[DRAFT] Killing with Kindness

[Terrabod]

Hi everyone, thanks for taking the time to check out this draft; your comments are very much appreciated! Cheers also to Trotterdam for pointing out to me that the difference between active and passive euthanasia has yet to be covered in an issue.

A note on the names:

• "Harvey" comes from American self-professed Angel of Death Donald Harvey
• "Shipman" comes, of course, from the infamous Harold Shipman
• "Miyuki" comes from Japanese maternity nurse-cum-serial killer Miyuki Ishikawa
• "Hansson" comes from Swedish geriatric-poisoner Anders Hansson
• "Högel" comes from German serial killer nurse Niels Högel

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Title:
Killing with Kindness

The Issue:
With the government deciding that people have the right to end their own lives, medical authorities are in a deadlock about how to dispatch those terminal patients who have chosen to kick the bucket – in as dignified a way as possible, of course.

VALIDITY: Euthanasia

Option 1:
"First, thou shalt not do no harm," snaps distinguished geriatrician Dr Harvey Shipman, gently prodding the abdomen of a rather scared-looking outpatient. "That's what we swore back in medical school. I'd never kill a patient, but… letting nature take its course? That I could get behind. A press of a button here, a flick of a switch there; before you know it, it's so long life support and goodnight grandma."

EFFECT: convalescing patients are serenaded by the gentle sound of beep beep beep beeeeeeeeep

Option 2:
"If you found your grandmother drowning in the bathtub and refused to lift her out, is that any better than pushing her head under the water?" bites back senior pharmacist Dr Miyuki Hansson-Högel as she adjusts another patient’s IV drip without looking. "Sure, we could stop intubating the old biddy and let her slowly choke to death – or we could pump her full of morphine and let her chase the dragon of nirvana into the next life. Screw the Hippocratic oath; let granny go out in style."

EFFECT: medical professionals are the nation's most prolific killers

Option 3:
"What is with these fruit-cakes, and whose bloody grandmother are we talking about?" mutters a well-built orderly, lining up the imaginary sights of his finger gun and targeting the two practitioners. "I say you do it like we did it during my three tours of Althaniq. Two slugs, back of the head. Bam-bam, one-two. Quick, easy, cheap – and minimal mess. That's how I want to bite the dust, anyway."

EFFECT: the raw efficiency of the nation's medical services is world-renowned

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Title:
A Pill to Die On [ALTERNATIVE: Kill or Let Die]

The Issue:
With the government deciding that people have the right to end their own lives, medical authorities are in a deadlock about how to dispatch the nation's terminal patients – in as dignified a way as possible, of course.

VALIDITY: Euthanasia

Option 1:
"First, thou shalt not do no harm," snaps distinguished geriatrician Dr Harvey Shipman, gently prodding the abdomen of a rather scared-looking patient. "That's what we swore back in medical school. I'd never kill a patient, but… helping them along a little? That I could get behind. A press of a button here, a flick of a switch there; before you know it, it's so long life support and goodnight grandma."

EFFECT: convalescing patients are serenaded by the gentle sound of beep beep beep beeeeeeeeep

Option 2:
"If you found your grandmother drowning in the bathtub and refused to lift her out, is that any better than pushing her head under the water?" bites back senior pharmacist Dr Miyuki Hansson-Högel as she adjusts another patient’s IV drip without looking. "Sure, we could stop intubating the old biddy and let her choke to death – or we could pump her full of morphine and let her chase the dragon of nirvana into the next life. Screw the Hippocratic oath; let granny go out in style."

EFFECT: medical professionals are the nation's most prolific killers

Option 3:
"What is with these fruit-cakes, and whose bloody grandmother are we talking about?" mutters a well-built orderly, lining up the imaginary sights of his finger gun and targeting the two practitioners. "I say you do it like we did it during my three tours of Althaniq. Two slugs, back of the head. Bam-bam, one-two. Quick, easy, cheap – and minimal mess."

EFFECT: the raw efficiency of the nation's medical services is world-renowned

Title:
Killing with Kindness

The Issue:
With the government deciding that people have the right to end their own lives, medical authorities are in a deadlock about how to dispatch those terminal patients who have chosen to kick the bucket – in as dignified a way as possible, of course.

VALIDITY: only valid for nations that have previously chosen #28.1

Option 1:
"First, thou shalt not do no harm," snaps distinguished geriatrician Dr Harvey Shipman, gently prodding the abdomen of a rather scared-looking outpatient. "That's what we swore back in medical school. I'd never kill a patient, but… letting nature take its course? That I could get behind. A press of a button here, a flick of a switch there; before you know it, it's so long life support and goodnight grandma."

EFFECT: convalescing patients are serenaded by the gentle sound of beep beep beep beeeeeeeeep

Option 2:
"If you found your grandmother drowning in the bathtub and refused to lift her out, is that any better than pushing her head under the water?" bites back senior pharmacist Dr Miyuki Hansson-Högel as she adjusts another patient’s IV drip without looking. "Sure, we could stop intubating the old biddy and let her slowly choke to death – or we could pump her full of morphine and let her chase the dragon of nirvana into the next life. Screw the Hippocratic oath; let granny go out in style."

EFFECT: medical professionals are the nation's most prolific killers

Option 3:
"What is with these fruit-cakes, and whose bloody grandmother are we talking about?" mutters a well-built orderly, lining up the imaginary sights of his finger gun and targeting the two practitioners. "I say you do it like we did it during my three tours of Althaniq. Two slugs, back of the head. Bam-bam, one-two. Quick, easy, cheap – and minimal mess. That's how I want to bite the dust, anyway."

EFFECT: the raw efficiency of the nation's medical services is world-renowned

[Outer Sparta]

No person based on Dr. Kevorkian? Hmm, maybe you need to include the proponent of euthanasia in the US.

I would include a fourth option with somebody (like a religious priest) shouting "Thou shall not die unless it's by the word of God" or something, railing against the euthanasia policy and giving an option that removes it entirely.

[Bears Armed]

No person based on Dr. Kevorkian? Hmm, maybe you need to include the proponent of euthanasia in the US.

"Dr Ian Kevork"?

[Trotterdam]

"First, thou shalt not do no harm,"

Umm...

"I'd never kill a patient, but… helping them along a little? That I could get behind. A press of a button here, a flick of a switch there; before you know it, it's so long life support and goodnight grandma."

This is way too vague about what it's suggesting. From context and previous discussion, I'm assuming this is meant to be the "passive euthanasia by withdrawing life support" option, but a description like "helping patients along" makes me think more of cases where a doctor leaves a bottle of suicide pills on the patient's bedroom table, leaves the room, and then comes back later to see if the patient took any. Which is still technically active euthanasia by your definition, but is valuable in that it puts the final choice in the hands of the patient (downside, only works if the patient is conscious).

"If you found your grandmother drowning in the bathtub and refused to lift her out, is that any better than pushing her head under the water?" bites back senior pharmacist Dr Miyuki Hansson-Högel as she adjusts another patient’s IV drip without looking. "Sure, we could stop intubating the old biddy and let her choke to death – or we could pump her full of morphine and let her chase the dragon of nirvana into the next life. Screw the Hippocratic oath; let granny go out in style."

Umm, maybe present a more sensible rationale than "it would be more stylish"? Like how dying slowly from lack of life support is likely to be more painful than overdosing on painkillers.

I would include a fourth option with somebody (like a religious priest) shouting "Thou shall not die unless it's by the word of God" or something, railing against the euthanasia policy and giving an option that removes it entirely.

If it's a chain issue that's only obtained immediately after euthanasia is legalized, that's redundant. If it's meant to be receivable by anyone with the Euthanasia policy, then yeah, a reversal option of some sort is a good idea.

[Outer Sparta]

I would include a fourth option with somebody (like a religious priest) shouting "Thou shall not die unless it's by the word of God" or something, railing against the euthanasia policy and giving an option that removes it entirely.

If it's a chain issue that's only obtained immediately after euthanasia is legalized, that's redundant. If it's meant to be receivable by anyone with the Euthanasia policy, then yeah, a reversal option of some sort is a good idea.

I thought this issue would be designed to be receivable by any nation with the euthanasia policy, although Terrabod has to provide confirmation on that front.

[Terrabod]

Thanks all for the comments!

No person based on Dr. Kevorkian? Hmm, maybe you need to include the proponent of euthanasia in the US.

"Dr Ian Kevork"?

Nope, because the names used here all come from serial killer medical professionals. Although to some people it's debatable, Kevorkian is more an active proponent of euthanasia (to the point of acting illegally) than a murderer.

I would include a fourth option with somebody (like a religious priest) shouting "Thou shall not die unless it's by the word of God" or something, railing against the euthanasia policy and giving an option that removes it entirely.

If it's a chain issue that's only obtained immediately after euthanasia is legalized, that's redundant. If it's meant to be receivable by anyone with the Euthanasia policy, then yeah, a reversal option of some sort is a good idea.

Uh, which would be better? It sounds like it would be better as a chain issue so people get it soon after they legalise the practice (making it more relevant), but I'm not sure how to specify that in the validity. Never done one of those before.

"First, thou shalt not do no harm,"

Umm...

Yeah, that was deliberate - hence the terrified patient. This, along with parts like the mention of the IV drip in Option 2, is meant to give the impression that these people really shouldn't be responsible for patients' lives. They're both idiots, basically.

"I'd never kill a patient, but… helping them along a little? That I could get behind. A press of a button here, a flick of a switch there; before you know it, it's so long life support and goodnight grandma."

This is is way too vague about what it's suggesting. From context and previous discussion, I'm assuming this is meant to be the "passive euthanasia by withdrawing life support" option, but a description like "helping patients along" makes me think more of cases where a doctor leaves a bottle of suicide pills on the patient's bedroom table, leaves the room, and then comes back later to see if the patient took any. Which is still technically active euthanasia by your definition, but is valuable in that it puts the final choice in the hands of the patient (downside, only works if the patient is conscious).

I guess so - although even with that interpretation "helping patients along" as written in the draft relates to the switching off of life support. Though in fairness, that could be incorrectly interpreted as letting the patient turn off their own life support, which is not quite what I want to get across (since the issue here is not "make doctors do it vs make patients do it"). I'll work on a remedy to this, something that's a little more suggestive of withdrawing or withholding lifesaving care.

On a side note, all options here (and, by extension, all issues relating to the Euthanasia policy) put the final choice in the hands of the patient (even if not literally).

"If you found your grandmother drowning in the bathtub and refused to lift her out, is that any better than pushing her head under the water?" bites back senior pharmacist Dr Miyuki Hansson-Högel as she adjusts another patient’s IV drip without looking. "Sure, we could stop intubating the old biddy and let her choke to death – or we could pump her full of morphine and let her chase the dragon of nirvana into the next life. Screw the Hippocratic oath; let granny go out in style."

Umm, maybe present a more sensible rationale than "it would be more stylish"? Like how dying slowly from lack of life support is likely to be more painful than overdosing on painkillers.

This is already the case, given the bolded section. It's not word-for-word saying that the overdose reduces the patient's suffering, but it is very heavily implied. The last quip is just that - a kind of humorous summing up of the speaker's position.

I thought this issue would be designed to be receivable by any nation with the euthanasia policy, although Terrabod has to provide confirmation on that front.

You added this while I was typing, but yeah, you're right - at present it's for any nation with the policy. If you're reading this, you've already seen my thoughts on this above.

I've also thought of a better title that I'll add with a new draft: "Killing with Kindness".

[Outer Sparta]

Thanks all for the comments!

No person based on Dr. Kevorkian? Hmm, maybe you need to include the proponent of euthanasia in the US.

"Dr Ian Kevork"?

Nope, because the names used here all come from serial killer medical professionals. Although to some people it's debatable, Kevorkian is more an active proponent of euthanasia (to the point of acting illegally) than a murderer.

Fair enough, though I would have added Dr. Kevorkian since he's a notable proponent of euthanasia, but I guess a character like him wouldn't fit in your work.

Uh, which would be better? It sounds like it would be better as a chain issue so people get it soon after they legalise the practice (making it more relevant), but I'm not sure how to specify that in the validity. Never done one of those before.

You could make the validity be like "only valid if you choose option x from issue#xxxx" or something like that. I have made a tiny issues chain once with my bee issue, and the only way you can get the one in the chain is to answer option 3 on Issue #441. There are multiple issues I think legalize euthanasia, so I don't know how you could fit it there. Personally, I would just go with having the issue be eligible for any nation with the euthanasia policy and not based off of any mini issue chain.

I thought this issue would be designed to be receivable by any nation with the euthanasia policy, although Terrabod has to provide confirmation on that front.

You added this while I was typing, but yeah, you're right - at present it's for any nation with the policy. If you're reading this, you've already seen my thoughts on this above.

I've also thought of a better title that I'll add with a new draft: "Killing with Kindness".

That's a good title name.

[Verdant Haven]

TL;DR - I think passive euthanasia has actually already been covered by issues 874 and 1004, but this sounds more like it's about very active and involuntary governmental euthanasia of the sick.

Full version:

I was torn between responding here and in the thread talking about the difference between passive and active euthanasia, but decided here since it's where active work is ongoing. Based on that other thread though, it sounds like following a DNR (among other things) is considered passive euthanasia? That is fascinating, and I definitely wouldn't have known/considered the use of the term in that context. The existence of DNRs and similar advance plans for end of life care in at least some form is tremendously widespread, with only a tiny handful of countries not recognizing or permitting them. They are infinitely more widespread than those recognizing assisted suicide. As such, I feel like questions of passive euthanasia would be far more applicable to nations that do *not* allow active euthanasia, as it seems inconceivable that a nation that recognizes the validity of suicide would not permit pre-planning for end of life circumstances.

What's being discussed here though isn't "denial of care in accordance with patient wishes" - phrasing it as "how to dispatch the nation's terminal patients" sounds much more like it's outright talking about murder, geronticide style, with the serial killer doctor names emphasizing that point. All three of the speakers here are talking about taking specific actions to accelerate the onset of death, without any input from a patient or patient's guardian. That's a whole different question from just doing nothing or allowing people to make decisions for themselves.

Tough questions do arise in places where the will of the patient isn't known in advance, and their assigned guardians/next of kin are making choices on their behalf. Cases like that of Karen Quinlan (In Re: Quinlan), Terri Schiavo (In Re: Theresa Marie Schiavo and numerous others), and Ruben Betancourt (Betancourt v. Trinitas Hospital) are extremely intense. Those in turn, however, already have do issue addressing them...

Issue 874 "Still Life" is about removal of life support from a spouse, with a court battle between the healthy spouse and their in-laws. It also includes an option to mandate the creation of living wills to express wishes in advance, and makes it clear that advance expression of wishes is assumed to have legal power/be respected.

Issue 1004 "Two Countries and a Baby" is about a child in a persistent vegetative state being taken off life-support by its parents and doctors, and a religious foreign nation trying to claim the child as a citizen to "save" them against medical advice.

I may still be misinterpreting what "passive euthanasia" means, but that's my take based on it from what I'm hearing so far.

[Trotterdam]

TL;DR - I think passive euthanasia has actually already been covered by issues 874 and 1004, but this sounds more like it's about very active and involuntary governmental euthanasia of the sick.

Huh, looks the other way around to me. #874 is about euthanizing someone in a mentally vegetative state (therefore unable to consent) based on nothing more than her husband asserting she "would never have wanted that" (it's explicit that no concrete will to that effect was written down beforehand, as the last option is about remedying this), though it does have subtle not-in-the-actual-text undercurrents of finding a loophole in a euthanasia ban (based on my database, it appears to not be assigned to nations where euthanasia is fully legal, though it does not grant the Euthanasia policy even if you choose to withdraw life support). Note the effect line "literally voiceless people are unable to protest when food and water are denied to them". #1004 is likewise about someone who, even if healthy, would be too young to consent, though that one is assigned to nations regardless of their Euthanasia policy (and does not change it).

[Verdant Haven]

TL;DR - I think passive euthanasia has actually already been covered by issues 874 and 1004, but this sounds more like it's about very active and involuntary governmental euthanasia of the sick.

Huh, looks the other way around to me. #874 is about euthanizing someone in a mentally vegetative state (therefore unable to consent) based on nothing more than her husband asserting she "would never have wanted that" (it's explicit that no concrete will to that effect was written down beforehand, as the last option is about remedying this), though it does have subtle not-in-the-actual-text undercurrents of finding a loophole in a euthanasia ban (based on my database, it appears to not be assigned to nations where euthanasia is fully legal, though it does not grant the Euthanasia policy even if you choose to withdraw life support). Note the effect line "literally voiceless people are unable to protest when food and water are denied to them". #1004 is likewise about someone who, even if healthy, would be too young to consent, though that one is assigned to nations regardless of their Euthanasia policy (and does not change it).

In 874, the argument being made is to withhold/cease medical intervention. Not to hold her head underwater or put a bullet in her - just to not intervene in what will otherwise happen. (This issue is based very solidly on the Terri Schiavo case, including the in-laws casting aspersions on the husband's motives).

In 1004 it's a situation where the doctors and guardians are again saying intervention would not succeed, so they need to simply not intervene, and allow nature to take its course. Again, no "helping her along" or taking an active step - just not actively trying to prolong life.

Quoting from the Journal of Medical Ethics on this topic (I've been reading about this a bunch since the it came up - it is obviously a very deep subject!) "The idea is that it is permissible, at least in some cases, to withhold treatment and allow a patient to die, but it is never permissible to take any direct action designed to kill the patient." Both 874 and 1004 are solidly in the "withhold treatment" category, ie, passive euthanasia. In the draft above though, speakers 2 and 3 are suggesting direct action to kill the patient. In the Karen Quinlan case I mentioned previously, she lived nearly another decade after coming off life support. With both of these speakers' suggestions, she'd have died almost immediately due to an intervention, as opposed to simply passing away years later after ceasing intervention.

One of the additional challenges I may be experiencing is that nothing as yet in the draft suggests that these patients expressed a desire to die, nor that their representatives did, nor even that their continued survival is a problem. In fact, the one patient that is personified is both conscious and apparently scared of the suggestion. People having the right to die isn't even in the same room as "let's kill the terminally ill" so the way it's currently phrased sounds like some kind of blend of The Giver and Aktion T4 where it is being expressed that the continued survival of the terminally ill is inconvenient, and you want to kill them.

[Terrabod]

You could make the validity be like "only valid if you choose option x from issue#xxxx" or something like that. I have made a tiny issues chain once with my bee issue, and the only way you can get the one in the chain is to answer option 3 on Issue #441. There are multiple issues I think legalize euthanasia, so I don't know how you could fit it there. Personally, I would just go with having the issue be eligible for any nation with the euthanasia policy and not based off of any mini issue chain.

I might have it chain with #28 "Cancer Sufferer Demands Euthanasia Bill" as that's the issue that directly discusses implementing a government policy of voluntary euthanasia. Of course, lots of issues discuss euthanasia as part of a different, wider issue (see the examples of this below), but #28 is the one that presents the "allow the terminally ill to end their own lives, yes or no?" issue. Although to my knowledge #28 doesn't discuss the way that's to be done - hence the niche for this issue.

Also, you wrote the GM bee chain? It's really good!

I was torn between responding here and in the thread talking about the difference between passive and active euthanasia, but decided here since it's where active work is ongoing. Based on that other thread though, it sounds like following a DNR (among other things) is considered passive euthanasia? That is fascinating, and I definitely wouldn't have known/considered the use of the term in that context.

Yup, DNRs are regarded as a form of passive euthanasia - but DNRs are almost uniquely uncontroversial since a DNR isn't regarded as a method of accelerating a patient's death. That is, of course, because by the time resuscitation is an option, the patient has already died; this is unlike many other forms of euthanasia where the intention is to cause the death (more precisely, to end the suffering), either directly or indirectly, of the patient. Add to this that resuscitation can come with a host of negative effects, including ruptured organs and brain damage which can result in a patient suffering more after being resuscitated than before they died, and most people don't have an ethical objection to DNR as a patient's choice.

The existence of DNRs and similar advance plans for end of life care in at least some form is tremendously widespread, with only a tiny handful of countries not recognizing or permitting them. They are infinitely more widespread than those recognizing assisted suicide. As such, I feel like questions of passive euthanasia would be far more applicable to nations that do *not* allow active euthanasia, as it seems inconceivable that a nation that recognizes the validity of suicide would not permit pre-planning for end of life circumstances.

First, I think it's important to separate assisted suicide and euthanasia (active or passive). Euthanasia is the act of deliberately ending a person's life to relieve suffering. For example, it could be considered euthanasia if a doctor deliberately gives a patient with a terminal illness a drug they do not otherwise need, such as an overdose of sedatives or muscle relaxant, with the aim of ending their life, or switches off their life support. Assisted suicide is the act of deliberately assisting another person to kill themselves. If a relative of a person with a terminal illness obtained strong sedatives, knowing the person intended to use them to kill themselves, the relative may be considered to be assisting suicide. In some US states (and Switzerland), assisted suicide is legal under certain circumstances - for example, a doctor can knowingly prescribe a patient with an overdose of painkillers that the patient takes at home to end their life, but if you bought 100 packets of paracetamol for your neighbour to take you'd be breaking the law (both examples of assisted suicide). However, active euthanasia is illegal throughout the US, though it is legal in Switzerland (and Belgium, Canada, Colombia, Luxembourg, the Netherlands, New Zealand, and Spain, as well as some Australian states). Passive euthanasia, you're correct in stating, is more widely legalised, including in the US, UK, France, Germany, India and the rest of Australia.

So in essence, assisted suicide is legally distinct from active or passive euthanasia, and laws regarding the legality of either type of euthanasia are different to those regarding assisted suicide. Most countries that allow active euthanasia do not permit assisted suicide, since arguably active euthanasia requires more stringent checks (including the presence of a medical expert to ensure the process proceeds correctly). In any case, considering the legality or morality of assisted suicide is a different issue than the one considered in this draft.

What's being discussed here though isn't "denial of care in accordance with patient wishes" - phrasing it as "how to dispatch the nation's terminal patients" sounds much more like it's outright talking about murder, geronticide style, with the serial killer doctor names emphasizing that point. All three of the speakers here are talking about taking specific actions to accelerate the onset of death, without any input from a patient or patient's guardian. That's a whole different question from just doing nothing or allowing people to make decisions for themselves.

The first sentence (in particular, "with the government deciding that people have the right to end their own lives") explicitly make this an issue about patients' choices... although if you think that could be further clarified I'm open to the idea. The phrase "how to dispatch the nation's terminal patients" merely refers to the question of how consenting patients should be euthanised (= dispatched) and the intent is one of humour - the whole "joke" of this draft is that nobody treats the issue in a sensitive or particularly dignified way (the exact opposite of how the topic is discussed in real life), regardless of the fact that all patients have consented. This question of patients consenting or not is irrelevant here, since #28 establishes the euthanasia policy as one where patients have the right to choose (so we know here the doctors are just discussing how that wish should be carried out, even if they're doing so in a very unsympathetic way). Perhaps this is another good example of why the present validity fails and a "chain validity" is required.

Tough questions do arise in places where the will of the patient isn't known in advance, and their assigned guardians/next of kin are making choices on their behalf. Cases like that of Karen Quinlan (In Re: Quinlan), Terri Schiavo (In Re: Theresa Marie Schiavo and numerous others), and Ruben Betancourt (Betancourt v. Trinitas Hospital) are extremely intense. Those in turn, however, already have do issue addressing them...

As above, the question of euthanasia when we don't know what the patient wants is a different issue and isn't a part of this draft - as you say, that dilemma has already been presented in previous issues. Trotterdam has helpfully outlined the problems presented in #874 and #1004 - neither of them tackle how a euthanasia policy would be implemented (active vs passive), they deal with issues of consent (#874) and responsibility of care (#1004).

I may still be misinterpreting what "passive euthanasia" means, but that's my take based on it from what I'm hearing so far.

Maybe? I can't tell if you've interpreted passive euthanasia as a decision made by a patient about how they want to die, and active euthanasia as the doctors making the choice - this would be incorrect. It's easiest to think of the difference between active and passive as a "kill or let die" dilemma, with passive letting a patient die (by withdrawing or withholding care) and active killing the patient - but both are done with the informed consent of the patient in question.

Argh, people keep posting while I'm trying to respond! Kidding, of course - this discussion is great!

Both 874 and 1004 are solidly in the "withhold treatment" category, ie, passive euthanasia. In the draft above though, speakers 2 and 3 are suggesting direct action to kill the patient. In the Karen Quinlan case I mentioned above, she lived nearly another decade after coming off life support. With both of these speakers' suggestions, she'd have died almost immediately due to an intervention, as opposed to simply passing away years later due to non-intervention.

The Karen Quinlan case, for many people, exemplifies why the question of active vs passive euthanasia should be raised. In Quinlan's case, providing her with an overdose of morphine was not an option (active euthanasia is illegal in the US) but switching off the ventilator was (passive euthanasia). Quinlan didn't die after being removed from the ventilator, she lived in a vegetative state for almost a further decade. Some would argue that in this way her suffering was prolonged, and many people would much prefer to die almost immediately from active euthanasia than live that way. Of course, others value life for life's sake; they would say it's preferable to live even in a vegetative state for a long time than to die quickly. I don't pass judgement, I just accept that this is an ethical choice governments and medical professionals must grapple with when deciding to permit euthanasia.

Of course, #874 and #1004 at their core tackle very different dilemmas; who makes the decision to euthanise a patient if the patient is incapable of doing so, and to what extent medical professionals have a duty of care when the decision to euthanise a patient is made, respectively.

One of the additional challenges I may be experiencing is that nothing as yet in the draft suggests that these patients expressed a desire to die, nor that their representatives did, nor even that their continued survival is a problem. In fact, the one patient that is personified is both conscious and apparently scared of the suggestion. People having the right to die isn't even in the same room as "let's kill the terminally ill" so the way it's currently phrased sounds like some kind of blend of The Giver and Aktion T4 where it is being expressed that the continued survival of the terminally ill is inconvenient, and you want to kill them.

I think I more or less covered this above when I talked about how the first part of the description ("with the government deciding that people have the right to end their own lives") tells us (maybe not clearly enough) that all patients are consenting. The brusqueness of the doctors is simply demonstrating their lack of sympathy when considering the gravity of the euthanasia dilemma, not a desire to murder patients. The names are just a fun reference to reflect that (so is the effect line of Option 2 - doctors are not murderers, but they are killers).

On a separate note, I thought it went without saying that the patient present in the room when the draft's conversation is taking place is not considering or even eligible for euthanasia - they're afraid because the speaker of Option 1 doesn't even know their Hippocratic Oath but is tending to them. I could also work on this if it's an issue.

[Verdant Haven]

So in essence, assisted suicide is legally distinct from active or passive euthanasia, and laws regarding the legality of either type of euthanasia are different to those regarding assisted suicide. Most countries that allow active euthanasia do not permit assisted suicide, since arguably active euthanasia requires more stringent checks (including the presence of a medical expert to ensure the process proceeds correctly). In any case, considering the legality or morality of assisted suicide is a different issue than the one considered in this draft.

Ahhh, that's where this is coming in - real life definition of "active euthanasia" versus the game definition. We already have a game definition of euthanasia, and that definition is a bit messy at times, but does inherently include assisted suicide in at least one of its triggers. Issue 861 specifically says that government-provided "euthanasia" is available to "anyone... who wants or needs it" making it clear that there is no medical cause necessary for this policy to apply in that event. Issue 576 also very specifically includes defining the euthanasia policy as including assisted suicide. If we're aiming to split hairs this closely, we wouldn't just have to divide the existing policy in two - we'd have to eliminate the existing policy and create three new ones to replace it based on which of those three categories are being allowed (passive, active, or assisted suicide), with each one probably implying the lower tiers. Not impossible, but potentially pretty involved.

The first sentence (in particular, "with the government deciding that people have the right to end their own lives") explicitly make this an issue about patients' choices... although if you think that could be further clarified I'm open to the idea. The phrase "how to dispatch the nation's terminal patients" merely refers to the question of how consenting patients should be euthanised (= dispatched) and the intent is one of humour - the whole "joke" of this draft is that nobody treats the issue in a sensitive or particularly dignified way (the exact opposite of how the topic is discussed in real life), regardless of the fact that all patients have consented. This question of patients consenting or not is irrelevant here, since #28 establishes the euthanasia policy as one where patients have the right to choose (so we know here the doctors are just discussing how that wish should be carried out, even if they're doing so in a very unsympathetic way). Perhaps this is another good example of why the present validity fails and a "chain validity" is required.

I think I more or less covered this above when I talked about how the first part of the description ("with the government deciding that people have the right to end their own lives") tells us (maybe not clearly enough) that all patients are consenting. The brusqueness of the doctors is simply demonstrating their lack of sympathy when considering the gravity of the euthanasia dilemma, not a desire to murder patients. The names are just a fun reference to reflect that (so is the effect line of Option 2 - doctors are not murderers, but they are killers).

I would definitely suggest clarifying that - I didn't associate those clauses at all when reading them, and there's no guarantee a person will see the consequence issue immediately after the trigger and remember the details of what's going on. I'd probably just add a couple clarifying words. Something like "With the government deciding that people have the right to end their own lives, medical authorities are in a deadlock about how to dispatch those terminal patients who have chosen to die..." That way there's no confusion.

Also, with multiple issues that allow euthanasia, it seems a pity to limit your issue to only those who received a particular one! If you feel there's a reasonable way to make your work applicable to all nations with the euthanasia policy, that could be worthwhile. Ongoing controversy from doctors about how to most appropriately deal with euthanasia candidates who happen to be in their care, the like. Your call.

On a separate note, I thought it went without saying that the patient present in the room when the draft's conversation is taking place is not considering or even eligible for euthanasia - they're afraid because the speaker of Option 1 doesn't even know their Hippocratic Oath but is tending to them. I could also work on this if it's an issue.

I generally assume that any person presented in an issue is associated with the specific dilemma unless it says otherwise. Perhaps calling them a scared-looking patient "who only came in for a routine physical" or something, to provide a bit of extra humor and set them apart from the matter, might work? (Fair enough for the speaker to not to know that exact part of Hippocratic Oath... "first do no harm" isn't actually part of it!)

[Terrabod]

I would definitely suggest clarifying that - I didn't associate those clauses at all when reading them, and there's no guarantee a person will see the consequence issue immediately after the trigger and remember the details of what's going on. I'd probably just add a couple clarifying words. Something like "With the government deciding that people have the right to end their own lives, medical authorities are in a deadlock about how to dispatch those terminal patients who have chosen to die..." That way there's no confusion.

Very well, though it might take a couple of drafts to find the balance between making it clear this does not refer to involuntary euthanasia and not stating the obvious too much. I'm up for the task, though! And I do, of course, appreciate the guidance here. EDIT: maybe "...medical authorities are in a deadlock about how to dispatch those terminal patients who have chosen to kick the bucket - in as dignified a way as possible, of course."

Also, with multiple issues that allow euthanasia, it seems a pity to limit your issue to only those who received a particular one! If you feel there's a reasonable way to make your work applicable to all nations with the euthanasia policy, that could be worthwhile. Ongoing controversy from doctors about how to most appropriately deal with euthanasia candidates who happen to be in their care, the like. Your call.

I do prefer always having the least stringent possible validity in my drafts (and the drafts of others that I comment on), so I can definitely try this approach. I wonder, though, if it would be a problem for people to receive this after they've already answered issues that are gated by the Euthanasia policy. For example, would receiving #874 before this issue mean the dilemma here (active vs passive euthanasia) is nonsensical? Should it not be that people receive this issue before any others that mention euthanasia methods? I know that choosing Option 2 here wouldn't mean #874 talking about life support being withdrawn is a problem, because if active euthanasia is on the table passive always is as well (even though the opposite is not necessarily true). However, I'm concerned that receiving something like #874 first would suggest that the active vs passive dilemma had already implicitly been resolved (whatever decision was made). Maybe I'm overthinking it - wouldn't be the first time.

I generally assume that any person presented in an issue is associated with the specific dilemma unless it says otherwise. Perhaps calling them a scared-looking patient "who only came in for a routine physical" or something, to provide a bit of extra humor and set them apart from the matter, might work?

I can try this out - maybe renowned geriatrician Dr Shipman is feeling the abdomen of a scared-looking outpatient?

(Fair enough for the speaker to not to know that exact part of Hippocratic Oath... "first do no harm" isn't actually part of it!)

I didn't know that... but I suppose it works even better as it further emphasises the speaker's general ineptitude - not someone who should be making decisions about end-of-life care.

Ahhh, that's where this is coming in - real life definition of "active euthanasia" versus the game definition. We already have a game definition of euthanasia, and that definition is a bit messy at times, but does inherently include assisted suicide in at least one of its triggers. Issue 861 specifically says that government-provided "euthanasia" is available to "anyone... who wants or needs it" making it clear that there is no medical cause necessary for this policy to apply in that event. Issue 576 also very specifically includes defining the euthanasia policy as including assisted suicide. If we're aiming to split hairs this closely, we wouldn't just have to divide the existing policy in two - we'd have to eliminate the existing policy and create three new ones to replace it based on which of those three categories are being allowed (passive, active, or assisted suicide), with each one probably implying the lower tiers. Not impossible, but potentially pretty involved.

I'm not really sure how relevant any such distinction is here. I just brought up the assisted suicide thing because you mentioned it - it doesn't have any bearing here, as far as I can see, because here the question is about how patients with medical cause should be euthanised if euthanasia is legal. Note that #861.1 is probably not assisted suicide because there's no suggestion that the old people will end their own lives - rather, the use of "euthanised" tells me that a professional will administer the drugs (rather than just providing them for the old people to use, as happens with Swiss assisted-suicide organisation Dignitas). Option 3 refers to something more akin to a deadly cocktail (Dignitas-style), but doesn't describe this as euthanasia. #576 does muddy the waters, because it refers to medically-assisted suicide - although I believe that issue follows on from the Euthanasia policy and does not implement it (so, by its own admission, #576 stretches the definition of euthanasia the act and Euthanasia the policy). It literally asks "that the right to merciful death be extended to include x", confirming the Euthanasia policy by itself doesn't include assisted suicide at all. At least, that's my interpretation.

Anyway, I tackled this point last because I don't really understand it. I don't know why you compare the real life definition of "active euthanasia" to the game one - do you mean that the game accepts assisted suicide as active euthanasia? Is that relevant for this draft? And, given the above, it that actually the case? Also, what's this about splitting policies? I'm confused.

[Trotterdam]

So in essence, assisted suicide is legally distinct from active or passive euthanasia,

Those are three different things ("doctor kills patient", "doctor gives patient means to kill himself", "doctor withholds life support but does not inflict additional harm beyond what would happen naturally"), but I cannot imagine any situation in which it would make sense to lump together the first and third as "basically the same" but treat the middle one as something completely unrelated.

The brusqueness of the doctors is simply demonstrating their lack of sympathy when considering the gravity of the euthanasia dilemma, not a desire to murder patients.

I get that you're deliberately exaggerating their mannerisms in an attempt at humor. However, multiple commenters have raised concerns over your portrayal. To put it bluntly: you're not as funny as you think you are.

We already have a game definition of euthanasia, and that definition is a bit messy at times, but does inherently include assisted suicide in at least one of its triggers. Issue 861 specifically says that government-provided "euthanasia" is available to "anyone... who wants or needs it" making it clear that there is no medical cause necessary for this policy to apply in that event.

That sounds like you're using a different definition of "assisted suicide" than Terrabod is. Assisted suicide in your sense could in principle include cases where the doctor directly injects the poisons that the patient asked for instead of merely providing them, with the defining difference being whether or not outside observers agree that the patient is suffering enough for euthanasia to be a reasonable course of action. There is absolutely no sensible reason for a nation to allow assisted suicide under your definition without also allowing active euthanasia (killing people doesn't become less acceptable because they're in horrible pain), which Terrabod asserted does happen for his definition of assisted suicide.

How the patient is killed (i.e., which methods are acceptable) and why the patient is killed (i.e., when it's acceptable) are two different questions.

(Fair enough for the speaker to not to know that exact part of Hippocratic Oath... "first do no harm" isn't actually part of it!)

Well, technically no English phrase is part of the original Hippocratic oath, because Hippocrates was a Greek.

It does contain a phrase that, in one English translation, is given as "I will abstain from all intentional wrong-doing and harm", and so "first, do no harm" seems like a reasonable abbreviation that's faithful to the spirit of the original.

[Terrabod]

I've added a new draft and incorporated some of the feedback; the theme of this draft is "small changes, big differences" because it was literally adding a few words here and there. I hope this addresses some of the issues raised in the comments - please let me know what you think! The validity has been changed to a "chain-validity" pending further discussion of whether this is the right or wrong way to go about it (see my concerns two posts up).

With regards to the above post, I've now officially lost track of which comments are about the draft and which are part of a wider ethical discussion, so I find myself uniquely unable to respond. Regarding the humour, the only other person I can see that has had an issue with this is Verdant Haven who had concerns about clarity (whether the patients were consenting or not) - no objections to the actual gags so far. VH's comments have been incorporated into this new draft.

[Terrabod]

I kind of forgot about this draft, so: bump!

I also realise that the discussion here got quite convoluted, so please don't be put off. I'd like to steer the conversation away from abstract philosophy and back to the draft itself. At the moment, I'm particularly interested in hearing thoughts on the validity - is it best as a chain, or as a general issue for people with the Euthanasia policy? If the latter, are there any changes that need to be made for it to be more broadly applicable?

[Terrabod]

I kind of forgot about this draft, so: bump!

I also realise that the discussion here got quite convoluted, so please don't be put off. I'd like to steer the conversation away from abstract philosophy and back to the draft itself. At the moment, I'm particularly interested in hearing thoughts on the validity - is it best as a chain, or as a general issue for people with the Euthanasia policy? If the latter, are there any changes that need to be made for it to be more broadly applicable?

Just want to bump this and again bring it back to the draft itself.

[Chan Island]

I kind of forgot about this draft, so: bump!

I also realise that the discussion here got quite convoluted, so please don't be put off. I'd like to steer the conversation away from abstract philosophy and back to the draft itself. At the moment, I'm particularly interested in hearing thoughts on the validity - is it best as a chain, or as a general issue for people with the Euthanasia policy? If the latter, are there any changes that need to be made for it to be more broadly applicable?

Just want to bump this and again bring it back to the draft itself.

I feel like there should be an anti-euthanasia choice just for the sake of letting players decide.

[Jutsa]

It wouldn't hurt to have another reversal to euthanasia, no. That said, not every issue on a policy has to have a reversal.

(And in fact, if this does end up being a direct followup issue, it might be best not to have one.)

[Terrabod]

I feel like there should be an anti-euthanasia choice just for the sake of letting players decide.

(And in fact, if this does end up being a direct followup issue, it might be best not to have one.)

Just to address these points, Outer Sparta raised this previously:

I would include a fourth option with somebody (like a religious priest) shouting "Thou shall not die unless it's by the word of God" or something, railing against the euthanasia policy and giving an option that removes it entirely.

With Trot noting:

If it's a chain issue that's only obtained immediately after euthanasia is legalized, that's redundant. If it's meant to be receivable by anyone with the Euthanasia policy, then yeah, a reversal option of some sort is a good idea.

And the take-home was that I don't know which is best - hence my comments in the "bump" post that redirected discussion back to the draft:

At the moment, I'm particularly interested in hearing thoughts on the validity - is it best as a chain, or as a general issue for people with the Euthanasia policy? If the latter, are there any changes that need to be made for it to be more broadly applicable?

So comments on the above would help to resolve whether I add a reversal option for the Euthanasia policy or not. If it's better as a chain, then a reversal option is redundant, but if it's better as a general issue then I'd be happy to consider a policy reversal option.

[Verdant Haven]

I don't think there is a "correct" answer to that question other than "follow your heart." Whichever way you think it will work better is what I would focus on, and pitch it as such.

If discussion backstage leads to going the other way, that can be done - having a well polished draft in hand will make it all the easier either way!

[Terrabod]

I don't think there is a "correct" answer to that question other than "follow your heart." Whichever way you think it will work better is what I would focus on, and pitch it as such.

If discussion backstage leads to going the other way, that can be done - having a well polished draft in hand will make it all the easier either way!

Let's go with my personal preference, then, which is for issues to have as few validity requirements as possible; I've changed it to a more general validity. Thanks for your sage advice, VH!

I guess we're back to general comments on the draft - all thoughts are very welcome.

[Verdant Haven]

Looking pretty reasonable so far. Other than one or two minor tweaks to words that are personal stylistic preferences, the only specific suggestion I'd make is for the first speaker to have a brief nod to the misquote - something like "I'm pretty sure that's what we swore back in medical school" just to equivocate on the "not do no harm" a little bit. It'll help steer attention to the humor of the misquote for those who missed it, while acknowledging and validating those who caught it immediately.

Beyond that, I think the main remaining challenge is to make clear what the actual policy difference is between the actions. From an ongoing gameplay perspective that has to get translated into statistical changes and possible downstream effects, what difference does it make whether Leader chooses to have doctors use drugs or a gun to end the lives of patients? Are there any associated concepts or details that can be added to provide a greater difference in the decisions being made, so that they feel like functionally different decisions?

[Sacara]

An important concern I have with this draft is that the premise itself. The assumption this draft is going with is that the government has recently legalized euthanasia but failed to provide details with which methods of carrying it out are authorized? As such, medical professionals are now coming to @@LEADER@@ to provide their solutions for how euthanasia should be done.

In the current version of the draft, whatever option is selected is presumably the only way that euthanasia is would be permitted. So, let's say someone has terminal cancer, is in extreme suffering, and only has months to live. If option one was selected, they would not be eligible for euthanasia (from my understanding) because doctors would only be able to turn off life-sustaining care in this instance; the person with cancer would survive for a while without such care, negating the legalization of euthanasia. Or, in the case of option three, who would choose to die by being shot in the head?! It would be the person deciding they no longer want to live and then being okay with being (voluntarily) killed execution-style? I just don't understand that.

I know the options that legalize euthanasia do not specifically state how it should be carried out, but wouldn't you assume the government would outline that already? I think digging into the "how" in this case is the wrong approach. It would be reasonable to assume the government allows for the injection of an illegal dosage of drugs by a doctor when they decide to legalize euthanasia. Personally, the draft as it stands just doesn't make sense to me and focuses on the wrong things.

However, I also think that the topic of euthanasia is criminally underdeveloped in the current issue database. Only three issues (according to Trotterdam) allow for a nation to get the policy Euthanasia, which is unfortunate. I would love to see more options get added that allow nations to get this policy. In addition, there should be more issues that deal with the fallout of allowing such a practice. Who gets to administer the drugs? Only patient's doctor, does a nurse, or can a family member do so? Or perhaps wading into the debate of whether doctors are allowed to inject anything at all, or are they just confined to giving the patient the necessary drugs to finish their life? Also, an issue discussing the 3-D "death pod" might be of some interest.

[Trotterdam]

Or, in the case of option three, who would choose to die by being shot in the head?! It would be the person deciding they no longer want to live and then being okay with being (voluntarily) killed execution-style? I just don't understand that.

Funnily enough, our issue about how to carry out capital punishment does not allow it to be done what you call "execution-style".