Canada: Politeness, Wokeness, and Assisted Dying

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Transcript

Regan: Hey, guys. Welcome, everyone. Today, we're going to be talking a little bit about the true north strong and free of Canada where we just were this weekend. And yeah, we're just going to be covering the whole country culture history policy.

Vaish: The context for this episode is really nothing other than our short little trip to Canada, which most of which we spent in Guelph, Ontario, which one of my friends can't say for the life of him. It's not that hard to say, I think, but anyway.

Regan: I honestly think Vaishnav is much easier than Arians in a lot of ways, but at least you have vowels in there. But OK, so just to start with the lighter stuff, what were your observations relative to New York? Obviously Canada and the US are probably the two most culturally similar countries. But yeah, what were your observations? Did you notice any differences just in terms of some of the cultural stereotypes about Canadians? Did they ring true?

Vaish: Yeah, even in the two minutes we were in the Toronto airport, I think I saw glimpses of it. There's just a lot more casual chitchat, small talk and hey, sorry. And just acknowledging each other a lot on the street. I think every time I passed by someone on the street, they acknowledged me.

Regan: And also don't you think the service is amazing? Like everyone is happy to split bills. They expect to split bills. They don't look at you like you're some kind of cheapskate.

Vaish: Yeah, this is true. The no splitting bills is a US thing. But yes, the general kind of hostility in service is a New York thing. It's funny because in New York, the service is pretty good, but it's always good in a fairly confrontational way. Not good in a collaborative "we're in this together" type of way.

Regan: We disappointed Vaish by not taking him to eastern Mass, so he didn't get that cultural experience this time. Next time we'll make sure we give you the full Catholic experience.

Vaish: I find myself instantly at peace in cathedrals. Maybe I should have been Catholic, who knows?

Regan: I think the basic point is that most of the stereotypes about Canadians are true. But what is the reason Canada has the image of being woke now? Is it actually woke? And why is that the stereotype?

Vaish: Let's separate that from the general left-leaning politics question. Like most other parts of the developed world, Canada's closer to maybe Western Europe in terms of how it views the state and the ability of the state to provide services. I mentioned this in a conversation with your dad - there is a self-fulfilling nature to big government or small government. In the US, smart people want to go make money in industry, not join the government bureaucracy. In Canada, so many people work for the government and the benefits are so good that it incentivizes better people to go work for the state, which means the state is then better able to provide services and the cycle continues.

Regan: Yeah, I mean, the government of Ontario is a very competitive employer. Like so many people from my Masters program ended up in government or government affiliated jobs. Most of my friends who have gone to grad school often end up in government. I think it employs like 25% of the province or something. It's a massive employer. The pay is moderate - you'll make a little bit less than in industry, but you'll get great benefits like 37.5 hour work weeks, 30+ days of vacation, etc.

But back to the woke thing - I think it's a combination of being shifted to the left in general which makes more people open to woke norms, but also that Canadian culture valorizes loyalty more than American culture does, while American culture valorizes individuality more. We're not that far apart, but relatively speaking Canada is less individualistic. If you think back to the founding, the US had a revolution against Britain while Canada did not. There's a deep difference there. Canadians are more open to letting the state do good things for them and open to giving up some freedoms in return for peace, stability and prosperity. You can see how those beliefs bleed into being open to following woke norms rather than always thinking through individual positions.

What we criticize about woke culture is not necessarily disagreeing with specific opinions, but rather outsourcing your opinions to others without thinking it through yourself, even when you run into inconsistencies. As soon as you think about it hard, you realize you can't outsource your opinions without problems.

Vaish: Maybe another dimension is the focus on groups versus individuals. Wokeness also seems focused on the 30th percentile rather than the median or top performers. It's a cultural framework that undervalues the top decile of performance, achievement and progress.

Regan: I think the left-wing has become very focused on outliers in general, whether that's in how people sexually identify, being gender non-conforming, etc. They're concerned about people who are outliers in whatever distribution who have traditionally been victimized. So it's a protection-oriented focus on minorities of any type.

I agree you could make an argument about preventing intelligent kids from getting the positions they should be getting. But I don't think social conservatives are concerned about high outliers either. They're concerned about the median and creating a culture that serves the median person the best. This is why they're into traditional gender roles and not into non-conforming sexual identities - it makes it slightly harder for the average person to get married and have normal families. So they write off anyone not within the 80% who will do the normal thing.

I think woke folks do too little of focusing on the median these days and are too focused on outliers. But social conservatives do way too little to improve lives for people who are different through no fault of their own. That's why I don't identify with social conservatism, even though I personally want a relatively socially conservative lifestyle - kids, marriage, being heterosexual etc.

Vaish: I have an appreciation for how, if I extrapolate my own not entirely typical childhood experience by 10X, I have empathy for making space for different types of people. I love stuff like accommodations for disabilities, wheelchair ramps, accommodations for autistic people, etc. If you're single-mindedly optimizing for the median person, there is no actual median person. There are different dimensions of weirdness and we have to make trade-offs in different ways.

Regan: That's a great point. Most people benefit in some ways from inclusive societies. Even with gender stuff, that's why I don't fit in with TERFs. I think there are ways we can accommodate trans people in most things. When you get to sports where there are legitimate competing rights it gets complicated and has to be thought about very carefully and scientifically, not just based on what makes people feel good socially.

For me too, I'm gender non-conforming in a bunch of ways. I would have hated growing up in a society where women are told to be demure. So there are legitimate reasons Canadian culture more easily fits onto woke culture. It's not surprising we see more divergence in the US.

I also think the floor on how bad your life can get is much higher in Canada than the US. Do you think Canada is higher trust than the US? It seems similar to Nordic countries or Western Europe in that way.

Vaish: That's my impression, though you disputed the premise that Canada has a more homogeneous population than the US.

Regan: Yeah, I don't think Canada is more homogeneous. We're also fully a country of immigrants. I think there's a similar percentage of minorities as in the US. My experience growing up in Guelph, Ontario in a Catholic school in the late 90s and 2000s was relatively homogeneous. But I think that's true if you grew up in a town in Connecticut too.

As in the US, there's a very big rural-urban divide on political stuff in Canada. My parents worked for the Ministry of Agriculture and were exposed to some more right-wing opinions. But that was moderated by the overall government structure which selects for liberal attitudes given where they're drawing employees from.

Vaish: The sense I get is Canada is not necessarily more homogeneous, but they're much better than the US at selecting immigrants who are likely to have an easier time assimilating, especially due to English language skills. About 1/3 of the 400-500k new permanent residents Canada admits each year are Indians, and the biggest reason for that is English skills.

Regan: And that's a lot - over 1% of Canada's population in new permanent residents per year, which is very high. The other thing to mention is we don't have a land border with countries people would want to illegally immigrate from in large numbers like the US does with Mexico and Central America. As far as I know, we don't have millions of illegal immigrants like the US does. And the more illegal immigration you have, the harder it often is to make the case for legal immigration.

Vaish: This is totally uninformed, but my intuition is curbing illegal immigration is not that hard a problem if you understand incentives. In the US, I can't fault the right-wing for leveraging the left's failures on illegal immigration, but they're using it to make a general stand against immigration which I don't agree with. Still, the left handed this issue to them by being so idiotic on illegal immigration. The fact that there would even be a debate about giving illegal immigrants or their kids citizenship is absurd. Why would you reward someone who's broken the laws of your country and the most fundamental contract with your citizens?

Regan: I think it's common for immigrants like us to feel more annoyed about illegal immigration. The right-wing in the US really hurts itself on this issue because immigrants to the US are some of the most patriotic people, since they chose to come here. For me, I chose to come to the US from Canada which also has very good opportunities and lifestyles. I'm not saying I'd never go back, but the economic opportunity I came to the US for is like a 1.5X salary bump, not a 5X difference. It's not an order of magnitude change. But I do feel patriotic - I'm about to become a US citizen on April 26th, so I'll be rescinding any loyalty to my homeland of Canada.

Vaish: Do you have a sense that immigrants in Canada are better or worse assimilated? I think Canada is selecting better, but it's unclear if there are still enclaves and segregation that looks more like Europe than the quite well-integrated US.

Regan: I'm not sure what the data would say, but when I was growing up and we discussed multiculturalism and immigration in school, they explicitly differentiated Canada's approach from the US. They said the US is a melting pot where everyone assimilates into one thing. But the Canadian model was a mosaic - we want different cultures to maintain their distinct nature and together form a beautiful multicultural picture. I don't know how that translates to reality, but at the values level there's a difference between Canada and US views on assimilation.

Vaish: I wonder how much filtering just on English skills and education levels alone alleviates concerns about assimilation. Do the traits that persist in immigrant communities become looser in the highly educated segments, especially if elite groups from places like India or China are more Westernized than the median person in those countries? Does that make assimilation less challenging?

Regan: My prior is the same, that it likely makes assimilation easier, but I don't think we have clear data on that. One thing I wanted to touch on is the joke in Canada that it's the best place to immigrate to if you have a PhD and want to drive a taxi. You do see a lot of over-skilled immigrants who were willing to take worse jobs to leave bad situations and give their kids a better shot. But I think it's incredibly patronizing to prevent someone from immigrating because you think they won't be happy due to lack of jobs matching their skill level. If they're saying they want to come to improve things for their kids in the long-term, it's wrong to tell them they're mistaken about that and you need to protect them from themselves by keeping them in a country where they don't see opportunity for their children. As long as no one is being forced, I think we should respect people's choices on that.

Vaish: I don't disagree with your specific point. I'm rethinking some assumptions around how great it is for a PhD from Asia to move somewhere like Canada and end up driving a taxi. Yes, their smart kids will make more money than in their home country. But the reality is, as you've told me, there isn't the same excitement around excelling and reaching the top of your profession in most places compared to the US and India. Higher trust countries with strong social safety nets don't seem to have that same drive, though I'm sure it's possible to balance the two. I'm not making the standard right-wing argument here.

Regan: I think that's over-exaggerating a bit. Yes, at the margin it's true that you'll have more outperformers move to the US for better opportunities. But lots of outperformers stay in Canada and have success. There have been big successful companies in Canada, great reasonably-priced universities, and apparently a lot of AI innovation happening. My point is not about whether a given family should move to Canada, but that it's insane for others to say they're doing someone a favor by preventing them from immigrating.

I do think there's a trade-off between being an excellence-focused culture and one that prevents people from falling through the cracks. There are positives to both and a balance to strike, rather than one always being better. The benefit of a social safety net is it can allow people to take more risks. The fact that you don't lose healthcare for your family if you quit your job in Canada makes it easier to become an entrepreneur in some ways. So there are factors that push in both directions.

Changing topics, I wanted to get your reaction to the recent controversy over Canada's very libertarian policy on medically assisted dying, or MAID.

Vaish: I've had a morbid interest in this for a while. I'm a relatively happy person and have never been depressed. But I think it's a horrendous crime to force people to live through intense physical or psychological suffering they don't want to endure anymore. People treat this too lightly and it's a grave moral sin.

What really riled me up was reading Noah Smith's piece on MAID. I agreed with parts of it - he's right that there can be perverse incentives, which I know you want to discuss. But to not even acknowledge the other side, that there might be people benefiting from having the option to die, is crazy. Why do people only see the potential for abuse and ignore the immeasurable suffering of those who aren't allowed to end their lives?

Regan: I think this comes down to basic moral foundations. I'm generally pro-liberty even when people point out potential harms. With sex and dating, I'm sure some women have bad experiences due to less guardrails on casual sex. But if they're choosing to engage in that, it's still better that they can do what they want and have some negative outcomes at the margin, rather than not having the choice.

But I don't think this MAID debate is even about utilitarianism. It's more about individualism versus theism. People opposing it are operating with an implicit theistic notion that you do not fully own your life, and to kill yourself is murder that should be prevented. Whereas you and I are coming from an individualist view that personal bodily autonomy is the most important right that supersedes others. In that framework, it's society that is sinning against the individual by curtailing their bodily autonomy, rather than the reverse.

Vaish: I agree with that rights-based argument, but I'm also making a consequentialist one. We have to start from the fact that even in very poor countries with war, famine, etc., most people still don't kill themselves for trivial reasons. We're very strongly wired to stay alive. So as a Bayesian, what should you infer when someone repeatedly says they want to die? Two things:

1. You can't know their subjective experience, but whatever it is, it's really bad. They're the ones suffering through it, no one else. The harm is internalized to them and they're the only ones capable of measuring, adjudicating and acting on it. Preventing that seems very troubling to me.

2. The other possibility is they're not thinking straight and a future version of themselves would regret it. I think for young or mentally ill people prone to impulsive decisions, there are practical policies you can put in place to mitigate those risks, which we can discuss. But I'm willing to still let the individual decide.

For older people who make up the vast majority of MAID cases, let's assume some small percentage are being coerced. But what is the quality of remaining life you're preserving? Even if it's net positive, I think it's very hard to believe that positive value is going to outweigh the horrific suffering people endure when you don't allow them this option.

Regan: Well, I don't think opponents are coming at this from a utilitarian perspective. I think they have an implicit theistic belief that you don't fully own your life, so killing yourself is considered murder that society should prevent.

I've seen memes going around like somebody goes to the doctor saying they're depressed, tried 2 medications that didn't work, and the doctor suggests killing themselves. I think people worry about social contagion - that if assisted death is an easy option, more people will choose it.

There's also a lot of confusion over determining competence for such a weighty and irreversible decision. Our current norms only take away people's rights if they're incredibly incompetent. But with the stakes this high, medical competence for MAID should arguably be assessed at a higher bar than other medical decisions.

Vaish: I get it, but I think we're missing the key point. When it comes to your own life, the fact that you're asking to die implies you're either in excruciating physical pain, or excruciating mental pain. I don't see how saying no isn't effectively telling people their suffering is fake and they should just endure it. That's what drives my intuition on this - we've discussed how for animal welfare, most people would trade years of happiness to avoid even 2 hours of the worst forms of torture. We just don't have enough empathy for how bad severe pain and suffering can be. If someone is asking to make that trade with their own life, I believe they should be able to because there's no other way to measure and act on their subjective experience.

Regan: But don't you see the inherent link between wanting to die and being mentally unwell? Suicidal ideation itself is a sign of mental illness. Our intuitions are to let people choose unless there are obvious signs they lack the capacity to do so rationally, perhaps due to low intelligence or something. But with MAID, the very nature of asking for it implies mental health issues that raise questions about the person's competence to make that choice.

Vaish: But then we should update our views if someone persistently requests it over multiple counseling sessions across many months or years. At some point, you have to be open to the possibility that their suffering is real and they are the only one who can assess it.

I'm not denying there are hard cases where intervention is warranted. But I feel strongly that, as a starting point, the right to end one's own life is fundamental to any meaningful conception of liberty. What's the point of freedom if you can't even decide to die? Bodily autonomy should only be curtailed based on overriding externalities, not because we've decided someone is wrong about their own subjective experience, except in the most extreme cases of incompetence.

That's why I like the idea of people setting meta-policies for themselves when they are young and healthy, specifying how much they want others to trust their wishes if they are compromised later on. There could be waiting periods and competence assessments, but not total barriers. You choose your own parameters ahead of time for if you lose capacity later.

Regan: I like that meta-policy idea too and agree we should normalize that kind of planning. But it doesn't fully resolve issues of consent and competence. At what point are you in sound enough mind to update those instructions? If you're depressed and want to shorten the waiting period, is that coming from the depression itself as an attempt to circumvent guardrails you set when healthy? It's legitimately difficult to get right.

I think the reason MAID for mental illness is so contentious is that suicidal ideation is itself a symptom that calls the person's competence into question. It's a sort of catch-22 - the nature of the condition makes it hard to assess capacity to decide. We recognize this for children and take away their rights to make irreversible decisions without parental involvement. There's a reason for that - kids aren't deemed competent to fully consider long-term consequences.

The same logic arguably applies to adults in some mental health situations. When we see homeless people on the street who are completely disconnected from reality, I believe they should be involuntarily institutionalized to restore their mental health and either reintegrate them into society or keep them safe apart from society if needed. We have breakpoints like this where individual rights get curtailed. MAID for mental illness is so complex because it's unclear how to handle those breakpoints when the procedure requested is inherently tied to compromised mental status.

Vaish: I get where you're coming from and agree it's not black and white. I think we should have waiting periods, multiple assessments spaced out over time, and other speed bumps for psychological rather than physical pain cases. But nothing that ultimately denies the individual's ability to choose.

I feel very strongly that if I were in a situation of ongoing severe suffering and wanted to die, it would be awful to be told my pain isn't real and I must keep enduring it because others have decided they know better than me. The possibility of that scenario is so viscerally repugnant to me.

Maybe I'm more comfortable with MAID because I place such a high value on the principle of bodily autonomy. To me, it's the most important right we have. There can be extreme situations where we violate it, but I would set that bar very high and not let it turn on assessments of whether someone is correct about their internal experience. I agree it's a difficult line to walk and I respect the deep discomfort people have with it. But I keep coming back to the individual as the ultimate arbiter of their subjective experience.

Regan: I understand the strong libertarian impulse and generally lean that way myself on most issues. And I agree it's patronizing to totally prevent people from accessing MAID if they are persistently asking for it. There should be a process that could ultimately lead to approval.

At the same time, a key feature of deep depression is a profoundly distorted view of reality. Depressed people demonstrably discount the future too steeply and fail to see the statistically high chances of improvement. Studies show most people who attempt suicide but survive are later glad they didn't die. So there's a strong case for at least putting speed bumps in place and not making the process too easy or quick, especially for younger people.

There will always be hard judgment calls, but I believe any sound MAID policy has to treat cases of pure mental illness very differently than terminal physical conditions. The required assessments of capacity should be much more extensive and the waiting periods longer. The bar to approve MAID for a physically healthy 30-year-old in an acute depressive episode should be worlds apart from an 80-year-old with terminal cancer.

But you've given me a lot to think about in terms of the primacy of bodily autonomy and problems with overriding individual authority over their lived experience. It's a complex issue I'll have to keep pondering.

To close us out on a lighter note, what did you think of Canadian food? You tried our famous poutine - any thoughts?

Vaish: I'm not going to claim any broad insight into Canadian cuisine from one short trip, but the poutine and other meals we had were all pretty good, especially considering we didn't try that hard to find the absolute best food. You and I have had good culinary experiences in India and Canada - I guess we just keep traveling to places with solid food scenes!

Regan: So you're saying in contrast to the US?

Vaish: Well, American food is pretty underwhelming outside of the big city restaurant scenes. But I'll have to reflect more on what we discussed regarding MAID. I may write something up exploring those issues further.

Regan: Glad I could provide some fodder for your Substack! Thanks to our listeners for tuning in. We'll be back in a few days with an interview with Malcolm Collins about fertility policy, religion, techno-optimism and more.