8 ms·

I haven't had a chance to read the article yet but as a physician--yes we often overtreat at the end of life. I have had horrible experiences basically torturin

• oski 4y ago
  Yeah, it’s very distressing. It seems that there is often a correlation between religious thinking and hoping for a miracle that defies reason.
  • sokoloff 4y ago
    That’s hardly surprising, given the treatments of miracles in the Bible. If you believe in those, why think that no more miracles are forthcoming?
  • candiddevmike 4y ago
    You'd think they'd be pro-death and look forward to meeting them again in whatever afterlife they believe in. Or does faith falter in the face of the fragility of life?
    • refurb 4y ago
      No, I wouldn't assume the religious are "pro-death".
  • denton-scratch 4y ago
    There's a correlation between being religious and being "pro-life". Even the dimmest pro-lifer can see that it's hypocritical to insist on saving the life of a foetus that has never seen daylight, at the risk of the mother, while allowing an old, sick person to die naturally. So they are forced into an "all lives matter" posture.
• kennend3 4y ago
  I feel bad for you having to deal with this stuff. It is strange how they often cite religious beliefs, but if they firmly believe in "god" why are they always willing to go to such great lengths to prevent dying? This is VERY unfortunate in Canada because these people cost the country a small fortune for no real reason. There was a story a while ago about an individual, 70+ and braindead, family fought and fought to keep him alive. I cant help but wonder if they had to pay, would they have continued to fight?
  • FpUser 4y ago
    Health care wise Canada already heading down the drain. Trying to save few people should be the least of your worries in this department. Our fucking "servants" are doing stellar job.
    • formerkrogemp 4y ago
      Don't denigrate healthcare workers. They're most often doing the best they can.
      • FpUser 4y ago
        I am "denigrating" our masters, not workers. And if you think we do not have huge problem in healthcare you've got your head firmly planted into the sand
        • FredPret 4y ago
          What exactly is wrong? There’s no perfect way to run a huge system, but Canada comes close.
          • FpUser 4y ago
            We must be living in different Canadas. It is getting worse every year. And the people responsible just keep raising their own salaries. "Heckuva job (TM)" they do.
• daniel-cussen 4y ago
• dominotw 4y ago
  As someone who was on the other side. I will say that these decisions are made by patients and family on a daily level, one at a time. It is hard to step back and look at a big picture and say ok today is the day when we pull the plug on the treatments. I do agree that a final 'big picture' decision needs to be made but its hard to get that mental clarity when you are in the eye of the storm. Also, I've personally decided to go by euthanasia after I lose my independence but I am also not clear at what point I should make that decision. I am worried that I will delay that decision and end up in a situation where I lose my faculties to make that decision.
  • citboin 4y ago
    “ I am worried that I will delay that decision and end up in a situation where I lose my faculties to make that decision.” Same. I have cognitive issues from m.s. and intend to move somewhere where my desire is respected. My quality of life already sucks, so I may make the decsision sooner than would normally be expected.
  • denton-scratch 4y ago
    > I am worried that I will delay that decision and end up in a situation where I lose my faculties to make that decision. I'm concerned about that too. Broadly, the circumstances in which I'd want to get it over with painlessly are circumstances where it's hard to see what I could do about it, like if I'm immobile in a hospital bed. I want a stash of Nembutal in my medicine cabinet, that's the drug recommended by Exit International; but I can't get it. You sometimes see sellers offering it on dark markets at $600 for 10g, but typically they have zero trades and zero reputation.
    • Eisenstein 4y ago
      Go to a big city and get a bindle of heroin. Or fentanyl on the dark markets.
      • denton-scratch 4y ago
        AFAIK, most "opiate deaths" are the result of vomiting while asleep.
• paranoidrobot 4y ago
  There's the "everything must be done" crowds, but they're not (just) religious folks. There's also the bean counters (more tests/treatments = more revenue), and the paranoid about litigation folks who worry more that it's easier to explain action than inaction. My grandmother went into a facility for palliative care in the last few weeks of her life. We saw all of these folks, and it was a struggle to reign them in. There's a whole lot of really terrible behaviour that's done just because it makes someone more money or someone's job easier, and if it results in actual pain/discomfort to the patient, who cares.
  • sxg 4y ago
    I wouldn’t characterize it as “paranoid about litigation”. Lawsuits against physicians are common, and you absolutely have to consider the small but real risk of having to defend your actions in court. I’m a physician and see this play out all the time, and there’s a reason malpractice insurance is as expensive as it is.
    • toast0 4y ago
      Just because you're paranoid doesn't mean they're not out to get you. Justified paranoia is still paranoia.
      • s1artibartfast 4y ago
        No it quite literally isn't
    • oa335 4y ago
      How expensive is malpractice insurance, as a proportion of your salary?
      • sxg 4y ago
        Depends on the specialty, but roughly $500–$1500 (higher for surgeons and proceduralists; ~5% of your salary). However, if you work as an employee for a hospital or a large group practice, you don't pay for malpractice insurance directly. The institution covers it, but obviously it will indirectly impact your salary.
• JoshTko 4y ago
  Blaming just the patients and families is disingenuous. The incentives on the hospital, and doctor to overtreat are large and are an equally contributing factor.
  • kennend3 4y ago
    You are very much mistaken, it is almost always the family doing this. As an example: https://www.canlii.org/en/on/onsc/doc/2017/2017onsc6511/2017onsc6511.html https://www.canlii.org/en/on/onsc/doc/2017/2017onsc6511/2017... [2] Following Shalom’s brain death his family had discussions with the staff at Humber River Hospital. They explained that in accordance with Shalom’s and their religious beliefs, Shalom was not considered to be dead under Jewish law until he stopped breathing and his heart stopped beating. Neither had occurred because he was on ventilator life support. The hospital board ruled he met the guidelines to be considered "dead" - the family went to court to overturn this.
  • Macha 4y ago
    Even in socialised medicine in western europe, this phenomenon exists, where the financial side of those incentives is much reduced as funding is much less directly tied to treatments.
  • ouid 4y ago
    having been on the family side of this, i can personally guarantee that the people actually performing the procedures are against it. You should draw a distinction between a hospital and its doctors.
  • lotsofpulp 4y ago
    The doctors I know (roughly ~10 to ~15) are very much against “overtreatment”. The biggest problem they have is dealing with emotional family members. There was also huge public fervor when the suggestion of funding mere discussion of end of life options was proposed with the Affordable Care Act: https://pubmed.ncbi.nlm.nih.gov/26195604/ https://pubmed.ncbi.nlm.nih.gov/26195604/
    • jstanley 4y ago
• deleted 4y ago
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• rs_rs_rs_rs_rs 4y ago
  >religious beliefs that "everything must be done" to save a life no matter how much pain or suffering is causes. It's morally distressing. A life full of pain and suffering is still a life. The alternative you're offering is not something without paid and suffering, it's worse. Notexisting is worse than pain and suffering.
  • jamesredman 4y ago
    Except that death is fact of life, pain and suffering are not.
  • ako 4y ago
    For some, the pain and suffering is so bad that notexisting is actually better.
  • bwhaley 4y ago
    > Notexisting is worse than pain and suffering. That’s a stretch. Far more important to come to terms with mortality than extend life indefinitely. Is it even still living to have a heartbeat but with motor control, limited or no ability to speak, and no memory? Is “living” in this way best for the next of kin? I found a recent episode of the Making Sense podcast in this topic to be thought provoking. You might give it a listen. https://www.samharris.org/podcasts/making-sense-episodes/297-preparing-for-the-end https://www.samharris.org/podcasts/making-sense-episodes/297...
  • Pwhy1 4y ago
    I completely disagree. I would rather not exist than be in truly agonising pain for the rest of my existence. Heck, I've had something as simple as bad food poisoning where, if it was a terminal symptom, I would have ended it.
  • secondcoming 4y ago
    You didn't exist until you were conceived. That wasn't so bad, was it?
  • _qua 4y ago
    A case I recall particularly vividly was a man in his late 90s who had end stage dementia to the point that he couldn’t interact with his environment or even speak. His limbs were contracted and he was permanently in a kind of fetal position. He was fed through a tube but was still severely malnourished. He had a line of bed sores starting from his coccyx extending up to his middle thoracic spine and most of the bones and ligaments could be clearly seen. The only real signs of life were moaning when he was turned in bed. I saw him in the icu where he was being treated for these incurable bed sores and bone infections. To me it was pure torture and his poor nurse was new to the job and broke down sobbing one day after she had to turn and clean his wounds. It was terrible for all of us. I would never want anything other than comfort care for me or my family in that situation but the families religion dictated that we continue.
• throwaway6734 4y ago
  who pays for these treatments?
• veltas 4y ago
  > In some cases this is motivated by religious beliefs that "everything must be done" to save a life no matter how much pain or suffering is causes. Can you explain what you mean by this?
  • ceejayoz 4y ago
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525567/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525567/ > Patients who rely heavily on their religious beliefs to cope with cancer have been shown to receive more aggressive interventions (e.g., cardiopulmonary resuscitation and ventilation) in the last week of life compared to those who rely less heavily on [Religion and spirituality] beliefs. > The most commonly highly endorsed items (i.e., at least ‘somewhat’) were “my faith helps me to endure the suffering that comes with difficult medical treatments” (71%); “I will accept every possible medical treatment because my faith tells me to do everything I can to stay alive longer” (67%); and “I believe God could perform a miracle in curing me of cancer” (69%). Most patients (87%) reported some (‘somewhat’, ‘quite a bit’ or ‘a great deal’) endorsement of at least one of the RBEC items and a majority (62%) endorsed three or more RBEC items. > Item-total correlations revealed high item-total correlations (>0.7) for five items and moderate correlations for the items “do not resuscitate orders are immoral due to religious beliefs” (0.48) and “I would be giving up on my faith if I stopped pursuing cancer treatment” (0.63).
• sandworm101 4y ago
  I have always considered some of that as practice for the eventual patient who may actually be helped. All those ecmo treatments on doomed elderly covid patients is good practice for when a 12yo kid with hope of survival needs the proceedure. Over the decades, hail mary treatments at end of life (radiation/chemo etc) eventually trickled down to become practical treatments for everyone. Appendectomies were likely debated as painful end-of-life treatments by those who first attempted them.
• alistairSH 4y ago
  I’ll counter with my own anecdote… My BIL passed earlier this year after a life of alcohol and drug abuse led to organ failure. He made peace with his fate and was ready to go. But, the hospital placed him in a coma and on a ventilator. Then made it extremely difficult to have him moved to hospice and removed from the vent. It took days of phone calls, lawyers, and social workers to allow him to die. This caused much unnecessary stress for my wife, who was the only family member present. This was at a facility run by Floridas largest hospital group. I wonder if it was profit or their own religious affiliation that caused this? Either way, it wasn’t as simple to let a family member pass on as it should have been.
  • oaktrout 4y ago
    Most times when this happens its because the patient doesn't have these goals clearly documented, in my experiences hospitals are willing to follow the wishes of the patient. If the patients wishes aren't clearly documented that's when it gets tricky.
  • sandworm101 4y ago
    Florida's largest hospital group has a religious affiliation? Ugh. We can be crititcal of goverment-run healthcare, but at least that headache is avoided. I live across the street from the one hospital in my small city. I think there would be protest marches if it ever proclaimed a paticular religion.
    • Parmenidea 4y ago
      Not just any religion, it’s a Seventh Day Adventist Hospital (an offshoot of the Mennonites, who believed the end of the world was predicted in the Bible). This has all sorts of weird implications; from my memory, they can’t serve caffeine on the premises. There’s a giant painting of Jesus guiding a surgeon’s hands in the front of the Orlando branch when you walk inside.
      • sandworm101 4y ago
        I grew up overseas. All the hospitals were technically "islamic" but the great thing about that was zero religeous paintings. There were no crosses hanging over beds, but neither was any other image. Christians felt as welcomed as anyone else. The architecture and decoration was agnostic. Even the attached mosque was basically just a square room pointing in a strange direction, and was open to all peoples.
• gedy 4y ago
  I know this an outlier, and not related to emotional hospice decisions, etc but my mother had a heart attack in her 60s and was flatlining after they were reviving from cooling? protocol at the hospital. The doctors used defribrillators multiple times while I and siblings were in the room. The head doctor turned to us with an annoyed tone saying "look this isn't ethical to continue" when we asked if they could do anything. He then agreed to give her an adrenaline? shot, then they packed up and everyone walked out to our confusion. She stabilized and survived, and is still here 12 years later. I appreciate what the doctors did for her, but I am very cynical about blindly trusting what overworked/numb medical workers tell us now though.
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• mattmaroon 4y ago
  I know a lot of doctors and all of them have told me much the same.
• nradov 4y ago
  How much freedom do physicians have to refuse to provide treatment in such cases?