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It's certainly true that "I intend to" (in the GP comment) can't be the same as "I will". I strongly disagree that it's useless talk, though. If you haven't p

by jtheory 14y ago

It's certainly true that "I intend to" (in the GP comment) can't be the same as "I will". I strongly disagree that it's useless talk, though. If you haven't put any thought into the possible ways to respond to life and death decisions, when you find yourself facing them -- quite possible in pain, short on sleep, and flooded with anxiety and emotion -- it's not a good bet you'll be able to make the best choices then.

dionidium 14y ago
That's fair, more or less. My argument is that it's very difficult to predict how you'll act when you're "in pain, short on sleep, and flooded with anxiety and emotion." Even if you've thought a lot about what you intend to do in advance.
- jtheory 14y ago
  I've had two personal experiences of making stressful life/death decisions after several physically taxing days with no sleep. Not end of life decisions -- and my own life wasn't on the line -- so it's not the same thing, but my personal experience was that the earlier research and prep I had done was like a ray of clear light in my otherwise clouded mind. I realize this is less persuasive given the lack of detail, but these are not really my stories to tell.
  - dionidium 14y ago
    We're in the realm of anecdotes now, so let me just add that I wouldn't want my last fully conscious decision -- asking for the morphine drip that might make the final few days of my life tolerable -- marred by the feeling that my resolve had suddenly failed. I think I want to remain open to the idea of a pain-reduced death at least until I know for sure how intense that pain is going to be. (And this just focuses on the pain aspect. Similar arguments could be made against limiting last-minute surgical options, as well.)
    - jtheory 14y ago
      Quite right on the anecdote comment; but I'm suddenly wondering what kinds of end-of-life plans you worry you could make that would require deep resolve. The kind of thinking I'm talking about isn't about choosing one option, regardless -- "no matter what, I will only die at home with my family, with no drugs whatsoever" is one of those things that might sound nice for a moment but is a horrible option for some situations. Instead, I think it's important to research the main philosophical approaches to end-of-life, to find out what the major decisions are (and what people tend to do, and what people tend to regret doing...), and just know what the options likely will be. Simply asking the practical question "what will my life probably be like, and for how long, if we attempt this treatment, vs if we don't?" is something you need to know how to ask. Another big one that you do need to decide in advance to avoid all kinds of potential problems: what guidelines should my loved ones follow when making decisions for me, if I'm comatose, seriously brain-damaged, etc.? Some people end up being kept alive for years in a hospital bed, even brain-dead with no chance of recovery, at huge expense, because they never thought to tell their loved ones "I wouldn't want that", and without that no one feels morally freed to pull the plug. If they can't say "it's what s/he explicitly instructed us to do", they may well feel morally trapped into doing anything medically possible to keep you alive (even with no hope of recovery), because otherwise it looks like they're doing what's easiest/cheapest for them.

by jtheory 14y ago

dionidium 14y ago

That's fair, more or less. My argument is that it's very difficult to predict how you'll act when you're "in pain, short on sleep, and flooded with anxiety and emotion." Even if you've thought a lot about what you intend to do in advance.

jtheory 14y ago
I've had two personal experiences of making stressful life/death decisions after several physically taxing days with no sleep. Not end of life decisions -- and my own life wasn't on the line -- so it's not the same thing, but my personal experience was that the earlier research and prep I had done was like a ray of clear light in my otherwise clouded mind. I realize this is less persuasive given the lack of detail, but these are not really my stories to tell.
- dionidium 14y ago
  We're in the realm of anecdotes now, so let me just add that I wouldn't want my last fully conscious decision -- asking for the morphine drip that might make the final few days of my life tolerable -- marred by the feeling that my resolve had suddenly failed. I think I want to remain open to the idea of a pain-reduced death at least until I know for sure how intense that pain is going to be. (And this just focuses on the pain aspect. Similar arguments could be made against limiting last-minute surgical options, as well.)
  - jtheory 14y ago
    Quite right on the anecdote comment; but I'm suddenly wondering what kinds of end-of-life plans you worry you could make that would require deep resolve. The kind of thinking I'm talking about isn't about choosing one option, regardless -- "no matter what, I will only die at home with my family, with no drugs whatsoever" is one of those things that might sound nice for a moment but is a horrible option for some situations. Instead, I think it's important to research the main philosophical approaches to end-of-life, to find out what the major decisions are (and what people tend to do, and what people tend to regret doing...), and just know what the options likely will be. Simply asking the practical question "what will my life probably be like, and for how long, if we attempt this treatment, vs if we don't?" is something you need to know how to ask. Another big one that you do need to decide in advance to avoid all kinds of potential problems: what guidelines should my loved ones follow when making decisions for me, if I'm comatose, seriously brain-damaged, etc.? Some people end up being kept alive for years in a hospital bed, even brain-dead with no chance of recovery, at huge expense, because they never thought to tell their loved ones "I wouldn't want that", and without that no one feels morally freed to pull the plug. If they can't say "it's what s/he explicitly instructed us to do", they may well feel morally trapped into doing anything medically possible to keep you alive (even with no hope of recovery), because otherwise it looks like they're doing what's easiest/cheapest for them.