19 ms·

How Doctors die. It’s not like the rest of us (2016)

272 points by jimmckin1 5y ago

deleted 5y ago
[deleted]
advisedwang 5y ago
This doctor clearly has a vision for how he feels end of life should be, and then implies all (most) doctors share this and non-doctors should follow and doctors should be more vocal about the implied belief. I'm a bit warey of his assertion that all doctors think the same way as him though. He relies pretty heavily on his experience and a few anecdotes. I wonder if there is any actual data on how doctors view "futile" care and end of life.
- jt2190 5y ago
  Here’s some actual data: “Most physicians would forgo aggressive treatment for themselves at the end of life, study finds” https://med.stanford.edu/news/all-news/2014/05/most-physicians-would-forgo-aggressive-treatment-for-themselves-.html https://med.stanford.edu/news/all-news/2014/05/most-physicia...
  - mertd 5y ago
    Take it with a grain of salt just like any self reported study. Their preference may very well change when they become the patient.
    - Igelau 5y ago
      Especially with something as heavy as "here's your choice of the last two calendar dates you can expect to be alive"
    - JohnJamesRambo 5y ago
      “Everybody has a plan until they get punched in the face.” -Mike Tyson
      - meepmorp 5y ago
        My dad was a physician who always was very clear that he did not want to live in an incapacitated sate. When he had the stroke that killed him, he tried to keep my mom from calling 911 till after he was dead. Some people are expecting to get punched in the face.
    - kibwen 5y ago
      Anyone with this opinion will have DNR orders on file. Their preference is already locked in.
- Spooky23 5y ago
  Most of my family are physicians or nurses. They are all of this opinion. My mom was an ER and ICU RN and NP. She’s to the point where I have a written protocol for when and how I am to call 911 in the event of an emergency for her. Nobody wants to die, but few who understand want to live in the purgatory between life and death that futile care entails.
- irrational 5y ago
  It's all ancedotal, but my dad is a doctor and, in talking with him, he agrees with the author and says every other doctor he knows concurs. He is in his 70s and not in the greatest of health (he was in a car accident years ago that seriously led to a decline in his health). He hasn't changed his mind at all as he has gotten older.
- husarcik 5y ago
  As a physician, I think it comes down to circumstance and goals of care. If I was in my forties and had several young children, I'd want everything done to be able to see them again. Even if I knew it was "futile". This is why palliative care is so important. All of our goals in life are vastly different all the time, even cycling every week.
brhsagain 5y ago
Related and very interesting read: https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...
- camkego 5y ago
  Far, far, far down in the blog post at section III., the author says this: > I (and the doctors in my family whom I’ve asked) am pretty much like the doctors in the article. If I get a terminal disease, I want to wring what I can out of the few months of life I have left and totally avoid any surgery, chemotherapy, amputations, ventilators, and the like. It would be a clean death. It would be okay. > My big fear, though, is that I won’t get a terminal disease.
  - nickthemagicman 5y ago
    Why would that be the big fear?
    - initplus 5y ago
      Answered in the subsequent paragraph after the end of the quotation...
    - renjimen 5y ago
      It's ambiguous but maybe they mean a chronic disease instead? i.e. constant suffering but no end date.
    - nemo44x 5y ago
      I think it means you get something like a degenerative COPD that just grinds you into the ground one suffering day after another while you’re in and out of hospitals, lose your mobility, and lose your basic organ functions; no chance to recover, just withering away neither quickly or slowly.
    - nicwilson 5y ago
      I'm guessing something like e.g. Alzheimers or some other quality of life degrading, but not lethal, disease that makes life (not as) worth living, at least past a certain point in the progression of the disease. But because its not lethal, it won't take you out of your misery.
jerlam 5y ago
This is a pretty popular topic, and discussed previously: https://news.ycombinator.com/item?id=3313570 https://news.ycombinator.com/item?id=3313570 (2011) https://news.ycombinator.com/item?id=5104430 https://news.ycombinator.com/item?id=5104430 (2013) https://news.ycombinator.com/item?id=9260286 https://news.ycombinator.com/item?id=9260286 (2015) https://news.ycombinator.com/item?id=13122408 https://news.ycombinator.com/item?id=13122408 (2016)
- fouc 5y ago
  those 4 HN links refer to these 2 articles: http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/ http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die... http://www.theguardian.com/society/2012/feb/08/how-doctors-choose-die http://www.theguardian.com/society/2012/feb/08/how-doctors-c...
  - jerlam 5y ago
    These are all derived from the original 2011 Zocalo article. The bottom of the Cancerworld article says: > This blogpost was first published in 2011 on Zócalo Public Square The bottom of the Guardian article says: > Taken from an article originally published at Zócalo Public Square.
spaceflunky 5y ago
Several of my grandparents spent way too long in ICU and hospice care and ultimately it wasn't worth it. I feel terrible about how their final days went, but other family members were adamant about 'throwing everything they could at it.' But the family members making that choice weren't footing the bill and they didn't have to lay in bed all day, so why wouldn't they try? I also feel they had a gross misunderstanding of the capabilities of modern medicine. In each case the doctor's asked, "do you want to give him/her a fighting chance?" Of course, no one wants to say 'no' to that question, because they don't really understand what's possible and don't understand what "winning" actually looks like.
- actually_a_dog 5y ago
  > In each case the doctor's asked, "do you want to give him/her a fighting chance?" Of course, no one wants to say 'no' to that question, because they don't really understand what's possible and don't understand what "winning" actually looks like. Right, and people don't generally think to ask those questions because, at that point, they're not in an emotional state that is conducive to stopping and asking questions. That said, the phrase "fighting chance" is absolutely terrible here. It's far too loaded to convey what would actually be meant here.
  - amatecha 5y ago
    Yeah, some might describe it as something more like "drawing it out as long as possible", from what I've observed of some people in their last days/weeks/months.
- gerdesj 5y ago
  "But the family members making that choice weren't footing the bill" That appears to be the crux of the problem: "footing the bill". It may sound counter intuitive but I have found that when cost is removed from the equation, then better decisions may arise or at least a few extra distortions are removed. When money is directly involved then there are several potential, and in my view damaging, extra approaches that might arise. There's the: "we've spent so much and achieved [something] so let's go all in." Or "we've only spent this much so let's go for gold" Or: "We are paying for this anyway and so let's give it a go". Health care systems that are funded by taxation ie pre-paid, in my view, escape those problems and encourage end of life scenarios that are more likely to be better (for a given value of better) I think that I am very lucky to have the UK's NHS to care for me. We pay for it nominally via a second income related tax called "National Insurance" - we also have a country wide "Income Tax". The NI rate is: https://www.gov.uk/national-insurance/how-much-you-pay https://www.gov.uk/national-insurance/how-much-you-pay - nominally 12% but is only levied on the first £x. It gets a bit complicated because employers also pay NI for their employees. The thing about an organisation like the National Health Service is that if you have one and you get hurt, you get it fixed without thinking about it too much. We do pay quite a lot for it but it works and the cost is not so noticeable compared to Income Tax. My dad had a few heart related snags a few years ago that involved a three week stay in Exeter General, then a helicopter flight to London and a six month stay in the Royal Brompton, mostly in their intensive care unit (ICU) which would have been horrendously expensive. One of the docs described how he massaged my Dad's heart in his hands when the bloody thing decided to get a bit weary of being fiddled with too much. The UK's NHS is not perfect or anywhere near perfect. It's a whopping great organisation with some good and some not so good staff and some horrendous bureaucracy. That said, I would prefer it to any other medical system. It works eventually and often works surprisingly well and often preemptively. Dad would be dead without it. Dad's GP practice missed a few clues. When his doc went on holiday, a Hospital Registrar (as it turns out) was drafted in to cover. Dad presented and his feet didn't touch the floor until he was in a hospital bed. Again, I have to emphasise that the UK's NHS is not perfect but I don't worry about what to do if my arm fell off or something. I get to A&E and they fix me up. I have also been at the far end of palliative care (Mum). Again the NHS did the business and did its best (cancer) but it had to accept defeat. That's when Hospice Care cuts in alongside the NHS. St Margarets were absolutely fantastic. In the end it is taxation that pays for this thing but the fact that you can forget about money when dealing with health care issues is quite important, I think.
hirundo 5y ago
My mom struggled with lung cancer for two terrible years with cutting edge treatment, and died badly. My dad cared for her through that, and when his turn came five years later, he had no doubts. He refused all but palliative care and died in two months. What he saw once, a physician will see over and over ad nauseam. Having seen one of each, I'm not conflicted over which path I'd take.
- drewg123 5y ago
  My parents had a very similar experience. I feel your pain, and I agree with your choice
- adventured 5y ago
  Was it small cell lung cancer? edit: for the remarkably special downvoters (stay classy HN) - that's the type of lung cancer my mother died from, in about 20 months time. You generally can't surgically remove small cell lung cancer. It was particularly brutal, with endless treatment attempts that were physically grueling and minimally effective. It's a highly aggressive cancer with a very low survival rate and few good treatment options. Accordingly, having watched her go through that, I can very much relate to what the parent said.
  - Johnny555 5y ago
    While I don't usually comment on downvotes, my guess is that the downvotes are because your question can come off as being insensitive. After someone tells you about the tragic death of both of his parents, maybe don't start a guessing game of what his mother died of even if your loved one died of that same disease.
    - adventured 5y ago
      The barrage of downvotes were typical HN assuming the worst (mindless insensitivity) rather than giving a benefit of the doubt about my intent. This, from HN's guidelines: Assume good faith. You won't see much of that on HN in my very long experience here. People so often jump right to assuming the worst, which is why that guideline exists. The assumption was that I was being insensitive, when the actuality was that I was going to attempt to start a conversation in order to better relate to the parent's story. I could have structured what I said better? That's fair, it happens, and it still doesn't change my intentions, which were positive. It's the classic and true line, that people judge others by their actions without considering intentions and they prefer to judge themselves by their intentions instead of their actions. That's why trying to assume good faith on the part of someone else is so useful on forums. I've got approximately four billion points here on HN, I don't care about the downvotes unto themselves, it's the lack of collegial communication instead of jumping right to a negative triggered reaction (a downvote, which represented a negative, incorrect assumption). You'll notice nobody asked why I was asking that very specific question, there was no attempt to give a shit about that, they all went right to behaving negatively.
paulpauper 5y ago
Years ago, Charlie, a highly respected orthopaedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds – from 5% to 15% – albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him. I am guessing that he had testing which determined it had spread and was terminal. It seems implausible that an otherwise healthy person would just pass up on a 15% chance of survival.
- robbyking 5y ago
  If I were given a 15% chance of survival (at best) where the most I could hope for was having a poor quality of life, I wouldn't be interested either. Even it at 2:1 it'd be a tough decision for me.
- moritonal 5y ago
  As a doctor, he'd understand more than most what a "poor quality of life" means.
- deleted 5y ago
  [deleted]
- Spooky23 5y ago
  With a major bowel surgery? You’re looking colostomy bag combined with a tough recovery. That means pressure sores, painful chemo or radiation, substandard care in rehab, etc. Plus, pancreatic cancer usually comes back in force once you run that gauntlet. My dad went through some of that post-stroke. No way.
- paulcole 5y ago
  15% for 5 years of unpleasant survival. Basically 0% chance for a “long” “normal” life after that. My mother (who worked in medicine and was very healthy) was diagnosed with a GBM and had a brief course of radiation to try to shrink it without a ton of luck. She stopped working and went home and had an OK year then an awful 4 months and then fell out of bed and broke her hip and never woke up. She could’ve maybe had 2 or 3 pretty bad years if she’d “fought” and was “lucky.”
amyjess 5y ago
I long ago decided that if I got a terminal disease, I would refuse any treatment that would extend my quantity of life at the expense of my quality of life. I've seen what chemo does to people. No thank you. If I get cancer, I'll just self-medicate with whatever opioids I can get my hands on until either the cancer kills me or the pain gets bad enough that the opioids stop being able to do anything for it, at which point I'd just intentionally OD by a massive amount while alone in a remote location. (and on top of all the debilitating, crippling effects of chemo, I am also, for multiple reasons, particularly attached to my hair... it's one of the only parts of my body I like, and I would literally rather die than lose my hair)
- amatecha 5y ago
  Don't be so quick to decide this now -- consider your options at the time, if such a thing arises. It may not be so cut & dry as "terminal" and there's a huge amount of variability in how cancer diagnoses go. In the meantime, take the best care of your body you possibly can :)
  - Johnny555 5y ago
    If you don't decide it now and write it down in a living will, you may be unable to make that decision when you need to.
  - amyjess 5y ago
    Even if the cancer has a very high survival rate following chemo, if the only way to save my life involves losing my hair I will refuse treatment and let myself die.
    - H8crilA 5y ago
      I mean, first - the loss of hair is temporary, second - not all cancers are that vicious. It might be worth it if the probability of survival after treatment is high. This article was about almost certainly incurable cases, treatment or not.
pochekailov 5y ago
Today's medicine is focused to treat the diseases, refusing to admit that people at 70-80 years old die not from disease, but from the old age. Everybody but a few enthusiasts refuse to treat ageing instead of cancer or heart diseases. People in general refuse to treat ageing as a disease, thinking it is something natural. I would not want a couple more miserable years on earth, I want a few million years of a healthy young life.
- SV_BubbleTime 5y ago
  > People in general refuse to treat ageing as a disease, thinking it is something natural. Aging is not natural? I certainly understand why someone would not consider it a disorder. > I want a few million years of a healthy young life. I would avoid literal genies if I were you.
  - indecisive_user 5y ago
    Aging is natural the same way heart disease and cancer are natural. Some people get unlucky and develop cancer at a young age, but we don't throw up our hands and say whelp it's just nature. We should treat aging the same way. Some people's bodies fail them at 80, but others live to be 100+. If we develop good treatments there's no reason that everyone can't live to be 100 in relatively good health.
    - ZephyrBlu 5y ago
      > Aging is natural the same way heart disease and cancer are natural How are heart disease and cancer not natural? Aging is also slightly different in that it's how our bodies are supposed to work as far as I understand it, which is not very well (Possibly as a cancer prevention mechanism). Telomeres and Aging: https://en.wikipedia.org/wiki/Telomere#Association_with_aging https://en.wikipedia.org/wiki/Telomere#Association_with_agin... Telomeres and Cancer prevention: https://en.wikipedia.org/wiki/Telomere#Telomerase https://en.wikipedia.org/wiki/Telomere#Telomerase
      - 5y ago
OneEyedRobot 5y ago
What ticks me off no end is the folks who (often successfully) fight against physician assisted suicide. Dementia is the interesting test case, but I think should still be allowed. With all the talk about 'controlling our bodies' in terms of abortion, and I can see both sides of that one, your own life is the one thing you really own. To have that control taken away is the worst kind of insult by the state.
- amatecha 5y ago
  Yeah, I know someone who said for basically their entire adult life "if I ever get like that, just shoot me" and meant it quite seriously. Unfortunately, they indeed spent their last few years gradually degrading in the throes of dementia. Very sad to see, and even more sad to know they would have absolutely hated being left to "rot" in such a way. The only consolation is the person hopefully didn't "know"? Who knows? :\
  - IncRnd 5y ago
    People say all sorts of things, but if they don't commit to writing directions down, how are people supposed to know what the person really wanted? Also, someone might say one thing, until death becomes immanent, and then they realize they want something else.
    - denton-scratch 5y ago
      I have written a formal, witnessed statement of my wishes, in the event that I'm unable to utter them. My physician has a copy; there's a copy in my desk-drawer at home, with my will. I understand that different health authorities here have different policies on the registration and application of such "living wills". I have no confidence that if I get sick in the wrong place, my statement will even be noticed, let alone respected. Also, there's no reason why a paramedic coming to my home would know to look in my desk-drawer (I live on my own), and so discover that I don't want any CPR, ever. And ultimately, these living wills are advisory only; medics can't be sued for ignoring them. It's a bloody mess. I really hope I don't ever get demented.
drdeadringer 5y ago
I took two psych classes in University. One was "Death and Dying". Perhaps a morbid class to take in your 20s, but it was a full class. The professor happened to be dying herself as she taught it. Very useful and enjoyable. It's one of the few textbooks I've kept since the long-ago graduation. A very useful course to take.
- mistrial9 5y ago
  in one view, most everyone is dying, while they read this.. a colleague did some hospice volunteer work for a while, and I made sure to quietly mention to her that I found it commendable and important.
MBCook 5y ago
Wasn’t this one of the things the “death panels” (as so expertly branded by Republicans) were supposed to help with? Helping people on Medicare decide on how they wanted to approach these kind of issues and what they wanted for advanced directives? Unfortunately so much of this is decided at the last minute as people are terrified or just desperate for any lifeline no matter the consequences. Choices that, had they made them without those immediate pressures they may have made differently and had time to truly think through.
- IncRnd 5y ago
  > Wasn’t this one of the things the “death panels” (as so expertly branded by Republicans) were supposed to help with? Helping people on Medicare decide on how they wanted to approach these kind of issues and what they wanted for advanced directives? No. A death panel does not decide when someone is to die but when treatment is to be stopped due to mounting costs, regardless of the wishes of the patient.
  - hindsightbias 5y ago
    There never was a death panel in the ACA
  - javagram 5y ago
    https://en.wikipedia.org/wiki/Death_panel https://en.wikipedia.org/wiki/Death_panel This was the definition of the death panel: > Palin's spokesperson pointed to Section 1233 of bill HR 3200 which would have paid physicians for providing voluntary counseling to Medicare patients about living wills, advance directives, and end-of-life care options.
noduerme 5y ago
I don't know how much this still applies, but in the 80s and 90s it also seemed like doctors and nurses smoked a lot more than the average population. Maybe it just seemed that way because you just saw them outside hospitals smoking in groups, but I remember driving by a childrens hospital once, and my father, an ex-smoker, saying they were all out there because they were accustomed to seeing death and weren't afraid of it.
irrational 5y ago
My wife and I feel the exact same way - we have it legalized in our will and in statements of health (I can't remember the legal name for them - but documents about what we want to have happen if we are very sick/near death and can't speak for ourselves). Basically neither of us want anything done for us, at all. Just let us die. Please do not try to prolong things through chemotherapy, intubation, tube feeding, etc.
wombatmobile 5y ago
The important difference between physicians and non-physicians in relation to death is not that doctors understand disease mechanisms. It is that doctor's are familiar with death. Ordinary people aren't as familiar with death, and don't have a wide range of responses to it because society hides it and pretends it doesn't exist. The main place regular people encounter death is on the news as a statistic of war and crime. Then when it visits their family and friends, they are unprepared, except for what they know of death, which is a calamity. Sitcoms don't include death because they exist to take your mind off work, and provide a platform for advertising consumer goods. Friends and acquaintances don't often talk about death in expansive terms. They only offer a cliche one liner - sorry for your loss - because that's the only response they've learnt. It's a well intentioned sentiment, and also one that's constrained by a fear of death that is unwarranted. That's a shame because death is an expansive part of life. It's the point at which a life becomes whole, and we can see someone in their entirety. Death, along with birth, is the context for life. It's going to happen to all of us, no matter how we try to deny it or hide it. Doctors know this and so they let it in. They do this before life descends into the shadows.
- raptorraver 5y ago
  Due religious reasons I'm contemplating my death quite often. Not daily but I try to do it at least weekly. I don't say it has made me comfortable about being mortal but compared to people around me I seem to have more casual relationship to it. Like the other day my boss asked me if I'll come to the office next week and with smile on my face I answered, that yes I'll come if I won't die during weekend. He got quite confused. Remembering that you'll die someday, and not just some distant day far away but literally any day or moment gives a good perspective to everything in your life and makes you focus on things that truly matters.
  - slim 5y ago
    What you said to your boss is actually a common expression in my country. To say "I hope so" about some event in the future, we say "If we live".
spoonjim 5y ago
The problem with euthanasia is that the certainty of it defies all human survival instincts so it’s psychologically very difficult to press a button that ends our existence. What would be better if you could legally hire a service, while healthy, that would sneak up on you and kill you painlessly if you were in a terrible condition with nothing but pain and misery to look forward to. You could cancel them at anytime, but if you didn’t, they’d bump you off mercilessly when you needed it.
- tonyedgecombe 5y ago
  Perhaps we could devise some kind of medical implant to do it. Although no doubt somebody here would offer it as a SaaS that triggered when you failed to renew your subscription.
  - eerikkivistik 5y ago
    Laughed a little bit too hard at this, 10/10, good joke.
eurasiantiger 5y ago
To me, this reveals the Christian roots of modern medicine. To me, these weeds are to be uprooted: Christians willingly inflict suffering unto others, as they believe it is the natural state of human being and must be increased in servitude of their God, especially near death.
- alentist 5y ago
  Christians are more generous than the general population, so your tripe makes no sense. https://www.hoover.org/research/religious-faith-and-charitable-giving https://www.hoover.org/research/religious-faith-and-charitab... > The differences in charity between secular and religious people are dramatic. Religious people are 25 percentage points more likely than secularists to donate money (91 percent to 66 percent) and 23 points more likely to volunteer time (67 percent to 44 percent). https://www.philanthropyroundtable.org/philanthropy-magazine/less-god-less-giving https://www.philanthropyroundtable.org/philanthropy-magazine... > In study after study, religious practice is the behavioral variable with the strongest and most consistent association with generous giving. And people with religious motivations don’t give just to faith-based causes—they are also much likelier to give to secular causes than the nonreligious. https://givingusa.org/just-released-giving-usa-special-report-on-giving-to-religion/ https://givingusa.org/just-released-giving-usa-special-repor... > People who are religiously affiliated are more likely to make a charitable donation of any kind, whether to a religious congregation or to another type of charitable organization. > Religiously affiliated households give as much or more to other types of charities as non-religiously affiliated households do.
  - eurasiantiger 5y ago
    I’m not referring to giving or philanthropy, I’m referring to the ”suffering erases sins” mindset perpetuated by Christians. It is Jesus’ final message. Sin does not exist, they made it up to make themselves and others suffer. Have you considered that some people are so keen on giving away their fortunes because it makes them suffer more, and thus makes them think they are now cleaner in God’s eyes?
    - 5y ago
King-Aaron 5y ago
I once worked with a cardiovascular surgeon who was possibly one of the most brilliant people I'd ever met. His wife was a neurosurgeon, and she was diagnosed with some rare form of brain tumour, and they both knew the prognosis. They ended up selling their little farm and all their cars and equipment, and bought a little float plane to travel the world with for her final years. I believe he passed away shortly after she did, but they got to spend the last of their time together with a very relaxing lifestyle.
abeppu 5y ago
This subverts the message a bit, but my grandmother was sent to a hospice to die as comfortably as possible. I was out of state during her treatment up until this point, but when she was being moved to hospice care, I was told to expect her passing very soon. In this case, her doctors really seemed to have run out of good options; she just hadn't responded to treatment. But, after she was moved to hospice care, she began to improve. She actually healed and recovered enough to live a few more years at an assisted living home, well enough to walk the halls (slowly) for quite a while every day, and have her kids visiting all the time. Why did she recover after she was switched to hospice care? The best explanation I have is that in the hospital, her access to opioids had been limited. Letting a patient have too much can be risky. But in the hospice, where death is regarded as impending, those risks don't matter and she could have as much as she needed to actually be comfortable. And not suffering, not being in pain was maybe what allowed her to begin to heal. I don't think exactly that her doctors were wrong in believing that her death was imminent and that a hospice was the right place for her. But what if we created a healthcare system where clinging to life is so exhausting for the patient that embracing the inevitability of death is the most healing option?
- ZWoz 5y ago
  > And not suffering, not being in pain was maybe what allowed her to begin to heal. I think that is somewhat well known? I don't have good references about humans, but veterinarian James Alfred Wight (wrote books as James Herriot) has written about it, how lost cause lamb "miraculously" recovered after big dose pain killer (sorry, don't remember details, only his thoughs, how getting rest from pain helps).
  - Nursie 5y ago
    It’s definitely true for some muscle injuries - the painkillers allow you to relax enough to start loosening up an healing.
  - type0 5y ago
    > how lost cause lamb "miraculously" recovered after big dose pain killer this probably have to do with movement (which applies to other animals and humans) if they feel pain they don't move, that slows down the blood circulation and the healing process.
galaxyLogic 5y ago
Everybody wants to go to Heaven but nobody wants to die. https://youtu.be/Lb-EJEWRxlM https://youtu.be/Lb-EJEWRxlM
nathias 5y ago
"A free man thinks of nothing less than of death, and his wisdom is a meditation, not on death, but on life." ― Baruch Spinoza
otikik 5y ago
I'm seeing a lot of people sharing very personal and very difficult anecdotes here, and I am worried that that would make someone decide to reject chemotherapy outright, or recommend a loved one to reject it. Yes, chemotherapy has very adverse side-effects. But it's also the best course of action we currently have for a lot of cancer patients. It varies depending on the type, grade and stage of the illness, as well as the patient's overall health [1]. It should not be rejected outright. Now for my personal anecdata: My sister in law was in her 30s when they detected her breast cancer, and got chemo for some time. It was a very difficult time for her, but it worked - the cancer receded. She kept having to do get periodical checks to keep tabs on it. Unfortunately her cancer came back, and this time it was more aggressive - it resisted all treatments and eventually metastasised. They took her off chemo, but her health deteriorated very quickly anyway. She died 1 and a half years ago, at home. On average, chemotherapy gave her and my brother around 7 years of life, in exchange of some very shitty quality of life moths due to side effects. They definitively made the right choice in taking chemo the first time, and not taking it the second time. A lot of people's cancers never come back. I am not saying that chemotherapy is worth it in all cases. I am painfully aware that it isn't. But it is worth in a lot of cases. Don't reject it outright. PS: I should mention that we live on a country with a civilized health care system where her treatments were paid for by the state's Social Security. No one in this story had to deal with "can we afford this treatment" problems. If you are in that situation, I am sorry for you. [1] https://www.medicalnewstoday.com/articles/326031 https://www.medicalnewstoday.com/articles/326031
PlasticTank 5y ago
My heart really goes out to those of you who went through long battles. Today would have been father’s birthday, sadly he passed away last year aged 61. I often anguished over how quickly he left us, two weeks from the day I found out he was sick to the day he died, I now realise that although I was robbed of time, he and I were both saved a lot of pain.
denton-scratch 5y ago
The author implies (by omission) that palliative care results in a peaceful, pain-free death. You can't rely on that! I wonder how often physicians die as a result of taking a drug such as Nembutal - the drug recommended by Exit International. Civilians can't buy this drug - not even illegally, e.g. on the Dark Web, as far as I can see. But physicians can. I don't want to get caught. I don't want the kind of "palliative care" that amounts to death-by-dehydration. If I get throat cancer and can't swallow, no amount of pain-killers will make my death pleasant. I want a stash of Nembutal, so that I can do myself in, if the prospect I'm facing is a nest of wires and tubes or untreatable pain. It's an ethical disgrace that it's illegal for me to manage the end of my own life. Apparently any relative that accompanies me on the plane to Switzerland risks prosecution for assisting a suicide. So if I want to die quickly and peacefully, I'll have to do that on my own. The amount of humbug that swirls around this subject makes my head swim.
telesilla 5y ago
The book When Breath Became Air by Dr. Paul Kalanithi tells the story of his dying. I found it very liberating to learn more about the process from a trauma expert. I'm also slowly making my way through a more medical book currently called How We Die that outlines the actual body processes of the ways we die. I cannot recommend it highly enough. https://www.goodreads.com/book/show/49286.How_We_Die https://www.goodreads.com/book/show/49286.How_We_Die
YeBanKo 5y ago
It is a personal story, is there any evidence that this is a rule? Like, maybe a research that compares costs and/or procedures rendered to terminally ill patients, doctors vs non-doctors. I also heard, that doctors themselves are horrible patients.

272 points by jimmckin1 5y ago

deleted 5y ago

[deleted]

This doctor clearly has a vision for how he feels end of life should be, and then implies all (most) doctors share this and non-doctors should follow and doctors should be more vocal about the implied belief. I'm a bit warey of his assertion that all doctors think the same way as him though. He relies pretty heavily on his experience and a few anecdotes. I wonder if there is any actual data on how doctors view "futile" care and end of life.

jt2190 5y ago
Here’s some actual data: “Most physicians would forgo aggressive treatment for themselves at the end of life, study finds” https://med.stanford.edu/news/all-news/2014/05/most-physicians-would-forgo-aggressive-treatment-for-themselves-.html https://med.stanford.edu/news/all-news/2014/05/most-physicia...
- mertd 5y ago
  Take it with a grain of salt just like any self reported study. Their preference may very well change when they become the patient.
  - Igelau 5y ago
    Especially with something as heavy as "here's your choice of the last two calendar dates you can expect to be alive"
  - JohnJamesRambo 5y ago
    “Everybody has a plan until they get punched in the face.” -Mike Tyson
    - meepmorp 5y ago
      My dad was a physician who always was very clear that he did not want to live in an incapacitated sate. When he had the stroke that killed him, he tried to keep my mom from calling 911 till after he was dead. Some people are expecting to get punched in the face.
  - kibwen 5y ago
    Anyone with this opinion will have DNR orders on file. Their preference is already locked in.
Spooky23 5y ago
Most of my family are physicians or nurses. They are all of this opinion. My mom was an ER and ICU RN and NP. She’s to the point where I have a written protocol for when and how I am to call 911 in the event of an emergency for her. Nobody wants to die, but few who understand want to live in the purgatory between life and death that futile care entails.
irrational 5y ago
It's all ancedotal, but my dad is a doctor and, in talking with him, he agrees with the author and says every other doctor he knows concurs. He is in his 70s and not in the greatest of health (he was in a car accident years ago that seriously led to a decline in his health). He hasn't changed his mind at all as he has gotten older.
husarcik 5y ago
As a physician, I think it comes down to circumstance and goals of care. If I was in my forties and had several young children, I'd want everything done to be able to see them again. Even if I knew it was "futile". This is why palliative care is so important. All of our goals in life are vastly different all the time, even cycling every week.

brhsagain 5y ago

Related and very interesting read: https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...

camkego 5y ago
Far, far, far down in the blog post at section III., the author says this: > I (and the doctors in my family whom I’ve asked) am pretty much like the doctors in the article. If I get a terminal disease, I want to wring what I can out of the few months of life I have left and totally avoid any surgery, chemotherapy, amputations, ventilators, and the like. It would be a clean death. It would be okay. > My big fear, though, is that I won’t get a terminal disease.
- nickthemagicman 5y ago
  Why would that be the big fear?
  - initplus 5y ago
    Answered in the subsequent paragraph after the end of the quotation...
  - renjimen 5y ago
    It's ambiguous but maybe they mean a chronic disease instead? i.e. constant suffering but no end date.
  - nemo44x 5y ago
    I think it means you get something like a degenerative COPD that just grinds you into the ground one suffering day after another while you’re in and out of hospitals, lose your mobility, and lose your basic organ functions; no chance to recover, just withering away neither quickly or slowly.
  - nicwilson 5y ago
    I'm guessing something like e.g. Alzheimers or some other quality of life degrading, but not lethal, disease that makes life (not as) worth living, at least past a certain point in the progression of the disease. But because its not lethal, it won't take you out of your misery.

jerlam 5y ago

This is a pretty popular topic, and discussed previously: https://news.ycombinator.com/item?id=3313570 https://news.ycombinator.com/item?id=3313570 (2011) https://news.ycombinator.com/item?id=5104430 https://news.ycombinator.com/item?id=5104430 (2013) https://news.ycombinator.com/item?id=9260286 https://news.ycombinator.com/item?id=9260286 (2015) https://news.ycombinator.com/item?id=13122408 https://news.ycombinator.com/item?id=13122408 (2016)

fouc 5y ago
those 4 HN links refer to these 2 articles: http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/ http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die... http://www.theguardian.com/society/2012/feb/08/how-doctors-choose-die http://www.theguardian.com/society/2012/feb/08/how-doctors-c...
- jerlam 5y ago
  These are all derived from the original 2011 Zocalo article. The bottom of the Cancerworld article says: > This blogpost was first published in 2011 on Zócalo Public Square The bottom of the Guardian article says: > Taken from an article originally published at Zócalo Public Square.

spaceflunky 5y ago

Several of my grandparents spent way too long in ICU and hospice care and ultimately it wasn't worth it. I feel terrible about how their final days went, but other family members were adamant about 'throwing everything they could at it.' But the family members making that choice weren't footing the bill and they didn't have to lay in bed all day, so why wouldn't they try? I also feel they had a gross misunderstanding of the capabilities of modern medicine. In each case the doctor's asked, "do you want to give him/her a fighting chance?" Of course, no one wants to say 'no' to that question, because they don't really understand what's possible and don't understand what "winning" actually looks like.

actually_a_dog 5y ago
> In each case the doctor's asked, "do you want to give him/her a fighting chance?" Of course, no one wants to say 'no' to that question, because they don't really understand what's possible and don't understand what "winning" actually looks like. Right, and people don't generally think to ask those questions because, at that point, they're not in an emotional state that is conducive to stopping and asking questions. That said, the phrase "fighting chance" is absolutely terrible here. It's far too loaded to convey what would actually be meant here.
- amatecha 5y ago
  Yeah, some might describe it as something more like "drawing it out as long as possible", from what I've observed of some people in their last days/weeks/months.
gerdesj 5y ago
"But the family members making that choice weren't footing the bill" That appears to be the crux of the problem: "footing the bill". It may sound counter intuitive but I have found that when cost is removed from the equation, then better decisions may arise or at least a few extra distortions are removed. When money is directly involved then there are several potential, and in my view damaging, extra approaches that might arise. There's the: "we've spent so much and achieved [something] so let's go all in." Or "we've only spent this much so let's go for gold" Or: "We are paying for this anyway and so let's give it a go". Health care systems that are funded by taxation ie pre-paid, in my view, escape those problems and encourage end of life scenarios that are more likely to be better (for a given value of better) I think that I am very lucky to have the UK's NHS to care for me. We pay for it nominally via a second income related tax called "National Insurance" - we also have a country wide "Income Tax". The NI rate is: https://www.gov.uk/national-insurance/how-much-you-pay https://www.gov.uk/national-insurance/how-much-you-pay - nominally 12% but is only levied on the first £x. It gets a bit complicated because employers also pay NI for their employees. The thing about an organisation like the National Health Service is that if you have one and you get hurt, you get it fixed without thinking about it too much. We do pay quite a lot for it but it works and the cost is not so noticeable compared to Income Tax. My dad had a few heart related snags a few years ago that involved a three week stay in Exeter General, then a helicopter flight to London and a six month stay in the Royal Brompton, mostly in their intensive care unit (ICU) which would have been horrendously expensive. One of the docs described how he massaged my Dad's heart in his hands when the bloody thing decided to get a bit weary of being fiddled with too much. The UK's NHS is not perfect or anywhere near perfect. It's a whopping great organisation with some good and some not so good staff and some horrendous bureaucracy. That said, I would prefer it to any other medical system. It works eventually and often works surprisingly well and often preemptively. Dad would be dead without it. Dad's GP practice missed a few clues. When his doc went on holiday, a Hospital Registrar (as it turns out) was drafted in to cover. Dad presented and his feet didn't touch the floor until he was in a hospital bed. Again, I have to emphasise that the UK's NHS is not perfect but I don't worry about what to do if my arm fell off or something. I get to A&E and they fix me up. I have also been at the far end of palliative care (Mum). Again the NHS did the business and did its best (cancer) but it had to accept defeat. That's when Hospice Care cuts in alongside the NHS. St Margarets were absolutely fantastic. In the end it is taxation that pays for this thing but the fact that you can forget about money when dealing with health care issues is quite important, I think.

hirundo 5y ago

My mom struggled with lung cancer for two terrible years with cutting edge treatment, and died badly. My dad cared for her through that, and when his turn came five years later, he had no doubts. He refused all but palliative care and died in two months. What he saw once, a physician will see over and over ad nauseam. Having seen one of each, I'm not conflicted over which path I'd take.

drewg123 5y ago
My parents had a very similar experience. I feel your pain, and I agree with your choice
adventured 5y ago
Was it small cell lung cancer? edit: for the remarkably special downvoters (stay classy HN) - that's the type of lung cancer my mother died from, in about 20 months time. You generally can't surgically remove small cell lung cancer. It was particularly brutal, with endless treatment attempts that were physically grueling and minimally effective. It's a highly aggressive cancer with a very low survival rate and few good treatment options. Accordingly, having watched her go through that, I can very much relate to what the parent said.
- Johnny555 5y ago
  While I don't usually comment on downvotes, my guess is that the downvotes are because your question can come off as being insensitive. After someone tells you about the tragic death of both of his parents, maybe don't start a guessing game of what his mother died of even if your loved one died of that same disease.
  - adventured 5y ago
    The barrage of downvotes were typical HN assuming the worst (mindless insensitivity) rather than giving a benefit of the doubt about my intent. This, from HN's guidelines: Assume good faith. You won't see much of that on HN in my very long experience here. People so often jump right to assuming the worst, which is why that guideline exists. The assumption was that I was being insensitive, when the actuality was that I was going to attempt to start a conversation in order to better relate to the parent's story. I could have structured what I said better? That's fair, it happens, and it still doesn't change my intentions, which were positive. It's the classic and true line, that people judge others by their actions without considering intentions and they prefer to judge themselves by their intentions instead of their actions. That's why trying to assume good faith on the part of someone else is so useful on forums. I've got approximately four billion points here on HN, I don't care about the downvotes unto themselves, it's the lack of collegial communication instead of jumping right to a negative triggered reaction (a downvote, which represented a negative, incorrect assumption). You'll notice nobody asked why I was asking that very specific question, there was no attempt to give a shit about that, they all went right to behaving negatively.

paulpauper 5y ago

Years ago, Charlie, a highly respected orthopaedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds – from 5% to 15% – albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him. I am guessing that he had testing which determined it had spread and was terminal. It seems implausible that an otherwise healthy person would just pass up on a 15% chance of survival.

robbyking 5y ago
If I were given a 15% chance of survival (at best) where the most I could hope for was having a poor quality of life, I wouldn't be interested either. Even it at 2:1 it'd be a tough decision for me.
moritonal 5y ago
As a doctor, he'd understand more than most what a "poor quality of life" means.
deleted 5y ago
[deleted]
Spooky23 5y ago
With a major bowel surgery? You’re looking colostomy bag combined with a tough recovery. That means pressure sores, painful chemo or radiation, substandard care in rehab, etc. Plus, pancreatic cancer usually comes back in force once you run that gauntlet. My dad went through some of that post-stroke. No way.
paulcole 5y ago
15% for 5 years of unpleasant survival. Basically 0% chance for a “long” “normal” life after that. My mother (who worked in medicine and was very healthy) was diagnosed with a GBM and had a brief course of radiation to try to shrink it without a ton of luck. She stopped working and went home and had an OK year then an awful 4 months and then fell out of bed and broke her hip and never woke up. She could’ve maybe had 2 or 3 pretty bad years if she’d “fought” and was “lucky.”

amyjess 5y ago

I long ago decided that if I got a terminal disease, I would refuse any treatment that would extend my quantity of life at the expense of my quality of life. I've seen what chemo does to people. No thank you. If I get cancer, I'll just self-medicate with whatever opioids I can get my hands on until either the cancer kills me or the pain gets bad enough that the opioids stop being able to do anything for it, at which point I'd just intentionally OD by a massive amount while alone in a remote location. (and on top of all the debilitating, crippling effects of chemo, I am also, for multiple reasons, particularly attached to my hair... it's one of the only parts of my body I like, and I would literally rather die than lose my hair)

amatecha 5y ago
Don't be so quick to decide this now -- consider your options at the time, if such a thing arises. It may not be so cut & dry as "terminal" and there's a huge amount of variability in how cancer diagnoses go. In the meantime, take the best care of your body you possibly can :)
- Johnny555 5y ago
  If you don't decide it now and write it down in a living will, you may be unable to make that decision when you need to.
- amyjess 5y ago
  Even if the cancer has a very high survival rate following chemo, if the only way to save my life involves losing my hair I will refuse treatment and let myself die.
  - H8crilA 5y ago
    I mean, first - the loss of hair is temporary, second - not all cancers are that vicious. It might be worth it if the probability of survival after treatment is high. This article was about almost certainly incurable cases, treatment or not.

pochekailov 5y ago

Today's medicine is focused to treat the diseases, refusing to admit that people at 70-80 years old die not from disease, but from the old age. Everybody but a few enthusiasts refuse to treat ageing instead of cancer or heart diseases. People in general refuse to treat ageing as a disease, thinking it is something natural. I would not want a couple more miserable years on earth, I want a few million years of a healthy young life.

SV_BubbleTime 5y ago
> People in general refuse to treat ageing as a disease, thinking it is something natural. Aging is not natural? I certainly understand why someone would not consider it a disorder. > I want a few million years of a healthy young life. I would avoid literal genies if I were you.
- indecisive_user 5y ago
  Aging is natural the same way heart disease and cancer are natural. Some people get unlucky and develop cancer at a young age, but we don't throw up our hands and say whelp it's just nature. We should treat aging the same way. Some people's bodies fail them at 80, but others live to be 100+. If we develop good treatments there's no reason that everyone can't live to be 100 in relatively good health.
  - ZephyrBlu 5y ago
    > Aging is natural the same way heart disease and cancer are natural How are heart disease and cancer not natural? Aging is also slightly different in that it's how our bodies are supposed to work as far as I understand it, which is not very well (Possibly as a cancer prevention mechanism). Telomeres and Aging: https://en.wikipedia.org/wiki/Telomere#Association_with_aging https://en.wikipedia.org/wiki/Telomere#Association_with_agin... Telomeres and Cancer prevention: https://en.wikipedia.org/wiki/Telomere#Telomerase https://en.wikipedia.org/wiki/Telomere#Telomerase
    - 5y ago

OneEyedRobot 5y ago

What ticks me off no end is the folks who (often successfully) fight against physician assisted suicide. Dementia is the interesting test case, but I think should still be allowed. With all the talk about 'controlling our bodies' in terms of abortion, and I can see both sides of that one, your own life is the one thing you really own. To have that control taken away is the worst kind of insult by the state.

amatecha 5y ago
Yeah, I know someone who said for basically their entire adult life "if I ever get like that, just shoot me" and meant it quite seriously. Unfortunately, they indeed spent their last few years gradually degrading in the throes of dementia. Very sad to see, and even more sad to know they would have absolutely hated being left to "rot" in such a way. The only consolation is the person hopefully didn't "know"? Who knows? :\
- IncRnd 5y ago
  People say all sorts of things, but if they don't commit to writing directions down, how are people supposed to know what the person really wanted? Also, someone might say one thing, until death becomes immanent, and then they realize they want something else.
  - denton-scratch 5y ago
    I have written a formal, witnessed statement of my wishes, in the event that I'm unable to utter them. My physician has a copy; there's a copy in my desk-drawer at home, with my will. I understand that different health authorities here have different policies on the registration and application of such "living wills". I have no confidence that if I get sick in the wrong place, my statement will even be noticed, let alone respected. Also, there's no reason why a paramedic coming to my home would know to look in my desk-drawer (I live on my own), and so discover that I don't want any CPR, ever. And ultimately, these living wills are advisory only; medics can't be sued for ignoring them. It's a bloody mess. I really hope I don't ever get demented.

drdeadringer 5y ago

I took two psych classes in University. One was "Death and Dying". Perhaps a morbid class to take in your 20s, but it was a full class. The professor happened to be dying herself as she taught it. Very useful and enjoyable. It's one of the few textbooks I've kept since the long-ago graduation. A very useful course to take.

mistrial9 5y ago
in one view, most everyone is dying, while they read this.. a colleague did some hospice volunteer work for a while, and I made sure to quietly mention to her that I found it commendable and important.

MBCook 5y ago

Wasn’t this one of the things the “death panels” (as so expertly branded by Republicans) were supposed to help with? Helping people on Medicare decide on how they wanted to approach these kind of issues and what they wanted for advanced directives? Unfortunately so much of this is decided at the last minute as people are terrified or just desperate for any lifeline no matter the consequences. Choices that, had they made them without those immediate pressures they may have made differently and had time to truly think through.

IncRnd 5y ago
> Wasn’t this one of the things the “death panels” (as so expertly branded by Republicans) were supposed to help with? Helping people on Medicare decide on how they wanted to approach these kind of issues and what they wanted for advanced directives? No. A death panel does not decide when someone is to die but when treatment is to be stopped due to mounting costs, regardless of the wishes of the patient.
- hindsightbias 5y ago
  There never was a death panel in the ACA
- javagram 5y ago
  https://en.wikipedia.org/wiki/Death_panel https://en.wikipedia.org/wiki/Death_panel This was the definition of the death panel: > Palin's spokesperson pointed to Section 1233 of bill HR 3200 which would have paid physicians for providing voluntary counseling to Medicare patients about living wills, advance directives, and end-of-life care options.

noduerme 5y ago

I don't know how much this still applies, but in the 80s and 90s it also seemed like doctors and nurses smoked a lot more than the average population. Maybe it just seemed that way because you just saw them outside hospitals smoking in groups, but I remember driving by a childrens hospital once, and my father, an ex-smoker, saying they were all out there because they were accustomed to seeing death and weren't afraid of it.

irrational 5y ago

My wife and I feel the exact same way - we have it legalized in our will and in statements of health (I can't remember the legal name for them - but documents about what we want to have happen if we are very sick/near death and can't speak for ourselves). Basically neither of us want anything done for us, at all. Just let us die. Please do not try to prolong things through chemotherapy, intubation, tube feeding, etc.

wombatmobile 5y ago

The important difference between physicians and non-physicians in relation to death is not that doctors understand disease mechanisms. It is that doctor's are familiar with death. Ordinary people aren't as familiar with death, and don't have a wide range of responses to it because society hides it and pretends it doesn't exist. The main place regular people encounter death is on the news as a statistic of war and crime. Then when it visits their family and friends, they are unprepared, except for what they know of death, which is a calamity. Sitcoms don't include death because they exist to take your mind off work, and provide a platform for advertising consumer goods. Friends and acquaintances don't often talk about death in expansive terms. They only offer a cliche one liner - sorry for your loss - because that's the only response they've learnt. It's a well intentioned sentiment, and also one that's constrained by a fear of death that is unwarranted. That's a shame because death is an expansive part of life. It's the point at which a life becomes whole, and we can see someone in their entirety. Death, along with birth, is the context for life. It's going to happen to all of us, no matter how we try to deny it or hide it. Doctors know this and so they let it in. They do this before life descends into the shadows.

raptorraver 5y ago
Due religious reasons I'm contemplating my death quite often. Not daily but I try to do it at least weekly. I don't say it has made me comfortable about being mortal but compared to people around me I seem to have more casual relationship to it. Like the other day my boss asked me if I'll come to the office next week and with smile on my face I answered, that yes I'll come if I won't die during weekend. He got quite confused. Remembering that you'll die someday, and not just some distant day far away but literally any day or moment gives a good perspective to everything in your life and makes you focus on things that truly matters.
- slim 5y ago
  What you said to your boss is actually a common expression in my country. To say "I hope so" about some event in the future, we say "If we live".

spoonjim 5y ago

The problem with euthanasia is that the certainty of it defies all human survival instincts so it’s psychologically very difficult to press a button that ends our existence. What would be better if you could legally hire a service, while healthy, that would sneak up on you and kill you painlessly if you were in a terrible condition with nothing but pain and misery to look forward to. You could cancel them at anytime, but if you didn’t, they’d bump you off mercilessly when you needed it.

tonyedgecombe 5y ago
Perhaps we could devise some kind of medical implant to do it. Although no doubt somebody here would offer it as a SaaS that triggered when you failed to renew your subscription.
- eerikkivistik 5y ago
  Laughed a little bit too hard at this, 10/10, good joke.

eurasiantiger 5y ago

To me, this reveals the Christian roots of modern medicine. To me, these weeds are to be uprooted: Christians willingly inflict suffering unto others, as they believe it is the natural state of human being and must be increased in servitude of their God, especially near death.

alentist 5y ago
Christians are more generous than the general population, so your tripe makes no sense. https://www.hoover.org/research/religious-faith-and-charitable-giving https://www.hoover.org/research/religious-faith-and-charitab... > The differences in charity between secular and religious people are dramatic. Religious people are 25 percentage points more likely than secularists to donate money (91 percent to 66 percent) and 23 points more likely to volunteer time (67 percent to 44 percent). https://www.philanthropyroundtable.org/philanthropy-magazine/less-god-less-giving https://www.philanthropyroundtable.org/philanthropy-magazine... > In study after study, religious practice is the behavioral variable with the strongest and most consistent association with generous giving. And people with religious motivations don’t give just to faith-based causes—they are also much likelier to give to secular causes than the nonreligious. https://givingusa.org/just-released-giving-usa-special-report-on-giving-to-religion/ https://givingusa.org/just-released-giving-usa-special-repor... > People who are religiously affiliated are more likely to make a charitable donation of any kind, whether to a religious congregation or to another type of charitable organization. > Religiously affiliated households give as much or more to other types of charities as non-religiously affiliated households do.
- eurasiantiger 5y ago
  I’m not referring to giving or philanthropy, I’m referring to the ”suffering erases sins” mindset perpetuated by Christians. It is Jesus’ final message. Sin does not exist, they made it up to make themselves and others suffer. Have you considered that some people are so keen on giving away their fortunes because it makes them suffer more, and thus makes them think they are now cleaner in God’s eyes?
  - 5y ago

King-Aaron 5y ago

I once worked with a cardiovascular surgeon who was possibly one of the most brilliant people I'd ever met. His wife was a neurosurgeon, and she was diagnosed with some rare form of brain tumour, and they both knew the prognosis. They ended up selling their little farm and all their cars and equipment, and bought a little float plane to travel the world with for her final years. I believe he passed away shortly after she did, but they got to spend the last of their time together with a very relaxing lifestyle.

abeppu 5y ago

This subverts the message a bit, but my grandmother was sent to a hospice to die as comfortably as possible. I was out of state during her treatment up until this point, but when she was being moved to hospice care, I was told to expect her passing very soon. In this case, her doctors really seemed to have run out of good options; she just hadn't responded to treatment. But, after she was moved to hospice care, she began to improve. She actually healed and recovered enough to live a few more years at an assisted living home, well enough to walk the halls (slowly) for quite a while every day, and have her kids visiting all the time. Why did she recover after she was switched to hospice care? The best explanation I have is that in the hospital, her access to opioids had been limited. Letting a patient have too much can be risky. But in the hospice, where death is regarded as impending, those risks don't matter and she could have as much as she needed to actually be comfortable. And not suffering, not being in pain was maybe what allowed her to begin to heal. I don't think exactly that her doctors were wrong in believing that her death was imminent and that a hospice was the right place for her. But what if we created a healthcare system where clinging to life is so exhausting for the patient that embracing the inevitability of death is the most healing option?

ZWoz 5y ago
> And not suffering, not being in pain was maybe what allowed her to begin to heal. I think that is somewhat well known? I don't have good references about humans, but veterinarian James Alfred Wight (wrote books as James Herriot) has written about it, how lost cause lamb "miraculously" recovered after big dose pain killer (sorry, don't remember details, only his thoughs, how getting rest from pain helps).
- Nursie 5y ago
  It’s definitely true for some muscle injuries - the painkillers allow you to relax enough to start loosening up an healing.
- type0 5y ago
  > how lost cause lamb "miraculously" recovered after big dose pain killer this probably have to do with movement (which applies to other animals and humans) if they feel pain they don't move, that slows down the blood circulation and the healing process.

galaxyLogic 5y ago

Everybody wants to go to Heaven but nobody wants to die. https://youtu.be/Lb-EJEWRxlM https://youtu.be/Lb-EJEWRxlM

nathias 5y ago

"A free man thinks of nothing less than of death, and his wisdom is a meditation, not on death, but on life." ― Baruch Spinoza

otikik 5y ago

I'm seeing a lot of people sharing very personal and very difficult anecdotes here, and I am worried that that would make someone decide to reject chemotherapy outright, or recommend a loved one to reject it. Yes, chemotherapy has very adverse side-effects. But it's also the best course of action we currently have for a lot of cancer patients. It varies depending on the type, grade and stage of the illness, as well as the patient's overall health [1]. It should not be rejected outright. Now for my personal anecdata: My sister in law was in her 30s when they detected her breast cancer, and got chemo for some time. It was a very difficult time for her, but it worked - the cancer receded. She kept having to do get periodical checks to keep tabs on it. Unfortunately her cancer came back, and this time it was more aggressive - it resisted all treatments and eventually metastasised. They took her off chemo, but her health deteriorated very quickly anyway. She died 1 and a half years ago, at home. On average, chemotherapy gave her and my brother around 7 years of life, in exchange of some very shitty quality of life moths due to side effects. They definitively made the right choice in taking chemo the first time, and not taking it the second time. A lot of people's cancers never come back. I am not saying that chemotherapy is worth it in all cases. I am painfully aware that it isn't. But it is worth in a lot of cases. Don't reject it outright. PS: I should mention that we live on a country with a civilized health care system where her treatments were paid for by the state's Social Security. No one in this story had to deal with "can we afford this treatment" problems. If you are in that situation, I am sorry for you. [1] https://www.medicalnewstoday.com/articles/326031 https://www.medicalnewstoday.com/articles/326031

PlasticTank 5y ago

My heart really goes out to those of you who went through long battles. Today would have been father’s birthday, sadly he passed away last year aged 61. I often anguished over how quickly he left us, two weeks from the day I found out he was sick to the day he died, I now realise that although I was robbed of time, he and I were both saved a lot of pain.

denton-scratch 5y ago

The author implies (by omission) that palliative care results in a peaceful, pain-free death. You can't rely on that! I wonder how often physicians die as a result of taking a drug such as Nembutal - the drug recommended by Exit International. Civilians can't buy this drug - not even illegally, e.g. on the Dark Web, as far as I can see. But physicians can. I don't want to get caught. I don't want the kind of "palliative care" that amounts to death-by-dehydration. If I get throat cancer and can't swallow, no amount of pain-killers will make my death pleasant. I want a stash of Nembutal, so that I can do myself in, if the prospect I'm facing is a nest of wires and tubes or untreatable pain. It's an ethical disgrace that it's illegal for me to manage the end of my own life. Apparently any relative that accompanies me on the plane to Switzerland risks prosecution for assisting a suicide. So if I want to die quickly and peacefully, I'll have to do that on my own. The amount of humbug that swirls around this subject makes my head swim.

telesilla 5y ago

The book When Breath Became Air by Dr. Paul Kalanithi tells the story of his dying. I found it very liberating to learn more about the process from a trauma expert. I'm also slowly making my way through a more medical book currently called How We Die that outlines the actual body processes of the ways we die. I cannot recommend it highly enough. https://www.goodreads.com/book/show/49286.How_We_Die https://www.goodreads.com/book/show/49286.How_We_Die

YeBanKo 5y ago

It is a personal story, is there any evidence that this is a rule? Like, maybe a research that compares costs and/or procedures rendered to terminally ill patients, doctors vs non-doctors. I also heard, that doctors themselves are horrible patients.