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Given that this is a forum with strong international participation I'd be interested to hear what non-Americans think about this. As an American, I believe that

Given that this is a forum with strong international participation I'd be interested to hear what non-Americans think about this. As an American, I believe that our culture has a very unhealthy attitude toward dying (often thinking about it as "if" instead of "when"). I think that attitude drives a lot of bad decisions surrounding end-of-life care (both for ourselves, and for loved ones). I know that attitude about euthanasia differ pretty markedly in other countries. How about the attitudes re: death and dying? Are the "attitude problems" I observe an American anomaly?

mekkkkkk 6y ago
I don't know if my experience is representative, but those I've known who have been terminally ill have all been calmly accepting of the fact after all reasonable options were exhausted. Same for their respective loved ones. One of my relatives went through assisted euthanasia before the illness got really bad, and it was mostly a respected decision by everyone. This is in Europe.
ACow_Adonis 6y ago
it's definitely consistent across the anglosphere in my experience. indeed, one of the non- American sensitivities, given other nation's relatively socialised medicines, is the application of comparatively redundant/ inefficient/pointless treatments on individuals nearing their end of life, because a lot of medical treatments assume the patient actually has prospects of recovery or the ability to gain utility from the outcome of a treatment. for instance, should you provide socialised elective (or otherwise) surgery to a 98 year old with dementia. what about physio for their "recovery period"? you can get a lot of pressure for treatments to "do something" (both from family members and from cost-recovery incentives... course in for profit systems those problems don't go away, and this is not addressing the issues with medicine that would genuinely require family intervention)
thinkingemote 6y ago
I think more interesting differences could come from cultures within America; do Irish Americans have different attidues than urban modern atheist ones, for example.
ce4 6y ago
I haven't heard of such stories here personally (Germany), it may exist, though my guess is that such behaviour is reserved for the upper class. There's also only one article on wikipedia in another language for this concept. Health insurance is compulsory (most have the basic form that is cheap and subsidized and some have fully private insurance). We have another issue though: Doctors and clinics have admitted to overtreating private patients even if an operation is risky or won't be too benefitial (e.g. artificial hips at an age 85+ or similar). Just to cash in 6 figures because the private plan is known to pay it. In such cases relatives will of course also have an influence on such treatments. Edit: style/grammar Edit2: what i have witnessed personally is that it's very easy to get pills for anything in the US. I once had a torn toe nail and got codeine for 40 days, that totally baffled me. I would not have gotten opioids at home for such a thing, maybe Novalgin for a few days on request and over the counter NSAID else
- rconti 6y ago
  Yeah, it can go either way. The profit motive means private facilities have an incentive to charge for care as long as someone is willing to pay, even if there's not a 'real' long-term benefit. On the other hand, some of the scare tactics in the US that have been used against government-run health care is that some bureaucrat is "rationing" care, deciding when it's "worth" paying for a procedure, which is of course true. Then again, as in the German model, there's nothing preventing you from paying out-of-pocket or acquiring additional private insurance coverage above what the state provides. And of course it's a personal issue, how much money you are willing to spend and how much you are willing to undergo to prolong your life, however briefly. As for pills, after too many decades of dependance and addiction, it's getting harder to get narcotics in the US (finally?) I'm currently sitting with my leg up being iced after an ACL replacement surgery on Thursday. My prescription for an opiate is for 20 pills (3 days worth) and has no refills. As it runs out in a day, I've talked to my doctor, and it sounds possible-but-not-easy to get a new prescription, if necessary. I'm hoping to not need it, but it at least sounds possible if I do.
  - ce4 6y ago
    Oh, I hope you recover soon! > there's nothing preventing you from paying out-of-pocket or acquiring additional private insurance Of course not, but from what I whitnessed, it's not really common. One ongoing personal health issue has changed my thinking about it (the commons plan treatment is more or less absent or negligent at best) but I do get strange looks when I tell that I pay out of pocket for that, even from colleagues that I know have similar issues and are much more wealthier than me. At some point they have had enough docs and gave up, living with it. You also cannot add general private health insurance as an addon (only stuff like dentist coverage), but you need to make a switch-once-and-for-all decision to private insurance (there's no going back to the subsidized commons model, it's possible via exceptions, but generally very hard). The earlier in life you do make this decision to switch, the cheaper the health plan gets - at an older age there's chances they will deny you or exclude treatment for known health issues & ask heavy prices. Switching between different private health plans is also difficult, for the same reasons. Although since 2010 or so, insurers must reserve 30% or so of accumulated capital to be transferred in case one switches private insurance funds. But old plans before that "don't vest" or how to say, when switching. The saying goes "it's easier to get divorced than to switch your private helth insurance"
galkk 6y ago
I have an example from Ukraine, where an acquaintance of mine spent insane amount of money on "care" on her elderly, sick grandmother (90+) yo. When public hospitals refused to continue care due to uselessness, she took her grandmother to private ones, who happily took her miney, and couldn't stop. It was about 10 years ago. Acquaintance's monthly salary was about $700 (that's Ukraine, after all), so she took debt etc. 6 months later and $15k in debt, grandmother still died. I had a lot of sad thoughts about entire situation - I understand the wish to help loved one. I understand the wish to live. I understand that it was much easier for me to look more objectively at the entire situation... I hope if my time will come, I won't be a burden for my family and will be able to make conscious decision.
- foogazi 6y ago
  It’s a sad situation all around. Do you trust the public professional or start paying? Then once you start paying - how can you stop?

mekkkkkk 6y ago

I don't know if my experience is representative, but those I've known who have been terminally ill have all been calmly accepting of the fact after all reasonable options were exhausted. Same for their respective loved ones. One of my relatives went through assisted euthanasia before the illness got really bad, and it was mostly a respected decision by everyone. This is in Europe.

ACow_Adonis 6y ago

it's definitely consistent across the anglosphere in my experience. indeed, one of the non- American sensitivities, given other nation's relatively socialised medicines, is the application of comparatively redundant/ inefficient/pointless treatments on individuals nearing their end of life, because a lot of medical treatments assume the patient actually has prospects of recovery or the ability to gain utility from the outcome of a treatment. for instance, should you provide socialised elective (or otherwise) surgery to a 98 year old with dementia. what about physio for their "recovery period"? you can get a lot of pressure for treatments to "do something" (both from family members and from cost-recovery incentives... course in for profit systems those problems don't go away, and this is not addressing the issues with medicine that would genuinely require family intervention)

thinkingemote 6y ago

I think more interesting differences could come from cultures within America; do Irish Americans have different attidues than urban modern atheist ones, for example.

ce4 6y ago

I haven't heard of such stories here personally (Germany), it may exist, though my guess is that such behaviour is reserved for the upper class. There's also only one article on wikipedia in another language for this concept. Health insurance is compulsory (most have the basic form that is cheap and subsidized and some have fully private insurance). We have another issue though: Doctors and clinics have admitted to overtreating private patients even if an operation is risky or won't be too benefitial (e.g. artificial hips at an age 85+ or similar). Just to cash in 6 figures because the private plan is known to pay it. In such cases relatives will of course also have an influence on such treatments. Edit: style/grammar Edit2: what i have witnessed personally is that it's very easy to get pills for anything in the US. I once had a torn toe nail and got codeine for 40 days, that totally baffled me. I would not have gotten opioids at home for such a thing, maybe Novalgin for a few days on request and over the counter NSAID else

rconti 6y ago
Yeah, it can go either way. The profit motive means private facilities have an incentive to charge for care as long as someone is willing to pay, even if there's not a 'real' long-term benefit. On the other hand, some of the scare tactics in the US that have been used against government-run health care is that some bureaucrat is "rationing" care, deciding when it's "worth" paying for a procedure, which is of course true. Then again, as in the German model, there's nothing preventing you from paying out-of-pocket or acquiring additional private insurance coverage above what the state provides. And of course it's a personal issue, how much money you are willing to spend and how much you are willing to undergo to prolong your life, however briefly. As for pills, after too many decades of dependance and addiction, it's getting harder to get narcotics in the US (finally?) I'm currently sitting with my leg up being iced after an ACL replacement surgery on Thursday. My prescription for an opiate is for 20 pills (3 days worth) and has no refills. As it runs out in a day, I've talked to my doctor, and it sounds possible-but-not-easy to get a new prescription, if necessary. I'm hoping to not need it, but it at least sounds possible if I do.
- ce4 6y ago
  Oh, I hope you recover soon! > there's nothing preventing you from paying out-of-pocket or acquiring additional private insurance Of course not, but from what I whitnessed, it's not really common. One ongoing personal health issue has changed my thinking about it (the commons plan treatment is more or less absent or negligent at best) but I do get strange looks when I tell that I pay out of pocket for that, even from colleagues that I know have similar issues and are much more wealthier than me. At some point they have had enough docs and gave up, living with it. You also cannot add general private health insurance as an addon (only stuff like dentist coverage), but you need to make a switch-once-and-for-all decision to private insurance (there's no going back to the subsidized commons model, it's possible via exceptions, but generally very hard). The earlier in life you do make this decision to switch, the cheaper the health plan gets - at an older age there's chances they will deny you or exclude treatment for known health issues & ask heavy prices. Switching between different private health plans is also difficult, for the same reasons. Although since 2010 or so, insurers must reserve 30% or so of accumulated capital to be transferred in case one switches private insurance funds. But old plans before that "don't vest" or how to say, when switching. The saying goes "it's easier to get divorced than to switch your private helth insurance"

galkk 6y ago

I have an example from Ukraine, where an acquaintance of mine spent insane amount of money on "care" on her elderly, sick grandmother (90+) yo. When public hospitals refused to continue care due to uselessness, she took her grandmother to private ones, who happily took her miney, and couldn't stop. It was about 10 years ago. Acquaintance's monthly salary was about $700 (that's Ukraine, after all), so she took debt etc. 6 months later and $15k in debt, grandmother still died. I had a lot of sad thoughts about entire situation - I understand the wish to help loved one. I understand the wish to live. I understand that it was much easier for me to look more objectively at the entire situation... I hope if my time will come, I won't be a burden for my family and will be able to make conscious decision.

foogazi 6y ago
It’s a sad situation all around. Do you trust the public professional or start paying? Then once you start paying - how can you stop?