that corresponds with the population growth would be a start. Lots more to that list.

	▲	snapplebobapple 2 hours ago \| parent [-]
		The political pressure is budgetary and care related. Are you claiming MAID does not save money and decrease usage by ending expensive care earlier than it would otherwise be ended? I would expect private care to uphold whatever I agreed to when buying insurance from them. You continue to miss the point that there is no other option in Canada because the government made the other options illegal, which is what creates the liability. They can't make care in any other form illegal and also not provide care. I am also talking about the specific case where the person is terminally ill, not the way more crazy version we have rolled out letting people with no impending doom opt for suicide. Limiting this to the defensible type of MAID limits the perverse incentive you are concerned about to almost nothing. You trust the government to do the right thing when they have continually proven they will choose the wrong thing if it is convenient or the outcome most likely under incompetent management.

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troad 17 hours ago | parent | prev [-]

> The debate about MAID is another example where a lot of otherwise rational people fall prey to misguided sloganeering.

This is the same level of argument as saying that people who vote for the other guys must have been tricked by FOX News / MSNBC / Russia / Tik Tok / transtrenders / tradwives, and if only they truly understood their actual self-interest they would agree with you on all things. It's a bad style of argumentation, albeit very popular in academia ('why do the poor keep voting wrong?').

There are legitimate reasons to oppose Canada's euthanasia program on its own terms, and it's not surprising the Canadian government has very carefully shielded MAID from any sort of public input or oversight, since it's deeply unlikely it would pass a majority vote in its current form. There is consistent public opposition to euthanasia being available to anyone but late-stage terminally-ill people (and even then, it's divisive at best). There is strong public opposition to euthanasia solely on the grounds of mental health.

More broadly, I think people are increasingly sick of the misuse of the term 'healthcare' (or 'public health') to sneak unpopular or controversial policies past the electorate, and the idea of 'death as healthcare' is probably the most extreme example of this trend. When people cannot express democratic opposition to policies they deeply oppose, don't be surprised if you get pushback and populism.

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greygoo222 15 hours ago | parent [-]

73% of Canadians support MAID https://pubmed.ncbi.nlm.nih.gov/38910003/ 71% of Americans believe doctors should be "allowed by law to end the patient’s life by some painless means if the patient and his or her family request it" https://news.gallup.com/poll/648215/americans-favor-legal-eu...

These policies are supported by a strong majority of people.

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troad 14 hours ago | parent [-]

Literally the abstract of that very study:

> Only 12.1% correctly answered ≥4 of 5 knowledge questions about the MAID law; only 19.2% knew terminal illness is not required and 20.2% knew treatment refusal is compatible with eligibility. 73.3% of participants expressed support for the MAID law in general, matching a nationally representative poll that used the same question. 40.4% of respondents supported MAID for mental illnesses. Support for MAID in the scenarios depicting refusal or lack of access to treatment ranged from 23.2% (lack of access in medical condition) to 32.0% (treatment refusal in medical illness)

Most Canadians express support for MAID but cannot correctly answer questions about it. When Canadians are actually told what's in MAID, they oppose it.

It's also worth noting that quite a lot of polling on this question is done by, or on behalf of, pro-euthanasia organisations; there is often a huge mismatch between the questions asked and the actual legislation proposed and passed (in a very motte-and-bailey kind of way).

	▲	greygoo222 12 hours ago \| parent [-]
		People stated they supported the policy after reading a full description of the policy. If you don't trust the paper (whose researchers are anti-euthanasia), the Canadian government found the same results. https://researchco.ca/2023/05/05/maid-canada-2023/ Nobody ever correctly answers questions about legislation, to put it glibly. Any piece of legislation newer than 10 years and more complex than a sentence is not going to pass such a test with the general public. 19.2% knew that terminal illness is not required? I would be shocked if 19.2% could correctly answer a few basic questions about the definition of "terminal illness."