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Dying Well: Stoicism and Euthanasia (Episode 27)
574 Plays1 year ago
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What's the Stoic view on active euthanasia?
In this conversation we discuss MAID (medical assistance in dying), Canada’s active euthanasia law.
Warning: We’re discussing suicide. That’s what this episode is about.
We discuss why this is an important issues, what the Stoic view on suicide is, and how that applies to the political issue of MAID.
(01:18) Why Talk about MAID?
(02:28) Background on MAID
(07:46) Stoics on Suicide
(23:22) The Stoic View of MAID
***
Stoa Conversations is Caleb Ontiveros and Michael Tremblay’s podcast on Stoic theory and practice.
Caleb and Michael work together on the Stoa app. Stoa is designed to help you build resilience and focus on what matters. It combines the practical philosophy of Stoicism with modern techniques and meditation.
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Caleb Ontiveros has a background in academic philosophy (MA) and startups. His favorite Stoic is Marcus Aurelius. Follow him here: https://twitter.com/calebmontiveros
Michael Tremblay also has a background in academic philosophy (PhD) where he focused on Epictetus. He is also a black belt in Brazilian Jiu-Jitsu. His favorite Stoic is Epictetus. Follow him here: https://twitter.com/_MikeTremblay
Thank you to Michael Levy for graciously letting us use his music in the conversations: https://ancientlyre.com/
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Transcript
Introduction to Stoicism and MAiD
00:00:00
Speaker
I think typically in the modern era for most of us, at least for me in the States, death isn't really very present. For most of us, I think it's something that we know will happen that occasionally happens to our loved ones, but on a day to day, it's just not at top of mind. But for the Stoics, they emphasize that we've chosen to continue living and there's a real freedom in that, that we've chosen to embrace life,
00:00:29
Speaker
Welcome to StoA Conversations. In this podcast, Michael Trombley and I discuss the theory and practice of stoicism. Each week we'll share two conversations, one between the two of us, and another we'll be an in-depth conversation with and experts.
00:00:46
Speaker
In this conversation, Michael and I discuss maid or medical assistance in dying, Canada's active euthanasia bill. As a warning, we are discussing suicide.
Significance of Discussing MAiD
00:00:57
Speaker
That's what this episode is about. We give some background on maid, talk about the stoic view of suicide, then move to how we think stoics should think about maid. Before that, we start with the discussion of why this issue matters. And here is our conversation.
00:01:18
Speaker
I suppose I would give two reasons for why this conversation is important to do. First, it's a matter of important policy and we often get questions like, what do the Stoics think about X? What's the stoic view on some controversial issue, some policy, what have you?
00:01:36
Speaker
And the second reason is that the Stoics and many other ancient philosophers thought that an aspect of living the good life was dying well. And that was a crucial part of what it was to live well, is to die well. And this policy made is part of the
00:01:59
Speaker
cultural picture, if you will, of what it is to die well.
Criteria and Framework of MAiD
00:02:04
Speaker
And for that reason, I think it's worth discussing. Yeah, that's a great way of putting it. The kind of the question, a really important question for the ancients is how to die properly, which not a question we ask that often, at least not proactively, or at least not until it's time to. And this is a policy that affects people's ability to die either properly or improperly to pay on your position on the matter.
00:02:28
Speaker
So first thing I'm going to do is provide some background context for those that aren't aware. So in terms of what made, so made is, as I mentioned before, it's medical assistance in dying. So it's, it's a law that allows healthcare professionals, doctors, and I believe kind of senior nurses and some to assist patients in, in dying. And obviously there's a number of criteria that are required for this to be, for it to qualify for made. It's not like.
00:02:55
Speaker
anybody can do it and it's not like it can happen under any circumstances but in the circumstances it does happen legally the medical professional is protected and is enabled or empowered to do that and that's the important distinction is they're not kind of it's not a it's not an ethical endorsement which i guess you could do regardless of the law but it's a it's a legal endorsement of this is an okay thing for you to do without committing murder and fulfilling your role as a as a health care provider
00:03:18
Speaker
So in terms of the criteria of what made requires, first of all, in Canada, you need to be 18 and you need to be mentally competent.
Legal Protections and Statistics for MAiD
00:03:25
Speaker
This is, this is the specific language. So you can't be below 18 and you can't be deemed medically incompetent to provide that. You have to have a grievous or.
00:03:35
Speaker
Irimediable, so incurable medical condition, and a grievous illness is defined as something with unbearable physical or mental pain that cannot be reversed, or a general state of decline that cannot be reversed.
00:03:51
Speaker
An important distinction here is that this currently excludes mental illness. So in terms of what can qualify under that criteria, it excludes mental illness, but the Canadian government will reevaluate mental illness's inclusion in 2024. So that's right at the edge of inclusion. So you have to be above 18 mentally competent. You have to have a grievous, irreversible, incurable medical condition.
00:04:16
Speaker
You have to make a voluntary request for made, not born from pressure or outside influence. That's part of the consent picture. So you have to voluntarily ask for it and you can't be pressured into doing so.
00:04:28
Speaker
And then you must provide informed consent and that final criteria informed, the important piece there is about the information you have. So the other ones were about the state of your condition and the state of whether your request is voluntary. This third criteria, this final criteria is that you have to have all the information first. So that means you must understand your full diagnosis and the available treatments.
00:04:53
Speaker
And you must provide consent at the start of the process. So you must request and say, I consent it. And you must provide consent immediately before made is administered. So you must voluntarily and with an informed knowledge, ask for beforehand and right before it is administered. I have some other interesting factors to note about the context. So one, just other things, if you haven't heard of this before, Canada cannot require any healthcare professional to provide made. So it is.
00:05:24
Speaker
Healthcare professionals are legally protected if they choose to do so, and it satisfies those previous criteria, but Canada cannot require as a doctor or senior nurse. Last year, in 2021, so two years ago, the last year we had statistics on this, 10,000 people received made in Canada with an average age of being 76.
00:05:44
Speaker
So it's quite an old population. I know sometimes the emphasis gets placed on fringe cases or extreme cases with younger people, but at 76, it is below the average age of death in Canada. I think that's around the low 80s, but quite old still. 65% of those 10,000 people, the irreversible medical condition they had was cancer, with the other largest percentages being from heart disease and lung disease.
00:06:14
Speaker
So very kind of general, like the very common illnesses that we see. And finally, only 2.2%, so 219 of those 10,000 people who received made were individuals who did not have foreseeable death in the immediate future.
00:06:31
Speaker
So these are people in a significant state of decline, but not with foreseeable death in the immediate future. And the highest cited reason in that category was a neurological degeneration. So you think of this, you know, something like Alzheimer's, I would assume, something along these lines where it's a mental deterioration, but not a physical deterioration that will immediately lead to death.
00:06:53
Speaker
So that's a bit about the context. Anything you wanted to add in there, Kilip? That was well said. That was well said. So I think we've got a good picture of the background of what made is. And now, of course, the question arises, what's the stoic view on this?
Stoic Philosophy on Suicide
00:07:10
Speaker
And the ancient Greeks and Romans didn't have, as far as I know, any laws about assisted death.
00:07:17
Speaker
But they were generally warmer towards suicide. At least they thought that suicide was a permissible thing to do in some circumstances. The early Christians who came after them who had a very negative view, an absolute vision against suicide, which is what we see in a number of political communities today, of course. So let's move on to with the Stoics, how they grounded that judgment, how they thought about suicide.
00:07:46
Speaker
And so the idea is, first and foremost, just to get, as you said, the stoics permit suicide. That's one thing. In certain cases, I think is the other caveat. And there's a quote from Seneca, Seneca's letters that I want to read where Seneca, I think, encapsulates the view quite nicely. So Seneca says, quote, as you know, life is not always something to hang on to. Our good does not consist merely in living, but in living well. Hence, the wise person lives as long as he ought to, not as long as he can.
00:08:16
Speaker
If he encounters many hardships that banish tranquility, he releases himself. Whether one dies sooner or later is not the issue. The issue is whether one dies well or badly, and dying well means that one escapes the risk of living badly.
00:08:32
Speaker
So pretty clear here that this is an endorsement of suicide in the right contexts. And so as you said, you know, what are those contexts? Why is it permitted? As Seneca speaks to here, that I just want to get across is that death is not an absolute bad. That's one of the things, and that's why it's permitted, is because death is not an absolute evil, there's going to be some cases where the smarter action is to choose death. That's worth emphasizing is that
00:08:59
Speaker
If you understand the stoic view on indifference and know that life is an indifferent, then you know that life is neither intrinsically good or bad. So that means there's going to be some situations where it is the virtuous act extends life and other situations where it doesn't. Yeah. And interestingly, Seneca in this next passage immediately following the quote I just read, the stoics can actually think that extending life
00:09:30
Speaker
could be cowardly.
Historical Stoic Examples
00:09:32
Speaker
Extending life could be misunderstanding death. If you think death is, if you're fearful of death and you're willing to do anything to avoid death or extend life, even when life is a poor life or a life that can't be virtuous, then not only is that kind of value judgment mistake,
00:09:52
Speaker
But it's also kind of, you're kind of acting out of fear. It's not a, it's not a, it's not a brave choice to continue to extend life. It's a, it's a cowardly choice to avoid death at all costs. And Setica has, I mean, it's kind of a.
00:10:06
Speaker
Kind of a dark quote here, but it's interesting what they think. Immediately following the one I read before, he says, I think it was quite unmanly what that fellow from Rhodes said, the one who had been thrown into a cage by a tyrant and being fed like some wild animal. When someone urged him to stop eating, he replied, while life endures, all hope remains. Even if that is true, life is not worth buying at every price.
00:10:31
Speaker
So, you know, we have this, I think this is quite a funny quote from Seneca. We have this example of, you know, somebody who's enduring this incredible hardship just to survive, just to persevere. And Seneca is actually saying, you know, well, I don't actually respect that situation. I think that's actually kind of the wrong thing to do. It would have been better if you have no hope in a good life, it would be better just to accept death and end your life. And again, this is the kind of example that you get in the ancient Roman times.
00:10:58
Speaker
someone thrown into a cage, you know, thrown into a cage with no, with no hope of leaving, being fed, you know, animal scraps. And Seneca, it's, yeah, it's interesting. Doesn't, doesn't think that is, doesn't think that's a light to be preserved at any cost.
00:11:15
Speaker
Yeah, that is interesting. And of course, Seneca himself was forced to commit suicide. So one could argue whether or not that is, in fact, a legitimate case of voluntary suicide given that he was ordered to do it by Nero. But he had in mind many other people who he saw as committing worthy suicides. Of course, there's Cato the Younger who preferred to kill himself rather than give way to Julius Caesar's clemency.
00:11:44
Speaker
always a principled model for the Stoics. And there's also a gladiator that Seneca mentions on in Anger, I believe, or perhaps it's one of his letters.
00:11:57
Speaker
That's one of his letters where this gladiator prefers to kill himself rather than be a part of this battle where he's going to be forced to kill others. And Sonic of course thinks what Kato the Younger did and what this gladiator did were virtuous acts. They preferred to cease living rather than continue on in a vicious state of affairs. Yeah. Can you say more about the Kato example?
00:12:27
Speaker
Yeah, so the Cato, the younger example is Cato was fighting to preserve the Roman Republic and he was fighting against Julius Caesar and it came to, yeah, things came to a head where Cato was in the losing position and knew that
00:12:48
Speaker
Caesar would offer clemency. He'd offer mercy to Cato because that's what he did with all of his enemies. And one aspect of this mercy was, of course, a moral innovation on the part of Julius Caesar. It ceased the cycle of revenge. So that was, I think, a very good aspect of Caesar's policy.
00:13:09
Speaker
But it's also a power play, a strategic play where Caesar says, I'm the kind of person who can grant you mercy as a way to legitimate his regime. And Cato prefers to lose and honor and kill himself rather than go on and live in Caesar's world.
00:13:29
Speaker
Yeah, so I guess the takeaway from that, or a couple of takeaways, one is, you know, it's not just that the Stoics think that suicide is permissible in some contexts. They actually think you have a, you know, a moral obligation, it's the right thing to do. And it's actually can be a vice to abstain from suicide when
00:13:48
Speaker
Life is not worth living. Now, we're just talking about the stoics themselves. We're not talking, we're not connecting this back to made yet. So not, not implying that, you know, it's very clear that life is not worth living in. If you have a significant medical illness, we're not.
00:14:03
Speaker
not sure about, or haven't brought up to that part yet, but at least if we take the Stoics in their context, suicide's permissible, not just permissible, it's the right thing to do sometimes, and it's cowardly not to do if it's the right thing to do in that case.
00:14:21
Speaker
In terms of why suicide is permitted, I have a nice quote here from Diogenes Lyertius, who explains the Stoic view. And he says, the Stoics say that the wise man will commit a well-reasoned suicide, both on behalf of his country and on behalf of his friends, and if he falls victim to unduly severe pain or mutilation or incurable illness.
00:14:45
Speaker
So here we have from Biogenes two criteria that the Stoics validate, two criteria that makes suicide permissible for the Stoics. One is to help your country or your friends.
00:14:57
Speaker
This is probably the Cato example. And then another is a balance of indifference. So the idea being that if you have, so physical pain is an indifferent, which means that it's, it's not an absolute good or an absolute evil. The same way it's not virtue or vice, which are the only absolute good, the only absolute evil. Sometimes we actively pursue pain. You know, if I'm an athlete, I actively pursue an experience that is, you know, physically painful working out so that I can get something else. Sometimes I might.
00:15:28
Speaker
You know, I might risk physical injury to get beat up by a bully to defend my friend. I might let myself face pain to do the courageous thing and defend my friend. Sometimes we actively select pain, but it's a, it's a dis-preferred indifferent, which means that all things being equal, I should actively avoid it. Maybe I'll step in front of the bully's punch to defend my friend, but
00:15:50
Speaker
There's so much to think there's something very strange with you if you were to just kind of, you know, sit at home and I don't know, inflict, inflict pain on yourself for no reason at all. Right. You're just all things being equal. It's a thing to, it's a thing to be avoided unless there's a reason that justifies having it. Right. There's another good that makes it worth, worth having.
00:16:11
Speaker
be that virtue or be that another set of preferred indifference or other indifference. But interesting to note here, right, this really clear example that we're balancing those, so we're always balancing those indifference, but
00:16:25
Speaker
If there is too much preferred indifference, and again, strongly with your severe pain, mutilation, incurable illness, if there is too severe a set of preferred indifference, it's actually well-reasoned.
Stoic Philosophy: Pain and Mutilation
00:16:42
Speaker
So not just permissible, but well-reasoned, the right thing to do to commit suicide on the stoic view. Interested in your thoughts on that, Caleb, because it's kind of controversial today, as you said, especially in consideration to kind of the Christian paradigm,
00:16:55
Speaker
we all really, I think, functioned from. So we could call it the principled case of suicide or the case where committing suicide is a way to fulfill your roles. I think that example makes sense. So the Cato example, of course, is the
00:17:16
Speaker
main example of that. And then you have this other idea of the balance of indifference. And I think here it's important to distinguish this view from
00:17:28
Speaker
what you could call the utilitarian view or the welfarist view, which says, look, there are a number of different kinds of goods in a life, pleasure, pains, and so on. And whether or not it is rational to continue living is just a matter of calculating whether the
00:17:48
Speaker
welfare of my life will be positive over the next few years. It's similar to this view, but you should remember that for the Stoics, these sorts of things, pains, pleasures, and so on are indifference. And the Stoic could find themselves in a case where their life might be net painful in some sense.
00:18:09
Speaker
But because of some other reason, say they're fulfilling, they have important obligations to their family or friends or some other role they've occupied. Because of their situation, expressing virtue might demand that they continue to live on. So I think that's important. It's not just balancing indifference in the same way that one could say the utilitarian balances pleasures and pains. But it's very important to keep in mind that virtue always trumps indifference.
00:18:38
Speaker
Yeah, that's a good clarification. I mean, a famous stoic saying, one that we've talked about here is this idea that the stoics think you can be happy on the rack, happy on the torture rack. So even, you know, someone can be living a good life, even if they're actively being tortured. But the key idea here is you have to have a reason.
00:18:55
Speaker
for being tortured. Maybe that reason is as simple as you're likely to be let go and you'll be able to continue being virtuous afterwards or pursuing virtuous ends afterwards. I guess another way of flippiness is there are plenty of things that can outweigh the negative indifference, virtue being one of them, other indifference being another example.
00:19:20
Speaker
But if the only reason you're avoiding suicide is a fear of death, if there's, if there's so many indifferent, like negative indifference, and the only reason you're kind of, or dis-preferred indifference, and the reason you're avoiding that as a fear of death, that's probably an indication.
00:19:36
Speaker
that you're making a mistake. At least that's the way I think about it. Yeah, I think it's also worth mentioning that the Stoics do give examples of what they think are bad suicides or they counsel against committing yourself in many cases, which I think is the right thing to do. It's very plausible to meet that.
00:19:53
Speaker
today we should default to counseling against it. And I think the Stoics had a similar position. Epictetus has a story about some friend who's starving himself for no reason. This is what Epictetus says. And he goes to this friend and he says, without any reason would you withdraw from us out of life a man who is a friend and a companion and a citizen of the same city, both a great and small city.
00:20:21
Speaker
Then, while you are committing murder and destroying a man who has done no wrong, do you say that you ought to abide by your determinations?
00:20:29
Speaker
So here, there's a strong argument against suicide. And of course, you have the mentioning of the roles here. This friend is a friend. He's a companion. He has a role in this city. And he's gotten south into a situation where he's decided that he will starve himself for whatever reason. And Epictetus says, look, does that mere fact he decided to do that for no good reason whatsoever mean that you need to follow through? And Epictetus, of course, is counseling against
00:20:59
Speaker
that. This is in discourses too. So I think that's a good example of the Stoic line, which is actually very strongly anti-suicide in a specific case. Epictetus likens it to murder, to killing an innocent person, killing for no reason. So this example also brings to mind sort of how serious this whole discussion is, right? It's a matter of
00:21:24
Speaker
thinking through situations carefully and decisions that can go wrong in multiple ways. Yeah, I think that we get so used to thinking of suicide as being maybe, maybe not, like I don't think I personally hold this view, but I think it kind of discourse is something that is always impermissible, if not impermissible and maybe understandable at best.
00:21:55
Speaker
and, but certainly regrettable at best. We kind of get in a habit, or I think contemporary culture, Canadian culture, American culture, used this way, probably inspired by that Christian background, as you mentioned. Something is like, well, that's really sad or that's really bad that that occurred, but I understand why it happened. Like I sympathize with the amount of pain they were in or the suffering they were in. So I think it's nice to emphasize this stoic view that like, no, sometimes the stoics are like, that person was great for doing that.
00:22:24
Speaker
That was actually the right call. And then so much of the focus can get on that. Just because the Stoics had that view, we can talk about it like, wow, the Stoics were really positive about suicide. And I think you did a good job kind of bringing the conversation back and go, okay, well, you know, even though they do think that in some cases, those are extreme cases. Those are not, this is not like a trivially positive thing.
00:22:46
Speaker
And when done trivially or when done for the wrong reasons, it's just as negative or harmful, at least in Epictetus' wording, calling it murder, just as negative and harmful as any sort of critical reading of suicide would be. It's just not always that, right? There's the good reasons of the bad reasons, the good cases and the bad cases, the admirable cases and the unadmirable cases.
00:23:10
Speaker
My next question for you Caleb would be moving to this stoic view on made. What do you think the stoics would have to say in this kind of context? What do you think their thoughts would be about made in a contemporary
Ethical vs Political Views on MAiD
00:23:22
Speaker
context? Yeah, so I would say a number of things. First, there's always the distinction between an ethical view and a political view. You could think that it's permissible to assist someone in dying in some cases, but
00:23:39
Speaker
think that it shouldn't be made legal, maybe because that will have bad effects down the line or because it can't be implemented in a reasonable way. So once you make that decision, I think you should realize we're sort of extracting out a bit from the Stoics ethical position to what their political position is.
00:24:01
Speaker
Yeah, and you can also flip. You could also try not to cut you off, but you could also flip those two. You can have something that you ethically disagree with, but think politically should be permitted as well. Right.
00:24:14
Speaker
So I think the relevant question for the Stoics would be, does this policy allow people to go through with good suicides without being too expansive that people will go through bad suicides, for lack of a better word, or kill themselves in cases when they should not have? So yeah, I was wondering, maybe there's a better word for a bad suicide,
00:24:42
Speaker
something that's not as strong as the ones F.I.T.S. gives, it does seem nice to have a good word for that. But at any rate, I think that that's the relevant question for the Stoics, is does this policy give people the opportunity, the relevant assistance they need or not to commit suicide without leading people to consider this as an option or even go through with it when they shouldn't be?
00:25:11
Speaker
As far as I can tell, I'm curious what you think about this as well, Michael. In general, it seems like the made case is pretty reasonable from the stoic point of view. It offers people who are perhaps unable to go with suicide themselves to get the assistance they need without being too expansive of a policy.
00:25:37
Speaker
The argument against that, look, this is a policy that basically just makes it easier to kill oneself. And that is an opportunity that people have, regardless of its legality in most cases, unless someone is, say, extremely physically impaired. And it's better to default to the side of life where people can live out their lives, where they can interact with
00:26:05
Speaker
loved ones, perhaps like the example that Seneca gives, where there's always hope, right? That things turn out well, and there's no need to make it easier to increase the temptation to let people leave this life. Since it's already an option, as Abitita says, you know, the door is always available for suicide if you need to take it. And there is a sense in which that is true. So that's the best argument that I have against the position. I think that argument is actually pretty persuasive when you
00:26:35
Speaker
consider opening a desk to making the maid more permissive. But as I see it right now, it does appear to be giving this to an option where people might fear having a lack of being able to follow through with their wishes because of severe cancer, severe other biological issues.
00:26:56
Speaker
Yeah, I think that's quite a nuanced way of putting it. So I think that's right. When we move from the ethical to the political, the question becomes, is this the kind of political position that enables or promotes more of the kind of things that are ethically positive, or does it enable and promote things that are ethically? And it is also kind of weird to frame it ethically.
00:27:18
Speaker
When you look at the bad examples, when you say bad suicide, that's why we're kind of like, is that the right word to use for it? Because I would think there's kind of a moral question. Like, Oh, you're being cowardly or something like this, which the stoics would use. I'm not in a position to say that about anybody.
00:27:34
Speaker
who commit suicide. I wouldn't, I wouldn't say that about anybody myself, but then there's also this, I don't know, epistemic question or kind of like, are you able to provide consent? Both, both knowledge based. Do you understand your likelihood of getting better?
00:27:52
Speaker
Are you able to kind of do that calculus in your mind accurately if you're physically suffering? Are you able to weigh the pros and cons appropriately? Like we talk about, you know, so, so I think it's this idea. I think there would be on the stoic view, there would be poor, poor suicides or I don't know, bad faith suicides that are promoted by incorrect value judgments.
00:28:11
Speaker
You know, but there would also be ones that are people that lack the facts or weren't able to make the right choice in the situation. And the Stoics would be very concerned about that as well. So I think Mike, I think, as you said, I think the Canadian government is getting the balance pretty good here, but I think the concern would be that your voluntary assents
00:28:33
Speaker
is not as voluntary. How voluntary can that be? Maybe you're not being coerced by external factors, but you might be being coerced by factors or physical pain. That's my best run at the counter argument. There's lots of checks and balances with made in there. So there's the one about age.
00:28:52
Speaker
There's one that it needs to be informed consent. So you need to understand your condition and have your doctor explain your condition to you. It needs to be voluntary, which means that, you know, you have to do it without coercion and you have to provide the consent beforehand and just before the moment of the moment of may be administered. So there are those checks and balances in place. And so I think it tends to get the balance right.
00:29:17
Speaker
But I do worry, I guess, not about a moral judgment on people making this decision, or I don't worry that made promotes immoral suicides. I don't think that's the case. I think it might promote uninformed circumstances because people are under extreme duress. I guess that would be my counter against it, and the stillks would be against uninformed circumstances.
00:29:44
Speaker
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Speaker
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00:30:35
Speaker
So my follow-up would be that, you know, when we get, I went back to that Diogenes quote where I said, so I said, look, there's this issue of being informed, right? Or being knowledgeable enough to make that decision. And that made, might promote more uninformed, uninformed, not just being, I don't have the information, but being, I can't reflect properly because I'm under duress. Now the Diogenes quote I did earlier said, the Stoics say that the wise man will commit a well reasoned suicide in these two cases. And then you might think, okay, well, only the wise person is okay to do it.
00:31:03
Speaker
But there's other quotes in support that the Stoics thought that not just wise people could make these correct decisions, non-wise people could make these correct decisions too. And there's a quote from Cicero that says, when a man has a reponderance of things in accordance with nature, it is his proper function to remain alive. When he has or foresees a preponderance of their opposites,
00:31:24
Speaker
things, not in accordance with nature. It is his proper function to depart from life. So the view here is that it's not even about, it's not about a wise or being unwise. It is that, you know, in these kinds of circumstances, it is, it is anyone's proper function to depart from life. And you don't need to be a sage to kind of discern that. That's kind of the counter argument to push back against my own devil's advocate take. Happy to hear what you think.
00:31:49
Speaker
Yeah, that seems like a plausible counter-argument to me. I suppose if you wanted to push that argument a bit.
00:31:57
Speaker
If you wanted to push that argument further, you could say that, look, a number of attempted suicides, you know, people are happy that those suicides failed. Most attempted suicides fail. And when you ask people who attempted to commit suicide and failed to do so, whether they are happy with the result, which is they continue living, they're glad that the attempt failed.
00:32:22
Speaker
and that's some indication that although that's a very different circumstance, quite a different circumstance from the sort of people who aren't going up for made, which is an important thing to say. It's at least an example that people might not in heightened emotional states in the heights of passion be good at judging the balance of indifference, as it were. Yeah, that would be, I think, one way to
00:32:49
Speaker
both push against made, but perhaps even more compellingly push up against considerations of suicide outside of this very specific context that we're talking about where one comes up to it. What's the end of one expected life? Tends to be older, you may tend not to have any dependents that you are responsible for at that time, which is a very different situation from a number of other situations one might find oneself in when facing this decision.
00:33:19
Speaker
Yeah. And it's, it's important when we're talking about this in a political sense that we grounded in the facts and there will always be edge cases, but the statistics showing that, you know, with an average age of 76, more than half, more than 60% because of incurable cancer. This is a, this is a very different kind of context where to me, it seems very clear that this is a net positive policy that promotes people who are making the right choice about their life, empowers them to make that choice more easily.
00:33:47
Speaker
in a way that's beneficial both for themselves and for their family.
Balancing Consent and Decision Making
00:33:51
Speaker
It seems to me very clear. But then, you know, there is this valid concern about these EDGE cases, and we can point to people that regret attempted suicides, but I think the difference there is these are often in states of heightened emotional states, right? And there's that kind of, in 2024, Canada is going to look at mental illness, and I think that is really
00:34:09
Speaker
complicated and I'm glad people are going to be looking at it carefully and making decisions because I think that's very complicated for the reasons you, but I don't, uh, I don't really have an issue with that kind of 80%, 90% bulk of cases. I think the stoics would endorse that and I endorse that of, of the, you know, the, the individual with cancer example that we provided. But I do think, as you point out, the, the, the state of passion as the stoics would say, or for us, the state of, you know, an episode of mental illness.
00:34:39
Speaker
There has to be kind of checks and balances to ensure that those aren't really the cases where this is going to be put into practice. Right, right. Yeah. So I suppose one thing that the policy does not take account of that the Stoics do care about is.
00:34:58
Speaker
whether you are in a position where you're able to fulfill your roles with your eligible for made. I just know as far as I can tell questions about dependents or questions about what other responsibilities you might have to persisting which
00:35:16
Speaker
It does seem like at one risk of this policy, of course, there are pros and cons to any policies that you will have some set of people who go through with this procedure when they shouldn't do so. I don't think that's a case against it as a whole, but it certainly is, I think wherever you draw the line with this sort of thing, there are some people who are going to sneak in and be able to make the unreason decision to depart.
00:35:41
Speaker
Yeah, to word that another way, given the stoic's view of what constitutes an ethical or an unethical or a well-reasoned or unwell-reasoned, not well-reasoned suicide, there are going to be some, there is likely some circumstances that are not well-reasoned. You know, as you said, either like, well, either, you know, someone is
00:36:00
Speaker
not considering kind of their roles or their relationships with others in this context. They're perhaps thinking exclusively about themselves and their own kind of, and exclusively weighing up kind of suffering versus not. But the inclusion of some of those cases doesn't necessarily push back on the policy itself. So the fact that some not well reasoned suicides would be
00:36:27
Speaker
Biden's stoic standards could be included, given current policy, just tells us something ethically about these individuals. It doesn't necessarily tell us something about the endorsement of the policy as a whole.
00:36:40
Speaker
Right. And like the current policy in the States has the impact that is opposite where there are well-reasoned suicides that people can come to decide on and they will require assistance to do so when someone assisting them would be breaking the law, even though on a stoic view, they wouldn't be doing something unjust.
00:37:02
Speaker
One sort of even more narrow stoic policy would be to be very concerned with this idea that assistance is necessary along with these other safeguards around informed consent and this case is having to do with having some incurable or grievous state.
00:37:24
Speaker
What do you think about that? I mean, that's the point you made earlier, which I think is kind of a, it's kind of a hardcore point. It would be kind of a hardcore soak position. Something along the lines of like, if you're so sure you want to do this, why don't you just like stop eating or something? Right? Like that's the kind of, that's the kind of view is like, why do you need help? Just like the door is always open, says Epictetus. Just like, just no matter how painful it is, just, just, you know, those options are available to you.
00:37:51
Speaker
I think it's a very hardcore point. I think if the goal was to only allow it in circumstances where people had 100% conviction, no assistance would achieve that. But I think you're losing the people that have 100% conviction, but I don't know.
00:38:14
Speaker
not the willingness to do it in such a, you know, that there is this, there is this crowd of people who have thought about it. This is what I want. I know this is the right thing for me. And I also want help. And I think that's, I think that's an appropriate position. Even if the Stokes might've been a bit more hardcore than that. I mean, they were also writing the time where, you know, people were getting locked in cages. So it's an, it's a, it's a, they're, they're working from quite an intense context.
00:38:40
Speaker
Right. And their modes of the suicide were often much more graphic than I think what people would want to do. They think about dying well. There are certain ways to do that, and not all of them are going to be accessible to every person, certainly. The most graphic example of that, of course, is Cato the Younger, who we mentioned earlier, who takes a sword to his stomach, which doesn't seem very pleasant. And
00:39:04
Speaker
in some ways is aesthetically pleasing in most circumstances. And I don't think that's just a, that's not just a point about taste. Like there is, I think a deeper, there is something that matters about aesthetics when it comes to, comes to dying well. So yeah, I think that's, that's pretty good. What else do you have to say on this, this policy? I think I've, I think I said what I wanted to say. I think this is, yeah, if you want to close it out.
00:39:30
Speaker
Yeah, so one way to close this out is to emphasize that the Stoic view on death was that it sort of gives people another avenue to freedom. So just to read from Epictetus, he has this line from the Discourses.
00:39:50
Speaker
Has someone made smoke in the house? If it is moderate, I'll stay. If too much, I exit. For you must always remember and hold fast to this, that the door is open. And what Epictetus is implying here is that most of us
00:40:06
Speaker
choose not to take the open door. We choose to continue living and that is the right choice. We have responsibilities. There are so many good things in this life to enjoy while we can and perhaps we'll face a decision later in life where the situation will be different before nearly all of us. We're in a situation where we choose to not take the door and
00:40:32
Speaker
that means that we are free in a real sense because we've chosen to face the worst consequence of our actions and decided that I'm going to embrace being in life now and will whatever happens. So I think that is
00:40:54
Speaker
Another reminder about why this discussion about death is so important is not just because of reasons of life planning, but this stoic view that in a way makes death sort of come closer, makes it more of a live option. I think
00:41:13
Speaker
typically in the modern era for most of us, at least for me in the States, death isn't really very present. For most of us, I think it's something that we know will happen that occasionally happens to our loved ones, but on a day-to-day, it's just not at top of mind.
00:41:30
Speaker
But for the Stoics, they emphasize that we've chosen to continue living, and there's a real freedom in that, that we've chosen to embrace life, and that means we can accept it and go on and live well while we can. Yeah, well put.
00:41:49
Speaker
I really like that smoke analogy. And as you said, I keep coming back to that idea about, you know, dying well as being in action, which is that we shouldn't take it frivolously. We shouldn't take it too early.
00:42:04
Speaker
but we shouldn't delay it and we shouldn't avoid it when it's the right time and just kind of as you said having that as an option having that present having that as a choice along with embracing life is also that choice of embracing the proper time to die and extend and being open to that not as a
00:42:22
Speaker
something to be avoided in all scenarios. That's something I think of. And I, and I, I mean, ultimately to bring it back to the policy, I think, I think made supports that in its current form. I think it, I think it does a better job of that helps people do that more often than if it wasn't the case. And so, you know, in doing research for it for this episode, I was like, this is pretty, I'm, I'm, I'm glad Canada does
Conversations on End-of-Life Preferences
00:42:40
Speaker
this. I'm glad this is.
00:42:41
Speaker
Yeah, and it's supposed to come up with a practical ending for this. I think it's worth talking with older loved ones you may know and see what their preferences are about the end of life, even if it seems like things are going quite well, because you never know when things will go south when fortune will strike. And it's good to not be making up decisions like this on the fly.
00:43:04
Speaker
not just for thinking about what to do in these sort of cases of active euthanasia, but of course administering healthcare generally. And questions about, you know, where would someone like to, how would they like to end their life? Would they prefer to be in a hospital? Or I think many people like to prefer to be surrounded by loved ones if it's possible in the safety of their home. But people have different preferences and it's important not to
00:43:29
Speaker
avoid, I suppose, these sorts of discussions so that they aren't just made up on the fly when you're forced to make them. Yeah, and we were talking about the grips of passion for people that were, you know,
00:43:44
Speaker
suffering, but there's also the passions that come as a caregiver by it or someone in a supporting position. So better to kind of have these conversations now and understand these positions now. So if you're in a position, because it could be hard to understand deliberate or do what it is in someone else's best interest as well. If you're, you know, if you're in the process of grieving or in the process of doing something very difficult, right? Absolutely. So do let us know what you think and thanks very much for listening. Awesome. Thanks everyone.
00:44:13
Speaker
Thanks for listening to Stoic Conversations. If you found this conversation useful, please give us a rating on Apple, Spotify, or whatever podcast platform you use, and share it with a friend. We are just starting this podcast, so every bit of help goes a long way.
00:44:28
Speaker
And I'd like to thank Michael Levy for graciously letting us use his music. Do check out his work at ancientliar.com and please get in touch with us at stoameditation.com if you ever have any feedback or questions. Until next time.