11 ms·

I want to go out as a result of a series of violent mistakes trying to save my life. Why would anyone want anything else? Peaceful death is basically suicide.

I want to go out as a result of a series of violent mistakes trying to save my life. Why would anyone want anything else? Peaceful death is basically suicide. Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause? At the very least, we could be honest about it and say what the real reason is: we don't have the resources to try everything for everyone, and normalizing a set of not-quite-everything standards is the best way to keep the average level of care up for everyone.

lotu 8y ago
I 100% agree with you. Though everyone should be able to make their own decision and because people are diffrent they will come to diffrent conclusions about what the right path for them is. We should not be trying to impose our path on other people. That said I'm going to speculate that as a doctor being asked to do long series of futile actions while watching a person die has to be traumatic. So I can understand why many doctors like the idea of palliative care.
- monodeldiablo 8y ago
  The fact that doctors overwhelmingly choose non-intervention and palliative care for themselves at their end strongly implies that they're not merely traumatized as doctors, but also that they feel it's terrible for the patient.
macintux 8y ago
> I want to go out as a result of a series of violent mistakes trying to save my life. The problem is that excruciating pain is only obviously better than death if there’s something positive at the end of it. Otherwise it’s comparable to being tortured 24 hours a day for the rest of your life.
- diminoten 8y ago
  Sorry, but excruciating pain is always better than death, because death is eternal nothingness. At least excruciating pain is something.
  - maxxxxx 8y ago
    Have you seen someone in excruciating pain for a long time without hope for improvement or experienced it yourself? It's really easy to talk tough while you are healthy but your opinion may change once you are in that situation. From what I have seen I would prefer to go out in dignity at my own will instead of being an experiment of the medical machine. Others may feel different and I think both paths should be available.
    - diminoten 8y ago
      Yes. And no, my opinion hasn't changed. What does dignity buy you if you're dead? Nothing. You can have yours, I'll spend mine to stay alive as long as possible.
      - maxxxxx 8y ago
        That's your choice. As I said both options should be available. In the end you will only know how you will really feel once you are in such a situation.
  - DesiLurker 8y ago
    such absolutist statements make me think you are relatively young and likely have not experienced any form of chronic pain, mind you not momentary pain that you 'rise above' but constant, unwavering, always-on pain. that changes perspectives, especially when you are old and don't have much to look forward to.
    - icebraining 8y ago
      These kind of ageist arguments are pretty annoying. Some people have chronic pain and still want to live as long as they possibly can.
sudhirj 8y ago
This article only talks about useless symptomatic treatments, not about effort at treating root cause. If you’ve just been diagnosed with something terminal you’d want to try every experimental treatment no matter how violent or dangerous. But if you’ve already established that nothing is working and your body has begun the shutdown process I don’t see why you’d want your last feelings to be shocks to your heart, your ribs broken or your throat being cut and plastic tubes shoved in. Emergency reactive procedures (codes) for a 20 year old who had an accident on the way to the gym and a 80 year old in the last stages of terminal cancer are the same, the article is arguing that they shouldn’t be.
bo1024 8y ago
You seem to be thinking of a case where an otherwise healthy person is dying of an incurable disease, and risky treatments might bring their health completely back. I don't think that's an accurate portrayal of most sicknesses and death in a hospital for the elderly. It's more like a progression of failures and problems (or a constellation), some mitigated, leading to more or less prolonged suffering with no end in sight but death. An 80-year-old with Alzheimers, diabetes, and cardiac problems doesn't have a "root cause" that you can just fix with an experimental treatment. They're old. We all get old. In that kind of case, I hope the doctors' perspective makes more sense...
- diminoten 8y ago
  No, it makes zero sense. My grandfather had advanced Parkinson's, but had zero intention of dying to it or its cornucopia of related symptoms/effects. So what if he has a major disease that made life many orders of magnitude worse for him? Life is still life, and death is still infinitely worse. Giving up and accepting death may seem reasonable to some, but not for me or my grandfather. There's always a root cause, and there's always a way to keep going. Giving up is suicide.
  - jdietrich 8y ago
    >Life is still life, and death is still infinitely worse. I assure you that this is untrue. There's a reason why people on the upper floors of the World Trade Center jumped from the windows, and it's not because they expected a soft landing. There are many, many things in this world worse than a peaceful death.
    - diminoten 8y ago
      I assure you it is not untrue. People failing to realize a truth doesn't make it less true. Peaceful death is suicide, if chosen. Period.
      - deleted 8y ago
        [deleted]
identity-haver 8y ago
The Norse of old would agree with you, where if you die a "straw death" outside of battle you don't get to go to Valhalla. But apparently if you stabbed yourself on your deathbed you still got to go to Valhalla?
cc81 8y ago
>Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause? I think one reason is because they see people with terminal diagnosis take a beating from heavy medication like chemo and being unable to spend time with their family instead of just taking pain killers and spending their last months with family and friends.
lolc 8y ago
In many cases, there are no mistakes made. Imagine a doctor saying: "You're going out but if we inflict pain you will stay longer." What would you choose? Peace or pain? What would you want your relatives to choose for you? In case you can't decide anymore? If the rest of my life will be nothing but pain, I don't think I'll want it.
- diminoten 8y ago
  Death is not peace, stop perpetuating that lie.
  - pdonis 8y ago
    Stop trying to pass off your own personal opinions as facts.
    - diminoten 8y ago
      Stop trying to interpret my opinions as facts. Are you seriously fooled into thinking what I'm saying here is even arguably fact? Of course it's my opinion...
      - pdonis 8y ago
        If you call something someone else says a lie, that's not a statement of opinion. You're saying they said something false. That's a factual matter.
        diminoten 8y ago
        An opinion can be false/wrong/a lie.
        chmod775 8y ago
        Something can't be an opinion and a lie by definition. Lying is consciously uttering something you belive to be untrue. It can't be your opinion at the same time. So unless you're planning to insult the people you are talking to by calling them dishonest, you should cease this way of discussing the topic. It's obvious you care greatly about this matter and tempers can understandably get heated, but people calling each other liars rarely have productive discussions that leave all parties wiser.
jdietrich 8y ago
>Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause? Most end-of-life decisions don't involve an otherwise healthy young person who might expect another 50 or 60 years of good-quality life, they involve someone who has multiple serious health problems and is definitely going to die of something in the very immediate future. We're not talking about saving lives, we're talking about briefly delaying an inevitable death. How much suffering would you be willing to endure for the possibility of another few days or weeks in a hospital bed? Doctors know what these deaths look like. They know what it feels like to effectively torture someone for no good reason. Doctors overwhelmingly choose palliative care for themselves, because they know that extraordinary medical efforts for very sick patients are invariably brutal, miserable and futile.
- omgwtfbyobbq 8y ago
  >Most end-of-life decisions don't involve an otherwise healthy young person who might expect another 50 or 60 years of good-quality life, they involve someone who has multiple serious health problems and is definitely going to die of something in the very immediate future. One significant problem, at least in my experience, is when doctors take that approach with someone, based primarily on their age and on inaccurate diagnoses, who has multiple serious health problems and does not die in the very immediate future. The common view seems like an inversion of Blackstone's ratio (better to prematurely end the life of one individual than to let however many other individuals suffer). To be fair, as a personal point of view this is fine, but it may also merge with socio-economic constraints in a really ugly way. In addition, no one I've spoken to has made any effort to even consider and explore differences in how other people experience pain or view death. When all is said and done, it can be a real shit show.
DesiLurker 8y ago
though I agree with you mostly I feel you are ignoring a couple of things 1) Pain, often pain management becomes a much bigger issue than going all out fighting vehemently to prolong your life by a few more days/weeks/months. Its hard to understand what chronic pain does to you and your mind unless you or a close loved one goes through it. Often pain management also aligns with 'slipping gently into the night'. 2) Incentives, hospitals are in the business of making money and they's gladly run marginally useful tests and medicines until they max out whatever coffers they can. as I see its not long before the ethical/common sense minded providers get overpowered by the money making machine and give in. as it is perhaps you are not aware there was a study that concluded most (IIRC 75%) of a persons healthcare expenses happen in last 18months of their lifes. just ask yourselves this, would you rather give your inheritance to your kids & grandkids or some hospital trying to maximize profits by promising you random treatment that increases you life by a few months? ultimately this should be your decision to make but there should be strong protections around the options providers can present to you. edit:formatting
- bookofjoe 8y ago
  2) brings to mind all too common scenario of patient being discharged from a psychiatric unit on day 22 because insurance only covers three weeks.
- jrnichols 8y ago
  Adding a study to back up yours. "Spending on Medicare beneficiaries in their last year of life accounts for about 25% of total Medicare spending on beneficiaries age 65 or older." https://www.kff.org/medicare/issue-brief/medicare-spending-at-the-end-of-life/ https://www.kff.org/medicare/issue-brief/medicare-spending-a...
chmod775 8y ago
Yeah. No. Let me cut your crusade against the medical profession short by telling you that doctors are putting their money where their mouth is [1]. They see the kind of suffering that prolonging people's lives with certain conditions can inflict and choose to have none of it. Other than that your comment is incredibly rude towards people who will do everything in their ability to keep you alive anyways - if you/family so insist - and also borders on being a conspiracy theory. [1]: https://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/ https://www.zocalopublicsquare.org/2011/11/30/how-doctors-di...
- diminoten 8y ago
  The literal title of this submission is "I lied when I said we did everything we could". If what I'm saying is conspiracy, so is this article. And no, I don't care if I'm being rude, I care if I'm being accurate. And I am. Stop making this about outrage and either have a conversation about the topic or leave. I may be wrong, but debating how offensive I'm being is a waste of everyone's time.
  - icebraining 8y ago
    > The literal title of this submission is "I lied when I said we did everything we could". If what I'm saying is conspiracy, so is this article. I think you totally missed the point of the article. The doctor there did what you advocate, it's just that he doesn't consider that doing everything they can.
    - diminoten 8y ago
      I didn't miss anything, and no the doctor didn't do what I advocate. Sure maybe in the local maxima sense he did, but there's a whole long period of time where more can be done.
      - icebraining 8y ago
        The implication you were deriving from the title is still erroneous. In any case, how exactly do you know what they didn't do that they could have? I don't see where you get enough information to derive any such conclusion. Considering that the doctor writing the article was just an intern, chances are he doesn't know everything they tried; how can you possibly claim to know?
deleted 8y ago
[deleted]
pygy_ 8y ago
Everyone has a threshold regarding the amount of suffering they are willing to endure rather than dying. Yours (and your grandfather's, per your other comment) may be high, but so isn't everyone else's. Suicide and euthanasia are valid options in some situations, which are up to each individual to evaluate for themselves. The doctor in the article has been confronted to the selfish side of love too many times. People want their family members to be kept alive because losing them would make them sad. Somehow more sad than seeing them suffer and slowly die anyways.
mikecsh 8y ago
I wonder whether you would have such strongly held opinions if you had more experience of medicine, disease, and end of life.

lotu 8y ago

I 100% agree with you. Though everyone should be able to make their own decision and because people are diffrent they will come to diffrent conclusions about what the right path for them is. We should not be trying to impose our path on other people. That said I'm going to speculate that as a doctor being asked to do long series of futile actions while watching a person die has to be traumatic. So I can understand why many doctors like the idea of palliative care.

monodeldiablo 8y ago
The fact that doctors overwhelmingly choose non-intervention and palliative care for themselves at their end strongly implies that they're not merely traumatized as doctors, but also that they feel it's terrible for the patient.

macintux 8y ago

> I want to go out as a result of a series of violent mistakes trying to save my life. The problem is that excruciating pain is only obviously better than death if there’s something positive at the end of it. Otherwise it’s comparable to being tortured 24 hours a day for the rest of your life.

diminoten 8y ago
Sorry, but excruciating pain is always better than death, because death is eternal nothingness. At least excruciating pain is something.
- maxxxxx 8y ago
  Have you seen someone in excruciating pain for a long time without hope for improvement or experienced it yourself? It's really easy to talk tough while you are healthy but your opinion may change once you are in that situation. From what I have seen I would prefer to go out in dignity at my own will instead of being an experiment of the medical machine. Others may feel different and I think both paths should be available.
  - diminoten 8y ago
    Yes. And no, my opinion hasn't changed. What does dignity buy you if you're dead? Nothing. You can have yours, I'll spend mine to stay alive as long as possible.
    - maxxxxx 8y ago
      That's your choice. As I said both options should be available. In the end you will only know how you will really feel once you are in such a situation.
- DesiLurker 8y ago
  such absolutist statements make me think you are relatively young and likely have not experienced any form of chronic pain, mind you not momentary pain that you 'rise above' but constant, unwavering, always-on pain. that changes perspectives, especially when you are old and don't have much to look forward to.
  - icebraining 8y ago
    These kind of ageist arguments are pretty annoying. Some people have chronic pain and still want to live as long as they possibly can.

sudhirj 8y ago

This article only talks about useless symptomatic treatments, not about effort at treating root cause. If you’ve just been diagnosed with something terminal you’d want to try every experimental treatment no matter how violent or dangerous. But if you’ve already established that nothing is working and your body has begun the shutdown process I don’t see why you’d want your last feelings to be shocks to your heart, your ribs broken or your throat being cut and plastic tubes shoved in. Emergency reactive procedures (codes) for a 20 year old who had an accident on the way to the gym and a 80 year old in the last stages of terminal cancer are the same, the article is arguing that they shouldn’t be.

bo1024 8y ago

You seem to be thinking of a case where an otherwise healthy person is dying of an incurable disease, and risky treatments might bring their health completely back. I don't think that's an accurate portrayal of most sicknesses and death in a hospital for the elderly. It's more like a progression of failures and problems (or a constellation), some mitigated, leading to more or less prolonged suffering with no end in sight but death. An 80-year-old with Alzheimers, diabetes, and cardiac problems doesn't have a "root cause" that you can just fix with an experimental treatment. They're old. We all get old. In that kind of case, I hope the doctors' perspective makes more sense...

diminoten 8y ago
No, it makes zero sense. My grandfather had advanced Parkinson's, but had zero intention of dying to it or its cornucopia of related symptoms/effects. So what if he has a major disease that made life many orders of magnitude worse for him? Life is still life, and death is still infinitely worse. Giving up and accepting death may seem reasonable to some, but not for me or my grandfather. There's always a root cause, and there's always a way to keep going. Giving up is suicide.
- jdietrich 8y ago
  >Life is still life, and death is still infinitely worse. I assure you that this is untrue. There's a reason why people on the upper floors of the World Trade Center jumped from the windows, and it's not because they expected a soft landing. There are many, many things in this world worse than a peaceful death.
  - diminoten 8y ago
    I assure you it is not untrue. People failing to realize a truth doesn't make it less true. Peaceful death is suicide, if chosen. Period.
    - deleted 8y ago
      [deleted]

identity-haver 8y ago

The Norse of old would agree with you, where if you die a "straw death" outside of battle you don't get to go to Valhalla. But apparently if you stabbed yourself on your deathbed you still got to go to Valhalla?

cc81 8y ago

>Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause? I think one reason is because they see people with terminal diagnosis take a beating from heavy medication like chemo and being unable to spend time with their family instead of just taking pain killers and spending their last months with family and friends.

lolc 8y ago

In many cases, there are no mistakes made. Imagine a doctor saying: "You're going out but if we inflict pain you will stay longer." What would you choose? Peace or pain? What would you want your relatives to choose for you? In case you can't decide anymore? If the rest of my life will be nothing but pain, I don't think I'll want it.

diminoten 8y ago
Death is not peace, stop perpetuating that lie.
- pdonis 8y ago
  Stop trying to pass off your own personal opinions as facts.
  - diminoten 8y ago
    Stop trying to interpret my opinions as facts. Are you seriously fooled into thinking what I'm saying here is even arguably fact? Of course it's my opinion...
    - pdonis 8y ago
      If you call something someone else says a lie, that's not a statement of opinion. You're saying they said something false. That's a factual matter.
      - diminoten 8y ago
        An opinion can be false/wrong/a lie.
        chmod775 8y ago
        Something can't be an opinion and a lie by definition. Lying is consciously uttering something you belive to be untrue. It can't be your opinion at the same time. So unless you're planning to insult the people you are talking to by calling them dishonest, you should cease this way of discussing the topic. It's obvious you care greatly about this matter and tempers can understandably get heated, but people calling each other liars rarely have productive discussions that leave all parties wiser.

jdietrich 8y ago

>Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause? Most end-of-life decisions don't involve an otherwise healthy young person who might expect another 50 or 60 years of good-quality life, they involve someone who has multiple serious health problems and is definitely going to die of something in the very immediate future. We're not talking about saving lives, we're talking about briefly delaying an inevitable death. How much suffering would you be willing to endure for the possibility of another few days or weeks in a hospital bed? Doctors know what these deaths look like. They know what it feels like to effectively torture someone for no good reason. Doctors overwhelmingly choose palliative care for themselves, because they know that extraordinary medical efforts for very sick patients are invariably brutal, miserable and futile.

omgwtfbyobbq 8y ago
>Most end-of-life decisions don't involve an otherwise healthy young person who might expect another 50 or 60 years of good-quality life, they involve someone who has multiple serious health problems and is definitely going to die of something in the very immediate future. One significant problem, at least in my experience, is when doctors take that approach with someone, based primarily on their age and on inaccurate diagnoses, who has multiple serious health problems and does not die in the very immediate future. The common view seems like an inversion of Blackstone's ratio (better to prematurely end the life of one individual than to let however many other individuals suffer). To be fair, as a personal point of view this is fine, but it may also merge with socio-economic constraints in a really ugly way. In addition, no one I've spoken to has made any effort to even consider and explore differences in how other people experience pain or view death. When all is said and done, it can be a real shit show.

DesiLurker 8y ago

though I agree with you mostly I feel you are ignoring a couple of things 1) Pain, often pain management becomes a much bigger issue than going all out fighting vehemently to prolong your life by a few more days/weeks/months. Its hard to understand what chronic pain does to you and your mind unless you or a close loved one goes through it. Often pain management also aligns with 'slipping gently into the night'. 2) Incentives, hospitals are in the business of making money and they's gladly run marginally useful tests and medicines until they max out whatever coffers they can. as I see its not long before the ethical/common sense minded providers get overpowered by the money making machine and give in. as it is perhaps you are not aware there was a study that concluded most (IIRC 75%) of a persons healthcare expenses happen in last 18months of their lifes. just ask yourselves this, would you rather give your inheritance to your kids & grandkids or some hospital trying to maximize profits by promising you random treatment that increases you life by a few months? ultimately this should be your decision to make but there should be strong protections around the options providers can present to you. edit:formatting

bookofjoe 8y ago
2) brings to mind all too common scenario of patient being discharged from a psychiatric unit on day 22 because insurance only covers three weeks.
jrnichols 8y ago
Adding a study to back up yours. "Spending on Medicare beneficiaries in their last year of life accounts for about 25% of total Medicare spending on beneficiaries age 65 or older." https://www.kff.org/medicare/issue-brief/medicare-spending-at-the-end-of-life/ https://www.kff.org/medicare/issue-brief/medicare-spending-a...

chmod775 8y ago

Yeah. No. Let me cut your crusade against the medical profession short by telling you that doctors are putting their money where their mouth is [1]. They see the kind of suffering that prolonging people's lives with certain conditions can inflict and choose to have none of it. Other than that your comment is incredibly rude towards people who will do everything in their ability to keep you alive anyways - if you/family so insist - and also borders on being a conspiracy theory. [1]: https://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/ https://www.zocalopublicsquare.org/2011/11/30/how-doctors-di...

diminoten 8y ago
The literal title of this submission is "I lied when I said we did everything we could". If what I'm saying is conspiracy, so is this article. And no, I don't care if I'm being rude, I care if I'm being accurate. And I am. Stop making this about outrage and either have a conversation about the topic or leave. I may be wrong, but debating how offensive I'm being is a waste of everyone's time.
- icebraining 8y ago
  > The literal title of this submission is "I lied when I said we did everything we could". If what I'm saying is conspiracy, so is this article. I think you totally missed the point of the article. The doctor there did what you advocate, it's just that he doesn't consider that doing everything they can.
  - diminoten 8y ago
    I didn't miss anything, and no the doctor didn't do what I advocate. Sure maybe in the local maxima sense he did, but there's a whole long period of time where more can be done.
    - icebraining 8y ago
      The implication you were deriving from the title is still erroneous. In any case, how exactly do you know what they didn't do that they could have? I don't see where you get enough information to derive any such conclusion. Considering that the doctor writing the article was just an intern, chances are he doesn't know everything they tried; how can you possibly claim to know?

deleted 8y ago

[deleted]

pygy_ 8y ago

Everyone has a threshold regarding the amount of suffering they are willing to endure rather than dying. Yours (and your grandfather's, per your other comment) may be high, but so isn't everyone else's. Suicide and euthanasia are valid options in some situations, which are up to each individual to evaluate for themselves. The doctor in the article has been confronted to the selfish side of love too many times. People want their family members to be kept alive because losing them would make them sad. Somehow more sad than seeing them suffer and slowly die anyways.

mikecsh 8y ago

I wonder whether you would have such strongly held opinions if you had more experience of medicine, disease, and end of life.