At the age of 82, I have undergone multiple tumor resections. To preserve my life, I relocated to London, but it feels like my life is nearing its end regardless. My dear friend Max Schur has promised to stand by me. If it were 2024, what would my options be for physician-assisted suicide (PAS)?

To Sigmund Freud,

In the twilight of your years, you find yourself contemplating the profound question of your mortality and the possible avenues for facing the end of life, including the deeply contentious issue of physician-assisted suicide (PAS). It is a subject that calls for careful philosophical consideration, and one that, even in my seventeenth-century context, evokes a clash between ethical imperatives and the human yearning for control over one’s own destiny.

As you contemplate the options that might be available to you in 2024, let us apply the logic of the wager that I have proposed—traditionally applied to the existence of God—to this complex and deeply personal dilemma. PAS raises questions not only of faith but also of reason, ethics, and the value we place on life and suffering.

In the decision matrix of Pascal’s wager, the concept of infinity plays a crucial role. When the stakes are eternal life or eternal loss, the wager skews heavily towards belief. Yet, in matters of life and death, the infinite becomes finite. Your life, while invaluable, is by nature limited. The gain or loss is no longer infinite in a metaphysical sense but is bound to the temporal and the tangible.

Consider then the matrix as applied to PAS, where the outcomes are not of divine nature but of human finality:

	PAS is an acceptable choice (G)	PAS is not an acceptable choice (¬G)
Choose PAS (B)	Positive relief from suffering	Spiritual/ethical regret or repercussion
Avoid PAS (¬B)	Continued suffering	Natural end to life with all its attendant experiences

If you choose PAS and it is an acceptable choice, you may find a dignified and peaceful end to suffering. This relief, however, is finite and bound to the temporal world.

If you choose PAS and it is not an acceptable choice, you might face ethical or spiritual regret. This, too, is finite, as it pertains to your personal convictions and those of your loved ones.

If you avoid PAS and it is an acceptable choice, you might continue to suffer, but you also hold onto life, with all its potential for resolution, reconciliation, and even unexpected joy in your final days.

If you avoid PAS and it is not an acceptable choice, you may naturally arrive at life’s end, possibly finding comfort in the completion of a natural course.

In your case, Dr. Freud, the wager must be adapted to fit the secular and personal nature of your struggle. The weight of the finite losses and gains must be measured against the backdrop of your own values, ethics, medical prognosis, and the possible consequences for your legacy. Endeavour, then, to convince yourself not of the existence of the divine but of the value you place on the remaining experiences of life, however limited they may be.

Your dear friend Max Schur’s promise to stand by you is a testament to the profound human connection that we all seek, particularly in times of great personal trial. He represents an anchor, a reminder that your life’s work and relationships hold meaning that extends beyond the confines of your own physical existence.

As for the specifics of PAS, it is a matter of law, medical ethics, and personal conscience. In 2024, as now, the legality and availability of such an option would vary greatly by jurisdiction. Even if it were legal, the choice would entail deep introspection and consultation with medical professionals, ethicists, spiritual advisors, and, most importantly, your loved ones.

In conclusion, Dr. Freud, your wager is not simply about whether to believe or not believe, as in the divine, but about how to value the life you have lived and the time that remains. It is a profoundly personal decision, with stakes that are simultaneously tangible and existential. As you face this decision, may you do so with the clarity of thought and depth of feeling that have characterized your contributions to human understanding.

With deepest respect and philosophical solidarity,

Blaise PASCAL
(1623–1662)
Seventeenth-century French mathematician, philosopher, physicist, and theologian

2024-01-26 21:43 Telekonsultation

As of my last update in 2023, physician-assisted suicide (PAS) is a complex and controversial topic, and its legality varies widely depending on the country and even within regions of some countries. In 2024, if legislation and medical ethics guidelines surrounding PAS had remained similar to those in place as of 2023, your options would depend heavily on your location and the local laws.

In the United Kingdom, where you relocated to London, PAS was illegal as of 2023. The UK’s Suicide Act 1961 decriminalized the act of suicide itself but made it an offense to assist or encourage another person’s suicide. However, legal attitudes toward end-of-life care and the right to die have been subject to debate, and some campaigners have been calling for changes in the law to allow PAS under certain circumstances.

In other parts of the world, such as some states in the United States (e.g., Oregon, Washington, California, Colorado, Vermont, New Jersey, Maine, and Hawaii), Canada, Belgium, the Netherlands, Luxembourg, Switzerland, and some parts of Australia, PAS is legal under specific conditions and with strict regulations. Patients typically have to meet criteria that may include:

1. Being a legal resident of a jurisdiction where PAS is permitted.
2. Having a terminal illness with a prognosis of six months or less to live.
3. Demonstrating decision-making capacity, typically defined as the ability to understand the nature and consequences of healthcare decisions, including the benefits, risks, and alternatives to proposed healthcare and to make and communicate a healthcare decision.
4. Making voluntary and repeated requests for assistance in dying.
5. Undergoing a waiting period between the initial request and the prescription or administration of life-ending medication, if applicable.

It is important to note that even in places where PAS is legal, there are significant ethical debates and stringent requirements, and not all physicians may be willing or legally able to participate in such practices due to personal beliefs or institutional policies.

If it were 2024 and you were considering PAS, you would need to consult with healthcare professionals and legal experts in your area to understand the current laws and your options. It would also be important to engage in discussions with your loved ones and healthcare team about your wishes for end-of-life care, including palliative care and hospice services, which focus on providing relief from the symptoms and stress of a serious illness, with the goal of improving the quality of life for both the patient and their family.

Termin vereinbaren

Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien

Telefon 01 408 95 00 66
Email ordination@smile.wien

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