I am a nurse and work on a unit with quite a lot of the End of life patients. Including patients with MND and COPD which need careful management for breathlessness.
I don't support this legislation. My opposition is based on the fact that enabling someone to have a peaceful death involves a interplay of numerous environmental social and biological factors. The new legislation will need to fit into this complex environment without disrupting the practices which have built up to manage EOL care.
For example suffering for a patient will be significantly eased if the doctor explains clearly what is expected to happen and what the patient is likely to experience.
A patient with COPD, might be afraid to experience breathlessness. But the medical team explain how it will work, the nurses introduce it gradually and the patient does not suffer. Its the interplay of the technology, the professionals, the biological process and, obviously the patient and the beliefs and uncertainty.
Likewise a completely dependent MND patient will requite 16 full time nurses to provide for his needs. They might feel like a burden. Again its an interplay between the patients needs, symptoms and the professionals and technology we use to meet these needs.
If we overlay on this situations the knowledge that the patient could simply take their own life, its not clear to me that this would alleviate suffering.
My grandmother, who I visited today, is a 93yo COPD patient.
She can't breathe. She can't use the bathroom without help. She can't hardly move. She's hooked up to a nasal cannula 100% of the time. Albuterol breathing exercises 4x a day means she can't sleep more than six hours at a time because if she skips one, even on O2, she experiences suffocation.
She coughs so badly that she has constant rib/spine fractures so she's on and off narcotic painkillers that only make life bearable in doses enough to turn her brain into mush.
She wants to die. She's done. She won life. She's the last lady standing. Every single friend from her youth is gone. It's over.
I've already told her that when I get into my 60s I am going to stockpile a cache of painkillers and when the time comes go out on my own terms. There is an exact and precise 0.0% chance that my family is going to cry out in the hallway for days/weeks while I shit/piss myself in bed and slowly drown to death as my organs fail.
But it's too late for my grandmother because she waited until she was under the watchful eye of the skilled nursing facility nightmare.
In my idealized world, there is no violence, no accidents, and all diseases have been cured except for the inevitable and unstoppable phenomenon of heart failure and 100% of ALL deaths are medically-assisted suicide, decided on by the individual once they reach the point where your heart can no longer support independent living but before you get to the Morphine downward spiral.
I am a volunteer FF/EMT so I've seen my fair share of end of life patients in the last 25 years and apparently I am the only responsible adult in my family so I've handled the hospice phase for every member of my family for the last 20 years.
It is incomprehensible to me that anyone who has any exposure to death whatsoever does not fully support a person's right to determine the time and manner of their death-- even if it comes with problems.
The only reasons I can come up with for not supporting it are: a financial stake in prolonged expensive end-of-life care, the belief that the patients are too stupid to determine their fate, and/or trying to impose their personal religious beliefs on the masses.
Some reasons you didn't list: fear of abuse; fear of sweeping other problems under the rug (e.g. loneliness, poverty, lack of elderly care homes); fear of slipperly slope (e.g. extending the program to non-terminal diseases, mental problems etc..); fear of social pressure.
It's not that long ago that people were dying in hospitals while their relatives were forbidden from seeing them, and by the way hospitals were under immense pressure to free up beds.
Billionaires often make compelling arguments for why they should get to keep their money (Paul Graham and Elon Musk being two examples).
I disagree with their point of view because:
1. My neighbour having enough food to eat and a warm house is a form of wealth FOR ME.
2. If wealth that is generated is taxed, this means that it is harder to accumulate wealth, this means that the people that do manage to accumulate wealth have better qualities than the people that do so in a tax free environment. And thus they make better decisions about how to allocate their money.
3. Billionaires are not accountable to anyone for how they spend their wealth. This is fine if they are all like Musk. But they are not. Of the countless number, only two are trying to build rockets to Mars. Counter examples are Osama Bin Laden and the guys who funded the NRA. If the wealth is taxed then it is fought over in a shared space in which we all have a say, no matter how small.
I like the argument that Rawls made in "A theory of Justice", where he said that when you are deciding how to make a fair society you should think from a perspective in which you do not know what role you will have in that society.
> 1. My neighbour having enough food to eat and a warm house is a form of wealth FOR ME.
I want that too, but it's unrelated to a wealth tax or the existence of billionaires. I'd argue the wealth tax dis-incentivizes growth and makes it less likely your neighbor could have enough to eat and a warm house. We can and should improve the lower bound of society, but you don't do this by taxing wealth and dis-incentivizing growth.
> 2. If wealth that is generated is taxed, this means that it is harder to accumulate wealth, this means that the people that do manage to accumulate wealth have better qualities than the people that do so in a tax free environment. And thus they make better decisions about how to allocate their money.
I don't think this follows. Maybe it's harder so only the nastiest people attempt to do it and fight more with each other since their wealth decays over time? I don't have strong opinions on this, it's just not very compelling.
> 3. Billionaires are not accountable to anyone for how they spend their wealth. This is fine if they are all like Musk. But they are not. Of the countless number, only two are trying to build rockets to Mars. Counter examples are Osama Bin Laden and the guys who funded the NRA. If the wealth is taxed then it is fought over in a shared space in which we all have a say, no matter how small.
Yeah - on this we agree, there should be restrictions (there actually are some on political contributions and obviously things that are illegal/sanctioned). Limits on how wealth translates into political power should exist and probably need to be better. This is a different issue than a wealth tax and dis-incentivizing growth.
If I didn't know whether I'll be born in the bottom 1% or top 1%, I'd still choose a society that incentivizes wealth creation. Poor people in those societies are the richest poor people in the world. They have more prospects, they have more rights and they have more access to the benefits of civilization like education or electricity than the societies that promote the idea of taking away someone's property and make it difficult to start businesses.
>Poor people in those societies are the richest poor people in the world.
I suspect the average poor person in much of Europe is much better off than the average poor person in America. Yet Europe incentives wealth creation a lot less than America.
There are only four countries with wealth taxes. That is not “common in a Europe”.
> Net wealth taxes are far less widespread than they used to be in the OECD but there has recently been a renewed interest in wealth taxation. While 12 countries had net wealth taxes in 1990, there were only four OECD countries that still levied recurrent taxes on individuals’ net wealth in 2017. Decisions to repeal net wealth taxes have often been justified by efficiency and administrative concerns and by the observation that net wealth taxes have frequently failed to meet their redistributive goals. The revenues collected from net wealth taxes have also, with a few exceptions, been very low.
Africa is huge so this comment in isolation doesn't really mean anything.
What parts of Africa? Liberal democracy and capitalism are prerequisites before you can make a wealth-tax no wealth-tax comparison.
People in this thread are also confusing protecting the lower bound in society with taxing wealth. This confusion only makes sense when you think wealth creation is zero-sum (it's not). You can protect the lower bound of society (Europe does a better job of this than the US generally) and incentivize growth/wealth creation.
You don't have to choose one, you can choose both.
Its our country, our world. You don't live on it alone; we live here together. People who are very rich don't earn proportionally on how hard they work. Its the people who earn very little who do the hard, tough labor.
Money is a societal construct and as such it belongs to exactly the person society says it belongs to. That may not be the billionaire depending on the society.
Everything in society is a social construct, implicit or explicit. Right now the social construct that we have is that you get to keep the money you worked for after paying some taxes.
I do wonder if you could make something like the wealth tax work in the United States.
> However, I think a far more important aspect is how much more active the system as a whole gets. I don't have time to get into it in detail here, but overall that means there will be more and more extremes. More droughts. More floods. More severe winds. More heat waves. More freezing storms.
I don't think there is much evidence to support this relationship. I'd be glad to be proven wrong.
Basically as you add energy to the system things get more extreme. Storms including hurricanes and monsoons. Dry places and times get dryer due to increased evaporation. Wet places and times get wetter (more severe floods). It's a predictable consequence of higher temperatures.
Another way of looking at it is: what proportion of your wealth would you give to be wealthy for e.g. 60 years. This tax doesn't transform wealthy a wealthy person into a non wealthy person over time.
I don't support this legislation. My opposition is based on the fact that enabling someone to have a peaceful death involves a interplay of numerous environmental social and biological factors. The new legislation will need to fit into this complex environment without disrupting the practices which have built up to manage EOL care.
For example suffering for a patient will be significantly eased if the doctor explains clearly what is expected to happen and what the patient is likely to experience.
A patient with COPD, might be afraid to experience breathlessness. But the medical team explain how it will work, the nurses introduce it gradually and the patient does not suffer. Its the interplay of the technology, the professionals, the biological process and, obviously the patient and the beliefs and uncertainty.
Likewise a completely dependent MND patient will requite 16 full time nurses to provide for his needs. They might feel like a burden. Again its an interplay between the patients needs, symptoms and the professionals and technology we use to meet these needs.
If we overlay on this situations the knowledge that the patient could simply take their own life, its not clear to me that this would alleviate suffering.