5 ms·

"The overarching problem here is that we have this fear of letting people die" This feels like a crazy thing to hear a physician say. Our acceptance of death a

by feoren 2y ago

"The overarching problem here is that we have this fear of letting people die" This feels like a crazy thing to hear a physician say. Our acceptance of death as inevitable is a learned helplessness. Modern medicine is not even 100 years old by some accounts, and every new decade brings new "miraculous" treatments that naysayers called completely unrealistic before. There's no reason to believe that humanity will need to accept death as inevitable forever. Any theory of medicine that is based on accepting that people die is dooming itself to a primitive, barbaric existence. The ethical dilemma goes away if these machines become more portable and 100x cheaper, a transformation we've seen many times. From keeping a cat alive for 30 minutes in 1934 to humans in 1952 to days in 1971 to months/years in the 2010s-2020s to ... what, decades? Centuries? These people are having conversations and we're saying "well we should let them die because death is a part of life" -- no, it clearly doesn't have to be. Yes, there are cost concerns, triage concerns and quality of life concerns, but those are engineering problems that we know we could dramatically improve if we actually invested significantly in this technology. I do not accept that we should not be afraid of "letting people die" -- let's be fucking terrified of it and do everything we can to stop it, please. Because everything we've seen from medicine over the last 100 years indicates that we can. And to those who say that death must be a part of life or (insert societal problem with shaky justification here) will happen, I ask: what if the situation were reversed? What if everyone lived forever and we were facing overcrowding or whatever -- would your solution be to kill everyone nearing 100 years of age?

FireBeyond 2y ago
I don't think it's so much that we kill people. It's that we let them die. If we are truly, brutally honest with ourselves (and overcoming denial, social, religious, whatever conditioning here is a huge struggle), much of the time, the efforts we put in to keeping loved ones alive is really often more about us than it is about them. The elderly (and I'm generalizing, I realize) are far more accepting of death. It's easier to accept that when you feel you have lived a full and happy life. Contrarily, that full and happy life often involves having the presence of loved ones, who are NOT ready to accept that their life will be - or rather, will feel - less full and happy without that person. Even just simple denial is a huge thing. One of my first experiences in emergency medicine was an older gentleman, family patriarch. The rest of his extended family had been able to gather at the hospital while he was in and out of arrest. A provider and support person went to talk to the extended family, who was adamant about following his son, the 'number two patriarch', and his steadfast insistence, "He is a good strong Christian man, and he is going to be okay." (I say this not to mock Christians, to be clear, and also to be clear, he didn't mean in the "eternal life" sense, he and the family truly believed almost that divine intervention was going to take care of things). After some discussion on this, a decision was made to bring the son into the ER where we were working on his father. Seeing the hopelessness and futility, seeing his father the shadow of the man he knew, and all of that assorted detail was no doubt traumatic, but it also made it viscerally real to his son. No matter the concerted efforts of nearly 10 medical professionals, drugs, defibrillation, ventilation, we were not going to be able to keep his father alive, and there was not going to be any divine intervention. He watched this silently for a few moments, and then asked us to discontinue CPR and if his father's organs were suitable for donation. My heart broke for him. But this is a struggle we have not figured out, recently. We had it figured out, historically, by necessity, but we are complacent now. Leaving aside the separate issue of healthcare costs, you can still look at the ratios: In the US, on average we spend more on healthcare keeping someone alive for the last year of their life than we do on the previous decade. And we spend more on that decade than we do on the rest of their life. Some of which seems obvious, given youth, but nonetheless.
- feoren 2y ago
  It's a powerful story, but it's simply not relevant to my argument, and I suspect the reason you think it is relevant is because you've deeply internalized the inevitability of death. Of course you, and we all, have: it's been inevitable for the entirety of human existence. But humans were never able to fly across the ocean for the vast majority of our existence either, nor were we able to orbit the Earth or communicate at near light speed with the other side of the Earth. People who say death is inevitable are putting it in a special category: it's the one thing humanity will never be able to solve with technology? We can colonize other planets, split the atom, develop computers and AI, but keeping oxygen flowing to the cells is just forever beyond our reach? No. Your story is about a man's denial that his father, currently in critical condition, would die. Yes, the probability that humanity would solve death in the hour of life his father had remaining was low. I'm talking about humanity's denial that death is just a giant bag of problems that we can, eventually, solve one by one. The probability that humanity will solve death in the next thousand years is nearly 100%; the probability that it will be solved in our lifetimes may be low, but it's not 0. (Keep in mind, 1000 years is ten times the lifespan of an exponentially accelerating medical field, not simply 1% of the whole human history in which basically no progress was made.) If we had a simple, maintainable, cheap machine that could keep people alive for 100 years without a working heart or lungs, there is no ethical dilemma, and the line between "killing them" and "letting them die" becomes pretty blurry. The reason this matters is that once we actually start to realize that death is a problem that we can actually solve, then we can get the fuck to work on it! We could be investing so much more than we are in treatments like ECMO. There should be a national moon-landing-level initiative to make these machines available to everyone. But the longer we mope around with our learned helplessness, calling people like me naive and in denial, the more people will die needlessly.
  - FireBeyond 2y ago
    Then going to your point, there are many discussions around theoretical upper bounds for human life, even factoring in technology. Studies look at blood cells and footsteps and establishing hard limits. One of the more recent ones suggests around 150 (today it's around 120). > with things that usually kill us omitted, our body's capacity to restore equilibrium to its myriad structural and metabolic systems after disruptions still fades with time. And even if we make it through life with few stressors, this incremental decline sets the maximum life span for humans at somewhere between 120 and 150 years. In the end, if the obvious hazards do not take our lives, this fundamental loss of resilience will do so. https://www.scientificamerican.com/article/humans-could-live-up-to-150-years-new-research-suggests/ https://www.scientificamerican.com/article/humans-could-live...
spondylosaurus 2y ago
For a contrasting viewpoint, you might consider this New Yorker article from a practicing physician ("The Hidden Harms of CPR"): https://www.newyorker.com/news/the-weekend-essay/the-hidden-harms-of-cpr https://www.newyorker.com/news/the-weekend-essay/the-hidden-... Death is a necessary consideration, but so is prolonged suffering.
steve76 2y ago
[dead]
nradov 2y ago
Death is not a problem that needs to be eliminated. It's fine that people eventually die. We are all expendable. The goal of medical care should be to extend healthspan, not lifespan. Minimize the burden of diseases and injuries. Despite the claims from charlatans and grifters like David Sinclair, there is no scientific evidence that significantly extending human lifespans is even possible. If we were making progress then we would expect to see a few outliers living to 125+. But instead the record remains at 122, and that was set in 1997. It's time to put aside pointless fantasies and focus on achievable goals.
alexey-salmin 2y ago
Excuse me, but I do want to live in a world where death is inevitable and will choose that option at any time. It has nothing to do with helplessness, it's pure reason and engineering considerations. The current system with auto-refreshing humans has got us very far and obviously it works really well. Not only it solves biological problems like cancer (which you can argue eternal humans will solve themselves) but most importantly it solves scientific, engineering and social problems. It avoids dead-ends, it can't get stuck, it iterates relentlessly over infinity of alternatives to find the one that brings us further. A mistaken scientist dies and so does his theory. A tyrant dies and so does his regime. A liar dies and no one maintains his lies. Starting life afresh, without decades of mental baggage is a blessing. Carrying it with you forever is hell for you and for others who will have to endure your presence.
- feoren 2y ago
  > Excuse me, but I do want to live in a world where death is inevitable and will choose that option at any time. This feels a little like saying "I like death, therefore everyone else must die too." Besides, you'd always be able to choose that option at any time. I'm not talking about some cursed-monkey-paw version of immortality. > the current system with auto-refreshing humans has got us very far The system of hunter-gathering got us pretty far too, and switching over to agriculture was indeed not 100% positive at first. The system of feudal/clan-based government and labor-and-wood-based energy economy got us very far, too, and switching to the industrial revolution also had its early downsides. Just because systems are working doesn't mean they can't be improved. > importantly [Senescence] solves scientific, engineering and social problems. Again I ask: if we already lived forever, and we were running into those scientific, engineering, and social problems that death supposedly "solves", then would your solution be to start killing everyone approaching 100 years old? Another solution to all our problems is that the sun goes supernova and the Earth is completely annihilated. That's along the same line of "solution" as yours. Besides, I haven't seen any convincing argument that such problems would necessarily occur, or at least be insurmountable. > A mistaken scientist dies and so does his theory. A tyrant dies and so does his regime. A liar dies and no one maintains his lies. This is unfortunately quite accurate for the time being. But death is a rather blunt solution to these problems, and I believe there are better ones. I also believe people would be more interested in ousting tyrants if they didn't think they just need to wait for them to die.
tsimionescu 2y ago
I can 100% promise that death will be a regular part of life not just 1000 years, but 100,000 years from now as well. Even if we solve senescence and we get 1,000,000 times better at emergency medicine, transplants etc. There are numerous ways to almost entirely destroy the brain in fractions of a second, or in hopelessly irreversible ways, or in covert ways that are slow but only get discovered too late. And, as long as such accidents are possible, if your life is otherwise endless, then they are in fact inevitable, no matter how unlikely they appear.
- feoren 2y ago
  There will always be some probability of dying in a given year. Let's say our futuristic society has solved aging/senescence, and is able to reduce the rate of "random death" by about 1% per year, through technology, medicine, brain-redundancy, whatever. So if you have a 1 in 1,000 chance of randomly dying this year, next year it will be about 1 in 1,010. The area under an infinite exponential decay curve is finite. In the scenario above, you have a finite probability of dying, ever. And it's not 100%, either. It could even be quite low. With the numbers above, it's about 10% chance to die, and 90% chance to never die. I know that's counter-intuitive, and it may be that maintaining 1% reduction in random death every year is impossible, but it's not a foregone conclusion that everyone must die. Of course the heat death of the universe presents a problem. That's a good problem to have.

by feoren 2y ago

FireBeyond 2y ago

I don't think it's so much that we kill people. It's that we let them die. If we are truly, brutally honest with ourselves (and overcoming denial, social, religious, whatever conditioning here is a huge struggle), much of the time, the efforts we put in to keeping loved ones alive is really often more about us than it is about them. The elderly (and I'm generalizing, I realize) are far more accepting of death. It's easier to accept that when you feel you have lived a full and happy life. Contrarily, that full and happy life often involves having the presence of loved ones, who are NOT ready to accept that their life will be - or rather, will feel - less full and happy without that person. Even just simple denial is a huge thing. One of my first experiences in emergency medicine was an older gentleman, family patriarch. The rest of his extended family had been able to gather at the hospital while he was in and out of arrest. A provider and support person went to talk to the extended family, who was adamant about following his son, the 'number two patriarch', and his steadfast insistence, "He is a good strong Christian man, and he is going to be okay." (I say this not to mock Christians, to be clear, and also to be clear, he didn't mean in the "eternal life" sense, he and the family truly believed almost that divine intervention was going to take care of things). After some discussion on this, a decision was made to bring the son into the ER where we were working on his father. Seeing the hopelessness and futility, seeing his father the shadow of the man he knew, and all of that assorted detail was no doubt traumatic, but it also made it viscerally real to his son. No matter the concerted efforts of nearly 10 medical professionals, drugs, defibrillation, ventilation, we were not going to be able to keep his father alive, and there was not going to be any divine intervention. He watched this silently for a few moments, and then asked us to discontinue CPR and if his father's organs were suitable for donation. My heart broke for him. But this is a struggle we have not figured out, recently. We had it figured out, historically, by necessity, but we are complacent now. Leaving aside the separate issue of healthcare costs, you can still look at the ratios: In the US, on average we spend more on healthcare keeping someone alive for the last year of their life than we do on the previous decade. And we spend more on that decade than we do on the rest of their life. Some of which seems obvious, given youth, but nonetheless.

feoren 2y ago
It's a powerful story, but it's simply not relevant to my argument, and I suspect the reason you think it is relevant is because you've deeply internalized the inevitability of death. Of course you, and we all, have: it's been inevitable for the entirety of human existence. But humans were never able to fly across the ocean for the vast majority of our existence either, nor were we able to orbit the Earth or communicate at near light speed with the other side of the Earth. People who say death is inevitable are putting it in a special category: it's the one thing humanity will never be able to solve with technology? We can colonize other planets, split the atom, develop computers and AI, but keeping oxygen flowing to the cells is just forever beyond our reach? No. Your story is about a man's denial that his father, currently in critical condition, would die. Yes, the probability that humanity would solve death in the hour of life his father had remaining was low. I'm talking about humanity's denial that death is just a giant bag of problems that we can, eventually, solve one by one. The probability that humanity will solve death in the next thousand years is nearly 100%; the probability that it will be solved in our lifetimes may be low, but it's not 0. (Keep in mind, 1000 years is ten times the lifespan of an exponentially accelerating medical field, not simply 1% of the whole human history in which basically no progress was made.) If we had a simple, maintainable, cheap machine that could keep people alive for 100 years without a working heart or lungs, there is no ethical dilemma, and the line between "killing them" and "letting them die" becomes pretty blurry. The reason this matters is that once we actually start to realize that death is a problem that we can actually solve, then we can get the fuck to work on it! We could be investing so much more than we are in treatments like ECMO. There should be a national moon-landing-level initiative to make these machines available to everyone. But the longer we mope around with our learned helplessness, calling people like me naive and in denial, the more people will die needlessly.
- FireBeyond 2y ago
  Then going to your point, there are many discussions around theoretical upper bounds for human life, even factoring in technology. Studies look at blood cells and footsteps and establishing hard limits. One of the more recent ones suggests around 150 (today it's around 120). > with things that usually kill us omitted, our body's capacity to restore equilibrium to its myriad structural and metabolic systems after disruptions still fades with time. And even if we make it through life with few stressors, this incremental decline sets the maximum life span for humans at somewhere between 120 and 150 years. In the end, if the obvious hazards do not take our lives, this fundamental loss of resilience will do so. https://www.scientificamerican.com/article/humans-could-live-up-to-150-years-new-research-suggests/ https://www.scientificamerican.com/article/humans-could-live...

spondylosaurus 2y ago

For a contrasting viewpoint, you might consider this New Yorker article from a practicing physician ("The Hidden Harms of CPR"): https://www.newyorker.com/news/the-weekend-essay/the-hidden-harms-of-cpr https://www.newyorker.com/news/the-weekend-essay/the-hidden-... Death is a necessary consideration, but so is prolonged suffering.

steve76 2y ago

[dead]

nradov 2y ago

Death is not a problem that needs to be eliminated. It's fine that people eventually die. We are all expendable. The goal of medical care should be to extend healthspan, not lifespan. Minimize the burden of diseases and injuries. Despite the claims from charlatans and grifters like David Sinclair, there is no scientific evidence that significantly extending human lifespans is even possible. If we were making progress then we would expect to see a few outliers living to 125+. But instead the record remains at 122, and that was set in 1997. It's time to put aside pointless fantasies and focus on achievable goals.

alexey-salmin 2y ago

Excuse me, but I do want to live in a world where death is inevitable and will choose that option at any time. It has nothing to do with helplessness, it's pure reason and engineering considerations. The current system with auto-refreshing humans has got us very far and obviously it works really well. Not only it solves biological problems like cancer (which you can argue eternal humans will solve themselves) but most importantly it solves scientific, engineering and social problems. It avoids dead-ends, it can't get stuck, it iterates relentlessly over infinity of alternatives to find the one that brings us further. A mistaken scientist dies and so does his theory. A tyrant dies and so does his regime. A liar dies and no one maintains his lies. Starting life afresh, without decades of mental baggage is a blessing. Carrying it with you forever is hell for you and for others who will have to endure your presence.

feoren 2y ago
> Excuse me, but I do want to live in a world where death is inevitable and will choose that option at any time. This feels a little like saying "I like death, therefore everyone else must die too." Besides, you'd always be able to choose that option at any time. I'm not talking about some cursed-monkey-paw version of immortality. > the current system with auto-refreshing humans has got us very far The system of hunter-gathering got us pretty far too, and switching over to agriculture was indeed not 100% positive at first. The system of feudal/clan-based government and labor-and-wood-based energy economy got us very far, too, and switching to the industrial revolution also had its early downsides. Just because systems are working doesn't mean they can't be improved. > importantly [Senescence] solves scientific, engineering and social problems. Again I ask: if we already lived forever, and we were running into those scientific, engineering, and social problems that death supposedly "solves", then would your solution be to start killing everyone approaching 100 years old? Another solution to all our problems is that the sun goes supernova and the Earth is completely annihilated. That's along the same line of "solution" as yours. Besides, I haven't seen any convincing argument that such problems would necessarily occur, or at least be insurmountable. > A mistaken scientist dies and so does his theory. A tyrant dies and so does his regime. A liar dies and no one maintains his lies. This is unfortunately quite accurate for the time being. But death is a rather blunt solution to these problems, and I believe there are better ones. I also believe people would be more interested in ousting tyrants if they didn't think they just need to wait for them to die.

tsimionescu 2y ago

I can 100% promise that death will be a regular part of life not just 1000 years, but 100,000 years from now as well. Even if we solve senescence and we get 1,000,000 times better at emergency medicine, transplants etc. There are numerous ways to almost entirely destroy the brain in fractions of a second, or in hopelessly irreversible ways, or in covert ways that are slow but only get discovered too late. And, as long as such accidents are possible, if your life is otherwise endless, then they are in fact inevitable, no matter how unlikely they appear.

feoren 2y ago
There will always be some probability of dying in a given year. Let's say our futuristic society has solved aging/senescence, and is able to reduce the rate of "random death" by about 1% per year, through technology, medicine, brain-redundancy, whatever. So if you have a 1 in 1,000 chance of randomly dying this year, next year it will be about 1 in 1,010. The area under an infinite exponential decay curve is finite. In the scenario above, you have a finite probability of dying, ever. And it's not 100%, either. It could even be quite low. With the numbers above, it's about 10% chance to die, and 90% chance to never die. I know that's counter-intuitive, and it may be that maintaining 1% reduction in random death every year is impossible, but it's not a foregone conclusion that everyone must die. Of course the heat death of the universe presents a problem. That's a good problem to have.