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Fake Consensualism

[A previous version of this essay was posted incomplete. This is the full version]


Dear friend, have you considered banning health care?

Several studies agree that sick people are often treated against their preferences and sometimes against their explicit consent. 51% of patients who request Do Not Resuscitate orders never get them. Among those who get them, 75% of their doctors don’t know about it. And among doctors who do know about it, 65% don’t feel a need to follow them if it conflicts with their own opinions.

So it should come as little surprise that 22% of people who sign forms saying they don’t want to be hospitalized get hospitalized and 31% of people who sign forms saying they don’t want CPR get CPR.

Or that patients who prefer to limit life-prolonging treatment get an amount of life-prolonging treatment that is statistically indistinguishable from everyone else.

Or that even though 80% of Americans say they want to avoid hospitalizations and intensive care as they are dying, in fact about 50% of Americans die in hospital and intensive care.

But in fact, the situation is far more dire than this. These studies only count people who have legally, explicitly spelled out a desire not to receive health care. What of people who sign off on all the dotted lines, but only under emotional blackmail that can hardly be called consensual?

The cancer patient who gets told she is “brave” and “a fighter” if and only if she accepts all the interventions modern medicine has to offer, but otherwise gets given “pep talks” on how she can’t “give up” on her family and friends.

The heart disease patient whose family constantly implies that if he really cares about them he’d “push on” as long as he could.

The elderly Muslim who consents to a massive and hopeless surgery only because she doesn’t want her community to remember her as a sinner who rejected God’s gift of life and who is burning in Hell for all eternity.

So although health care produces more than its share of obvious and legally binding consent violations, we have every reason to think this is only the tip of the iceberg, that countless millions of people who don’t want health care are pressured and bullied into accepting it and undergoing unnecessary suffering against their deepest wishes.

And the obvious solution, dear friend, is to ban health care. If there is no health care, no one can be coerced into receiving health care against their wishes. We tried having a health care system that operated on the principle of informed consent, it failed terribly, and now we must pass laws imprisoning anyone who provides any form of medication, surgery, or any other treatment attempting to alleviate disease or prolong life. While doctors, nurses, et cetera may be well-meaning, the real (and indeed realized) risk of nonconsensual treatment is far too dire to allow this so-called “humane” practice to continue.

Now you may think to yourself: this seems like it would be politically unpalatable. If the Republicans obstructed President Obama at every turn merely because he wanted to slightly modify the health system, what would they think of a law that would dismantle the health system entirely, and indeed threaten large fines and jail time to anyone trying to assume its functions?

This would indeed be a significant complication if not for the fact that the Republican Party must in any case very soon be eliminated forever.

Perhaps you recall the 2000 presidential election? That one with the whole rigamarole in Florida, with the hanging chads and so on? Several thousands Democrats tried to vote for Al Gore, but the ballot was confusingly designed and they ended up voting for Pat Buchanan.

Now, the right to vote is absolutely sacred, and to have your vote unfairly shifted to another candidate is an egregious violation. Imagine how those poor Miami-Dade residents – most of them elderly liberal Jews – must have felt when they were told their votes went to an uberconservative Christian often accused of anti-Semitism and Holocaust denial. Dear friend, was that fair?

No Democrat should have to go through that. Yet as long as there are non-Democrats on the ballot, inevitably some Democrat – whether through poor ballot design, poor reading comprehension, or simple bad luck – will accidentally vote for them.

Even if they say they intended to vote for a non-Democratic candidate, can we really trust them? Perhaps they come from a very conservative area, where liberals risk violence or ostracism, and in order to maintain their relationships they must vote against their deeply held beliefs. Maybe their bosses have threatened to fire them if they vote Republicans. It is a very real possibility, and quite frankly our nation’s Democrats deserve better.

The only way to protect the sacred right to vote for the candidate you truly believe is best, without the threat of accidental mishap or outside pressure distorting your choice, is to remove all non-Democrat candidates from the ballot. That way, no one can force a Democrat to vote for another party’s candidates, and we can rest secure knowing that the wishes of our nation’s electorate are being respected.

Except that some people don’t like Democrats – which is why in order to ensure absolute fairness and consensuality, instead of only including Democrats, the ballot will actually just include candidates from my own party, the Ban Everything That Anyone Might Experience And Later Regret (BETA-MEALR) Party.

Yes, we want to ban health care, but we’re about so much more than that! We also oppose gay marriage, and straight marriage to boot. We are against prostitution but also all other forms of employment and all other sex (but especially BDSM). Also religion, vasectomies, all social gatherings, gender roles and breaking out of gender roles, gift-giving, telephones…

…what is that? You say this fundamentally misunderstands consent, that it tramples the delicate balance between “freedom to” and “freedom from”? What balderdash! And here I thought you were my dear friend! How could you…oh, I believe I know what your problem is. You are being pressured to say this; some force not your own has pushed you to criticize my remarkably astute policy proposals despite a clear hidden preference against doing so. Do not worry, dear friend! I will save you! Once we get elected, criticizing our policies will be forbidden on pain of death, giving everyone complete freedom to avoid outside interference and express their honest positive opinion of us at last!

BETA-MEALR 2016: because your preferences can only be violated if you were allowed to have them in the first place!


Even though most people dislike libertarians, their basic insight – that you can get a lot of the way to morality by saying things that people consent to are okay and things people don’t consent to are bad – holds a pretty eminent place in moral discourse, especially on the Left. This is with good reason. In a country where no one really agrees on what exactly morality is, consent is a useful semi-neutral principle that allows everyone to go off and do their own thing.

I’ve written a bit before about fake consequentialism, where people who have nonconsequentialist reasons for what they believe make up consequentialist ones so they can appeal to the general populace. I don’t think anyone has ever been convinced gay marriage is wrong because of sincere concern about the fate of children adopted by gay couples, but that argument keeps getting trotted out again and again because it’s one of the few anti-gay-marriage arguments that sounds remotely consequentialist. Or people who dislike porn claiming it will encourage viewers to rape people, even though as far as anyone can tell exactly the opposite is true.

And where there is fake consequentialism, not far behind you will find fake consensualism. Suppose there’s something you don’t like, but every time you argue against it, people say “Well, it’s all consensual and it doesn’t harm anyone except the people who have agreed to it, so mind your own business.” You can come back with “Yes, but how can we be sure the people involved in it really consented? Deep down? I bet they didn’t!” Or even “I bet this would lead to something nonconsensual happening somewhere else down the line!” Consensual BDSM? Just going to glorify abuse and lead to more nonconsensual abusing, right?

I used to automatically steelman BETA-MEALRs into proper utilitarian arguments. “Well, euthanasia produces a gain of utility, by allowing people who want to die to do so. But it also produces a loss in utility, because it might unfortunately result in some people who didn’t want to die doing so. Who could possibly ever know which of these would be greater? So I guess all we can do is play it safe, right?”

But at some point, I started wondering how likely it was – even in cases where we genuinely have good reasons to worry about mistakes or pressure – that allowing people to choose whatever they preferred would result in fewer people getting what they want than banning all choices except one.

I mean, okay. You say we have to ban euthanasia, because if it’s not banned, some people who don’t want to die might have to. Okay. I come back and say “But if we ban euthanasia, some people who don’t want to live might have to. Except wait, no, not some people. All people. And not might have to. Definitely will have to. Required by law.” You say “Get the hell out of my office.”

And I tried to steelman even this. Well, I told myself, there are more people who don’t want euthanasia than who do want euthanasia. And it would be a really, really big loss in utility if we killed people who didn’t want to die. Maybe the numbers still check out.

Except when I tried to check the numbers, it was immediately apparent that they didn’t. There’s loads of good data from the Netherlands we can use to estimate how nonconsensual and slippery-slopey real world euthanasia is, and the answer is statistically indistinguishable from zero.

(you may have heard the usual suspects claim that “studies show 92.7% of Dutch males die by being seized by goons and euthanized against their will” or something. These is based on extremely creative readings of the data, but proving this is a job for another blog post.)

I no longer try to steelman BETA-MEALR arguments as utilitarian. When I do, I just end up yelling at my interlocutor, asking how she could possibly get her calculations so wrong, only for her to reasonably protest that she wasn’t make any calculations and what am I even talking about?

And yet without the utilitarian angle, this whole argument falls apart on exactly the “proving too much” grounds pushed by our hypothetical politician above. If you want to ban euthanasia, why not ban health care? If you want to ban prostitution, why not McJobs? If you want to ban BDSM, why not all consensual sex? If you don’t have a good quantitative argument ready, you sure can’t support it on qualitative grounds alone.

Look around you. Just look around you. Have you figured out what we’re looking for yet? That’s right. The answer is sacred values and taboo trade-offs.


According to Philip Tetlock’s dichotomy, a sacred value is a value in Far Mode, one that has big flashing signs saying “MORALITY!” around it. A secular value is one that is nice but not morally important, like saving money or increasing productivity.

A taboo tradeoff is when someone asks you to trade a secular value off against a sacred value, and tends to get people morally up in arms.

For example, suppose I asked you whether the government should spend a recent windfall of ten million dollars on a public education campaign about avoiding dangerous chemicals which is projected to reduce the incidence of cancer by 300 cases per year, or on a renovation of Yellowstone National Park. Different people would have different opinions, and no one would think it was an especially odd question.

But suppose I asked you whether the government should spend a recent windfall of ten million dollars paying for years of extremely expensive hospital care for an impoverished nine-year old girl who is critically ill with cancer – or, again on the renovation of Yellowstone? Obviously you HAVE to do the former and to do the latter would be inhuman.

The inhumanity here is not in making a spectacularly bad choice. After all, the choice in the first case was even starker than in the second – saving 300 cancer patients is clearly better than maybe saving just one cancer patient. Yet the first choice offers to trade one secular value against another, while the second choice offers to trade a sacred value (life) against a secular value (national parks).

BETA-MEALR arguments offer taboo tradeoffs. BDSM opponents don’t care if a ban prevents one billion people who really really wanted to do BDSM from getting to do that. It’s wrong to have even one person be pressured into something they will later decide felt like abuse.

(Three hundred people? No problem, that’s just a statistic! But one person? SACRED VALUE SACRED VALUE SACRED VALUE.)

The same is true of euthanasia. It’s not that there’s any difference at all between the argument that would ban euthanasia and the argument that would ban health care. It’s just that not allowing even the tiniest possibility of a person involuntarily being euthanized is a sacred value, but not allowing even the tiniest possibility of a person involuntarily getting health care isn’t.

Now, I don’t like the idea of sacred values much, but other people do, and merely saying “You’re treating life as a sacred value!” isn’t going to make people start crying and protesting “I’m sorry! I didn’t mean to!” Mostly they’ll just say “Yeah, life is a sacred value to me.” Okay, fine.

What bothers me is when they do this and they pretend they’re making a value-free statement about respecting the rights of others. “Oh, well, we’re a liberal democracy and people should be able to do whatever they like with their own bodies, but I’m just worried about people being euthanized against their will, and that would be a violation of consent, and a good liberal democracy like us wouldn’t want to violate consent, nosirree!”

No. You do not care how many people are kept alive without their consent, just like you do not care how many people work McJobs without their consent, or how many people feel pressured into going to social gatherings they don’t want to attend. You care about consent solely when it serves the purpose of your sacred values. You would gladly violate the consent of a billion people on some unrelated issue rather than risk a single consent violation of your own personal pet project.

When you start preferring that every single Republican be disenfranchised rather than risk the disenfranchisement of a single Democrat, you can no longer credibly claim to be standing for the sanctity of the electoral system. You’re standing up for the Democratic Party, plain and simple, and “sanctity of electoral system” is your convenient excuse to people who would otherwise have a dim view of “let’s disenfranchise all Republicans because Democrats are better”.

Likewise, when you start preferring that every single person who desires euthanasia be thwarted rather than risk thwarting a single person who wants to live, you can no longer claim to be standing for the principle of concern for people’s preferences. You’re standing up for your religion, or your personal revulsion at seeing people die, or whatever else, plain and simple. Concern for people who might get forcibly euthanized is your convenient excuse to people who would otherwise have a dim view of “let’s force everyone to abide by my religion’s views.”

One possible counterargument: “But people dying by accident is so much worse than people living by accident!” Well, says your value system. I actually happen to feel the opposite (the reasons why are complicated, but this comic is a pretty good start). Which of us is right? I don’t know, but “I can use my value system when deciding about my own life, you can use your value system when deciding about yours” seems a heck of a lot less horrifying than a lot of the alternatives. I happen to think voting for a Republican by mistake is far more horrifying than voting for a Democrat by mistake, but insofar as we’re a democracy that choice is for each of us to make without interference.

Certainly people being pressured or dragged into something that on the surface appears consensual is a genuine problem. When people have good suggestions for how to increase the certainty that consent is genuine – like the sex-positivity community’s friendly reminders not to have sex with really drunk people – I am all in favor of this. And the one intervention that would go further than any other into ensuring all acts of consent are genuine – giving people a Basic Income Guarantee so that no one gets forced to consent to any unpleasant job or relationship out of fear of starving to death – well, I’m in favor of that too.

But when people start saying we should ban the thing entirely because they can never be totally sure it will be utilized 100% consensually, or won’t cause a slippery slope that leads to consent violations in some vague and hypothetical future – well, I support a moratorium on using that argument. The very rare cases where it might be true don’t seem worth the extreme latitude it gives everyone to declare that they are outraged at consent violations that might conceivably occur if we don’t support their pet project to abolish all possibility of consent on a certain topic. At the very least, anyone so arguing should be required to meet an extraordinarily high burden of proof, like having numbers that aren’t made up.

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88 Responses to Fake Consensualism

  1. Oligopsony says:

    The true reductio ad absurdum of this is, of course, antinatalism. Except I’m not actually sure it’s all that absurd.

    • Scott Alexander says:

      No, antinatalists are making a much stronger case. They are saying that in fact, by design, and perfectly obviously, people can’t consent to being born.

      I’m arguing against the position that we can ban things merely because even though we try to make sure everyone consented we can’t prove that no episodes of nonconsent ever slip through.

      We still want to catch actual consent violations!

      • Randy M says:

        “We still want to catch actual consent violations!”
        Are you saying this in the context of birth being one such violation?
        (I suspect if so you have an ideosyncratic abortion position “Personally I feel it’s something everyone should do, but I am politically pro-choice.”)

        • Scott Alexander says:

          I’m not an antinatalist. I’m okay with certain nonconsensual things, especially ones where seeking consent is impossible (like birth), or ones where not doing them would mean the destruction of the human race (like birth).

          I don’t really find consent to be a super amazing moral solution anyway, just an unusually good political compromise when nothing better is available and a heuristic that usually gives results identical to utilitarianism. This post is more “Don’t claim you’re basing an argument around consent if you’re not” than “everyone should base moral arguments around consent all the time”

    • Anonymous says:

      Mind you, David Benatar’s famous argument has nothing to do with consent. It’s based on the premise that a world without any people at all is just as good as a world with perfectly happy people, but that a world with suffering people is worse than either – hence, you can only lose by bringing people into the world. This, of course, is the very abstract, clean version about having a world with people vs. having a world with not people. The fact of the matter is, though, that we already have people, who are affected by other people being brought into existence, and this leads to all sorts of complications in applying the idea. Which is why he wrote a whole book about it after the original short paper that presents the asymmetry-based argument.

  2. Andrew Rettek says:

    Scott, how do we know you really did consent to not going to Burning Man? We should mandate your attendance!

  3. Misha says:

    This seems to be largely another example of whether people should be allowed to make bad decisions.

  4. suntzuanime says:

    I might be a radical consensualist. I found myself nodding along to your anti-medicine ad absurdum and didn’t realize it was intended as one until you got to the part about banning opposition political parties. And I’ve often thought that society should be abolished because of the pernicious effects of social pressure violating people’s preferences.

    People trick and bully each other into things. Until we can figure out how to prevent that, we mustn’t let them interact.

  5. Alicorn says:

    The anti-euthanasia perspective that most often comes to my attention is from a woman who is severely disabled, does not want to die, and has had experiences of healthcare people trying to convince her to, assuming that she would be going to, believing that someone as disabled as her could not competently consent to not dying (either because they thought she was in fact incompetent to make decisions or because they didn’t think anyone could want to live while that disabled), etc. As far as I can tell she suspects that the availability of euthanasia to people in general will turn it into a tool of suspect authorities to prune the population of people those authorities find undesirable. I’ve seen very similar arguments about sterilization. I’m not sure what to do with this perspective, because I have been trained to consider discriminatory unwanted death worse (and more sacred) than random mistake-based unwanted death.

    • Vanzetti says:

      >>>The anti-euthanasia perspective that most often comes to my attention is from a woman who is severely disabled, does not want to die, and has had experiences of healthcare people trying to convince her to

      Is this real?

      • Deiseach says:

        The current re-consideration of the Liverpool Care Pathway in our neighbouring island shows that there is no reason to think this is a fake story.

        Introduced to bring over best-practice hospice care methods to mainstream hospitals when dealing with the terminally ill, some (not all, I hasten to emphasise but definitely some) patients and families had experiences where at the least, the system was misapplied (e.g. refusing food and fluids even though the Pathway says that if a patient can take them, they should be offered, and if they can’t, IV feeding should be considered) to what one family at least felt was pressure on them by the healthcare team to more or less euthanise an elderly family member.

        Payments to hospitals for hitting targets for putting patients on the LCP didn’t help, either.

      • ozymandias says:

        Yes. I suspect Alicorn is talking about Amanda Baggs. If not… there’s two of them?

        I feel like the solution here is something like “end ableism” but that’s kind of hard to do.

    • Erin says:

      Since I came over here (from an RSS reader that is) to make essentially this comment, let me just second everything Alicorn says above.

    • Anonymous says:

      I think the true problem here is that we have systems forcing people to pay for the care of other people, even if it is more expensive than those lives are worth.

      I don’t want to be cared for if I’m disabled and require thousands of dollars per month to upkeep my mere existence. It’s too wasteful. More precisely, I don’t want to be required to pay this cost during the time I’m still healthy.

      If a person costs three times as much as the voluntary lives of a happy additional child that we could make, or the difference between an unhappy poor and a happy non-poor child, we should not give free care to that person.

      Maybe it would help if insurance for such care were voluntary, and people who can’t afford it get euthanasia instead.

      • Multiheaded says:

        Why hello there Adolf, how’s the weather in Antarctica?

        • Anonymous says:

          If it’s your morality, you should pay for it.

          If I don’t want something, why should I be forced to pay for it? I don’t want to consume expensive care myself, and I have no such obligation for strangers either.

          Again, you can always pay the difference. It’s your moral preference, which means the cost is yours.

          • Decius says:

            Look at what your insurance costs without public subsidy, and add the cost of lives lost due to emergency care being delayed for payment verification.

      • Multiheaded says:

        If a person costs three times as much as the voluntary lives of a happy additional child that we could make, or the difference between an unhappy poor and a happy non-poor child, we should not give free care to that person.

        Except that’s NOTHING REMOTELY LIKE how public choice in the area of resource distribution ever works in a real country. The percentage of national income spent on healthcare and on fighting poverty is always strongly correlated AFAIK; if a country callously disregards one kind of “entitlements”, it sure as hell won’t be spending “enough” on other kinds, either. People just seem to work that way politically; the conscious tradeoffs only occur on the broadest level of e.g. “more welfare vs tax cuts vs more guns”.

        Your hypothetical is just as meaningless a fantasy as the “ticking-bomb” scenario habitually used by torture apologists.

        • Anonymous says:

          You automatically assume that the funds have to be spent by the state, rather than private actors acting rationally for their own values. They could choose to donate efficiently, or to have more children, or to take better care of their own children, etc.

          Now you may argue people are selfish and therefore will spend the money on themselves, which is even less efficient than the wasteful socialized care. But I think even that is more efficient since people know what they want and what makes them happy, e.g. not be tortured by the state when they’re old and not to be forced to pay tons of money for it when they’re young.

  6. von Kalifornen says:

    Robin Hanson’s horcrux is missing. This is very, very bad.

    I’d add that for many situations, the mainstream view of consensuality requires a certain mainstream individualist view of society, and people who don’t have that individualist view of society often don’t make the case for it, or even realize that they are unusual. This results in consensuality arguments for matters that on their surface don’t even seem consensuality-related.

    A second problem is that some people (in particular some radical feminists) have unrealistic expectations about how un-influenced people can be, and have standards that either would require every single person in the world to be a Nietzschian superman, or sound like they think that to consensually choose a choice, it has to be the *inferior* choice, completely un-nudged, which makes no sense.

  7. Nisan says:

    Your link for banning “all other sex” doesn’t seem to be about banning sex at all:

    “If you obtain consent with reasonable belief that they could give it and without coercion but one of these other issues exists in your partner’s head […] and you didn’t know that, their trauma is still genuine, their consent is still invalid, their pain is still genuine, but you are innocent of having committed a wrong.”

    This sounds analogous to “hey, don’t pressure your relatives into chemotherapy”.

    • Charlie says:

      Ah, but even when it seems like someone consents to sex, it’s totally reasonable that they might not actually have consented, therefore we need to ban sex to prevent this horrendous violation.

    • Scott Alexander says:

      No, it’s not about banning sex. The analogy was meant to be:

      1. We should ban euthanasia because sometimes people might consent to euthanasia without really wanting it and then have their true preferences violated and that would be horrible and can’t be allowed to happen.

      2. This article gives cases where sometimes people might consent to sex without really wanting it. And then have their true preferences violated and that would be horrible.

      3. Therefore, if you believe (1), we should ban sex.

      I agree it was confusing to stick that in with all those other articles actually making the “ban” cases, but I couldn’t find anyone arguing for banning sex. Even those “all sex is rape” feminists turn out to have been mostly misquoted.

  8. Grognor says:

    As oligopsony accidentally implies, ubiquitous pronatalism is evidence that people don’t really care about consent. Nigh-ubiquitous nonvegetarianism is too, to the meager extent that the masses can model animals as having preferences worth respecting.

    Okay. We’ve established that people don’t really care about consent except where it benefits them or their pet causes. Where do we go from there? My intuition shouts that people aren’t making a mistake by doing this: as I’ve said on twitter, what matters isn’t an agent’s verbal self-reports of preferences, but the actual cost-benefit calculation, i.e., whether the action benefits or harms the thing you’re interrogating for consent. (The self-reports would be merely strong-ish evidence therefrom.) But as some of the smarter libertarians are keen to point out, often (they would probably say usually) agents have more self-knowledge than anyone else has about them: this is simply false in the average case with parents, which is among the reasons you don’t see arguments that children should have the same legal rights as adults.

    But as I would be keen to point out, the rabbit hole of human fallibility is infinitely deep, and neither self-knowledge nor other-knowledge is in practice good enough. A rare non-straw version of negative utilitarianism drops out of this perspective, in which prudence demands the promotion of antisuffering (that is to say, the reduction of suffering) by hook or by crook.

    This is already the sort of comment that I might wish I had never made if I ever acquired a career, so I might as well go further. In one of those silly modern political debates there are two sides which call themselves pro-life and pro-choice. As you’ve guessed, I am neither. I would describe myself as anti-choice: I don’t give a fuck what you want. I only care about maximizing the good. A special case is I don’t give a fuck what Hitler wants. I only care about preventing Holocausts.

    • MugaSofer says:

      Oh, hey, someone suggesting we do whatever is, y’know, *the right thing to do*, not an applause light! My word, what are the odds.

      (I agree wholeheartedly, in case that wasn’t clear.)

    • Bakkot says:

      I’m not sure this ends up looking very different from most people’s position. On a substantial fraction of decisions I make, “forced to choose option A by an external party” ends up with me less happy than either option A or option B would have, were they unforced. As such, maximizing the good (for many definitions of good) involves allowing me to make my own decisions.

      (Well. Actually, maximizing the good involves tricking me into not realizing I ever had a choice other than option A, but generally I try to avoid admitting that in public. And the disutility from realizing I’d been tricked is likely to outweigh the utility from having been tricked towards the right decision in the first place, so this only works if you the enforcement agency are better at keeping secrets than such agents typically are, so don’t try.)

    • Scott Alexander says:

      I think I agree with your framework but come to the same conclusion.

      Consent isn’t a good in itself, it’s only evidence we can use to improve our ability to match people’s preferences.

      Suppose a genie told me any random person I punch really hard in the groin will gain $1 million, as long as I don’t tell them about this arrangement first or ask their consent in any way. I think it would still be moral, on priors, to punch some poor homeless people in the groin on the assumption that they probably prefer the money to the non-groin-punch.

      Birth seems like a similar case. We can’t ask babies’ consent, but if on priors we think they’d rather exist than not, then the cost-benefit still comes through. You and I may have different estimates of how exactly the cost-benefit goes, but I don’t think we’re operating from a different framework here.

      (of course, the best solution would be to selectively create those children most likely to be happy and offer them ample opportunities to cancel our mistake if we chose wrong)

      • Randy M says:

        Then the genie laughs as you and/or your employer are sued for $1,000,000.

        Actually this reminds me of the statement that people in long marriages often go through times when they are tempted to divorce but, even when divorce is harder to acquire, are glad they didn’t do so. (So its not entirely selection effects). There may well be some alls the other ways around (didn’t and wish they did, did and glad, etc.) but it underlines that peoples whims and preferences are often transitory. Not that they can be violated liberally, necessarily, but it is complicated.

      • Yadal says:

        Nitpick- even ignoring Randy M’s nitpick, most people would agree if asked the hypothetical that they would prefer to be punched in the gut and get the million dollars than the alternative. A more advanced deontological theory would take this into account.

        More seriously, might I point out that this seems to be a decisive rejection of preference utilitarianism? What people want IS their preferences. This isn’t an argument against the posistion, of course, but I don’t see how a preference utility theory can apply here. Even CEV doesn’t seem to fit.

      • Deiseach says:

        Scott, if you ever figure out what makes humans “most likely to be happy”, please tell me so I can try it! Being poor is miserable, but money can’t buy you happiness; health is better than wealth; better a meal of herbs and peace than a stalled ox and contention; rich and miserable is better than poor and miserable; love makes the world go round; love ain’t nothing but sex misspelled – and other sayings, proverbs and nostrums of the type where we try to figure out what is happiness and how to get it.

        I think the problem with the pure libertarian approach is that it would work lovely if we were all independent monads that only interacted through a conscious, mutual decision to do so – but we don’t. Is there a thing called the common good? Can we enforce the will of the majority on the minority in such a case? What about if 100 of us gather together and all agree, giving our consent, to paint our front doors navy blue. Then 1 door is painted red because the person withdrew their consent or changed their mind. In a libertarian society, we don’t get to tell that person “Paint your door blue like you agreed to do”, do we? Or do we? Does the consent of 99 outweigh the withdrawal of consent by 1? How big does a minority have to be before it gets a say?

        What about, say, things like the Noxious Weeds Act? Ragwort (or ragweed as it is also known) is “is toxic to cattle, horses, deer, goats, pigs and chickens” which is why there’s an act requiring people on whose lands it is found to destroy it or be fined.

        Can a libertarian be bound by this act? It’s my property, I don’t keep animals, I don’t care if my fields are full of weeds, I am not going to spend money or effort on destroying them. Okay, so the pollen and seed is windblown and ends up on my neighbours’ fields and the plants grow and maybe their cattle or horses eat it and die. Tough!

        Can the state interfere here? Can my consent be impinged upon for ‘the greater good’? Is threatening me with monetary punishment or even time in prison not using force against me outside the bounds of our agreement to live in society (after all, I’m not going around shaking out bags of seeds on other people’s land; it’s all the fault of the wind if the seeds get scattered).

        These are the kinds of kludges and work-arounds and compromises that any system has to figure out. Even if we make consent the highest value by which to gauge the rightness/morality/usefulness of an act, we’re still going to have to decide is consent an absolute absolute in all cases or are there competing levels of consent applying to the interests of all involved?

        • Yadal says:

          If libertarianism is your starting moral prior (and given that in a certain philosophical sense any choice of prior is arbitrary this is as reasonable as preference utilitarianism), then none of these things matter anyway and your last question is automatically answered.

          From an emotive perspective at least, the counter-argument would be that in a non-libertarian state humans are effectively born into slavery. You could say that there is a significant matter of degree between being born with positive duties you can’t opt out of and having so many legally enforced duties as not to have a life, but I can see how from such a perspective a person could lose any sense of pride in themselves.

          From a rational perspective it’s really a matter of starting priors so I don’t see a way to get an answer.

    • Yadal says:

      1- How do you define “the good”? Presumably if you care about it you have a more detailed idea in your head of what is good and why.
      2- What is the reason to value whatever fits your definition of what is good?

    • Multiheaded says:

      Mandatory gay abortions! (Looks like this is a meme in the US-wingnut-bashing-sphere, not sure why.)

  9. Deiseach says:

    It is the problem of “Do people have the right to harm themselves?” Okay, so if B and C agree that they will engage in consensual flogging under the “safe, sane, consensual” system, you can say it’s none of our business what they do in their own dungeon and we – particularly the law – should keep our noses out of it.

    Fine. How about when it comes to causing more serious injury than a flogging? English law (to date) arising out of the decision in Operation Spanner basically says that consent to battery is not consent (something along the lines of age of consent laws, where even if a minor says he or she consented to having sex with the adult, that is not considered informed consent).

    What about persons who want to have a limb removed? Should a surgeon agree to amputate a healthy limb for the sole reason that the person wants it done? And if you say “That’s different, this is a mental disorder”, aren’t you just being paternalistic, labelling things you find ‘deviant’ as “mental illness”?

    Duelling used to be legal, then it was criminalised. Would you or would you not agree to a prosecution if two persons set up a duel? Even if both parties consented? Why do we think attempted killing is wrong in that instance?

    • Creutzer says:

      > It is the problem of “Do people have the right to harm themselves?”

      Not always. If you frame it that way, you already presuppose one premise that I wouldn’t grant: that death is unconditionally harmful.

    • Oligopsony says:

      When dueling was legal, saying that a good number of people(=upper-class men) were socially coerced into it was far from speculation. People sort of knew this so the social convention was that you could get satisfaction just by firing off to the side, but in many cases hiring a professional duelist to publicly embarrass someone served as a form of legal assassination.

      • Deiseach says:

        And there was always the dodge of refusing to duel someone because they were not the same social class as you and therefore not an equal (a very late example of this is in Charles Dickens’ “Nicholas Nicholby” where Sir Mulberry Hawke refuses to give satisfaction about his insulting references to Kate Nicholby to Nicholas, on the grounds that he is not an equal, while Nicholas is claiming that as a gentleman’s son he is indeed Hawke’s social equal).

        So honour was restricted to a class-bound basis and you could insult small tradesmen, professionals and others to your heart’s content while not addressing someone of your own class with the right degree of familiarity could mean a fight for your life.

    • MugaSofer says:

      Personally, I would allow the amputation *if their doctor agreed it was beneficial* (because there’s such thing as BIID, and…) but not if they agreed it was just them being pathologically confused. I would not allow a duel, but then I would not allow euthanasia either, because honestly I think death is just a bit too dangerous to let people consent to, like hard drugs (you forgot those BTW.)

      • MugaSofer says:

        Darn, there should be an “in most cases” somewhere in that last sentence.

      • Deiseach says:

        But does “I hate my left arm, I wish I could cut it off” count as being beneficial? If someone is going to attempt to hack their arm off with an axe at home, do we give them surgery to lose a functional limb or do we treat them as suffering a disorder?

        What if they refuse the mental health intervention on the grounds that we are pathologising them and using the label of ‘crazy’, ‘insane’, ‘lunatic’ as social control?

        I don’t think cutting off a working limb is a better solution but if you go the reductio ad absurdum to the very end of the conclusion of “I and I alone own my body and can say what I want to do with it”, why not have clinics for those who want to amputate parts they find offensive?

    • Scott Alexander says:

      I’ve previously come out in support of amputation in BIID.

      Regarding duelling and battery, I’d like to hack society so that people are healthy enough not to want those things, I’d like to create safeguards like requiring a waiting/cooling-down period (also things I’d support in the case of euthanasia, btw) but if all that’s done and they still want to duel/batter, I’ll bite that bullet and say meh, okay.

      • von Kalifornen says:

        I’d agree that death and permanent injury are sufficiently serious and unrecoverable that consent to them should be difficult and highly circumscribed, and should probably require an external investigation as to coerced consent.

    • English law (to date) arising out of the decision in Operation Spanner basically says that consent to battery is not consent (something along the lines of age of consent laws, where even if a minor says he or she consented to having sex with the adult, that is not considered informed consent).

      If this is true, then boxing would be illegal in England. Boxing is not illegal in England. Therefore, this is not true.

      • Salem says:

        Correct. The rule is you can consent to battery (e.g. boxing) but you can’t consent to harm (e.g. the freaks in R v Smith).

        • anon1 says:

          Is it that in boxing you risk being injured but don’t know which injuries if any will actually occur, and it’s different if the specific injury is known beforehand?

          Or is there just no way this makes any sense?

        • Anonymous says:

          It’s actually more complicated than that.

          You can consent to anything up to GBH (but not murder / manslaughter) on a wide range of ‘acceptable’ grounds – many of which are totally reasonable (e.g. medical care, extreme sports) but up to and including including ‘rough horseplay’, used to great effect as a defence in cases of military hazing…

          But ‘sexual’ is not one of those grounds for consent.

          You _can_ consent to battery for sexual purposes – it’s ABH and above that you can’t consent to for that purpose. (ABH being essentially ‘anything that doesn’t heal up in a couple of days’).

    • Anonymous says:

      “Do people have the right to harm themselves?”

      Yes. People are self-owned and have an absolute right to harm themselves. Consensual duels whose rules aren’t misrepresented should obviously be legal.

      • Deiseach says:

        Okay. Joe cuts his throat. Tom finds Joe lying in a pool of blood. Tom does not call an ambulance, or offer any aid, because “Joe is self-owned and has an absolute right to harm himself”.

        That at least has the virtue of clarity, so we all know where we stand.

        • Anonymous says:

          Yes, that’s correct, if you know Joe cut his own throat without external force. However, it is an unrealistic scenario. Would you ever expect this to happen?

          Consensual duels – and certainly well-reflected euthanasia – are realistic and should of course be legal.

        • Anonymous says:

          “offer any aid”

          Of course you can offer him aid on a voluntary basis. I think that should go without saying.

  10. James says:

    I’m surprised you didn’t mention the law of officious intermeddling. It is usually illegal to demand payment for services that were not solicited. However, when a doctor treats a temporarily incapacitated person, consent is presumed and the victim is legally required to pay the costs of the treatment. I hope that most libertarians would endorse this exception.

    A sensible discussion of the topics that you mention would require us to make fine distinctions to clarify varied instances of “coercion” and “consent”. There are important differences between, e.g., a typical violation of a child’s consent by its parent, and the various powers of a stranger, the police, a bureaucrat, a lobby group or a politician to coerce.

    The libertarian meme that “coercion is evil” belongs to mass consumption discourse. Public opinion is not directly moved by the type of discriminative arguments that can take place between reasonable people in private. Nonetheless, it is not easy for libertarians (and everyone else) to segregate themselves from the influence of this mass discourse. One heuristic that would help is that deontological rules, applied to politics and law, are almost always an inadvisable oversimplification.

  11. Randy M says:

    “No. You do not care how many people are kept alive without their consent, just like you do not care how many people work McJobs without their consent, or how many people feel pressured into going to social gatherings they don’t want to attend.”

    I feel like you elide critical differences in this section, which may not necessarily negate your larger arguements, but still present a weak point. To me, there are qualitative differences between ignoring stated wished, in writing no less (which would be more egregious) and “pressure”, the more common connotation of which would be simply verbal. (I feel like, in the spirit of reductio ad absurdium, when multiple interpretations of a term are common, the one which weakens the argument should be assumed up front, lest it be slipped in later). Someone having the mob threaten their family is under pressure, but so is someone nagged by a girlfriend, and to express the latter as some kind of societal problem to be solved is very non-compelling (even as an introvert).

  12. MugaSofer says:

    Is it a bad sign that I immediately guessed that the beginning was a parody of anti-euthanasia? PROTIP: I’m against euthanasia, although if Scott actually runs the numbers and it turns out OK my certainty of that position will be greatly weakened, maybe gone completely considering the strength of his other arguments.

    “If you want to ban prostitution, why not McJobs?”

    … um, because those are different kinds of “consent” – sexual consent and contractual consent – and I’m given to understand rape brings with it negative repercussions for the rapee above and beyond that of having to go to work when you don’t really feel like it that day. Seriously, what kind of question is that?

    (Now, if you actually worked out how much utility prostitution generates versus disutility from rape, and it comes out positive … somehow … then that’s another thing. But no way in hell have you done that, because that’s BS.)

    • ozymandias says:

      But prostitution isn’t rape! A prostitute consents to sex, it’s just sex that they wouldn’t have consented to if they weren’t paid for it. I mean, you don’t get to do literally anything you want to a prostitute just because you paid them; *most* prostitutes have things they won’t do (sex without condoms, kink, a particular sex act they find too intimate or degrading, w/e). And if you have sex with a prostitute that they don’t consent to, it’s still rape, even if you pay them afterward.

      Of course there is a massive problem that some prostitutes will have to choose between having sex that violates their boundaries and not being able to make rent/eat/whatever. But a lot of prostitutes don’t fall into that category.

      • MugaSofer says:

        Well, there’s the “it’s this or be poor” thing you mentioned, the strength of which ultimately depends on how much nonviolent coercion you’re OK with in your sex, but actually my point was that if you don’t want to do your McJob, then you still have to; if you don’t want to have sex, and you’re a prostitute, there a risk some people might get legally raped on a “contractual obligations” basis.

        Oh, also sex trafficking. But in theory that could be eliminated without harming prostitution, although I suspect in practice that’s not a great strategy (I haven’t run the numbers on this, though.)

        • MugaSofer says:

          Whoops, forgot to note that obviously there must be prostitutes who never get raped, even if you have quite strict standards, because statistically there will be some who were OK with having that sex.

          Hmm, that actually suggests an empirical test of here we should be drawing the rape-line…

    • Daniel says:

      “um, because those are different kinds of “consent” – sexual consent and contractual consent – and I’m given to understand rape brings with it negative repercussions for the rapee above and beyond that of having to go to work when you don’t really feel like it that day.”

      There are different kinds of “coersion”. The equivalent of physically forced rape is not a McJob. It’s slavery.

      Really, all I care about is the consequences. If prostitution really is as bad as you imply, then clearly it should be banned. I don’t think it is, but I could be wrong. This isn’t all that difficult to check, and I expect that someone has. Can someone here who is less lazy than me cite a relevant study?

      • von Kalifornen says:

        It’s touched on here, but not quite directly explained by anyone: the distinction between influenced/constrained/whatever choices and the traumatizing boundary violation of rape, which I think is pretty different psychologically from, say, wage-slavery. I don’t think that there is a really salient nonsexual analogy that doesn’t involve, say, cold-blooded torture.

    • Scott Alexander says:

      I’m extremely confused. If a prostitute signs a (presumably implied rather than actual) contract to provide sexual services for money, how is this a different form of consent than when a McWorker signs a contract to provide food services for money?

      Yes, it’s true that prostitutes might also have extracontractual sex with their partners whereas a McWorker is unlikely to serve fast food unpaid on the side, but why should this difference cloud the main point?

      • von Kalifornen says:

        There are two kinds of consent. The first is the personal boundary consent, which exists for sex and probably a few other things, but not most kinds of labor, and which is psychologically important. Violating this consent causes trauma. Some people actually give this consent to avoid said trauma, which is just tragic. The second is the influenced decision consent, which is universal. A sex-wage-slave might have no alternatives to prostitution and find prostitution highly undesirable, but not suffer trauma, be able to decline boundary consent for individual customers, and not see herself as having suffered rape. This situation is, of course, still pretty horrible, but it’s only breaking one of the forms of consent.

    • Anonymous says:

      “I’m against euthanasia”

      Funny: In my mind, this automatically translates to: “I demand a claim on your body and life, a right to make you suffer arbitrarily against your will, to cause you arbitrary financial costs against your will, and use physical violence to brute-force it if you disagree.” Aimed at me personally.

      Let me be very clear: After this personal declaration of war, I will no longer accept any other rights on your part.

      • MugaSofer says:

        Well that’s very … melodramatic, and of course hypocritical (initiation of force my arse.) But yeah, as a matter of fact, I do “make a claim on” things you plan to use to cause me disutility. And I am willing to use whatever force is optimal for avoiding disutility.

        With that said, I have since read Scott’s follow-up suggesting the netherlands slippery-slope data is flawed, and Yudowsky’s point that it’s much much better to just use cryogenics rather than struggle this hard to give people small, unpleasant amounts of time. So I’m not quite as anti-euthanasia as I was when I wrote that.

        • Anonymous says:

          “initiation of force my arse.”

          What do you think the police do when someone breaks these laws, e.g. allows me to buy suitable euthanasia drugs? Or what they do if I am “caught” trying to end my life?

          “And I am willing to use whatever force is optimal for avoiding disutility.”

          I have no idea how my self-ownership causes you disutility! Unlike you, I have not demanded a right to meddle with your body, money and life!

  13. Eric Rall says:

    If you want to ban prostitution, why not McJobs?

    One can make the argument that many people actually do want to ban McJobs. Living Wage laws, employer health insurance mandates, and other similar rules seem to be intended to forbid jobs that don’t at least yield middle-class level pay and benefits. The big disagreement seems to be over whether the ban will produce similar jobs with higher pay and benefits (as supporters of these measures generally argue or assume) or that many or most of the jobs will go away completely (as opponents generally argue or assume).

    • Scott Alexander says:

      Yes, but first of all these mostly aren’t the people who want to ban prostitution, and second of all I don’t think any of them are drawing the connection.

      (also, most people’s attitude to “undignified” jobs like fast food work is that they need to pay more and be safer. People who want prostitution banned seem to want this regardless of price and safety, although I’m sure there are a few people for whom a guarantee that every prostitute would be well-treated would make them back down)

      • Eric Rall says:

        There seems to be two clusters of people who want prostitution illegal: those who oppose it due to a combination of moral and “ruining the neighborhood” concerns, and those who oppose it on exploitation grounds. I’d expect there to be a substantial (but not total) overlap between the latter cluster and proponents of living wage laws.

        Granted, they’re probably not viewing it in those terms. “Banning low-wage jobs” is usually a framing preferred by wonkish libertarian opponents of the laws in question.

        I’ll also grant your parenthetical point.

  14. Said Achmiz says:

    Oh boy, Scott linked to my comment as an example of absurdity :p

    I have some objections!

    1. Further discussion between us in that comment thread revealed a bit of misunderstanding on both sides. Notably, my comment was not really about consent per se, at least not the way you had initially interpreted it.

    2. Social pressure exists. Let’s not pretend it doesn’t, shall we? All else being equal, I’d rather not be pressured to do things I don’t want to do, regardless of whether we use the word “consent” to describe what’s going on in such a case.

    3. I wasn’t saying “let’s ban this thing”. I was saying “let’s not do this thing” — well, actually I wasn’t even saying that; it was more like “I don’t like that we/you are doing this thing, and I think whether you do this thing or not will affect whether I want to be part of your group”. It’s a far cry from that to advocating a ban.

    4. Some people are not so sanguine about simple utilitarianism as you seem to be (which is not the same thing as not being a consequentialist). This does not make said people obviously wrong/crazy; naive utilitarianism has some nontrivial issues! (Witness the recent LessWrong discussions about animal rights for just a small sample.)

    I am entirely sympathetic to your complaints about people who come to their views from religion or what have you, and then attempt to disguise that by making utilitarian arguments. However, “this view fails a straightforward utilitarian test” is not a knockdown argument even if you throw out religion and all similar, i.e. all deontological, moralities.

    • Scott Alexander says:

      I was being a bit unfair there – links are kind of tricky and this one sent the wrong impression. I didn’t mean that you were in fact advocating this policy, just using our conversation there as a pointer to why the BETA-MEALR philosophy would lead to a ban on social interaction.

      In order to avoid confusion/offense I’ve removed the link.

      • Said Achmiz says:

        Mmm… ok. I thank you for the consideration, but I wasn’t so much objecting to being used as an example, as I was to the point my post was allegedly an example of. Which is to say: that comment thread was not an example of the thing you mention; but also and relatedly, maybe the thing you mention doesn’t really exist?

        Like I said, I would rather, all else being equal, not be pressured into things I don’t want. Do you disagree?

        But: I don’t want to “ban” (like with laws and whatnot) pressuring people into things they don’t want. Are there people who want such a ban? Where are they?

  15. Nick de Vera says:

    There’s the flipside of the sacred, something like “Deadly Sins” with infinite negative value: torture, rape, Nazis, etc. Torture vs dust specks is weighing the unholy vs the mundane. Take that away, and you just have to do that math, shut up and multiply.

    • MugaSofer says:

      Actually, I think “don’t torture people” is a regular Sacred Value.

      • Nick de Vera says:

        I’m not torturing anyone right now, but I don’t feel sanctified or even virtuous. Someone who has tortured or raped incurs a heavy taboo.

        • MugaSofer says:

          Dude, sacred value is just a term. It’s a question of how people react when you suggest trading it off against, say, 3^^^^^3 dustspecks.

  16. Yadal says:

    Requesting advice from people who might know more than me. Is there any way to increase the odds that if I end up hospitalised, what I want will be followed rather than what the doctor wants? I particularly worry about being euthanised against my will (based on preference utility that’s the worst fate I can think of in such a situation).

    • naath says:

      My research (mostly in the direction of desiring not to have my life dragged out endlessly, but I expect it works for other things too) is to make sure (as far as possible) that you will have someone there to argue your case when you can’t; someone who you trust to argue for what you actually want.

      If you are in an emergency situation it’s good to have an “ICE” (in case of emergency) contact in your phone, or on a piece of paper in your wallet. Make sure that’s someone who you trust to truthfully report your wishes to medical staff. Change the contact names for people who medical staff might *expect* are your emergency contact but who you do not trust (so if “Mum” is not to be relied on put her first name in your phone book not “Mum”).

  17. Zvi Mowshowitz says:

    The problem with your starting example is that if you switch from banning all health care to banning the types described in the statistics, it’s pretty hard to find a good answer other than “impractical” even on Libertarian grounds not to ban. There’s a huge difference between “someone might not consent” and “most people who it’s done to, if asked, would have said hell no and many in fact said exactly that and it happened anyway.”

    If your statements in the beginning about end of life care are true, there is a subset of health care (end of life care) where it’s not simply a matter of consent being ignored on occasion, it’s a case where the majority of the time, even explicit non-consent – active saying no in a legal document! – is ignored, and the majority of the time that the event takes place, the person it is happening to would prefer it not to happen, and on top of that, a large number of those who do consent, or at least don’t object, would prefer the world in which it somehow hadn’t happened.

    Add to that the fact that this spending is horribly inefficient in terms of QALY gains per dollar spent even in most of the most favorable scenarios and models, and that the public usually pays for a lot and often all of the costs.

    That certainly sounds like something we should at a minimum move to an explicit Opt-In, and probably ban outright since experience says that explicit Opt-Outs are being ignored so often. The very least we could do is enforce criminal penalties or at least civil ones (civil should be enough) against those who knowingly go against signed documents in ways that are obviously criminal! If you can’t provide a service without a steady stream of aggravated assaults or worse, and most people you do it to don’t want your service, and it costs an obscene amount without much in the way of gains, it seems clear several times over you need to stop providing the service.

    Also note that since we already ban 99%+ of all people from practicing medicine, and we already ban any drug until we prove that it’s safe which usually costs 9 figures to do in the best case, so it’s not like it’s some great leap. The point that it’s not going to happen is accurate, but it seems obviously correct on the margin.

    • Scott Alexander says:

      The only statistic that I can interpret as matching your claim that the majority of people who get such interventions don’t want them is the last one, about 80% of Americans saying they want to avoid hospitalizations while dying.

      But I think your interpretation is too strong (actually, I think that entire first section is too strong and I used it more as an example than as ironclad statistics). First of all, it’s possible that people have a different opinion when they’re young and thinking in Far Mode than when they’re actually in the situation (cf. the Rolling Stones’ comment about how they hoped they died before being the sort of people who still do music in middle age). Second, people might prefer to die at home, but also prefer that they be brought to the hospital for all acute illness events with <100% chance of dying because even a small possibility of living longer is more important than dying at home; of course, all acute illness events have a <100% chance of dying.

      I think studies on DNR orders usually find that, even when they are explained very clearly, only about 1/3 of people want them, though that number varies a bit with age.

  18. Pingback: Fake Euthanasia Statistics | Slate Star Codex

  19. MugaSofer says:

    It’s wrong to have even one person be pressured into something they will later decide felt like abuse.

    Later decide felt like being sexually abused? You been on the redpill again, Scott?

    Seriously, I think the sheer obvious truth that BSDM should be legal is making you overstate your case by trivializing rape. Probably a similar effect is responsible for much trivializing of rape in similar ways by conservatives actually … hmm, thanks for the insight into that.

  20. Decius says:

    Apparently signing a form saying you don’t want cpr is very hazardous, based on how much more likely you are to need it.