16 ms·

Our unrealistic views of death, through a doctor’s eyes

349 points by llambda 15y ago

berntb 15y ago
I haven't studied medicin, but have a smattering of chemistry so I follow the subject a bit. The article miss the probably most interesting aspect. In fifteen years, there will almost certainly be organs grown from stem cells, which allows transplants without immunity problems. What would happen to the first example in the article when the hearth and kidneys are replaced? When growth factors and (more or less) young stem cells start repairing the brain damage and the Parkinsons? It might take twenty years. It will still be in time for most people on HN when you grow old. Anyway, it is probably only of academic interest to me (old health problems will probably get me).
- polyfractal 15y ago
  Edit: I don't think everyone should be downvoting the parent. It's a logical statement from someone outside the field - you see "organs grown in XYZ lab!" all the time in the press. As a biologist, I can tell you that home-grown organs are waaay more than 15 years away. Currently, we can grow skin pretty well. Mostly because skin likes to grow and is very simple in structure. We are making progress on growing liver tissue, again because liver cells are particularly robust and the liver is not a strongly organized tissue. It is (mostly) a big blog of heterogeneous cells that does not require complicated geometry and organization. Anything past those two are wishful thoughts. I'm not discounting the advances that we have made in growing organs. We've done some very cool work, but it is certainly a long way away. Once the basic science is established, it will still take a long time to get widespread medical approval. Re: "repairing" the brain makes growing an organ look trivial. The difference is like building a house vs repairing CERN's LHC.
  - joering2 15y ago
    interesting. can you explain bit more why repairing brain would be that complicated (asked by someone that never touched biology [me]) side note: your Cloudera job post has cudazi tags visible.
    - polyfractal 15y ago
      Sure. With a lot of organs, the function is a relatively mundane process. The heart pumps. The liver filters. The skin grows and dies and grows some more. This simplifies things a bit. The challenge is to get all the right cells in the right places. Heart cells need to be arranged specifically so that the heart can pump. Wikipedia has a good animated gif of how the conduction wave flows through the heart [1]. Fortunately, this is a surmountable challenge. You can throw progenitor cells into a pre-built scaffold and they tend to organize like they should. This is because most organs in your body are built of relatively interchangeable parts. E.g. Most of your heart is the same kind of muscle cell. The brain is a bit different. First, the type of damage is very dependent on the disease state. Have we lost entire neurons? What regions are affected? Are our neurons de-mylenating? Second, your brain is unique to you. Sure, we both share stereotyped architecture: we both have a hippocampus, a cerebral cortex, a cerebellum, etc etc. The structure inside each region is pretty stereotyped too - we both have cortical bundles in our neocortex. But when you drill down to the cellular level, we are very, very different. Each neuron I possess in my brain has a unique (and dynamic) synaptic arbor that connects to thousands of other, unique neurons. If I suffer a stroke and a portion of my brain dies, you can't simply throw more neurons in to compensate. Effectively, neurons are not interchangeable parts like heart muscle cells. You need to coax those neurons to: A) live in relatively hostile environment B) synapse to appropriate neuronal populations C) weight those synapses correctly. [1]http://en.wikipedia.org/wiki/File:ECG_Principle_fast.gif http://en.wikipedia.org/wiki/File:ECG_Principle_fast.gif Side note: Thanks for the heads-up on the Cloudera post - I just migrated themes and servers last night :)
      - loup-vaillant 15y ago
        (I'm a programmer, I know little about biology) Another way to look at it is the information theoretic perspective: when organ X is damaged? what information do you need to grow it back? If X is anything but the brain (and maybe part of the spine), the information you need can almost always be picked from somewhere else (Stem cells plus standard human anatomy). We can't do that now, but in principle it should work. But if you lose part of your brain, then it's a tougher challenge, because your personal memories, skills and more are stored in it. The only way to recover that would be to use the redundancy your brain might feature. Otherwise, it's lost. Sometimes, you cannot recover a code from a burned piece of paper. Now, if your brain just suffers a terminal illness, but the information is still there, then healing you may be as difficult as copying your whole soul into a computer, synapse per synapse. (Or it may not: we do have way to slow down —not heal— Parkinson, for instance.)
  - ricree 15y ago
    I seem to remember some promising experiments that grew replacement hearts on an existing extracellular matrix. While they were still a long way from being true replacements, they showed enough functionality to look like a promising direction. Did that not pan out, or are there other major hurdles that would prevent this from being viable within a couple decades?
  - berntb 15y ago
    >>Anything past those two are wishful thoughts. hardly just skin and liver! It is easy to find information about e.g. therapies for horses' joints. This link is about humans, just a few years from patients. http://news.bbc.co.uk/2/hi/health/1809322.stm http://news.bbc.co.uk/2/hi/health/1809322.stm There are people walking around with bladders and (built with a scaffold) throats. There are grown muscle patches for hearts, etc. (I didn't mean to replace parts of the brain surgically of course, stem cells rebuild damaged areas after strokes.) (I assume you aren't claiming that Parkinson won't be cured in 20 years?) Do you have any references? What are the show stoppers to scale to more complex tissue? The field obviously moves fast. Muscles like the heart and "simple" organs like kidneys should probably be possible. Is blood supply not solvable? Edit: Sorry for coming back a few hours later. (I was downvoted a while? :-) )
  - berntb 15y ago
    Here is a group working on muscle with 3D printers. As I wrote in previous comment, building simple organs (hardly eyes) seems to move quite fast. http://www.technologyreview.com/biomedicine/39687/?%3C http://www.technologyreview.com/biomedicine/39687/?%3C
Alex3917 15y ago
I think the fundamental misunderstanding is that most people think that people die from diseases, but in reality it's much closer to the other way around; people get diseases when they are about to die. Even if we had the cure to every single cancer the average life expectancy would only go up by about 3 years, because most cancer patients would just die from something else anyway.
- deleted 15y ago
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- JulianMorrison 15y ago
  True but overly defeatist. Fixing one problem would not solve things. Fixing several problems (cancer, intra-cellular junk, extra-cellular junk, etc etc, Google "SENS" for a suggested list) would actually cure death from ageing - or at minimum, would reveal what other problems we would also need to solve. People get sick because they are damaged, and they are damaged because they are old, but the damage is in principle something that can be repaired.
- hyko 15y ago
  You make an important point: treating ageing itself is superior to tackling diseases individually. Ageing is a risk factor for practically every major disease. Therefore reversing, halting, or even just slowing the process would reduce the incidence and burden of every major disease.
polyfractal 15y ago
Two poignant quotes from the article really stood out to me: "When their loved one does die, family members can tell themselves, “We did everything we could for Mom.” In my experience, this is a stronger inclination than the equally valid (and perhaps more honest) admission that “we sure put Dad through the wringer those last few months.”" "A retired nurse once wrote to me: “I am so glad I don’t have to hurt old people any more.”" Makes you stop and think about how we treat end-of-life situations.
- joering2 15y ago
  I think your timing is plausible, given what we can do now and 15 years ago. I cant remember how astonished I was when I saw this! [1] 25 years to re-print entire human body without cancer cells, tumors, perhaps without fat and boldness as well? :) [1] http://www.youtube.com/watch?v=9RMx31GnNXY http://www.youtube.com/watch?v=9RMx31GnNXY
  - barefoot 15y ago
    That TED talk was amazing. Thanks.
    - joering2 15y ago
      sure, no problem, although I dont recall when, but I stumbled upon it on HN as well :)
- JshWright 15y ago
  Twice in the past month, I've participated in restarting a stopped heart belonging to someone over the age of 75. In both those cases, the patient never regained consciousness, and passed away in the ICU a few days later. This story repeats itself over and over again... I don't know what the actual percentage is, but the number of elderly patients who are 'resuscitated' only to never wake up again is surely north of 99%. I'm conflicted about my participation in this process... CPR is a very brutal process, and all the interventions we use to restart someone's heart are equally traumatic. So, why do we do this? In most cases, it's because someone doesn't have a DNR, or any other sort of advanced directive. In most (all?) states, if you call EMS and don't have a DNR, you need to actually threaten us to absolve us of our legal duty to start resuscitative efforts (in reality, most of us are human beings, and simply explaining the situation should be enough). The other situation is when a patient _does_ have a DNR, but the family is insistent that we "Do something!" In both of my recent experiences, our efforts kept the patient 'alive' long enough for out of town family to travel back to say their goodbyes. Was it worth it though? The financial, emotion, and physical costs are pretty high... I'm not sure...
michaelbuckbee 15y ago
My uncle recently passed away (pancreatic cancer) and the people from Hospice were all amazing in helping him and the family. To my mind they embody the different way of handling end of life issues than standard medical treatment.
taf2 15y ago
i knew at 31 i should start feeling old... so 47 is the end, that means i have 16 good years left in me... here's to enjoying it and making something great of it... cheers!
kiba 15y ago
We shouldn't inflict unnecessary pain and suffering but we must fight death and continue medical research for the future generation of elders so that they will be able to see their great-great-great grandchildren and beyond and be healthy at the same time.
- gnu8 15y ago
  Why?
  - sliverstorm 15y ago
    Agreed, where does this "must" come from?
    - kiba 15y ago
      Death is wrong.
      - gnu8 15y ago
        It's not though, death is natural and inevitable. There are also practical considerations: if death is eliminated, we must stop reproduction too.
        kiba 15y ago
        It's not though, death is natural and inevitable You committed the naturalistic fallacy. Also, inevitability isn't a justification for bad things happening. There are also practical considerations: if death is eliminated, we must stop reproduction too. I would prioritize existing lives over the yet to be born.
        rayiner 15y ago
        > I would prioritize existing lives over the yet to be born. From an evolutionary point of view that makes very little sense.
mistercow 15y ago
> our culture has come to view death as a medical failure rather than life’s natural conclusion. Death is a medical failure, just like our inability to cure herpes is a medical failure. That there's no way to overcome the failure yet does not imply that it is not a failure.
- icebraining 15y ago
  It's not so much the death itself but the fact that we can't really fix falling organs, just put band-aids to keep it running. My grandmother has osteoporosis and surgery isn't an option. When her bones finally give in and tie her to a bed, that's the end of her life, even if she lives for a few years more.
- deleted 15y ago
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- dasil003 15y ago
  There's an ethical question that you're dodging though. Personally I don't think immortality is a good thing, and I suspect most arguments in its favor our heavily driven by fear of death.
  - delinquentme 15y ago
    I'd guess your argument against immortality is one of those covered many many times: overpopulation, overlords yadda, yadda. If you believe in 1000 years humans are still living to 80 years old, and are STILL bound to ONLY this planet ... well I think you're crazier than your love of death ( the norm ) suggests. It requires a bit of human insight to realize that the slice of cake religion advertises IS escape from the vast darkness of a perception-less void.
  - zanny 15y ago
    My argument is that if we could develop functional immortality we could preserve the lives of the next Newton, Einstein, or even some currently living scientific minds like Hawking. Rather than have the great generational risk of losing all the collective knowledge such people accumulate and then suddenly have them die and expect their void to be filled by bright young minds interested in the same material, who then have to commit half a century just catching back up to where their progenitors were, it would be a never ending cascade of innovation and progress.
bradleyland 15y ago
At first, I was confused by this statement, given the data.. > "...modern medicine may be doing more to complicate the end of life than to prolong or improve it" 1900 65 -> +12 85 -> +4 2007 65 -> +19 85 -> +6 The engineer in me said, but we've improved! But then I realized that evaluating life by measuring in years is like reviewing tech products by looking at spec sheets. "But it has more megapixels!? Aren't megapixels what we want?" Reality is far more subtle.
- SkyMarshal 15y ago
  Gotta consider cost. If the marginal cost per megapixel is a million dollars, then maybe a few extra aren't so worth it.
  - jbjohns 15y ago
    Forget cost. The important question is quality. In cameras, extra megapixels can mean the sensor sites are so small that they have a harder time distinguishing electronic noise from actual light, leading to worse pictures. Likewise, what good is getting me 10 more years if I can't do anything with them because they're spent in total agony.
  - checker 15y ago
    It'd be nice to have the option to choose to spend that million on pursuing a bucket list, or on a horrendous treatment with a single-digit success rate.
- _delirium 15y ago
  The improvement at the upper end isn't even that much in absolute terms. I guess it's hard to imagine accurately, but I think that when I'm 85, I'm going to be a lot more worried about the quality of my next few years, rather than whether there are going to be 4 or 6 of them. Four high-quality years would be far preferable to six questionable ones. (Of course, six high-quality ones would be even better, but if I had to choose, I'd choose quality.)
- rmc 15y ago
scott_s 15y ago
Related article from a few months ago, "How Doctors Die": https://news.ycombinator.com/item?id=3313570 https://news.ycombinator.com/item?id=3313570
- lunarscape 15y ago
  I wish more people read things like this. "I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.”" I have a parent who's a medical professional and their response was exactly the same. On a related note I wonder if support for euthanasia is higher among those who work in medicine.
delinquentme 15y ago
TLDR: We all are afraid of death and the reason humans invented religion was to cope with this fear. If you're going to downvote... Instead say something so we can discuss!
rdl 15y ago
If I were in medicine, I'd sure rather be working on trauma on a healthy patient population (soldiers, young adults, etc.) than illnesses of the elderly or already sick -- vastly simpler, sort of like developing new software (even if it is doing something difficult) vs. working in a complex legacy system with no documentation and lots of hidden mines.
- Someone 15y ago
  Are you sure you have a realistic view of working on trauma, especially with soldiers, in the current era? The combination of modern bulletproof helmets and clothing with the almost immediate availability of good medical care allow the survival of some horrendously wounded people for whom we can do a lot, but not, by far, enough. For example, a soldier can loose al his limbs due to a IED, be burnt over large parts of the rest of his body, and survive. I think I would rather work with elderly people even if comfort is almost all we can give them. Also, if you went into the field, I bet your educators would try to get you change your opinion. Everybody wants the glamorous job, but most employment is elsewhere. I have heard this phrased as "all the girls want to work with children, and all the boys want to work in ambulances; we need to work a bit to change their minds."
  - rdl 15y ago
    Yes. I worked in US military hospitals in Iraq and Afghanistan from 2008-2010, as well as spending some time in them in 2003-2007. I also spent a fair bit of time in third world clinics (in North Africa, Middle East, Southwest Asia, and also Iraq/Afghanistan), where the main care was for sickness or maternity, including working with NGOs. The US hospitals also had plenty of local nationals coming in, either due to trauma, or due to illness. I also got to go out with some teams (i.e. the "other" people) when they did medical outreach. A few of my friends are Army SF medics, I lived with an Air Ambulance company for most of 2005, and dated a (non-US, coalition partner) doctor for a few months. I did combat lifesaver and some other advanced first aid stuff, and dive medic. I did get to help out with trauma a fair bit, and I've been first responder at a bunch of traffic accidents worldwide. Actually, neuroradiology would be my #1 pick (I hate being around conscious patients, and even talking to people who talk to conscious patients is bad. A rad at least talks to other specialists, and a neurorad is going to talk to specialists (rads, neurosurgeons) who talk to other specialists (surgeons, oncologists) who talk to normal doctors who talk to patients, so you're pretty far removed. ER docs are kind of looked down on by other doctors (for basically being stream of consciousness, get them in, patch them up, pass them along), but trauma surgeons are well respected. There's clearly a lot of money in gerontology, and demand for internal medicine (although badly paid, and often in crappy parts of the country), but I'd hate those things. However, I'm doing a non-medical startup, and going to med school seems very unlikely to be in my future.
lunarscape 15y ago
This brings to mind the following article, in which doctors place greater emphasis on quality of life when making decisions themselves: Physicians Recommend Different Treatments for Patients Than They Choose for Themselves, Study Finds, http://www.sciencedaily.com/releases/2011/04/110411163904.htm http://www.sciencedaily.com/releases/2011/04/110411163904.ht...
javajosh 15y ago
Yes. Now what doctors need is an effective, compassionate way to communicate the simple fact that we need to let old people die. Here's one way: A family brings an elderly patient suffering from stroke, diabetes, etc. into the ER. The patient is in a coma. Before asking them what they want to do, take the family into the NICU and tell them: we have limited resources, and we can either save a baby in here, giving him a chance for a healthy productive life, or we can perform heroic measures on your loved one, almost certainly doing nothing but prolonging his suffering. What is your choice?
- wpietri 15y ago
  Having recently been an advocate for an elderly patient with severe medical problems, I can say with confidence that this is a terrible idea twice over. Not only would it not work well, but it's also so lacking in compassion as to be horrific. The time to educate people on these choices is years before you have to make them. The solution isn't to take people thrust into tragedy and threaten to kill babies if they don't do the "right" thing. It's to change our culture such that people consider these hard choices much earlier and life, and feel comfortable discussing these issues with their families.
  - javajosh 15y ago
    What I'm trying to get at is that doctors need some sort of tools to help explain the situation to their patients and their patient's families. It doesn't have to be my suggestion, but some way of making the twin points that: a) prolonging life at any cost is not compassionate to the patient, and b) prolonging life at any cost is not compassionate to people who actually can be healed to go live a happy remainder of their life.
- dwynings 15y ago
  I can't think of a worse idea. Families need to sit down and have an honest discussion about death before it's necessary. It's a hard conversation to have, but it can save constantly questioning and second guessing yourself what your loved one would want to happen.
rayiner 15y ago
I think one of the things he mentions, people not living with their elderly parents, is responsible for a lot of our bizarre attitudes towards old age and death. How much of the "just a couple of more years" attitude is to help assuage the guilt of ignoring the person for the last 10-20 years of their lives?
- arnoldwh 15y ago
  I agree. You try to do everything because you realize you've done so little during the time you've had. I guess that's the normal way of being though. It seems like it is every child's fate to not appreciate their parents enough until it is too late, and to repeat this same cycle when they have children of their own.
coolestuk 15y ago
"At a certain stage of life, aggressive medical treatment can become sanctioned torture. " I just went through a month with a 90 year old friend whose life ended almost exactly like the story in that story. He had one lucid 30 mins when I was there and his family was there (he had been a general physician for almost 50 years). In his brief period when he had the energy to try and communicate whilst almost totally paralysed, it was clear he was telling the attending doctor that he wanted them to stop all medication and let him die. His own family could not face that fact, and said they'd ask him again the following day (unfortunately the cowardly doctor backed them up on this). He was never again lucid or strong enough to insist that treatment be stopped. He lived for another 10 days, struggling to breathe, almost totally paralysed, unable to control his bowels. This was a man who when I last went on holiday with him at the age of 85, he insisted on carrying his own suitcase and refused a wheelchair, even though he had trouble walking and had blood pressure and angina problems. I don't blame his family not being able to make that decision (it's so hard to let go of someone one loves). But his last weeks were undoubtedly torture, and they know they refused to follow his wishes. It was just terribly sad and an awful dilemma. I was really glad of something else I read on HN about 6 months ago, where a doctor had a brain tumouur (or something like that) and instead of treatment, he lived out the remainder of his life doing the things he loved. I think that idea was what meant I could come to terms with the need to respect my friend's last wishes. I just could not convince his family.
- wpietri 15y ago
  I encourage everybody to talk things like this through with their family. Last year my mom was diagnosed with a terminal brain tumor. She elected to pursue treatment vigorously, but brain tumors being what they are, there were a number of points where she was unable to answer questions about her wishes. At every one of those points we knew what she wanted because we had discussed it extensively before. I was incredibly grateful for that. It is bad enough to have to make complicated, life-or-death decisions for someone you love. I cannot imagine the horror of trying to do that without a clear understanding of what they would want. Please talk with your family about this. Right now if possible. Just forward your sibling, parent, or child this article and tell them it made you think. Then tell them what you'd want. Don't just think you'll do it "later"; the right time will never come on its own.
publicus 15y ago
The real problem is we are at the stone ages when it comes to medicine. The problem is worsen by the fact that treatment is more profitable than cure. In fact, cure eliminates income all together.
luser001 15y ago
For a book length treatment of this topic, see "How we Die", one of the most amazing books I've read. http://www.amazon.com/How-We-Die-Reflections-Chapter/dp/0679742441 http://www.amazon.com/How-We-Die-Reflections-Chapter/dp/0679...
jdavid 15y ago
Ray Kurzweil should read this article.
jdavid 15y ago
This is one of the reasons I find it hard to talk to my mother. She is beholden to grief about her father and is doing everything to prolong the life of my grandmother even though she can't walk, needs help eating, and constantly falls asleep. On top of that she hardly knows who is around her. it's sad. Watching how my parents have dealt with my aging parents really puts pause on me and has me thinking about creating a living Will to make my own wishes very clear.
Craiggybear 15y ago
I think just because you can do something to prolong someone's life, there used to be a time when a good doctor knew this didn't automatically mean you should. I know my grandparents didn't fear or refuse to believe in death in the same way as people do now (and they had seen a lot of it). I hope I'm strong enough and happy enough with myself that I will gladly relinquish my hold on the reins of life when its properly time to do so, and not fear it or be sad.
jtothapreston 15y ago
I think this underestimates our most primal of instincts, survival. Those people who died at 48 a century ago had no less want or determination to live longer, than did those who die today at 78. In those times, their options were extremely limited, so as a culture, our norms prepared them better to accept death. Nowadays we have many options, and modern medicine has become the ultimate tool of our survival. Yet another profound ability that separates us from other animals.
ThaddeusQuay2 15y ago
This reminds me of Percy Bridgman, whose work with high pressure got him a Nobel Prize in physics, and which led to the creation of synthetic diamonds at GE. "Bridgman committed suicide by gunshot [at age 79] after living with metastatic cancer for some time. His suicide note read in part, "It isn't decent for society to make a man do this thing himself. Probably this is the last day I will be able to do it myself." Bridgman's words have been quoted by many on both sides of the assisted suicide debate." http://en.wikipedia.org/wiki/Percy_Williams_Bridgman#Death http://en.wikipedia.org/wiki/Percy_Williams_Bridgman#Death http://en.wikipedia.org/wiki/Synthetic_diamond#GE_diamond_project http://en.wikipedia.org/wiki/Synthetic_diamond#GE_diamond_pr... EDIT: I forgot to end with: Mr. SENS, FTW. http://en.wikipedia.org/wiki/Aubrey_de_Grey http://en.wikipedia.org/wiki/Aubrey_de_Grey
philwelch 15y ago
I watched my father die last year, and I'm thankful I did the dignified thing and let him go when he was obviously at the end. The metaphor of "checkmate" is quite apt--once you're old enough and you've developed enough problems, every plausible means of escape from one problem is blocked by the next. If you don't want to spend your last days being tortured to death in a hospital, tell someone you love and trust and write up the legal documents necessary to enforce that decision. It's an incredibly hard decision to make though, and it's sad that not everyone has someone they can trust to make that decision. My dad was lucky to have an only child who followed his wishes. I can't imagine what it would be like to have some hysterical sibling try to undermine my dad's wishes, but that's what a lot of families go through.
hendrix 15y ago
There is no such thing as 'aging' in the traditional sense. As explained by Aubrey De Grey Sens' founder "the set of accumulated side effects from metabolism that eventually kills us" http://en.wikipedia.org/wiki/Strategies_for_Engineered_Negligible_Senescence http://en.wikipedia.org/wiki/Strategies_for_Engineered_Negli... sens.org It might not work but it is a _much_ better use of our tax dollars than blowing up brown people in the middle east.
srean 15y ago
I went straight to the HN discussion rather than the WP page and on my way was thinking to myself, hope some one brings up the issue of "right to die". To my pleasant surprise that is the central topic of the discussion. Many have argued for prolonging the life span of humans to the point of immortality. Its a thought provoking idea to entertain. One comment ponders rhetorically, wouldn't it be nice to have Einstein and Tesla around. Not only am I ok with right to die, I absolutely covet it. Not just for myself but the entire society. I am not so sure about "right to life", though it might seem such a no-brainer, Though we use the word "right" they are often privileges and the important question to think over is who gets to exercise the privileges. That is never uniform, it always comes down to who has the wherewithal to secure that privilege. It is this that causes me to worry. Sure it would be great to have Socrates and Einstein with us if they chose to, we don't know if they would have. Many assholes would, but more seriously, one can conjecture that the dictators who were not defeated but died naturally would probably choose to live. World history would be a lot different. Would authoritarian regimes live longer ? Difficult to answer. Then there is the question of ideas. Ideas, both good and bad, they often die not because better ideas replace them, but because their champions die. I don't know whether this is an argument in favor of or against prolonging life, but the need to discuss it will only become more urgent over the years.
evo_9 15y ago
Well worth reading and really considering before people assume 'death' is a fact of life: http://www.nickbostrom.com/fable/dragon.html http://www.nickbostrom.com/fable/dragon.html
joelrunyon 15y ago
Honest Question If we all lived forever, where would we put all the people?
- orangecat 15y ago
  Space. Maybe silicon.
danbmil99 15y ago
> very few elderly patients are lucky enough to die in their sleep. That doesn't have to be a matter of luck. If we allowed people the dignity to choose, while still lucid, to end their life, or to set up a strict set of conditions upon which their life will end, we could drastically reduce the suffering involved in death, both for the dying and for their families and friends.
InclinedPlane 15y ago
These sorts of things strike me as a bit off. One of the problems of being a doctor, much like being a police officer, is that you tend to get exposed to the worst experiences. Good folks may have the occasional run-in. With police but by far the bulk of encounters a police officer has will be with the worst parts of humanity, again and again. Which can lead them to become jaded, depressed, etc. The same sort of dynamics play out with doctors too. People who get better stop spending time in the hospital, and stop being seen by doctors so often. This can lead doctors to a false view of late stage medical care. They see every moment of the pain and suffering, the struggling that turns out to be in vain, the sheer cost of heroic measures, but they often miss out on seeing the benefits. The time given back to patients who then spend happy years with their family away from hospitals and doctors.
ilaksh 15y ago
This all sounds reasonable to many people. Unfortunately, the motivation for these kinds of testimonials is not sentiment or reasonableness. Its profit. Its just not profitable for health insurance companies to treat old people -- that's where they lose all of their money.
- dennisgorelik 15y ago
  I don't think insurance companies care much one way or another. If people prefer to prolong their life as long as possible, then insurance companies would just increase premium payments and pay for these procedures.
deleted 15y ago
[deleted]
martinklein 15y ago
My comment on article was deleted by washingtonpost moderator. [someone] 2/18/2012 9:16 PM GMT+0100 [Implying they removed a feeding tube] My response: You didn't feed him? He died of starvation? That could be painful. You should kill him using exit-bag with helium gas. I'm being serious. My response was replaced with: postmoderator responds: This comment has been deleted by a moderator for violating the site's discussion policy.
charlieok 15y ago
"According to the Centers for Disease Control and Prevention, a person who made it to 65 in 1900 could expect to live an average of 12 more years; if she made it to 85, she could expect to go another fouryears. In 2007, a 65-year-old American could expect to live, on average, another 19 years; if he made it to 85, he could expect to go another six years." I get that gender neutral language like this is the norm these days, but the way it's used in this particular statement, it isn't helping!
crag 15y ago
When we are born, nature promises us nothing except death. It's just that simple. It's unfortunate we've surrounded it with so much fear. Our ideas on death must change. Cause frankly, it's killing us. Death is the natural order. I heard a great line from one of the few TV shows i watch, Supernatural; "Who came first? The chicken or the egg? We're too old to remember. But I know this, I'll reap god too". - the aspect of Death.
lizzard 15y ago
When I am clearly near death I would prefer pain relief and hospice-style care at home rather than extreme intervention. And yet, as a wheelchair user (on and off) for the last 20 years and a person in constant pain, I've had people tell me to my face they'd rather be dead than be "disabled". I would like to at least mention the importance of listening to people with disabilities on this issue. Because of societal prejudice against people with disabilities, often people's judgement is that we would be better off dead than suffering or impaired. When a disabled person is depressed or suicidal, they are encouraged to die by fans of the likes of Peter Singer or Kevorkian, rather than treated for depression, and helped to have the medical and personal care, and societal infrastructure, that might improve their enjoyment of life. So, please keep this in mind and perhaps read up on the complexity of the issues -- from the perspectives of disability rights activists as well as doctors or the caretakers of people who are extremely ill. Our slogan is "nothing about us without us" and yet unfortunately, this article is only from the perspectives of caretakers.
ern 15y ago
The article seems to be part of a trend where people are made aware of the value of letting go, rather than engaging in futile medical care. However, before making end of life decisions, one should be aware that there is a large and growing hospice industry that benefits from people "giving up" (sometimes leading to greater suffering, as treatable conditions go untreated), and weigh one's decisions carefully: http://www.businessweek.com/news/2011-12-06/aunt-midge-not-dying-in-hospice-reveals-14-billion-u-s-market.html http://www.businessweek.com/news/2011-12-06/aunt-midge-not-d...
lizzard 15y ago
For more on death and disability and "right to die" issues, here's a great post by Bad Cripple. http://badcripple.blogspot.com/2012/02/mainstream-media-discovers-christina.html http://badcripple.blogspot.com/2012/02/mainstream-media-disc...

349 points by llambda 15y ago

I haven't studied medicin, but have a smattering of chemistry so I follow the subject a bit. The article miss the probably most interesting aspect. In fifteen years, there will almost certainly be organs grown from stem cells, which allows transplants without immunity problems. What would happen to the first example in the article when the hearth and kidneys are replaced? When growth factors and (more or less) young stem cells start repairing the brain damage and the Parkinsons? It might take twenty years. It will still be in time for most people on HN when you grow old. Anyway, it is probably only of academic interest to me (old health problems will probably get me).

polyfractal 15y ago
Edit: I don't think everyone should be downvoting the parent. It's a logical statement from someone outside the field - you see "organs grown in XYZ lab!" all the time in the press. As a biologist, I can tell you that home-grown organs are waaay more than 15 years away. Currently, we can grow skin pretty well. Mostly because skin likes to grow and is very simple in structure. We are making progress on growing liver tissue, again because liver cells are particularly robust and the liver is not a strongly organized tissue. It is (mostly) a big blog of heterogeneous cells that does not require complicated geometry and organization. Anything past those two are wishful thoughts. I'm not discounting the advances that we have made in growing organs. We've done some very cool work, but it is certainly a long way away. Once the basic science is established, it will still take a long time to get widespread medical approval. Re: "repairing" the brain makes growing an organ look trivial. The difference is like building a house vs repairing CERN's LHC.
- joering2 15y ago
  interesting. can you explain bit more why repairing brain would be that complicated (asked by someone that never touched biology [me]) side note: your Cloudera job post has cudazi tags visible.
  - polyfractal 15y ago
    Sure. With a lot of organs, the function is a relatively mundane process. The heart pumps. The liver filters. The skin grows and dies and grows some more. This simplifies things a bit. The challenge is to get all the right cells in the right places. Heart cells need to be arranged specifically so that the heart can pump. Wikipedia has a good animated gif of how the conduction wave flows through the heart [1]. Fortunately, this is a surmountable challenge. You can throw progenitor cells into a pre-built scaffold and they tend to organize like they should. This is because most organs in your body are built of relatively interchangeable parts. E.g. Most of your heart is the same kind of muscle cell. The brain is a bit different. First, the type of damage is very dependent on the disease state. Have we lost entire neurons? What regions are affected? Are our neurons de-mylenating? Second, your brain is unique to you. Sure, we both share stereotyped architecture: we both have a hippocampus, a cerebral cortex, a cerebellum, etc etc. The structure inside each region is pretty stereotyped too - we both have cortical bundles in our neocortex. But when you drill down to the cellular level, we are very, very different. Each neuron I possess in my brain has a unique (and dynamic) synaptic arbor that connects to thousands of other, unique neurons. If I suffer a stroke and a portion of my brain dies, you can't simply throw more neurons in to compensate. Effectively, neurons are not interchangeable parts like heart muscle cells. You need to coax those neurons to: A) live in relatively hostile environment B) synapse to appropriate neuronal populations C) weight those synapses correctly. [1]http://en.wikipedia.org/wiki/File:ECG_Principle_fast.gif http://en.wikipedia.org/wiki/File:ECG_Principle_fast.gif Side note: Thanks for the heads-up on the Cloudera post - I just migrated themes and servers last night :)
    - loup-vaillant 15y ago
      (I'm a programmer, I know little about biology) Another way to look at it is the information theoretic perspective: when organ X is damaged? what information do you need to grow it back? If X is anything but the brain (and maybe part of the spine), the information you need can almost always be picked from somewhere else (Stem cells plus standard human anatomy). We can't do that now, but in principle it should work. But if you lose part of your brain, then it's a tougher challenge, because your personal memories, skills and more are stored in it. The only way to recover that would be to use the redundancy your brain might feature. Otherwise, it's lost. Sometimes, you cannot recover a code from a burned piece of paper. Now, if your brain just suffers a terminal illness, but the information is still there, then healing you may be as difficult as copying your whole soul into a computer, synapse per synapse. (Or it may not: we do have way to slow down —not heal— Parkinson, for instance.)
- ricree 15y ago
  I seem to remember some promising experiments that grew replacement hearts on an existing extracellular matrix. While they were still a long way from being true replacements, they showed enough functionality to look like a promising direction. Did that not pan out, or are there other major hurdles that would prevent this from being viable within a couple decades?
- berntb 15y ago
  >>Anything past those two are wishful thoughts. hardly just skin and liver! It is easy to find information about e.g. therapies for horses' joints. This link is about humans, just a few years from patients. http://news.bbc.co.uk/2/hi/health/1809322.stm http://news.bbc.co.uk/2/hi/health/1809322.stm There are people walking around with bladders and (built with a scaffold) throats. There are grown muscle patches for hearts, etc. (I didn't mean to replace parts of the brain surgically of course, stem cells rebuild damaged areas after strokes.) (I assume you aren't claiming that Parkinson won't be cured in 20 years?) Do you have any references? What are the show stoppers to scale to more complex tissue? The field obviously moves fast. Muscles like the heart and "simple" organs like kidneys should probably be possible. Is blood supply not solvable? Edit: Sorry for coming back a few hours later. (I was downvoted a while? :-) )
- berntb 15y ago
  Here is a group working on muscle with 3D printers. As I wrote in previous comment, building simple organs (hardly eyes) seems to move quite fast. http://www.technologyreview.com/biomedicine/39687/?%3C http://www.technologyreview.com/biomedicine/39687/?%3C

Alex3917 15y ago

I think the fundamental misunderstanding is that most people think that people die from diseases, but in reality it's much closer to the other way around; people get diseases when they are about to die. Even if we had the cure to every single cancer the average life expectancy would only go up by about 3 years, because most cancer patients would just die from something else anyway.

deleted 15y ago
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JulianMorrison 15y ago
True but overly defeatist. Fixing one problem would not solve things. Fixing several problems (cancer, intra-cellular junk, extra-cellular junk, etc etc, Google "SENS" for a suggested list) would actually cure death from ageing - or at minimum, would reveal what other problems we would also need to solve. People get sick because they are damaged, and they are damaged because they are old, but the damage is in principle something that can be repaired.
hyko 15y ago
You make an important point: treating ageing itself is superior to tackling diseases individually. Ageing is a risk factor for practically every major disease. Therefore reversing, halting, or even just slowing the process would reduce the incidence and burden of every major disease.

polyfractal 15y ago

Two poignant quotes from the article really stood out to me: "When their loved one does die, family members can tell themselves, “We did everything we could for Mom.” In my experience, this is a stronger inclination than the equally valid (and perhaps more honest) admission that “we sure put Dad through the wringer those last few months.”" "A retired nurse once wrote to me: “I am so glad I don’t have to hurt old people any more.”" Makes you stop and think about how we treat end-of-life situations.

joering2 15y ago
I think your timing is plausible, given what we can do now and 15 years ago. I cant remember how astonished I was when I saw this! [1] 25 years to re-print entire human body without cancer cells, tumors, perhaps without fat and boldness as well? :) [1] http://www.youtube.com/watch?v=9RMx31GnNXY http://www.youtube.com/watch?v=9RMx31GnNXY
- barefoot 15y ago
  That TED talk was amazing. Thanks.
  - joering2 15y ago
    sure, no problem, although I dont recall when, but I stumbled upon it on HN as well :)
JshWright 15y ago
Twice in the past month, I've participated in restarting a stopped heart belonging to someone over the age of 75. In both those cases, the patient never regained consciousness, and passed away in the ICU a few days later. This story repeats itself over and over again... I don't know what the actual percentage is, but the number of elderly patients who are 'resuscitated' only to never wake up again is surely north of 99%. I'm conflicted about my participation in this process... CPR is a very brutal process, and all the interventions we use to restart someone's heart are equally traumatic. So, why do we do this? In most cases, it's because someone doesn't have a DNR, or any other sort of advanced directive. In most (all?) states, if you call EMS and don't have a DNR, you need to actually threaten us to absolve us of our legal duty to start resuscitative efforts (in reality, most of us are human beings, and simply explaining the situation should be enough). The other situation is when a patient _does_ have a DNR, but the family is insistent that we "Do something!" In both of my recent experiences, our efforts kept the patient 'alive' long enough for out of town family to travel back to say their goodbyes. Was it worth it though? The financial, emotion, and physical costs are pretty high... I'm not sure...

michaelbuckbee 15y ago

My uncle recently passed away (pancreatic cancer) and the people from Hospice were all amazing in helping him and the family. To my mind they embody the different way of handling end of life issues than standard medical treatment.

taf2 15y ago

i knew at 31 i should start feeling old... so 47 is the end, that means i have 16 good years left in me... here's to enjoying it and making something great of it... cheers!

kiba 15y ago

We shouldn't inflict unnecessary pain and suffering but we must fight death and continue medical research for the future generation of elders so that they will be able to see their great-great-great grandchildren and beyond and be healthy at the same time.

gnu8 15y ago
Why?
- sliverstorm 15y ago
  Agreed, where does this "must" come from?
  - kiba 15y ago
    Death is wrong.
    - gnu8 15y ago
      It's not though, death is natural and inevitable. There are also practical considerations: if death is eliminated, we must stop reproduction too.
      - kiba 15y ago
        It's not though, death is natural and inevitable You committed the naturalistic fallacy. Also, inevitability isn't a justification for bad things happening. There are also practical considerations: if death is eliminated, we must stop reproduction too. I would prioritize existing lives over the yet to be born.
        rayiner 15y ago
        > I would prioritize existing lives over the yet to be born. From an evolutionary point of view that makes very little sense.

mistercow 15y ago

> our culture has come to view death as a medical failure rather than life’s natural conclusion. Death is a medical failure, just like our inability to cure herpes is a medical failure. That there's no way to overcome the failure yet does not imply that it is not a failure.

icebraining 15y ago
It's not so much the death itself but the fact that we can't really fix falling organs, just put band-aids to keep it running. My grandmother has osteoporosis and surgery isn't an option. When her bones finally give in and tie her to a bed, that's the end of her life, even if she lives for a few years more.
deleted 15y ago
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dasil003 15y ago
There's an ethical question that you're dodging though. Personally I don't think immortality is a good thing, and I suspect most arguments in its favor our heavily driven by fear of death.
- delinquentme 15y ago
  I'd guess your argument against immortality is one of those covered many many times: overpopulation, overlords yadda, yadda. If you believe in 1000 years humans are still living to 80 years old, and are STILL bound to ONLY this planet ... well I think you're crazier than your love of death ( the norm ) suggests. It requires a bit of human insight to realize that the slice of cake religion advertises IS escape from the vast darkness of a perception-less void.
- zanny 15y ago
  My argument is that if we could develop functional immortality we could preserve the lives of the next Newton, Einstein, or even some currently living scientific minds like Hawking. Rather than have the great generational risk of losing all the collective knowledge such people accumulate and then suddenly have them die and expect their void to be filled by bright young minds interested in the same material, who then have to commit half a century just catching back up to where their progenitors were, it would be a never ending cascade of innovation and progress.

bradleyland 15y ago

At first, I was confused by this statement, given the data.. > "...modern medicine may be doing more to complicate the end of life than to prolong or improve it" 1900 65 -> +12 85 -> +4 2007 65 -> +19 85 -> +6 The engineer in me said, but we've improved! But then I realized that evaluating life by measuring in years is like reviewing tech products by looking at spec sheets. "But it has more megapixels!? Aren't megapixels what we want?" Reality is far more subtle.

SkyMarshal 15y ago
Gotta consider cost. If the marginal cost per megapixel is a million dollars, then maybe a few extra aren't so worth it.
- jbjohns 15y ago
  Forget cost. The important question is quality. In cameras, extra megapixels can mean the sensor sites are so small that they have a harder time distinguishing electronic noise from actual light, leading to worse pictures. Likewise, what good is getting me 10 more years if I can't do anything with them because they're spent in total agony.
- checker 15y ago
  It'd be nice to have the option to choose to spend that million on pursuing a bucket list, or on a horrendous treatment with a single-digit success rate.
_delirium 15y ago
The improvement at the upper end isn't even that much in absolute terms. I guess it's hard to imagine accurately, but I think that when I'm 85, I'm going to be a lot more worried about the quality of my next few years, rather than whether there are going to be 4 or 6 of them. Four high-quality years would be far preferable to six questionable ones. (Of course, six high-quality ones would be even better, but if I had to choose, I'd choose quality.)
rmc 15y ago

scott_s 15y ago

Related article from a few months ago, "How Doctors Die": https://news.ycombinator.com/item?id=3313570 https://news.ycombinator.com/item?id=3313570

lunarscape 15y ago
I wish more people read things like this. "I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.”" I have a parent who's a medical professional and their response was exactly the same. On a related note I wonder if support for euthanasia is higher among those who work in medicine.

delinquentme 15y ago

TLDR: We all are afraid of death and the reason humans invented religion was to cope with this fear. If you're going to downvote... Instead say something so we can discuss!

rdl 15y ago

If I were in medicine, I'd sure rather be working on trauma on a healthy patient population (soldiers, young adults, etc.) than illnesses of the elderly or already sick -- vastly simpler, sort of like developing new software (even if it is doing something difficult) vs. working in a complex legacy system with no documentation and lots of hidden mines.

Someone 15y ago
Are you sure you have a realistic view of working on trauma, especially with soldiers, in the current era? The combination of modern bulletproof helmets and clothing with the almost immediate availability of good medical care allow the survival of some horrendously wounded people for whom we can do a lot, but not, by far, enough. For example, a soldier can loose al his limbs due to a IED, be burnt over large parts of the rest of his body, and survive. I think I would rather work with elderly people even if comfort is almost all we can give them. Also, if you went into the field, I bet your educators would try to get you change your opinion. Everybody wants the glamorous job, but most employment is elsewhere. I have heard this phrased as "all the girls want to work with children, and all the boys want to work in ambulances; we need to work a bit to change their minds."
- rdl 15y ago
  Yes. I worked in US military hospitals in Iraq and Afghanistan from 2008-2010, as well as spending some time in them in 2003-2007. I also spent a fair bit of time in third world clinics (in North Africa, Middle East, Southwest Asia, and also Iraq/Afghanistan), where the main care was for sickness or maternity, including working with NGOs. The US hospitals also had plenty of local nationals coming in, either due to trauma, or due to illness. I also got to go out with some teams (i.e. the "other" people) when they did medical outreach. A few of my friends are Army SF medics, I lived with an Air Ambulance company for most of 2005, and dated a (non-US, coalition partner) doctor for a few months. I did combat lifesaver and some other advanced first aid stuff, and dive medic. I did get to help out with trauma a fair bit, and I've been first responder at a bunch of traffic accidents worldwide. Actually, neuroradiology would be my #1 pick (I hate being around conscious patients, and even talking to people who talk to conscious patients is bad. A rad at least talks to other specialists, and a neurorad is going to talk to specialists (rads, neurosurgeons) who talk to other specialists (surgeons, oncologists) who talk to normal doctors who talk to patients, so you're pretty far removed. ER docs are kind of looked down on by other doctors (for basically being stream of consciousness, get them in, patch them up, pass them along), but trauma surgeons are well respected. There's clearly a lot of money in gerontology, and demand for internal medicine (although badly paid, and often in crappy parts of the country), but I'd hate those things. However, I'm doing a non-medical startup, and going to med school seems very unlikely to be in my future.

lunarscape 15y ago

This brings to mind the following article, in which doctors place greater emphasis on quality of life when making decisions themselves: Physicians Recommend Different Treatments for Patients Than They Choose for Themselves, Study Finds, http://www.sciencedaily.com/releases/2011/04/110411163904.htm http://www.sciencedaily.com/releases/2011/04/110411163904.ht...

javajosh 15y ago

Yes. Now what doctors need is an effective, compassionate way to communicate the simple fact that we need to let old people die. Here's one way: A family brings an elderly patient suffering from stroke, diabetes, etc. into the ER. The patient is in a coma. Before asking them what they want to do, take the family into the NICU and tell them: we have limited resources, and we can either save a baby in here, giving him a chance for a healthy productive life, or we can perform heroic measures on your loved one, almost certainly doing nothing but prolonging his suffering. What is your choice?

wpietri 15y ago
Having recently been an advocate for an elderly patient with severe medical problems, I can say with confidence that this is a terrible idea twice over. Not only would it not work well, but it's also so lacking in compassion as to be horrific. The time to educate people on these choices is years before you have to make them. The solution isn't to take people thrust into tragedy and threaten to kill babies if they don't do the "right" thing. It's to change our culture such that people consider these hard choices much earlier and life, and feel comfortable discussing these issues with their families.
- javajosh 15y ago
  What I'm trying to get at is that doctors need some sort of tools to help explain the situation to their patients and their patient's families. It doesn't have to be my suggestion, but some way of making the twin points that: a) prolonging life at any cost is not compassionate to the patient, and b) prolonging life at any cost is not compassionate to people who actually can be healed to go live a happy remainder of their life.
dwynings 15y ago
I can't think of a worse idea. Families need to sit down and have an honest discussion about death before it's necessary. It's a hard conversation to have, but it can save constantly questioning and second guessing yourself what your loved one would want to happen.

rayiner 15y ago

I think one of the things he mentions, people not living with their elderly parents, is responsible for a lot of our bizarre attitudes towards old age and death. How much of the "just a couple of more years" attitude is to help assuage the guilt of ignoring the person for the last 10-20 years of their lives?

arnoldwh 15y ago
I agree. You try to do everything because you realize you've done so little during the time you've had. I guess that's the normal way of being though. It seems like it is every child's fate to not appreciate their parents enough until it is too late, and to repeat this same cycle when they have children of their own.

coolestuk 15y ago

"At a certain stage of life, aggressive medical treatment can become sanctioned torture. " I just went through a month with a 90 year old friend whose life ended almost exactly like the story in that story. He had one lucid 30 mins when I was there and his family was there (he had been a general physician for almost 50 years). In his brief period when he had the energy to try and communicate whilst almost totally paralysed, it was clear he was telling the attending doctor that he wanted them to stop all medication and let him die. His own family could not face that fact, and said they'd ask him again the following day (unfortunately the cowardly doctor backed them up on this). He was never again lucid or strong enough to insist that treatment be stopped. He lived for another 10 days, struggling to breathe, almost totally paralysed, unable to control his bowels. This was a man who when I last went on holiday with him at the age of 85, he insisted on carrying his own suitcase and refused a wheelchair, even though he had trouble walking and had blood pressure and angina problems. I don't blame his family not being able to make that decision (it's so hard to let go of someone one loves). But his last weeks were undoubtedly torture, and they know they refused to follow his wishes. It was just terribly sad and an awful dilemma. I was really glad of something else I read on HN about 6 months ago, where a doctor had a brain tumouur (or something like that) and instead of treatment, he lived out the remainder of his life doing the things he loved. I think that idea was what meant I could come to terms with the need to respect my friend's last wishes. I just could not convince his family.

wpietri 15y ago
I encourage everybody to talk things like this through with their family. Last year my mom was diagnosed with a terminal brain tumor. She elected to pursue treatment vigorously, but brain tumors being what they are, there were a number of points where she was unable to answer questions about her wishes. At every one of those points we knew what she wanted because we had discussed it extensively before. I was incredibly grateful for that. It is bad enough to have to make complicated, life-or-death decisions for someone you love. I cannot imagine the horror of trying to do that without a clear understanding of what they would want. Please talk with your family about this. Right now if possible. Just forward your sibling, parent, or child this article and tell them it made you think. Then tell them what you'd want. Don't just think you'll do it "later"; the right time will never come on its own.

publicus 15y ago

The real problem is we are at the stone ages when it comes to medicine. The problem is worsen by the fact that treatment is more profitable than cure. In fact, cure eliminates income all together.

luser001 15y ago

For a book length treatment of this topic, see "How we Die", one of the most amazing books I've read. http://www.amazon.com/How-We-Die-Reflections-Chapter/dp/0679742441 http://www.amazon.com/How-We-Die-Reflections-Chapter/dp/0679...

jdavid 15y ago

Ray Kurzweil should read this article.

jdavid 15y ago

This is one of the reasons I find it hard to talk to my mother. She is beholden to grief about her father and is doing everything to prolong the life of my grandmother even though she can't walk, needs help eating, and constantly falls asleep. On top of that she hardly knows who is around her. it's sad. Watching how my parents have dealt with my aging parents really puts pause on me and has me thinking about creating a living Will to make my own wishes very clear.

Craiggybear 15y ago

I think just because you can do something to prolong someone's life, there used to be a time when a good doctor knew this didn't automatically mean you should. I know my grandparents didn't fear or refuse to believe in death in the same way as people do now (and they had seen a lot of it). I hope I'm strong enough and happy enough with myself that I will gladly relinquish my hold on the reins of life when its properly time to do so, and not fear it or be sad.

jtothapreston 15y ago

I think this underestimates our most primal of instincts, survival. Those people who died at 48 a century ago had no less want or determination to live longer, than did those who die today at 78. In those times, their options were extremely limited, so as a culture, our norms prepared them better to accept death. Nowadays we have many options, and modern medicine has become the ultimate tool of our survival. Yet another profound ability that separates us from other animals.

ThaddeusQuay2 15y ago

This reminds me of Percy Bridgman, whose work with high pressure got him a Nobel Prize in physics, and which led to the creation of synthetic diamonds at GE. "Bridgman committed suicide by gunshot [at age 79] after living with metastatic cancer for some time. His suicide note read in part, "It isn't decent for society to make a man do this thing himself. Probably this is the last day I will be able to do it myself." Bridgman's words have been quoted by many on both sides of the assisted suicide debate." http://en.wikipedia.org/wiki/Percy_Williams_Bridgman#Death http://en.wikipedia.org/wiki/Percy_Williams_Bridgman#Death http://en.wikipedia.org/wiki/Synthetic_diamond#GE_diamond_project http://en.wikipedia.org/wiki/Synthetic_diamond#GE_diamond_pr... EDIT: I forgot to end with: Mr. SENS, FTW. http://en.wikipedia.org/wiki/Aubrey_de_Grey http://en.wikipedia.org/wiki/Aubrey_de_Grey

philwelch 15y ago

I watched my father die last year, and I'm thankful I did the dignified thing and let him go when he was obviously at the end. The metaphor of "checkmate" is quite apt--once you're old enough and you've developed enough problems, every plausible means of escape from one problem is blocked by the next. If you don't want to spend your last days being tortured to death in a hospital, tell someone you love and trust and write up the legal documents necessary to enforce that decision. It's an incredibly hard decision to make though, and it's sad that not everyone has someone they can trust to make that decision. My dad was lucky to have an only child who followed his wishes. I can't imagine what it would be like to have some hysterical sibling try to undermine my dad's wishes, but that's what a lot of families go through.

hendrix 15y ago

There is no such thing as 'aging' in the traditional sense. As explained by Aubrey De Grey Sens' founder "the set of accumulated side effects from metabolism that eventually kills us" http://en.wikipedia.org/wiki/Strategies_for_Engineered_Negligible_Senescence http://en.wikipedia.org/wiki/Strategies_for_Engineered_Negli... sens.org It might not work but it is a _much_ better use of our tax dollars than blowing up brown people in the middle east.

srean 15y ago

I went straight to the HN discussion rather than the WP page and on my way was thinking to myself, hope some one brings up the issue of "right to die". To my pleasant surprise that is the central topic of the discussion. Many have argued for prolonging the life span of humans to the point of immortality. Its a thought provoking idea to entertain. One comment ponders rhetorically, wouldn't it be nice to have Einstein and Tesla around. Not only am I ok with right to die, I absolutely covet it. Not just for myself but the entire society. I am not so sure about "right to life", though it might seem such a no-brainer, Though we use the word "right" they are often privileges and the important question to think over is who gets to exercise the privileges. That is never uniform, it always comes down to who has the wherewithal to secure that privilege. It is this that causes me to worry. Sure it would be great to have Socrates and Einstein with us if they chose to, we don't know if they would have. Many assholes would, but more seriously, one can conjecture that the dictators who were not defeated but died naturally would probably choose to live. World history would be a lot different. Would authoritarian regimes live longer ? Difficult to answer. Then there is the question of ideas. Ideas, both good and bad, they often die not because better ideas replace them, but because their champions die. I don't know whether this is an argument in favor of or against prolonging life, but the need to discuss it will only become more urgent over the years.

evo_9 15y ago

Well worth reading and really considering before people assume 'death' is a fact of life: http://www.nickbostrom.com/fable/dragon.html http://www.nickbostrom.com/fable/dragon.html

joelrunyon 15y ago

Honest Question If we all lived forever, where would we put all the people?

orangecat 15y ago
Space. Maybe silicon.

danbmil99 15y ago

> very few elderly patients are lucky enough to die in their sleep. That doesn't have to be a matter of luck. If we allowed people the dignity to choose, while still lucid, to end their life, or to set up a strict set of conditions upon which their life will end, we could drastically reduce the suffering involved in death, both for the dying and for their families and friends.

InclinedPlane 15y ago

These sorts of things strike me as a bit off. One of the problems of being a doctor, much like being a police officer, is that you tend to get exposed to the worst experiences. Good folks may have the occasional run-in. With police but by far the bulk of encounters a police officer has will be with the worst parts of humanity, again and again. Which can lead them to become jaded, depressed, etc. The same sort of dynamics play out with doctors too. People who get better stop spending time in the hospital, and stop being seen by doctors so often. This can lead doctors to a false view of late stage medical care. They see every moment of the pain and suffering, the struggling that turns out to be in vain, the sheer cost of heroic measures, but they often miss out on seeing the benefits. The time given back to patients who then spend happy years with their family away from hospitals and doctors.

ilaksh 15y ago

This all sounds reasonable to many people. Unfortunately, the motivation for these kinds of testimonials is not sentiment or reasonableness. Its profit. Its just not profitable for health insurance companies to treat old people -- that's where they lose all of their money.

dennisgorelik 15y ago
I don't think insurance companies care much one way or another. If people prefer to prolong their life as long as possible, then insurance companies would just increase premium payments and pay for these procedures.

deleted 15y ago

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martinklein 15y ago

My comment on article was deleted by washingtonpost moderator. [someone] 2/18/2012 9:16 PM GMT+0100 [Implying they removed a feeding tube] My response: You didn't feed him? He died of starvation? That could be painful. You should kill him using exit-bag with helium gas. I'm being serious. My response was replaced with: postmoderator responds: This comment has been deleted by a moderator for violating the site's discussion policy.

charlieok 15y ago

"According to the Centers for Disease Control and Prevention, a person who made it to 65 in 1900 could expect to live an average of 12 more years; if she made it to 85, she could expect to go another fouryears. In 2007, a 65-year-old American could expect to live, on average, another 19 years; if he made it to 85, he could expect to go another six years." I get that gender neutral language like this is the norm these days, but the way it's used in this particular statement, it isn't helping!

crag 15y ago

When we are born, nature promises us nothing except death. It's just that simple. It's unfortunate we've surrounded it with so much fear. Our ideas on death must change. Cause frankly, it's killing us. Death is the natural order. I heard a great line from one of the few TV shows i watch, Supernatural; "Who came first? The chicken or the egg? We're too old to remember. But I know this, I'll reap god too". - the aspect of Death.

lizzard 15y ago

When I am clearly near death I would prefer pain relief and hospice-style care at home rather than extreme intervention. And yet, as a wheelchair user (on and off) for the last 20 years and a person in constant pain, I've had people tell me to my face they'd rather be dead than be "disabled". I would like to at least mention the importance of listening to people with disabilities on this issue. Because of societal prejudice against people with disabilities, often people's judgement is that we would be better off dead than suffering or impaired. When a disabled person is depressed or suicidal, they are encouraged to die by fans of the likes of Peter Singer or Kevorkian, rather than treated for depression, and helped to have the medical and personal care, and societal infrastructure, that might improve their enjoyment of life. So, please keep this in mind and perhaps read up on the complexity of the issues -- from the perspectives of disability rights activists as well as doctors or the caretakers of people who are extremely ill. Our slogan is "nothing about us without us" and yet unfortunately, this article is only from the perspectives of caretakers.

ern 15y ago

The article seems to be part of a trend where people are made aware of the value of letting go, rather than engaging in futile medical care. However, before making end of life decisions, one should be aware that there is a large and growing hospice industry that benefits from people "giving up" (sometimes leading to greater suffering, as treatable conditions go untreated), and weigh one's decisions carefully: http://www.businessweek.com/news/2011-12-06/aunt-midge-not-dying-in-hospice-reveals-14-billion-u-s-market.html http://www.businessweek.com/news/2011-12-06/aunt-midge-not-d...

lizzard 15y ago

For more on death and disability and "right to die" issues, here's a great post by Bad Cripple. http://badcripple.blogspot.com/2012/02/mainstream-media-discovers-christina.html http://badcripple.blogspot.com/2012/02/mainstream-media-disc...