14 ms·

It's getting harder to die

242 points by baud147258 2y ago

Modified3019 2y ago
The topic of a “living will” came up in a family discussion after my mother’s funeral. None of us have a pathological desire to live at all costs, but as it turns out, figuring out when to say “yeah I’m done, see yah” and halt treatment is way more complex than it first seems, especially when making the decision for someone else. Things can happen very fast, and there’s a bunch of things that basically require a job in the industry to know ahead of time. If anyone knows of some comprehensive resources for helping define reasonable limits, I’d love to hear it.
- rustcleaner 2y ago
  There is the POLST form for governing interventions. There is durable medical and general powers of attorney. There are irrevocable trusts to protect trust assets from long term care.
- complaintdept 2y ago
  Talk to an estate attorney and they can give you some advice, but ultimately you'll never be able to account for every possibility, and you're going to have to trust somebody to make the right decisions for you at some point.
  - onlypassingthru 2y ago
    Anecdotally, a family friend was barely clinging on to life for a couple weeks enduring heavy pain meds and abject misery. Only when his close friend, and executor of his estate, sat beside him and told him everything was going to be alright did he finally find peace and let go. He was gone within 30 minutes.
- magnetowasright 2y ago
  The Order of the Good Death has loads of resources on how to have these conversations, what your options for advanced directives etc. are, and guides on how to set everything up. https://www.orderofthegooddeath.com/ https://www.orderofthegooddeath.com/ They also do a lot of advocacy around green burial, alkaline hydrolysis, and whatnot as well. Caitlin Doughty (who founded the Order of the Good Death) Ask a Mortician channel on youtube covers this stuff too, but the older videos might be out of date.
  - zhynn 2y ago
    Thank you so so so much for posting this! I had no idea it existed, and I am so happy that it does. I also discovered that my home state has ZERO listed green burial sites, which is shocking to me because... I live in VT. I would have guessed it would be the leader in green burial, it is right up our wheelhouse!
    - magnetowasright 2y ago
      I'm glad you found it useful! They've got template letters for sending to politicians on the topics of greener death options and other related stuff. Maybe you can help your politicians know that it's an option that people want. I want to be composted, personally. I hate those 'put your cremains in a seedling pot and turn into a tree' things because cremains can't nourish anything. Skip the cremation, have a green burial or be composted, and ACTUALLY nourish a tree! I'd have thought green burials and human composting would be an easier sell because of the popularity of those cremains tree things, but apparently not. Soapbox time: you (almost certainly) do not have to have your loved one embalmed. Bodies are safe and clean and won't smell if kept appropriately. If you are utilising the services of a funeral home and they tell you they won't (or can't) let you have an open casket or other viewing without the person being embalmed, it will be a policy of the funeral home at highest authority. It almost certainly is not the law, as much as some of these homes may try to convince you it is. If it is the law, make them explain which law it is and check. Bodies do not have to be embalmed for viewings. You can take your loved to another funeral home who doesn't pull that rubbish and they will have to release the body. Death is not an emergency and you can take a little time to know your rights and the law before being strong armed into an expensive and unnecessary procedure like embalming. Do it if you want to do it. Don't do it because you've been pressured into it in a time of grief.
- JansjoFromIkea 2y ago
  "especially when making the decision for someone else" This gets additionally terrible when it's for someone else whilst handling the wishes of everyone else with significant ties to them. Had a relative die a while back who was going through absolute hell the final few days; some family members still have a massive grudge towards the hospice for what they feel like were moves done to ensure they died quicker. I've absolutely no clue why they seemed to think dying in massive pain over a longer span of time seemed better but they did.
  - LorenPechtel 2y ago
    I saw it with my father, also. Some people aren't ready to accept that death is coming and blame anyone/anything they can rather than accept it. Just try harder, you can do it! No. The cancer was everywhere and it was aggressive. Try what harder? There was nothing to do. Someone close to them felt my mother was being evil and incompetent in not pushing him to eat more. While he lost a lot of weight the cause of death was when it got his kidney (one had already been removed when it was thought to be stage 1.)
ericmcer 2y ago
Kind of a tough read, I just turned 37 and this was the year when it really hit home that your body degrades and sometimes it never goes back to "normal". I was used to sports injuries being a pattern of injury -> recovery -> ramp back up to 100%, but have suffered some injuries recently and am coming to terms with realizing I will never return to 100%. They will be lingering things I deal with for the rest of my life. It is terrifying transitioning from seeing health as innate to viewing it as something you need to carefully nurture or it will slip away.
- silverquiet 2y ago
  Not everyone gets even that - I've had mobility issues since I was seven years old. It's been strange to realize that it probably shaped my personality somewhat; I always felt older than my peers in some way. The silver lining might be that while now they are starting to say how old they feel (I'm basically the same age as you), I'll often tell them that I don't feel any older.
  - ryukafalz 2y ago
    > The silver lining might be that while now they are starting to say how old they feel (I'm basically the same age as you), I'll often tell them that I don't feel any older. As someone with chronic back pain since my late teens, this is... a nice perspective. My friend group isn't old enough yet for it to come up very often but I feel like I can relate.
    - spoiler 2y ago
      Sorry if I'm being nosey, but I'm curious about the chronic back pain. Is it something that developed over time, is it gwneti, is it an injury? How do you cope and manage it?
- cjk2 2y ago
  Hey you're me 15 years ago. I stopped the sports and switched to sustained low damage exercise like cycling, hiking, swimming etc. While you can't undo the damage done if you have a very high level of fitness, you can reduce the effects of the further progression of time. Better be as fit as a 50 year old with some damage when you're 70 than as fit as a 70 year old with some damage. End game is not pretty. My ex wife didn't do any fitness stuff at all and she's walking with a stick while I'm doing 30km hikes at 3000m...
complaintdept 2y ago
...and it's getting harder on the families too with nothing to really address it. It used to be one day you'd drop dead, or get really sick and be dead not long after, and your family after a terrible shock could begin readjusting to the new reality without their loved one. Now you can have what used to be a death sentence and continue living for years or even decades. But the systems which support the patient's life are not supporting their families, who have to live with the stress and financial burden of keeping their loved one alive, and the prolonged grieving process which can now take up a huge chunk of their lives and still doesn't really prepare them for death anyway. I'm not saying that we need to get rid of medical advances that prolong life, it's just that these things have created new problems that we aren't dealing with and that not many people are really talking about.
- cogman10 2y ago
  The problem is it's not black and white what the long term outcome will be. A cancer diagnosis that was terminal 20 years ago could mean in 20 years you'll die of a heart attack with a short period of horrible treatment. It gets even more dicey when you start talking about things like "well, the 20% chance is you'll survive this. The 80% chance is you'll die". Almost everyone is going to want to roll the 1/5 chance of living rather than taking the "you do nothing and you die" path, even if the 1/5 path is horribly terrible.
FactKnower69 2y ago
a Christian fundamentalist doing a 180 on Terri Schiavo because she rediscovered Luddism is certainly an interesting take
- spondylosaurus 2y ago
  The fundamentalist stance on Schiavo's case (to continue care at all costs) was always interesting/puzzling to me. On some level I would assume that people with a strong belief in the afterlife would be more open to letting people pass from this mortal earth than those of us who don't have strong beliefs about an afterlife... but clearly that wasn't the case :P
  - downrightmike 2y ago
    Fundamentalists don't do things for others, they do them for themselves, to make themselves look better, or to be praised. They are superficial and fake. No one will miss them when they are gone.
  - qgin 2y ago
    Growing up in the church, it eventually became pretty clear that nobody actually believed in heaven. Almost nobody’s actions were congruent with what you would do if you actually believed in heaven. The stances on death, the reactions when people died… it all matched what you’d do if you believed death was the end and none of it matched what you’d do if you believed people went on to eternal paradise.
    - bigstrat2003 2y ago
      These are easily explained, and not evidence of your claim that Christians don't actually believe in heaven. I assume that by "stances on death" you mean that Christians generally believe that it is immoral to allow people to die. That is because we believe that the life of humans has a fundamental moral worth, such that it is wrong to kill them no matter the circumstances. Many Christians would agree that the patient of some terminal illness would be better off dead, but that doesn't give us the right to do the deed. We aren't consequentialists, we are deontologists. If something (i.e. killing people) is wrong, then it is wrong no matter if it leads to a better outcome. As far as "reactions when people died", it should be obvious but it sucks to lose your loved ones no matter what. Even if you felt completely certain that someone's soul was in heaven (and few would claim to be that certain, more on that in a bit), it's still very painful to have to be separated from them. It's comforting to believe that someone is (or will be) in heaven, but that comfort does not just erase the pain that you have to endure in the here and now. People aren't Vulcans, who can shrug things off through logical reasoning. They have feelings that are sometimes irrational but no less real because of it. Furthermore, nobody can have complete certainty of the future. If I were to lose my job, I would be upset and worried because of how that might impact my family. By your logic, this would mean that I don't actually believe that I'll be able to find a new job. But no, it just means that I know that the future isn't certain. I believe I could find a new job if I lost my current job today. But I'm not certain, and that means I would be upset if I did lose my job. In a similar way, Christians believe in heaven but we can't be certain, so we still fear death sometimes. I mean, Jesus himself was afraid of his impending torture and death at the hands of the Romans! It's just part of being human.
vundercind 2y ago
Recently watched someone close die over a couple days, after a long decline. The last 24 hours were monstrous to inflict on anyone. Torture. Evil. Hours and hours of faltering breathing, often restarting with what was plainly a panicked adrenaline-pumping response. It looked like they felt like they were about to drown every few minutes, hour, after hour, no relief. No IV fluids (terminal anyway, so no trying to keep them alive with techniques like that) and unable to drink, so certainly terribly thirsty the whole time. Unable to communicate or really engage with surroundings, and quite high on pain meds anyway (the closest thing to a mercy in all this). It’s fucked up that that’s a fairly normal way for dying people to make their exit. I’m sure there are all kinds of problems with trying to provide a way out when someone can’t make the choice for themselves, without opening it up to abuse, but damn, I hope this isn’t the best we can do because it’s terrible.
- conroydave 2y ago
  Watched my grandfather pass in the same way. Didn’t seem right to let him pass of basically lack of food and hydration after 95 years even though also terminal. I just wanted to see him comfortable and he was far from it.
  - dghlsakjg 2y ago
    In the last days when organs start failing, food and drink don’t necessarily make things more comfortable since the body can’t handle it.
    - conroydave 2y ago
      Thanks for sharing. Helps a little bit
  - pineaux 2y ago
    Same here, but i have been told that dying is like that unless thoroughly drugged.
- spurgu 2y ago
  I'm sorry for your loss. Edit: I feel a bit dumb now, I hadn't actually read the article yet, went straight for the comments. Seems like I'm just reiterating what it says. When I'm in that shape I just wanna go in peace. Preferably at home, in my own bed, surrounded by loved ones. No tubes down my throat, no shots to keep me alive at any cost, with no end in sight. Here's some good discussion on the topic between two doctors that I watched recently: https://youtu.be/O0YIGAUDlzQ?t=242 https://youtu.be/O0YIGAUDlzQ?t=242
atleastoptimal 2y ago
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Theodores 2y ago
This is a really good article, not least for the list of ways that you will be kept medically alive. As for the premise of the article, it is definitely getting easier to die. We had the plumbers and the rubbish collecting workers clear up our communicable chronic diseases, we de-industrialised and cleared up the air, we quit smoking, put on our seat belts and reigned in the alcohol. So far so good. But, if you look at the physiques of people, the levels of car dependency and the predominance of the Standard American Diet, it seems that people are going the way of Joe Biden in old age, to have what you might call a loss of cognitive abilities, yet able to be preserved near indefinitely. The President isn't unalive, but he isn't really there. Millions are in the same boat, functionally alive but only from the eye-sockets down, and probably with bits of their colon or bladder removed due to cancer that they have bravely fought with a diet of highly processed food and a sedentary lifestyle. When it comes to how to live a healthy life, there is so much misinformation that we are all an experiment of n = 1. There is no realm of information that is anywhere near as confusing as diet. Really you are forced to join one tribe or another if longevity is your game. Either you are going to go all in on 'everything in moderation' or go fully ketogenic meat only carnivore, or the other way, full on vegan. The Google confirmation bias is strong with the whole topic, and I am sure that I could look up 'can I get omega three fatty acid things from eating goat hair' and somewhere there will be an article or 'scientific paper' promoting the eating of goat hair, with a study from some goat herders living in Outer Mongolia, thousands of miles away from any fish, with excellent omega three things going on. There will also be an 'adsense' advert for where you can get goat hair online and Reddit threads on whether you need yak shavings instead.
- 01HNNWZ0MV43FF 2y ago
  I mean Biden also comes off slow cause of his stutter. He just has to survive inauguration.
  - blue_dragon 2y ago
    To me, Biden comes off as slow because he frequently trails off mid-sentence without finishing his thoughts.
- 2y ago
paxys 2y ago
Regular reminder to read Being Mortal: Medicine and What Matters in the End by Atul Gawande. It offers a detailed and sometimes shocking look into the end of life/palliative care system in the country and show just how broken the incentives are industry-wide.
- gammarator 2y ago
  Strongly seconding this recommendation. Dr. Gawanda distills down how to be led by the dying person’s priorities.
mbesto 2y ago
We don't let people die with grace in the US. Not only is pathetic and not very noble, but its a massive drain on the cost of healthcare.
pb060 2y ago
I faced a similar problem as my wife had a chorionangioma, a placenta tumor. Or it was my son, it’s even hard to tell who had it as placenta is external to both. In the hospital where we were, they were doing their best to keep the baby alive despite all the issues with the rupture of the amniotic sac and body damages that he already had, which I understand. What I didn’t understand, and still don’t, is how they were getting ready to try and keep him alive once he would be born, most probably at the 6th month and with probable brain and other physical damages. I respect doctors who can’t choose between their patients life and death, and most of all parents who love their to be born kids so much that they are ready to face a life or hardship. I just think that medicine should not just focus on keeping patients alive, but also consider the quality of their life before taking a decision together with the relatives.
mcshicks 2y ago
Had a pretty close childhood friend choose assisted suicide (in California) a few years ago after a year long battle with blood cancer. It's not easy to do, I think his biggest fear was losing his ability to consent as his mental condition declined rapidly. The link below outlines the process. He was getting home hospice care staying at an Aunt's house hear the hospital he was treated at. I don't think it is the right choice for everybody, but I certainly think in my friends case it was. https://www.uclahealth.org/patient-resources/support-information/patient-education/california-end-life-option-act-eoloa https://www.uclahealth.org/patient-resources/support-informa...
globalnode 2y ago
if you opt to stay home to die but youre in terrible pain, who's going to administer the pain meds? whos going to be there 24/7 to clean up or get you whatever you need? what this article is talking about is either very very very expensive home care or a family that basically become full time carers. with our society no longer advocating communal living and a sort of "every man for themselves" attitude throughout life, how is all of this actually supposed to work in reality? -- nice sentiment but unrealistic except for a very lucky few it seems. this is what hospitals are for now.
- spondylosaurus 2y ago
  At-home hospice care exists for exactly this reason :)
  - globalnode 2y ago
    " very very very expensive home care "
    - deleted 2y ago
      [deleted]
  - everybodyknows 2y ago
    In California, "hospice care" consists only of drug and supply deliveries plus occasional checkins from a nurse. The rest of the 23/7 care falls to the family.
TriangleEdge 2y ago
I'd like to see a survey about opinions on keeping people alive using modern medicine. The survey would have a filter for people who believe in evolution and survival of the fittest. How is the cognitive dissonance around it resolved?
- michaelhoney 2y ago
  Tell me more about the dissonance you see. “Survival of the fittest” just means that in a challenging environment, those who can adapt will survive to go on and have children. If you are saying that modern medicine keeps some people alive through to parenthood who would otherwise have perished: yes, that’s true. We have made our environment less challenging.
  - anonymouskimmer 2y ago
    I'm not the GP, but a social Darwinist would presumably be in favor of medical extension of life (for those who can access it), while a moral evolutionist would presumably be against it. I think there is the possibility of a philosophical dissonance here in some of the Randian types.
- snakeyjake 2y ago
  "The fittest" isn't "the strongest" or "the mostest toughest" it is "the best at procreation in the environment in which they live". Assuming that people being kept alive by modern medicine are better at procreation, they are indeed the fittest. Of course most of the people being kept alive by modern medicine are old as hell, though, so they are hardly the childbearing or rearing type. So now I'm confused as to why you brought it up?
  - anonymouskimmer 2y ago
    I think this: > The survey would have a filter for people who believe in evolution and survival of the fittest. Just means that the survey would ask that question. I'm guessing that GP wants to check whether those who believe in the Darwin awards as well as the moral justness of evolutionary pressure killing certain people earlier that other people, would be more opposed to using modern medicine to keep people alive. Maybe? It really depends because modern medicine is part of social Darwinism, even though it is against evolutionary biological survival of the fittest. So I could see this going multiple ways among this subset of people. I'd expect the richest of them to believe both in medical extension of life (and fertility treatments) as well as believing that only those who can personally, or societally, afford such intervention should get it. This may be the dissonance GP is mentioning.
j_bum 2y ago
Slightly tangential, but I believe this article segues into a discussion about assisted suicide or euthanasia at the end of life. My entire family has been suffering over the past 18 months watching my 88-year-old grandmother slowly pass away from age-related deterioration and AD. I worked with mice during my PhD training in the US. If a lab was caught with lab mice suffering like my grandmother is without euthanizing them, the lab would be liable to be shut down. So I ask: why am I forced to sit and watch my grandmother suffer slowly to death? Why can't there be assisted suicide/euthanasia protocols in place to prevent this suffering?
- squigz 2y ago
  Because far too many people believe that human life is the most precious thing on Earth and willingly ending it is literally the worst thing you could ever do.
  - candiddevmike 2y ago
    Or even more grotesque, that the suffering for death is a key part to a righteous afterlife.
  - tsol 2y ago
    There's also the worry that it will be abused. Kids who want their inheritance, people who have been abused and told it's the right thing for them when it's not, or just insurance trying to save money by avoiding more expensive treatments
- anonymouskimmer 2y ago
  You aren't forced to. You can take matters into your own hands and trust that a jury will let you off the hook. > Why can't there be assisted suicide/euthanasia protocols in place to prevent this suffering? Even most religious people believe in mercy killing. The issue is the slippery slope, and the fact that various people have slid down this slope in every country with legal assisted suicide or euthanasia. Whenever you are going to have a third party, or even just a second party, involve itself in someone's death, you have to figure out how to deal with issues every bit as serious as letting someone suffer to death. https://www.pewresearch.org/short-reads/2015/10/05/california-legalizes-assisted-suicide-amid-growing-support-for-such-laws/ https://www.pewresearch.org/short-reads/2015/10/05/californi...
Perenti 2y ago
It's worse than the article says, because it's from a doctor's perspective. I have CRPS, one of the contenders for worst chronic pain you can have. It's a "suicide disease", because if it advances to stage 3/4, there's a suicide rate of about 70%. It sucks a lot. I've had well over 200 spinal procedures over the last 30 years to try to mitigate the pain, with dozens of other surgical procedures in less tricky spots. I also have Brugada Syndrome, a "drop dead suddenly without warning" disease. When diagnosed, I wanted to take my time before consenting to having an implanted defib. The doctors announced that "Mr Foster, we believe you are not rational at the moment", fortunately I had a friend with me who assured them I was probably the most rational man in Brisbane. I was threatened with an ITO (Involuntary Treatment Order) if I didn't go ahead with having an internal defibrilator put in me. I went ahead with the procedure. So I can't even die by refusing treatment, as "sane" people resist dying at all odds. If I don't want invasive, painful procedures that take over a year to recover from, then the courts will claim I'm suicidal and issue an order to the hospitals to proceed with more bloody cutting. No, sane people say "I've had enough". Fortunately my current GP understands, as he says "Sometimes people feel they've had enough medicine".
- nextaccountic 2y ago
  > I was threatened with an ITO (Involuntary Treatment Order) if I didn't go ahead with having an internal defibrilator put in me. Did this threat come from a doctor? What an astounding lack of empathy. I would switch medical providers in a heartbeat if at all possible.
  - cm2012 2y ago
    I personally would be so upset in that situation, that I would refuse it on principal from that provider after being threatened, health be damned.
    - fdsavjakslj 2y ago
      It's not personal-- the docs are there to cure disease and just doing what they know, personhood be darned. Also, in the moment, it's entirely possible that somebody who is otherwise completely rational who just had a life-altering experience is temporarily less than completely rational and you're only hearing that one side of the story.
pvaldes 2y ago
And that's a good thing Or maybe people got softer. Do we remember the 90% of time where humans roamed this planet barefoot without painkillers, or healthcare, or a guaranteed source of water that does not carry those roundworm parasites that love to swim inside your eyes, or anti polar bear sprays so they didn't tear you off and eat alive?. Those were hard deaths. The 120% of the times, being alive is the smartest option, even if this carries a cost.
- anonymouskimmer 2y ago
  : barefoot That's what calluses are for. : without painkillers And poppies, and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9785912/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9785912/ . Even animals know what plants to eat to help with pain. : or healthcare Someone in the tribe knew how to make a splint and what herbs or foods were best for what ailment. : or a guaranteed source of water that does not carry those roundworm parasites that love to swim inside your eyes In general I expect that there would be few enough people, and they'd be sufficiently knowledgeable of the water sources among the areas they frequented, that this usually wouldn't be a problem. https://askdruniverse.wsu.edu/2018/08/31/dr-universe-people-ancient-times-filter-water/ https://askdruniverse.wsu.edu/2018/08/31/dr-universe-people-... https://www.theatlantic.com/science/archive/2020/01/how-did-humans-cook-before-the-invention-of-pots/605008/ https://www.theatlantic.com/science/archive/2020/01/how-did-... > One group of students decided to put this method to the test. They hoisted their water-filled deer hide directly over a fire, and they planned to let it go as long as the hide stayed intact. The hair on the outside singed, but the skin itself held up just fine. So the students waited and waited and waited. Four hours later, the hide was still intact. It did get very hard, but neither sprung a leak nor burned. : or anti polar bear sprays so they didn't tear you off and eat alive?. I'm pretty sure that by the time some of us migrated to where polar bears live we had some pretty good spear technology.
- wiseowise 2y ago
  > Or maybe people got softer. Do we remember the 90% of time where humans roamed this planet barefoot without painkillers, or healthcare, or a guaranteed source of water that does not carry those roundworm parasites that love to swim inside your eyes, or anti polar bear sprays so they didn't tear you off and eat alive?. Those were hard deaths. What’s your point here?
qgin 2y ago
ICUs are amazing technology. You can keep almost anyone in a temporary state of stasis. This is great for people who have a condition that just needs more time to heal (like a lot of people with Covid, or people after car accidents). But for people who have something unrecoverable, it’s a very weird place to be. You’ve been pushed off the ledge and are now frozen in midair. You will hit the ground when the magic is removed, but you also can’t stay frozen forever.
2-3-7-43-1807 2y ago
how about suicide? i'd compare it to knowing when the party is over and then going home instead of getting yet another drink and miserably trying to score with the last remaining woman. it's an art and it can be trained at many occasions. now for the act itself - the regular hn crowd should be technically apt enough to assemble the required gear around a big gas cylinder of nitrogen. that's as peaceful as it gets.
delta_p_delta_x 2y ago
I'd like dying to be as easy as flicking a switch. Medically-assisted suicide ought to be available to anyone (not only of sound mind and not only with a terminal condition), and at any time. People ought to have the right to die, just like they have the right to water, food, and shelter. In most countries it is currently easier to take other people's lives than to take one's own. People ought to be able to step into a hospital, ask 'hey, I'd like to die', sign a couple of forms saying 'yes, I'd really really like to die', step into an anoxic chamber, and be put into hypoxia and brain death in a matter of minutes. Obviously, an emergency stop plunger ought to be available in case the person in question changes their mind. The belief that life is a gift from a god is a highly Christocentric, Western view that I disagree with. We are brought into the world without any real consent; we should at least be able to easily choose the date, time, and manner of our passing if we so desire.
- xboxnolifes 2y ago
  I think death should be easily accessible, but not immediately executable. Mental states can swing quickly and dramatically, and it would be a shame for suicide to be in reach for a short-term, temporary situation. I'm not sure about the best delay, but my current ballpark is at least around a month delay.
- treprinum 2y ago
  Let's run a thought experiment - you make death super easy like in a suicide booth in Futurama. How many people are going to fight life obstacles, pushing society forward, or rather terminally quit at the first sign of troubles? Nihilism was quite popular in the 19th century and led us to two world wars already. All you'll get is a quick extinction of people like you in favor of those that persist and your opinion will be eliminated from the gene pool.
  - mistrial9 2y ago
    In the West I think alcohol is a massive factor, when talking about the moods of large numbers of people in those days. It is no accident that alcoholic drinking was banned outright for some time, despite the deep cultural roots.
timnetworks 2y ago
Someone in the medical profession explained to me what 'do everything you can' means to doctors and surgeons, it's a binding command. My instructions are likely going to be 'do two things that you probably should at this point and then go have lunch'
- Zenzero 2y ago
  > Someone in the medical profession explained to me what 'do everything you can' means to doctors and surgeons, it's a binding command I've found that usually the people who said that to me were the least prepared for what that meant.
progrus 2y ago
[flagged]
erie 2y ago
It means also that "Do not go gentle into that good night" is not realistic most of the time. We have a saying in Arabic that I only understood after my father died, it to the effect that something is so difficult that:'' it is harder than the spirit leaving the body'. I think it is time that hospice care evolve to make it easier.
julianeon 2y ago
I think sometimes these articles don't pose the question all that well. The way I would ask it is: Imagine a pain scale of 1-10; pretend 10 is so high that you die from the pain. Is it worth living at a 7-8 at every moment continuously, to extend your life for 2 months? How about living at a 9 for just 2 more weeks? If you say "no" that just means you're not hooked up to a machine where that's your living experience (not like someone is actively killing you). I think, when you put it that way, it becomes easier to set some rules around it. Btw I'm pretty close to someone who would always choose to live longer, but even I would say no to, for example, living at a 10 of pain for just 1 more week of life.
- Zenzero 2y ago
  Doctor here. This is overly simplistic. There is little to debate about your example of living at a 7/8 for 2 months. What is more realistic is some hypothetical situation where the average patient has an expected survival of 6 to 18 months, with the hope that the 7/8 pain can be reduced to a 4/5, and with acknowledgement that some days may be a score of 5, some days may be a score of 9. Then what? As a provider on the other side of it you witness two similar patients take two different paths. Perhaps the first patient lives 36 months with pain score averaging a 3. The family will often appreciate the intervention and effort. The other patient experiences a string of complications and dies after 2 weeks, living at a pain score of 10. Their family paints you as an evil torturer who should have never been listened to. In fact you can see both types of opinions in this very thread.
  - julianeon 2y ago
    Thank you for taking the time to explain this, a really valuable contribution to this thread. When I consider this going forward, I'll think of it this way.
    - Zenzero 2y ago
      I'm glad I could help. Thank you for your kindness.
  - 2y ago
martinpw 2y ago
> Spend your remaining days at home if possible. This sounds appealing in the abstract but one thing to consider is the impact on other family members. My parents had a neighbor who chose to remain at home. However that meant his wife also had to stay at home to look after him (yes there were nurses who came in a couple of times a day, but a lot of the burden was still on the wife.) This meant her own life basically shut down. She never went out, and spent at least a year fully housebound for his care. Once he died, she was able to go out, reconnect with friends, kickstart her life again. Couldn't help feeling the husband's choice here was a selfish one.
- scottcorgan 2y ago
  No place is rather be than with my spouse in a time like that!
  - martinpw 2y ago
    I think that's easy to say in the abstract, but the reality can be quite different. Of course every case is different, but for example: * Spouse has dementia, does not recognize you, abuses you for being an intruder in the house, constantly shouts for help all times of day and night. * Feeding, cleaning (double incontinence). * Can't go out except for a few minutes when nurses are present. The above goes on for months and even years with no end in sight. No chance to go out for exercise, hikes in nature, meeting friends. Isolation. At home carers have significantly reduced life expectancy for good reason. Having hospice care where they can be well looked after is not a bad option, and is not a sign of weakness or failure for a partner.
    - LorenPechtel 2y ago
      Dementia is particularly evil. As far as I'm concerned I am my mind. If my mind is gone my body doesn't matter, please don't waste effort in caring for it.
      - namtab00 2y ago
LocalH 2y ago
Humans have long handled death in a very backwards and disgusting manner. We have humans, who can clearly assert a particular desire when of sound, lucid mind. Yet we do not allow them to have any control over one of the most personal experiences their life will ever offer them, when in a medical establishment. We don't allow people to assert a desire to be euthanized gently. We force them to die on their own (by being unwilling to do anything more than remove care), no matter how much they may be suffering. Of course, we always have the option of taking matters into our own hands, with all the potential stumbling blocks that provides. In contrast, we have pets, who can not verbally assert any particular desire, due to the lack of common language. We can't ask them if they want to stay with their loved ones, or if they're suffering and want to be free. Yet we make the decision to actively end their lives every single day in the world. Logically, this seems completely backwards to me. It seems like we should err on the side of not ending a pet's life when they don't want us to, and that we should allow people of sound mind to articulate a self-aware desire to have a more dignified, gentle death as much as possible.
jl6 2y ago
I hope "noble sacrifice" becomes a viable end-of-life option one day. Specifically, one-way tickets to Mars, which will be invaluable for doing human-led research and construction, paving the way for future colonists, but without the expense and burden of a return journey. There must be some ultra-high-risk test pilot jobs available for 75 year olds with inoperable diseases. Go out with a bang!
salzig 2y ago
The author doesn’t believe his content is worth reading (full page „popup“). Good he included this feature so I can leave the page early.
627467 2y ago
in this modern day of increased privatized medicine, health insurances and self-absorbed people, what is the incentive to let a person die? the longer you keep someone with medical needs and decent insurance the more you can milk the their insurance or whatever wealth they may have accumulated. self-absorbed closed ones can also easily dismiss the sick person desires and needs. I see no incentive for this to change.
cityzen 2y ago
There is a great book called The Conspiracy Against the Human Race that talks about this in a way that makes sense to me: As a survival-happy species, our successes are calculated in the number of years we have extended our lives, with the reduction of suffering being only incidental to this aim. To stay alive under almost any circumstances is a sickness with us. Nothing could be more unhealthy than to “watch one’s health” as a means of stalling death. The lengths we will go as procrastinators of that last gasp only demonstrate a morbid dread of that event. By contrast, our fear of suffering is deficient. The book is very pessimistic but that’s the point, I quite enjoyed it.

242 points by baud147258 2y ago

The topic of a “living will” came up in a family discussion after my mother’s funeral. None of us have a pathological desire to live at all costs, but as it turns out, figuring out when to say “yeah I’m done, see yah” and halt treatment is way more complex than it first seems, especially when making the decision for someone else. Things can happen very fast, and there’s a bunch of things that basically require a job in the industry to know ahead of time. If anyone knows of some comprehensive resources for helping define reasonable limits, I’d love to hear it.

rustcleaner 2y ago
There is the POLST form for governing interventions. There is durable medical and general powers of attorney. There are irrevocable trusts to protect trust assets from long term care.
complaintdept 2y ago
Talk to an estate attorney and they can give you some advice, but ultimately you'll never be able to account for every possibility, and you're going to have to trust somebody to make the right decisions for you at some point.
- onlypassingthru 2y ago
  Anecdotally, a family friend was barely clinging on to life for a couple weeks enduring heavy pain meds and abject misery. Only when his close friend, and executor of his estate, sat beside him and told him everything was going to be alright did he finally find peace and let go. He was gone within 30 minutes.
magnetowasright 2y ago
The Order of the Good Death has loads of resources on how to have these conversations, what your options for advanced directives etc. are, and guides on how to set everything up. https://www.orderofthegooddeath.com/ https://www.orderofthegooddeath.com/ They also do a lot of advocacy around green burial, alkaline hydrolysis, and whatnot as well. Caitlin Doughty (who founded the Order of the Good Death) Ask a Mortician channel on youtube covers this stuff too, but the older videos might be out of date.
- zhynn 2y ago
  Thank you so so so much for posting this! I had no idea it existed, and I am so happy that it does. I also discovered that my home state has ZERO listed green burial sites, which is shocking to me because... I live in VT. I would have guessed it would be the leader in green burial, it is right up our wheelhouse!
  - magnetowasright 2y ago
    I'm glad you found it useful! They've got template letters for sending to politicians on the topics of greener death options and other related stuff. Maybe you can help your politicians know that it's an option that people want. I want to be composted, personally. I hate those 'put your cremains in a seedling pot and turn into a tree' things because cremains can't nourish anything. Skip the cremation, have a green burial or be composted, and ACTUALLY nourish a tree! I'd have thought green burials and human composting would be an easier sell because of the popularity of those cremains tree things, but apparently not. Soapbox time: you (almost certainly) do not have to have your loved one embalmed. Bodies are safe and clean and won't smell if kept appropriately. If you are utilising the services of a funeral home and they tell you they won't (or can't) let you have an open casket or other viewing without the person being embalmed, it will be a policy of the funeral home at highest authority. It almost certainly is not the law, as much as some of these homes may try to convince you it is. If it is the law, make them explain which law it is and check. Bodies do not have to be embalmed for viewings. You can take your loved to another funeral home who doesn't pull that rubbish and they will have to release the body. Death is not an emergency and you can take a little time to know your rights and the law before being strong armed into an expensive and unnecessary procedure like embalming. Do it if you want to do it. Don't do it because you've been pressured into it in a time of grief.
JansjoFromIkea 2y ago
"especially when making the decision for someone else" This gets additionally terrible when it's for someone else whilst handling the wishes of everyone else with significant ties to them. Had a relative die a while back who was going through absolute hell the final few days; some family members still have a massive grudge towards the hospice for what they feel like were moves done to ensure they died quicker. I've absolutely no clue why they seemed to think dying in massive pain over a longer span of time seemed better but they did.
- LorenPechtel 2y ago
  I saw it with my father, also. Some people aren't ready to accept that death is coming and blame anyone/anything they can rather than accept it. Just try harder, you can do it! No. The cancer was everywhere and it was aggressive. Try what harder? There was nothing to do. Someone close to them felt my mother was being evil and incompetent in not pushing him to eat more. While he lost a lot of weight the cause of death was when it got his kidney (one had already been removed when it was thought to be stage 1.)

ericmcer 2y ago

Kind of a tough read, I just turned 37 and this was the year when it really hit home that your body degrades and sometimes it never goes back to "normal". I was used to sports injuries being a pattern of injury -> recovery -> ramp back up to 100%, but have suffered some injuries recently and am coming to terms with realizing I will never return to 100%. They will be lingering things I deal with for the rest of my life. It is terrifying transitioning from seeing health as innate to viewing it as something you need to carefully nurture or it will slip away.

silverquiet 2y ago
Not everyone gets even that - I've had mobility issues since I was seven years old. It's been strange to realize that it probably shaped my personality somewhat; I always felt older than my peers in some way. The silver lining might be that while now they are starting to say how old they feel (I'm basically the same age as you), I'll often tell them that I don't feel any older.
- ryukafalz 2y ago
  > The silver lining might be that while now they are starting to say how old they feel (I'm basically the same age as you), I'll often tell them that I don't feel any older. As someone with chronic back pain since my late teens, this is... a nice perspective. My friend group isn't old enough yet for it to come up very often but I feel like I can relate.
  - spoiler 2y ago
    Sorry if I'm being nosey, but I'm curious about the chronic back pain. Is it something that developed over time, is it gwneti, is it an injury? How do you cope and manage it?
cjk2 2y ago
Hey you're me 15 years ago. I stopped the sports and switched to sustained low damage exercise like cycling, hiking, swimming etc. While you can't undo the damage done if you have a very high level of fitness, you can reduce the effects of the further progression of time. Better be as fit as a 50 year old with some damage when you're 70 than as fit as a 70 year old with some damage. End game is not pretty. My ex wife didn't do any fitness stuff at all and she's walking with a stick while I'm doing 30km hikes at 3000m...

complaintdept 2y ago

...and it's getting harder on the families too with nothing to really address it. It used to be one day you'd drop dead, or get really sick and be dead not long after, and your family after a terrible shock could begin readjusting to the new reality without their loved one. Now you can have what used to be a death sentence and continue living for years or even decades. But the systems which support the patient's life are not supporting their families, who have to live with the stress and financial burden of keeping their loved one alive, and the prolonged grieving process which can now take up a huge chunk of their lives and still doesn't really prepare them for death anyway. I'm not saying that we need to get rid of medical advances that prolong life, it's just that these things have created new problems that we aren't dealing with and that not many people are really talking about.

cogman10 2y ago
The problem is it's not black and white what the long term outcome will be. A cancer diagnosis that was terminal 20 years ago could mean in 20 years you'll die of a heart attack with a short period of horrible treatment. It gets even more dicey when you start talking about things like "well, the 20% chance is you'll survive this. The 80% chance is you'll die". Almost everyone is going to want to roll the 1/5 chance of living rather than taking the "you do nothing and you die" path, even if the 1/5 path is horribly terrible.

FactKnower69 2y ago

a Christian fundamentalist doing a 180 on Terri Schiavo because she rediscovered Luddism is certainly an interesting take

spondylosaurus 2y ago
The fundamentalist stance on Schiavo's case (to continue care at all costs) was always interesting/puzzling to me. On some level I would assume that people with a strong belief in the afterlife would be more open to letting people pass from this mortal earth than those of us who don't have strong beliefs about an afterlife... but clearly that wasn't the case :P
- downrightmike 2y ago
  Fundamentalists don't do things for others, they do them for themselves, to make themselves look better, or to be praised. They are superficial and fake. No one will miss them when they are gone.
- qgin 2y ago
  Growing up in the church, it eventually became pretty clear that nobody actually believed in heaven. Almost nobody’s actions were congruent with what you would do if you actually believed in heaven. The stances on death, the reactions when people died… it all matched what you’d do if you believed death was the end and none of it matched what you’d do if you believed people went on to eternal paradise.
  - bigstrat2003 2y ago
    These are easily explained, and not evidence of your claim that Christians don't actually believe in heaven. I assume that by "stances on death" you mean that Christians generally believe that it is immoral to allow people to die. That is because we believe that the life of humans has a fundamental moral worth, such that it is wrong to kill them no matter the circumstances. Many Christians would agree that the patient of some terminal illness would be better off dead, but that doesn't give us the right to do the deed. We aren't consequentialists, we are deontologists. If something (i.e. killing people) is wrong, then it is wrong no matter if it leads to a better outcome. As far as "reactions when people died", it should be obvious but it sucks to lose your loved ones no matter what. Even if you felt completely certain that someone's soul was in heaven (and few would claim to be that certain, more on that in a bit), it's still very painful to have to be separated from them. It's comforting to believe that someone is (or will be) in heaven, but that comfort does not just erase the pain that you have to endure in the here and now. People aren't Vulcans, who can shrug things off through logical reasoning. They have feelings that are sometimes irrational but no less real because of it. Furthermore, nobody can have complete certainty of the future. If I were to lose my job, I would be upset and worried because of how that might impact my family. By your logic, this would mean that I don't actually believe that I'll be able to find a new job. But no, it just means that I know that the future isn't certain. I believe I could find a new job if I lost my current job today. But I'm not certain, and that means I would be upset if I did lose my job. In a similar way, Christians believe in heaven but we can't be certain, so we still fear death sometimes. I mean, Jesus himself was afraid of his impending torture and death at the hands of the Romans! It's just part of being human.

vundercind 2y ago

Recently watched someone close die over a couple days, after a long decline. The last 24 hours were monstrous to inflict on anyone. Torture. Evil. Hours and hours of faltering breathing, often restarting with what was plainly a panicked adrenaline-pumping response. It looked like they felt like they were about to drown every few minutes, hour, after hour, no relief. No IV fluids (terminal anyway, so no trying to keep them alive with techniques like that) and unable to drink, so certainly terribly thirsty the whole time. Unable to communicate or really engage with surroundings, and quite high on pain meds anyway (the closest thing to a mercy in all this). It’s fucked up that that’s a fairly normal way for dying people to make their exit. I’m sure there are all kinds of problems with trying to provide a way out when someone can’t make the choice for themselves, without opening it up to abuse, but damn, I hope this isn’t the best we can do because it’s terrible.

conroydave 2y ago
Watched my grandfather pass in the same way. Didn’t seem right to let him pass of basically lack of food and hydration after 95 years even though also terminal. I just wanted to see him comfortable and he was far from it.
- dghlsakjg 2y ago
  In the last days when organs start failing, food and drink don’t necessarily make things more comfortable since the body can’t handle it.
  - conroydave 2y ago
    Thanks for sharing. Helps a little bit
- pineaux 2y ago
  Same here, but i have been told that dying is like that unless thoroughly drugged.
spurgu 2y ago
I'm sorry for your loss. Edit: I feel a bit dumb now, I hadn't actually read the article yet, went straight for the comments. Seems like I'm just reiterating what it says. When I'm in that shape I just wanna go in peace. Preferably at home, in my own bed, surrounded by loved ones. No tubes down my throat, no shots to keep me alive at any cost, with no end in sight. Here's some good discussion on the topic between two doctors that I watched recently: https://youtu.be/O0YIGAUDlzQ?t=242 https://youtu.be/O0YIGAUDlzQ?t=242

atleastoptimal 2y ago

[flagged]

Theodores 2y ago

This is a really good article, not least for the list of ways that you will be kept medically alive. As for the premise of the article, it is definitely getting easier to die. We had the plumbers and the rubbish collecting workers clear up our communicable chronic diseases, we de-industrialised and cleared up the air, we quit smoking, put on our seat belts and reigned in the alcohol. So far so good. But, if you look at the physiques of people, the levels of car dependency and the predominance of the Standard American Diet, it seems that people are going the way of Joe Biden in old age, to have what you might call a loss of cognitive abilities, yet able to be preserved near indefinitely. The President isn't unalive, but he isn't really there. Millions are in the same boat, functionally alive but only from the eye-sockets down, and probably with bits of their colon or bladder removed due to cancer that they have bravely fought with a diet of highly processed food and a sedentary lifestyle. When it comes to how to live a healthy life, there is so much misinformation that we are all an experiment of n = 1. There is no realm of information that is anywhere near as confusing as diet. Really you are forced to join one tribe or another if longevity is your game. Either you are going to go all in on 'everything in moderation' or go fully ketogenic meat only carnivore, or the other way, full on vegan. The Google confirmation bias is strong with the whole topic, and I am sure that I could look up 'can I get omega three fatty acid things from eating goat hair' and somewhere there will be an article or 'scientific paper' promoting the eating of goat hair, with a study from some goat herders living in Outer Mongolia, thousands of miles away from any fish, with excellent omega three things going on. There will also be an 'adsense' advert for where you can get goat hair online and Reddit threads on whether you need yak shavings instead.

01HNNWZ0MV43FF 2y ago
I mean Biden also comes off slow cause of his stutter. He just has to survive inauguration.
- blue_dragon 2y ago
  To me, Biden comes off as slow because he frequently trails off mid-sentence without finishing his thoughts.
2y ago

paxys 2y ago

Regular reminder to read Being Mortal: Medicine and What Matters in the End by Atul Gawande. It offers a detailed and sometimes shocking look into the end of life/palliative care system in the country and show just how broken the incentives are industry-wide.

gammarator 2y ago
Strongly seconding this recommendation. Dr. Gawanda distills down how to be led by the dying person’s priorities.

mbesto 2y ago

We don't let people die with grace in the US. Not only is pathetic and not very noble, but its a massive drain on the cost of healthcare.

pb060 2y ago

I faced a similar problem as my wife had a chorionangioma, a placenta tumor. Or it was my son, it’s even hard to tell who had it as placenta is external to both. In the hospital where we were, they were doing their best to keep the baby alive despite all the issues with the rupture of the amniotic sac and body damages that he already had, which I understand. What I didn’t understand, and still don’t, is how they were getting ready to try and keep him alive once he would be born, most probably at the 6th month and with probable brain and other physical damages. I respect doctors who can’t choose between their patients life and death, and most of all parents who love their to be born kids so much that they are ready to face a life or hardship. I just think that medicine should not just focus on keeping patients alive, but also consider the quality of their life before taking a decision together with the relatives.

mcshicks 2y ago

Had a pretty close childhood friend choose assisted suicide (in California) a few years ago after a year long battle with blood cancer. It's not easy to do, I think his biggest fear was losing his ability to consent as his mental condition declined rapidly. The link below outlines the process. He was getting home hospice care staying at an Aunt's house hear the hospital he was treated at. I don't think it is the right choice for everybody, but I certainly think in my friends case it was. https://www.uclahealth.org/patient-resources/support-information/patient-education/california-end-life-option-act-eoloa https://www.uclahealth.org/patient-resources/support-informa...

globalnode 2y ago

if you opt to stay home to die but youre in terrible pain, who's going to administer the pain meds? whos going to be there 24/7 to clean up or get you whatever you need? what this article is talking about is either very very very expensive home care or a family that basically become full time carers. with our society no longer advocating communal living and a sort of "every man for themselves" attitude throughout life, how is all of this actually supposed to work in reality? -- nice sentiment but unrealistic except for a very lucky few it seems. this is what hospitals are for now.

spondylosaurus 2y ago
At-home hospice care exists for exactly this reason :)
- globalnode 2y ago
  " very very very expensive home care "
  - deleted 2y ago
    [deleted]
- everybodyknows 2y ago
  In California, "hospice care" consists only of drug and supply deliveries plus occasional checkins from a nurse. The rest of the 23/7 care falls to the family.

TriangleEdge 2y ago

I'd like to see a survey about opinions on keeping people alive using modern medicine. The survey would have a filter for people who believe in evolution and survival of the fittest. How is the cognitive dissonance around it resolved?

michaelhoney 2y ago
Tell me more about the dissonance you see. “Survival of the fittest” just means that in a challenging environment, those who can adapt will survive to go on and have children. If you are saying that modern medicine keeps some people alive through to parenthood who would otherwise have perished: yes, that’s true. We have made our environment less challenging.
- anonymouskimmer 2y ago
  I'm not the GP, but a social Darwinist would presumably be in favor of medical extension of life (for those who can access it), while a moral evolutionist would presumably be against it. I think there is the possibility of a philosophical dissonance here in some of the Randian types.
snakeyjake 2y ago
"The fittest" isn't "the strongest" or "the mostest toughest" it is "the best at procreation in the environment in which they live". Assuming that people being kept alive by modern medicine are better at procreation, they are indeed the fittest. Of course most of the people being kept alive by modern medicine are old as hell, though, so they are hardly the childbearing or rearing type. So now I'm confused as to why you brought it up?
- anonymouskimmer 2y ago
  I think this: > The survey would have a filter for people who believe in evolution and survival of the fittest. Just means that the survey would ask that question. I'm guessing that GP wants to check whether those who believe in the Darwin awards as well as the moral justness of evolutionary pressure killing certain people earlier that other people, would be more opposed to using modern medicine to keep people alive. Maybe? It really depends because modern medicine is part of social Darwinism, even though it is against evolutionary biological survival of the fittest. So I could see this going multiple ways among this subset of people. I'd expect the richest of them to believe both in medical extension of life (and fertility treatments) as well as believing that only those who can personally, or societally, afford such intervention should get it. This may be the dissonance GP is mentioning.

j_bum 2y ago

Slightly tangential, but I believe this article segues into a discussion about assisted suicide or euthanasia at the end of life. My entire family has been suffering over the past 18 months watching my 88-year-old grandmother slowly pass away from age-related deterioration and AD. I worked with mice during my PhD training in the US. If a lab was caught with lab mice suffering like my grandmother is without euthanizing them, the lab would be liable to be shut down. So I ask: why am I forced to sit and watch my grandmother suffer slowly to death? Why can't there be assisted suicide/euthanasia protocols in place to prevent this suffering?

squigz 2y ago
Because far too many people believe that human life is the most precious thing on Earth and willingly ending it is literally the worst thing you could ever do.
- candiddevmike 2y ago
  Or even more grotesque, that the suffering for death is a key part to a righteous afterlife.
- tsol 2y ago
  There's also the worry that it will be abused. Kids who want their inheritance, people who have been abused and told it's the right thing for them when it's not, or just insurance trying to save money by avoiding more expensive treatments
anonymouskimmer 2y ago
You aren't forced to. You can take matters into your own hands and trust that a jury will let you off the hook. > Why can't there be assisted suicide/euthanasia protocols in place to prevent this suffering? Even most religious people believe in mercy killing. The issue is the slippery slope, and the fact that various people have slid down this slope in every country with legal assisted suicide or euthanasia. Whenever you are going to have a third party, or even just a second party, involve itself in someone's death, you have to figure out how to deal with issues every bit as serious as letting someone suffer to death. https://www.pewresearch.org/short-reads/2015/10/05/california-legalizes-assisted-suicide-amid-growing-support-for-such-laws/ https://www.pewresearch.org/short-reads/2015/10/05/californi...

Perenti 2y ago

It's worse than the article says, because it's from a doctor's perspective. I have CRPS, one of the contenders for worst chronic pain you can have. It's a "suicide disease", because if it advances to stage 3/4, there's a suicide rate of about 70%. It sucks a lot. I've had well over 200 spinal procedures over the last 30 years to try to mitigate the pain, with dozens of other surgical procedures in less tricky spots. I also have Brugada Syndrome, a "drop dead suddenly without warning" disease. When diagnosed, I wanted to take my time before consenting to having an implanted defib. The doctors announced that "Mr Foster, we believe you are not rational at the moment", fortunately I had a friend with me who assured them I was probably the most rational man in Brisbane. I was threatened with an ITO (Involuntary Treatment Order) if I didn't go ahead with having an internal defibrilator put in me. I went ahead with the procedure. So I can't even die by refusing treatment, as "sane" people resist dying at all odds. If I don't want invasive, painful procedures that take over a year to recover from, then the courts will claim I'm suicidal and issue an order to the hospitals to proceed with more bloody cutting. No, sane people say "I've had enough". Fortunately my current GP understands, as he says "Sometimes people feel they've had enough medicine".

nextaccountic 2y ago
> I was threatened with an ITO (Involuntary Treatment Order) if I didn't go ahead with having an internal defibrilator put in me. Did this threat come from a doctor? What an astounding lack of empathy. I would switch medical providers in a heartbeat if at all possible.
- cm2012 2y ago
  I personally would be so upset in that situation, that I would refuse it on principal from that provider after being threatened, health be damned.
  - fdsavjakslj 2y ago
    It's not personal-- the docs are there to cure disease and just doing what they know, personhood be darned. Also, in the moment, it's entirely possible that somebody who is otherwise completely rational who just had a life-altering experience is temporarily less than completely rational and you're only hearing that one side of the story.

pvaldes 2y ago

And that's a good thing Or maybe people got softer. Do we remember the 90% of time where humans roamed this planet barefoot without painkillers, or healthcare, or a guaranteed source of water that does not carry those roundworm parasites that love to swim inside your eyes, or anti polar bear sprays so they didn't tear you off and eat alive?. Those were hard deaths. The 120% of the times, being alive is the smartest option, even if this carries a cost.

anonymouskimmer 2y ago
: barefoot That's what calluses are for. : without painkillers And poppies, and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9785912/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9785912/ . Even animals know what plants to eat to help with pain. : or healthcare Someone in the tribe knew how to make a splint and what herbs or foods were best for what ailment. : or a guaranteed source of water that does not carry those roundworm parasites that love to swim inside your eyes In general I expect that there would be few enough people, and they'd be sufficiently knowledgeable of the water sources among the areas they frequented, that this usually wouldn't be a problem. https://askdruniverse.wsu.edu/2018/08/31/dr-universe-people-ancient-times-filter-water/ https://askdruniverse.wsu.edu/2018/08/31/dr-universe-people-... https://www.theatlantic.com/science/archive/2020/01/how-did-humans-cook-before-the-invention-of-pots/605008/ https://www.theatlantic.com/science/archive/2020/01/how-did-... > One group of students decided to put this method to the test. They hoisted their water-filled deer hide directly over a fire, and they planned to let it go as long as the hide stayed intact. The hair on the outside singed, but the skin itself held up just fine. So the students waited and waited and waited. Four hours later, the hide was still intact. It did get very hard, but neither sprung a leak nor burned. : or anti polar bear sprays so they didn't tear you off and eat alive?. I'm pretty sure that by the time some of us migrated to where polar bears live we had some pretty good spear technology.
wiseowise 2y ago
> Or maybe people got softer. Do we remember the 90% of time where humans roamed this planet barefoot without painkillers, or healthcare, or a guaranteed source of water that does not carry those roundworm parasites that love to swim inside your eyes, or anti polar bear sprays so they didn't tear you off and eat alive?. Those were hard deaths. What’s your point here?

qgin 2y ago

ICUs are amazing technology. You can keep almost anyone in a temporary state of stasis. This is great for people who have a condition that just needs more time to heal (like a lot of people with Covid, or people after car accidents). But for people who have something unrecoverable, it’s a very weird place to be. You’ve been pushed off the ledge and are now frozen in midair. You will hit the ground when the magic is removed, but you also can’t stay frozen forever.

2-3-7-43-1807 2y ago

how about suicide? i'd compare it to knowing when the party is over and then going home instead of getting yet another drink and miserably trying to score with the last remaining woman. it's an art and it can be trained at many occasions. now for the act itself - the regular hn crowd should be technically apt enough to assemble the required gear around a big gas cylinder of nitrogen. that's as peaceful as it gets.

delta_p_delta_x 2y ago

I'd like dying to be as easy as flicking a switch. Medically-assisted suicide ought to be available to anyone (not only of sound mind and not only with a terminal condition), and at any time. People ought to have the right to die, just like they have the right to water, food, and shelter. In most countries it is currently easier to take other people's lives than to take one's own. People ought to be able to step into a hospital, ask 'hey, I'd like to die', sign a couple of forms saying 'yes, I'd really really like to die', step into an anoxic chamber, and be put into hypoxia and brain death in a matter of minutes. Obviously, an emergency stop plunger ought to be available in case the person in question changes their mind. The belief that life is a gift from a god is a highly Christocentric, Western view that I disagree with. We are brought into the world without any real consent; we should at least be able to easily choose the date, time, and manner of our passing if we so desire.

xboxnolifes 2y ago
I think death should be easily accessible, but not immediately executable. Mental states can swing quickly and dramatically, and it would be a shame for suicide to be in reach for a short-term, temporary situation. I'm not sure about the best delay, but my current ballpark is at least around a month delay.
treprinum 2y ago
Let's run a thought experiment - you make death super easy like in a suicide booth in Futurama. How many people are going to fight life obstacles, pushing society forward, or rather terminally quit at the first sign of troubles? Nihilism was quite popular in the 19th century and led us to two world wars already. All you'll get is a quick extinction of people like you in favor of those that persist and your opinion will be eliminated from the gene pool.
- mistrial9 2y ago
  In the West I think alcohol is a massive factor, when talking about the moods of large numbers of people in those days. It is no accident that alcoholic drinking was banned outright for some time, despite the deep cultural roots.

timnetworks 2y ago

Someone in the medical profession explained to me what 'do everything you can' means to doctors and surgeons, it's a binding command. My instructions are likely going to be 'do two things that you probably should at this point and then go have lunch'

Zenzero 2y ago
> Someone in the medical profession explained to me what 'do everything you can' means to doctors and surgeons, it's a binding command I've found that usually the people who said that to me were the least prepared for what that meant.

progrus 2y ago

[flagged]

erie 2y ago

It means also that "Do not go gentle into that good night" is not realistic most of the time. We have a saying in Arabic that I only understood after my father died, it to the effect that something is so difficult that:'' it is harder than the spirit leaving the body'. I think it is time that hospice care evolve to make it easier.

julianeon 2y ago

I think sometimes these articles don't pose the question all that well. The way I would ask it is: Imagine a pain scale of 1-10; pretend 10 is so high that you die from the pain. Is it worth living at a 7-8 at every moment continuously, to extend your life for 2 months? How about living at a 9 for just 2 more weeks? If you say "no" that just means you're not hooked up to a machine where that's your living experience (not like someone is actively killing you). I think, when you put it that way, it becomes easier to set some rules around it. Btw I'm pretty close to someone who would always choose to live longer, but even I would say no to, for example, living at a 10 of pain for just 1 more week of life.

Zenzero 2y ago
Doctor here. This is overly simplistic. There is little to debate about your example of living at a 7/8 for 2 months. What is more realistic is some hypothetical situation where the average patient has an expected survival of 6 to 18 months, with the hope that the 7/8 pain can be reduced to a 4/5, and with acknowledgement that some days may be a score of 5, some days may be a score of 9. Then what? As a provider on the other side of it you witness two similar patients take two different paths. Perhaps the first patient lives 36 months with pain score averaging a 3. The family will often appreciate the intervention and effort. The other patient experiences a string of complications and dies after 2 weeks, living at a pain score of 10. Their family paints you as an evil torturer who should have never been listened to. In fact you can see both types of opinions in this very thread.
- julianeon 2y ago
  Thank you for taking the time to explain this, a really valuable contribution to this thread. When I consider this going forward, I'll think of it this way.
  - Zenzero 2y ago
    I'm glad I could help. Thank you for your kindness.
- 2y ago

martinpw 2y ago

> Spend your remaining days at home if possible. This sounds appealing in the abstract but one thing to consider is the impact on other family members. My parents had a neighbor who chose to remain at home. However that meant his wife also had to stay at home to look after him (yes there were nurses who came in a couple of times a day, but a lot of the burden was still on the wife.) This meant her own life basically shut down. She never went out, and spent at least a year fully housebound for his care. Once he died, she was able to go out, reconnect with friends, kickstart her life again. Couldn't help feeling the husband's choice here was a selfish one.

scottcorgan 2y ago
No place is rather be than with my spouse in a time like that!
- martinpw 2y ago
  I think that's easy to say in the abstract, but the reality can be quite different. Of course every case is different, but for example: * Spouse has dementia, does not recognize you, abuses you for being an intruder in the house, constantly shouts for help all times of day and night. * Feeding, cleaning (double incontinence). * Can't go out except for a few minutes when nurses are present. The above goes on for months and even years with no end in sight. No chance to go out for exercise, hikes in nature, meeting friends. Isolation. At home carers have significantly reduced life expectancy for good reason. Having hospice care where they can be well looked after is not a bad option, and is not a sign of weakness or failure for a partner.
  - LorenPechtel 2y ago
    Dementia is particularly evil. As far as I'm concerned I am my mind. If my mind is gone my body doesn't matter, please don't waste effort in caring for it.
    - namtab00 2y ago

LocalH 2y ago

Humans have long handled death in a very backwards and disgusting manner. We have humans, who can clearly assert a particular desire when of sound, lucid mind. Yet we do not allow them to have any control over one of the most personal experiences their life will ever offer them, when in a medical establishment. We don't allow people to assert a desire to be euthanized gently. We force them to die on their own (by being unwilling to do anything more than remove care), no matter how much they may be suffering. Of course, we always have the option of taking matters into our own hands, with all the potential stumbling blocks that provides. In contrast, we have pets, who can not verbally assert any particular desire, due to the lack of common language. We can't ask them if they want to stay with their loved ones, or if they're suffering and want to be free. Yet we make the decision to actively end their lives every single day in the world. Logically, this seems completely backwards to me. It seems like we should err on the side of not ending a pet's life when they don't want us to, and that we should allow people of sound mind to articulate a self-aware desire to have a more dignified, gentle death as much as possible.

jl6 2y ago

I hope "noble sacrifice" becomes a viable end-of-life option one day. Specifically, one-way tickets to Mars, which will be invaluable for doing human-led research and construction, paving the way for future colonists, but without the expense and burden of a return journey. There must be some ultra-high-risk test pilot jobs available for 75 year olds with inoperable diseases. Go out with a bang!

salzig 2y ago

The author doesn’t believe his content is worth reading (full page „popup“). Good he included this feature so I can leave the page early.

627467 2y ago

in this modern day of increased privatized medicine, health insurances and self-absorbed people, what is the incentive to let a person die? the longer you keep someone with medical needs and decent insurance the more you can milk the their insurance or whatever wealth they may have accumulated. self-absorbed closed ones can also easily dismiss the sick person desires and needs. I see no incentive for this to change.

cityzen 2y ago

There is a great book called The Conspiracy Against the Human Race that talks about this in a way that makes sense to me: As a survival-happy species, our successes are calculated in the number of years we have extended our lives, with the reduction of suffering being only incidental to this aim. To stay alive under almost any circumstances is a sickness with us. Nothing could be more unhealthy than to “watch one’s health” as a means of stalling death. The lengths we will go as procrastinators of that last gasp only demonstrate a morbid dread of that event. By contrast, our fear of suffering is deficient. The book is very pessimistic but that’s the point, I quite enjoyed it.