9 ms·

How Doctors die. It’s not like the rest of us (2016)

258 points by downbad_ 3mo ago

ggm 3mo ago
> Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a ‘tension pneumothorax’), walked out of the hospital. This point has been made by many medically trained people over decades. It's a very energetic intensive process, it cracks ribs. If it's not done promptly the brain has been starved of oxygen. While I understand people not wanting to drag politics into everything I invite you to think about this and the situation of the senior senator for Kentucky.
- j-conn 3mo ago
  Totally misleading. Early CPR (+AED if available) absolutely saves lives. Article is from 2011 by a family med doctor. Overly aggressive resuscitation attempts are definitely a problem but context matters
  - bonsai_spool 3mo ago
    > Early CPR (+AED if available) absolutely saves lives. Article is from 2011 by a family med doctor. You have to provide a denominator to make this statement. 30-day survival for out-of-hospital CPR is 10%, and discharge from the hospital (let alone functional status) is even lower. CPR is thus a great example of the OP's thesis that doctors refuse certain things based on their poor efficacy. https://www.redcross.org/take-a-class/resources/articles/cpr-facts-and-statistics https://www.redcross.org/take-a-class/resources/articles/cpr...
    - kryogen1c 3mo ago
      Did you read what you linked? It's not a study of the effects of cpr, it's a list of facts about cardiac arrest that occurs outside a hospital. It explicitly says cpr is life saving: >Survival chances decrease by 10% for every minute that immediate CPR and use of an AED is delayed.
      - bonsai_spool 3mo ago
        > Did you read what you linked? It's not a study of the effects of cpr, it's a list of facts about cardiac arrest that occurs outside a hospital. It explicitly says cpr is life saving: Oh my goodness, did YOU read anything on the page? Here's a literal quote with a link to a study you could have followed if you weren't just here for outrage points: "For the past 20 years, the survival rate for cardiac arrest has hovered around 10 percent for out-of-hospital incidences and 21 percent for in-hospital events, yet research shows that high-quality CPR has a significant impact on survival outcomes, whether inside or outside the hospital." link: https://mycares.net/sitepages/uploads/2026/2025_flipbook/index.html?page=52 https://mycares.net/sitepages/uploads/2026/2025_flipbook/ind...
    - krisoft 3mo ago
      > 30-day survival for out-of-hospital CPR is 10% Okay. And what is the 30-day survival for cases where CPR would be otherwise indicated but are not performed? It is a bit like complaining that jumping out of a burning airplane with a parachute is dangerous. Yes, it is. But jumping out of a parachute, or burning inside, is even more dangerous.
      - bonsai_spool 3mo ago
        > Okay. And what is the 30-day survival for cases where CPR would be otherwise indicated but are not performed? Great question, but it's obviously not possible to answer. I suspect the survival rate won't be 0, and maybe won't even be less than 10%. The point of this whole subtree is that there are interventions that people wouldn't want for themselves because the expected outcome is very poor.
  - classichasclass 3mo ago
    "Early" is load-bearing. Even brief delays, just mere minutes, significantly decrease survival or positive outcomes. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010116 https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010... It's important to get people to realize the benefits of early CPR and more people should be trained on how to do it, or else it won't be prompt and the outcomes will be worse. That's what the Red Cross and AHA promulgate to the public, in so many words.
    - lsaferite 3mo ago
      I've never heard the term "load-bearing" used outside of the civil engineering world until the more recent versions of Claude suddenly decided everything was "load-bearing". Did you internalize Claude terminology, use Claude to write/translate your post, or lead Claude into temptation by being the OG? Asking out of genuine curiosity and not at all trying to throw shade.
      - classichasclass 3mo ago
        No. I do use the term.
        lsaferite 3mo ago
        I'm curious where you picked it up originally. I've been mystified why Claude started using it so much.
        hawaiianbrah 3mo ago
        I’ve been using it in the tech space for many years now, no idea where I picked it up. Also this is the first I’ve heard Claude is using it!
      - switchbak 3mo ago
        "Load bearing beliefs" is a thing in the podcast/YouTube world at a minimum. Perhaps you're not as online as some other folks (probably a good thing!).
  - oh_my_goodness 3mo ago
    How has CPR (or CPR data) changed since 2011? What type of medicine do you practice?
    - j-conn 3mo ago
      My only point was that this article shouldn’t be considered authoritative, wanted to put it in perspective for someone surfing hn and just reading the comments The person closest to me was saved by CPR after cardiac arrest (and cooling at the hospital), with no neurological deficits
  - clukic 3mo ago
    100%. CPR initiated within 2 minutes of cardiac arrest increases survival rate by 81%. The fact that CPR is rarely initiated so quickly (and thus survival rates are extremely low), says nothing about the efficacy of CPR. In the best cases where CPR is initiated < 2 mins, and AED shock within < 5mins survival rate can be as high as 50%. https://newsroom.heart.org/news/bystander-cpr-up-to-10-minutes-after-cardiac-arrest-may-protect-brain-function?utm_source=chatgpt.com https://newsroom.heart.org/news/bystander-cpr-up-to-10-minut...
    - lostlogin 3mo ago
      I struggle square those numbers with the ones below, showing 11% survival (22% making it to hospital alive). I can’t find a source for it, but I’m told that survival after an arrest in hospital is actually lower, due to the co-morbidities that patients have. https://www.resus.org.nz/assets/OHCA_All_NZ_Feb23.pdf https://www.resus.org.nz/assets/OHCA_All_NZ_Feb23.pdf
      - LorenPechtel 3mo ago
        A big increase in a small number can still be a small number.
      - GoodOldNe 3mo ago
        Cardiac arrest is an incredibly heterogenous condition. A witnessed VF arrest in a young person with an inherited electrical type heart condition who gets compressions and a shock on a gym basketball court can wake up and walk away normal. A 98 year old who codes from sepsis or a fentanyl OD who is profoundly hypoxic or acidemic who gets enough Narcan and CPR to start having a heartbeat again after 15 minutes is very different. The statistics reflect this but you can’t generalize from the general to the specific in this case.
  - shellfishgene 3mo ago
    What are the statistics for quality of life after CPR even if it saves the patients life? I think this is more what the article is about.
  - LorenPechtel 3mo ago
    Note how the data gets contaminated here. CPR is simply buying time, at best it can delay death in the hope the doctors can do something about whatever caused the heart to quit. Usually they can't. AED is different. Despite what Hollywood would have you believe the shocker does not start your heart and it is never used on a stopped heart. Shocking is about the heart beating ineffectively. It has a chance of actually treating the problem, not merely buying time. If the heart is stopped the AED just sits there and says continue CPR. And people blame it for being defective.
- 2bitencryption 3mo ago
  > It's a very energetic intensive process, it cracks ribs. I feel like lately this is becoming more common knowledge - but still something most people don't realize. Part of it is probably the fact that it's impossible to depict "real" CPR in popular culture (movies, TV shows, etc) unless the production goes to extreme lengths to use a fake dummy. Even on The Pitt (which seems to make a point of being hyper realistic) I've seen them do "fake" CPR with shallow compressions.
  - tialaramex 3mo ago
    Yeah, akin to the Gell-mann Amnesia Effect, we notice a few things where we're experts but then forget everything else is likely just as bogus. Apparently one reason "Queen's Gambit" was a big deal was that most pop culture chess isn't just not very good chess (as you might innocently assume), it's literally nonsense. Like, pieces on the wrong squares, illegal moves, even simple continuity errors where pieces move between camera shots. So QG begins scoring points for chess fans when it remembers stuff like the White Queen starts on a White square...
  - thejazzman 3mo ago
    so on Lost when Jack is really upset about Charlie, and he beats the shit out of his lifeless body, ... and it worked, did he do real or fake CPR? These comments make it sound very real.
    - stavros 3mo ago
      Fake. You can't have fire without oxygen, but that doesn't mean you can't have oxygen without fire. Breaking someone's ribs doesn't necessarily mean you're performing CPR.
- biomattr 3mo ago
  If CPR is done right ~10% will walk out of the hospital. But that's a big if! Must be near a trained bystander. AED is much better on shockable rhythms, ~70%. Unfortunately most out-of-hospital cardiac events occur in homes which rarely have access to a device. In 2021, a drone-delivered AED was used to successfully shock a 71-year-old man back into a stable rhythm in Sweden. The drone delivered the AED in just over three minutes from a 911 call. Studying years of emergency drone data back up the anecdotes. The AED gets there 10-15 min ahead of medics and boosts survival 70%.
  - vixen99 3mo ago
    AED: automated external defibrillator.
  - hobo123 3mo ago
    This is very cool and should become a standard feature at least in reasonably dense populated areas.
- MajorTakeaway 3mo ago
  MY ex-wife who was a CNA had made it a point to me that she had a DNR. How or where, she never told me. Probably for the best.
- Loughla 3mo ago
  Do you know what is happening with McConnell? Because the news is everywhere from he's fine to he's dead. Edit: this is not meant to be snarky. This is a real question.
  - ggm 3mo ago
    No I have no more information than anyone else. But, even at normal response times he was incapacitated for more than 2-3 minutes before CPR and after that, reportage is divergent with frankly bizarre variances around talking to somebody and talking with somebody.
- gcanyon 3mo ago
  I have a friend who had a spontaneous pneumothorax. He even wrote a song about it after he recovered. I myself punctured and collapsed both lungs. My thinking is: if there's a reasonable chance I'll survive, go for it. If there's not, stop trying to prolong the inevitable. That said, when I had the accident they told my wife to get there as fast as she could because I was likely not going to make it, and that was thirty years ago. So: if they're confident I'm going to die, don't try to prolong it :-)
djoldman 3mo ago
> Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack... He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. > Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. It's interesting that our laws punish homicide with maximum criminal penalties, but the opposite (keeping someone alive against their wishes) seems to be assault and battery at worst, with much much lighter punishment.
- gerdesj 3mo ago
  Does the US have the concept of DNR (Do Not Resuscitate)?
  - glimshe 3mo ago
    Yes
  - djoldman 3mo ago
    Yes. If one lives in the US and feels strongly about it, they should file an Out-of-Hospital DNR and POLST with every local hospital. Also consider wearing or carrying official bracelets/necklaces (varies state to state). I'm neither a lawyer nor a doctor. :)
  - netsharc 3mo ago
    There was a "culture war" (the rightwing government intervening due to religious reasons) in the 2000's involving a "DNR"-esque case https://en.wikipedia.org/wiki/Terri_Schiavo_case https://en.wikipedia.org/wiki/Terri_Schiavo_case
    - ButlerianJihad 3mo ago
      Let us not forget https://en.wikipedia.org/wiki/Karen_Ann_Quinlan https://en.wikipedia.org/wiki/Karen_Ann_Quinlan And also https://en.wikipedia.org/wiki/Jahi_McMath_case https://en.wikipedia.org/wiki/Jahi_McMath_case But it is disingenuous to invoke "rightwing government", when a Franciscan friar was sneaking into the hospital trying to feed a starving woman [Terri], who was so hated by her husband that he would take extreme measures to get rid of her. I have found it quite elusive to get a DNR properly executed. I could do all the other Advance Directives from home, and I could get them notarized without issue. But in my state, a DNR must be printed on a special hue of orange paper, and shit, if that isn't the most difficult step... Also there are probably at least 12 facilities where it'd need to be filed, because who knows where the EMTs would haul me off to, around here. There are so many health care systems, not to mention the BH ones, which are quasi-medical.
aaron695 3mo ago
[dead]
jordanpg 3mo ago
Can confirm. Top of the article could be about my dad. Same flavor of cancer and everything.
jrapdx3 3mo ago
I'm a physician, an old one. We're lucky to live as long as we do, but life will end. The article emphasizes the value of dying peacefully. Sure, that's how we want it to be, but we have to make it known to assure it goes that way. Don't know what happens elsewhere, but every time I see a doctor someone asks if I have a signed, notarized directive. Yes, I've done that, but so should everybody else concerned about the issue. I have asked aged patients the same question. More than not the answer is "no". Why haven't you? Various versions of "on my list of things to do". We can't really predict future events, in our own interests best to be prepared. Some will take the hint, more than not, people procrastinate. At least I've done what I can do, but we can't save people from themselves. Maybe people in healthcare are more aware of what's at stake, but everyone has the option to make it as clear as possible their wish (no, their demand) to die in peace.
- teiferer 3mo ago
  > Why haven't you? It is (mentally) painful to think about that this life is going to end. And even more (mentally) painful to think about the consequences of a (physically) painful end. The mind goes to great lengths to avoid pain. Plus, society doesn't exactly create a culture in which this kind of talk and preparations are encouraged.
- voiper1 3mo ago
  >At least I've done what I can do, but we can't save people from themselves. Why should doctors NEED to save people from themselves? The default should be what the people in the industry have learned, with full permission to say "For myself, I have written a legally binding document that this is my personal wishes. I suggest you make that decision for your loved one, too." Patients have the ability to ask for more, but there shouldn't be a constant need to save people from inadvertently choosing risky/painful low payoff medical care!
- deleted 3mo ago
  [deleted]
____tom____ 3mo ago
On the spectrum or go gentle vs fight, I'd have to say, now is the time is history where "fight" makes the most sense. This is not abstract for me. I have not one, but two forms of cancer. Both were considered incurable when I was diagnosed. Both have treatments now that, IN SOME PEOPLE, lead to remission. I still don't know which group I am, but I'd be dead from either one by now, if I hadn't elected to treat. New treatments, for SOME cancers are literally coming out monthly. So the fact that you can't be cured today, does mean there won't be a better treatment by next year, if you can hang on. I should find out soon on my more aggressive one. Either way, I plan on continuing to try.
- hirvi74 3mo ago
  Keep fighting the good fight, Internet friend. I look forward to reading your remission comment one day.
- sghiassy 3mo ago
  Sending good wishes
- eth0up 3mo ago
  Sending thoughts of remission through the aether. And wishing your tries become success.
- hexeater 3mo ago
  Hero - keep fighting!
  - teiferer 3mo ago
    I think it's exactly this attitude which the article is about. Of course I wish the best to whoever decides to fight. But fighting at any cost isn't the best advice.
- deleted 3mo ago
  [deleted]
- ComputerPerson 3mo ago
Stratoscope 3mo ago
Title should be corrected to the original: --- How doctors die. It’s not like the rest of us, but it should be --- Note to submitters: Check the title after submitting. If the HN algorithm mangled it as badly as this one, edit it!
Alien1Being 3mo ago
Last week one of my patients with preterminal NYHA Stage IV cardiac failure looked into euthanasia. He found predictably that it is now legal in my country but takes months and formidable legal resources to obtain it. Legalisation of euthanasia has, as everyone in the field warned multiple times, made it much harder to obtain and now requires a lot of time, effort and money. The well meaning, naive proponents of legalisation of euthanasia have actually made things a lot harder for those who want it. The potential legal penalties for not getting the paperwork right, include loss of employment, deregistration and homicide charges. So now virtually no doctor wants to be involved for any amount of money. So I told him how to contact the local palliative care unit when he decides to die, gave him documentation attesting to his preterminal , incurable status and taught him the magic words to almost instantly access that terminal, euthanising, life ending dose of mist. morphine... "I have breathlessness and bone pain" Also told him never again to say the word "euthanasia" to anyone, unless he wants a ride on the endless merry-go-round of legal paperwork. Placing the hands in the abhaya mudra is optional...
- cowthulhu 3mo ago
  If I’m understanding correctly, it was already quasi-legal through a loophole, but formally legalizing it made the loophole much trickier to use? That does sound frustrating. I hope they simplify the legal rails… having to wait around in pain waiting for multiple rounds of paperwork to clear sounds terrible.
- teiferer 3mo ago
  > The well meaning, naive proponents of legalisation of euthanasia have actually made things a lot harder for those who want it. In your mind, what should have been done instead of legalizing it?
- fhdkweig 3mo ago
  > The well meaning, naive proponents of legalisation of euthanasia have actually made things a lot harder for those who want it. That sounds like the actions of a politician who wants to claim they are for something while secretly trying to destroy it. It doesn't seem "well meaning" to me. That's what the US Republicans did to the ObamaCare act.
tpoacher 3mo ago
This article is making a LOT of "convenient" assumptions. For all we know, the more likely scenario is that Charlie, like a sizeable percentage of his doctor peers, was burnt out, tired, and depressed, did not really have an overwhelming (some might say "healthy") desire to survive (in fact, perhaps quite the opposite), and saw the cancer as a non-undignified quick "way out". Doctors (and medical professionals more generally) rank among the highest in occupational risk of mental health disease, especially for things like addiction, alcoholism, generalised anxiety, ptsd, depression and suicide. I have no objection regarding the choice he made, but let's not glorify it as the "natural" thing to do either. This narrative is harmful to people who "do" desire to survive but are scared, which may then prevent them from making a dispassionate decision regarding their care.
- LaurensBER 3mo ago
  This is an interesting point and the article should definitely take these factors into account. It's indeed very worrying what we ask medical professionals to put themselves through for their jobs. I think we can all agree that having a well rested doctor or nurse would be preferable over a stressed/tired one. The amount of hours and night shifts that (young) doctors have to do and the extreme competitiveness of the field (partly) drives this. I understand that it would drive wages down (somewhat) if we educated more doctors and obviously we shouldn't lower our standards substantially but it seems like everyone involved would benefit from this. A friend of mine, whose a doctor, told me once that the best way to ask for medical advice is to ask the doctor what he/she would recommend for their own sister/brother. Siblings are close enough that he would not want them to suffer unnecessarily but it eliminates the personal factors. Obviously it differs per doctor but in my experience it usually leads to a good conversation about the trade-offs for medical care.
- LorenPechtel 3mo ago
  Why do you think this was basically a form of suicide? Pancreatic cancer still has a dismal "survival" rate, and I hesitate to even call it "survival" as it's more a matter of not having died yet. He's seen what chemotherapy does to patients, he knows it's trading the horrors of chemo for a bit longer life. That article is 10 years old--pancreatic cancer is still very deadly. No reprieve was coming down the road. False hope generally leads to inferior outcomes.
tomhow 3mo ago
Previously... How Doctors die. It’s not like the rest of us (2016) - https://news.ycombinator.com/item?id=28463482 https://news.ycombinator.com/item?id=28463482 - Sept 2021 (291 comments)
tsoukase 3mo ago
As a doctor, I think we are prepared for our own death (not so much for illness though). Especially during the last days or months we know exactly what's happening. I agree that the less-care-but-less-side-effects way is chosen much more often by doctors for themselves and their close relatives (I personally administered to my mother opioid to accelerate death due to terminal cancer a couple of days before the expected end that would be tortuous). For my end stage patients I advise full palliative analgesic and sedative therapy but usually against futile chemos and intubations. There is a discussion where ICU doctors and oncologists have to take part.
- ido 3mo ago
  > administered to my mother opioid to accelerate death Isn't that illegal is most countries? Does it not count as doctor assisted suicide?
  - codemog 3mo ago
    What are you hoping to get out of asking this question? It sounds like you already know the answer.
    - ido 3mo ago
      I don't know, that's why I'm asking! If I'm in that situation I hope this option is available to me, and want to know what to ask for. If the answer is that it's illegal I'd know I can't ask this directly/explicitly (but maybe there's a "secret handshake" way of asking for it). If it is I'd know I can. I wish no harm to OP.
      - warshinder 3mo ago
        I believe it varies by state but typically must be administered by a doctor or hospice nurse.
      - freedomben 3mo ago
        See https://news.ycombinator.com/item?id=48878167 https://news.ycombinator.com/item?id=48878167 IANAD but have paid close attention to this for the same reasons. When my time comes I plan to let them know I'm in serious pain and prefer pain relief to life extension (though maybe in a more subtle way). I expect most will understand that.
sneak 3mo ago
> They want to be sure, when the time comes, that no heroic measures will happen – that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with cardiopulmonary resuscitation (that’s what happens if CPR is done right). I have been seeing so much anti-LUCAS-machine content on the internet lately; it is far too prevalent to be anything but an astroturfing campaign. From whence this meme?
mimo84 3mo ago
I recently read the book Being Mortal by Atul Gawande, a doctor. He emphasized how terminal care should focus on quality of life instead of attempting to prolong it and making it awful.
alex-moon 3mo ago
Here in the UK there is an ongoing debate happening more or less behind the scenes around the language that should be used for families of patients nearing end of life. The standard question is: Should we "do everything possible" to keep someone alive? The proposed better question is: Should we "allow natural death"? Any doctor understands intimately that these two questions are equivalent. Understandably, the average person doesn't. Why wouldn't you "do everything possible"? In most of these conversations the argument against just doesn't come up.
khalic 3mo ago
I really don’t agree here. The focus should be on combating the observational bias that is the cause of these decisions. The doctors remember the “futile” cares for the patients where it had the worst results. We’re wired to concentrate on the negative outcomes, and doctors are bathing in it.
Sam6late 3mo ago
My mother died last month,I have seen that same costly futile care before when it was performed on my father two decades before, but we had no choice. Both were injected with a dozen drugs syringes and perforated with tubes, hooked up to machines. Although I am somewhat healthy, yet looking at rocking 60 made me contemplate and feel contentment just upon reading about psilocybin for patients dealing with life-threatening diagnoses, end-of-life anxiety (plus a dozen documentaries and 2 on Netflix). Learning about it has offered me relief and lasting drop in existential distress, especially as it helps melt the ego into everything. https://pmc.ncbi.nlm.nih.gov/articles/PMC9833165/ https://pmc.ncbi.nlm.nih.gov/articles/PMC9833165/
devonsolomon 3mo ago
I worked for some years in cancer prevention. Last year, my mom was diagnosed with Stage 4 cancer. My family largely agrees with this article: treatment was a mistake and likely worse than the disease (bar palliative care and a stent). The headline we used in cancer education is about 38% of cancer cases are likely caused and perhaps preventable by modifiable lifestyle factors: Tabbaco, infections, alcohol, UV. Widespread vaccination (HPV, Hep B/C etc) and precision prevention (genetic counseling and preventative interventions) add another layer of preventative opportunity, and could significantly move the needle inclusive of and beyond/above lifestyle factors. This leaves a lot of room for change, but requires a changing of economic incentives and cultural factors: which are incredibly slow moving ships. The next layer is early detection (pre-cancer and early cancer); and technology advancements look promising - multi-cancer blood tests like Galleri and whole-body MRI (Prenuvo, Neko, Midjourney) are scientifically and economically promising, but all commercially ahead of their time. These two additional pots potentially provide another significant opportunity to reduce the burden where the cost-benefit on personal suffering makes sense. I’d add as the last personal suffering cost-benefit promising intervention layer targeted immunotherapy (and perhaps to a lesser extent ADCs/smart-bombs), where many patients enjoy results without bearing equal or exceeding suffering. Though with smart bombs, the maths isn’t as convincing, and with both you’re heading into lower odds bets. Ofcourse, many people are helped by classical chemo, but much of the time (and especially in later stages) you’re hoping to be the exception, and at this point, the population wide experience is in many cancer types net negative. Many people pin there hopes on this last, narrow category of intervention for breakthroughs; and hopefully they come; but likely this hope, attention and capital is misplaced.
TomMasz 3mo ago
As the article points out, CPR really is oversold. I was a volunteer firefighter and did CPR multiple times, none of those people survived. I watched (and listened) as firefighters did CPR on my wife after she had a massive heart attack, hanging on to some hope but knowing deep down it was futile. But they transported her to emergency anyway. I watched my father slowly die from sepsis that began with an infection in a toe. Surgery to improve leg circulation failed and his toe was amputated. The antibiotics not only induced the sepsis but led to a C. difficile infection. His mind deteriorated almost overnight. My mom couldn't make the decision to end care and place him in hospice, so the decision was passed to me. He had made his care wishes clear in writing, so while it was a hard decision, I knew it's what he wanted. He died less than a day later. I'm working on my own care directives so my kids know exactly what to do when it's my time. With luck, they'll be able to ensure those directives are followed.
1970-01-01 3mo ago
I thought this was going to speak to the fact of doctors being overconfident in aviation, to the point of crashing more than any other pilot. I see they're still overconfident. :P https://www.faa.gov/data_research/research/med_humanfacs/oamtechreports/1970s/1971/7109 https://www.faa.gov/data_research/research/med_humanfacs/oam...
rimeice 3mo ago
I don’t think you have to be a doctor to come to this conclusion. After therapy I realised that the most traumatic thing that took the longest to get over wasn’t watching my Dad die, it was watching him suffer through futile attempts to prolong his life by a few days in intensive care. I wish the doctors had been clearer with us about his chances of survival, I wish we had been brave/knowledgable enough to accept that it was the end and I vow never to put my loves ones through that when my time comes.
- bonsai_spool 3mo ago
  > I wish the doctors had been clearer with us about his chances of survival What would they have done differently from what they actually did?
  - rimeice 3mo ago
    I think honestly they shied away from really clearly saying this was the end until a couple of hours before he died when really I believe it was clear at least a few days out. For some reason through their communication, bouncing between different doctors and clearly some overwhelming emotions on our part, we thought he had a chance of coming back from the brink so made some decisions in his behalf I wish we hadn’t.
ezoe 3mo ago
I think I've read the exact thing like 20 or 30 years ago. But I wonder... isn't it US specific local trend where medical bill is ridiculous? There is no way ICU cost 10K USD/day... except in US.
- blobcode 3mo ago
  ICU costs are quite high in general, often 3-4x a regular bed, and about 5k USD average in countries such as Canada and the UK.
fzeroracer 3mo ago
I can't say I agree, I think it's more about the death's you're exposed to. Doctors get to experience the full brunt of how the medical system treats patients, the good and the bad. So they opt out of it when it's close to their time so they can die a peaceful death. But a peaceful death at home is rarely real in my opinion. My father was pretty badly traumatized by his mother who had oral cancer, got a bit through treatment and then refused to continue. His last days with her were spent as she slowly starved and went through terminal dehydration, barely conscious through the drugs hospice used to try and make the passage easier. It's something we tell ourselves post-hoc to try and make ourselves feel better because they died at home with family. This doesn't mean dying in a hospital is much easier and often family keeps people in a state of semi-torture so that they can have more time. But that I think sometimes we have this 'ideal' of how we want to die, and the reality will always be much messier than that.
NalNezumi 3mo ago
I remember reading this article a few years back, and it left an impression enough that I could retell it (but couldn't find it). Which turned out to be helpful, during/after my mother's passing half year ago. Thanks for sharing it, I can now share it to my siblings. A silver lining that despite the cancer she could leave relatively peacefully. The article & some comments do make me wonder: my mother refused any medication, including any painkillers, for 6 weeks after terminal diagnosis. Only on her last day, when breathing got painful did she accept a fentanyl patch to be administered. She lost her consciousness a few hours later, and less than a day later her breath. I wonder if it was dosed for that (as some form of mercy)
kazinator 3mo ago
> Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died. Life imitating Madame Bovary.
temporary_cat 3mo ago
man, what an article. my father's a surgeon, and my aunt was diagnosed with pancreatic cancer recently. he told me he checked the literature to see that there's a very high mortality rate, and seems to have accepted whats to come. but my aunt and her family is doing the "everything" part. I have a feeling that they're resenting my father for not involving as much as they think he should, and I can see from both angles. I have a feeling that my father would also choose the same path of just retiring and patiently waiting to die in a similar circumstance. I wish both him and people who read this comment a dignified and easy end.
Caius-Cosades 3mo ago
I have had the misfortune of having had to work in a nursing home for a while and if there is such thing as torture nexus then that was it. On average dogs get to have a more dignified manner of passing away than people in nursing home.
afarviral 3mo ago
There are so many bold claims in this article. I think this deserves taking with a grain of salt.

258 points by downbad_ 3mo ago

ggm 3mo ago

> Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a ‘tension pneumothorax’), walked out of the hospital. This point has been made by many medically trained people over decades. It's a very energetic intensive process, it cracks ribs. If it's not done promptly the brain has been starved of oxygen. While I understand people not wanting to drag politics into everything I invite you to think about this and the situation of the senior senator for Kentucky.

j-conn 3mo ago
Totally misleading. Early CPR (+AED if available) absolutely saves lives. Article is from 2011 by a family med doctor. Overly aggressive resuscitation attempts are definitely a problem but context matters
- bonsai_spool 3mo ago
  > Early CPR (+AED if available) absolutely saves lives. Article is from 2011 by a family med doctor. You have to provide a denominator to make this statement. 30-day survival for out-of-hospital CPR is 10%, and discharge from the hospital (let alone functional status) is even lower. CPR is thus a great example of the OP's thesis that doctors refuse certain things based on their poor efficacy. https://www.redcross.org/take-a-class/resources/articles/cpr-facts-and-statistics https://www.redcross.org/take-a-class/resources/articles/cpr...
  - kryogen1c 3mo ago
    Did you read what you linked? It's not a study of the effects of cpr, it's a list of facts about cardiac arrest that occurs outside a hospital. It explicitly says cpr is life saving: >Survival chances decrease by 10% for every minute that immediate CPR and use of an AED is delayed.
    - bonsai_spool 3mo ago
      > Did you read what you linked? It's not a study of the effects of cpr, it's a list of facts about cardiac arrest that occurs outside a hospital. It explicitly says cpr is life saving: Oh my goodness, did YOU read anything on the page? Here's a literal quote with a link to a study you could have followed if you weren't just here for outrage points: "For the past 20 years, the survival rate for cardiac arrest has hovered around 10 percent for out-of-hospital incidences and 21 percent for in-hospital events, yet research shows that high-quality CPR has a significant impact on survival outcomes, whether inside or outside the hospital." link: https://mycares.net/sitepages/uploads/2026/2025_flipbook/index.html?page=52 https://mycares.net/sitepages/uploads/2026/2025_flipbook/ind...
  - krisoft 3mo ago
    > 30-day survival for out-of-hospital CPR is 10% Okay. And what is the 30-day survival for cases where CPR would be otherwise indicated but are not performed? It is a bit like complaining that jumping out of a burning airplane with a parachute is dangerous. Yes, it is. But jumping out of a parachute, or burning inside, is even more dangerous.
    - bonsai_spool 3mo ago
      > Okay. And what is the 30-day survival for cases where CPR would be otherwise indicated but are not performed? Great question, but it's obviously not possible to answer. I suspect the survival rate won't be 0, and maybe won't even be less than 10%. The point of this whole subtree is that there are interventions that people wouldn't want for themselves because the expected outcome is very poor.
- classichasclass 3mo ago
  "Early" is load-bearing. Even brief delays, just mere minutes, significantly decrease survival or positive outcomes. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010116 https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010... It's important to get people to realize the benefits of early CPR and more people should be trained on how to do it, or else it won't be prompt and the outcomes will be worse. That's what the Red Cross and AHA promulgate to the public, in so many words.
  - lsaferite 3mo ago
    I've never heard the term "load-bearing" used outside of the civil engineering world until the more recent versions of Claude suddenly decided everything was "load-bearing". Did you internalize Claude terminology, use Claude to write/translate your post, or lead Claude into temptation by being the OG? Asking out of genuine curiosity and not at all trying to throw shade.
    - classichasclass 3mo ago
      No. I do use the term.
      - lsaferite 3mo ago
        I'm curious where you picked it up originally. I've been mystified why Claude started using it so much.
        hawaiianbrah 3mo ago
        I’ve been using it in the tech space for many years now, no idea where I picked it up. Also this is the first I’ve heard Claude is using it!
    - switchbak 3mo ago
      "Load bearing beliefs" is a thing in the podcast/YouTube world at a minimum. Perhaps you're not as online as some other folks (probably a good thing!).
- oh_my_goodness 3mo ago
  How has CPR (or CPR data) changed since 2011? What type of medicine do you practice?
  - j-conn 3mo ago
    My only point was that this article shouldn’t be considered authoritative, wanted to put it in perspective for someone surfing hn and just reading the comments The person closest to me was saved by CPR after cardiac arrest (and cooling at the hospital), with no neurological deficits
- clukic 3mo ago
  100%. CPR initiated within 2 minutes of cardiac arrest increases survival rate by 81%. The fact that CPR is rarely initiated so quickly (and thus survival rates are extremely low), says nothing about the efficacy of CPR. In the best cases where CPR is initiated < 2 mins, and AED shock within < 5mins survival rate can be as high as 50%. https://newsroom.heart.org/news/bystander-cpr-up-to-10-minutes-after-cardiac-arrest-may-protect-brain-function?utm_source=chatgpt.com https://newsroom.heart.org/news/bystander-cpr-up-to-10-minut...
  - lostlogin 3mo ago
    I struggle square those numbers with the ones below, showing 11% survival (22% making it to hospital alive). I can’t find a source for it, but I’m told that survival after an arrest in hospital is actually lower, due to the co-morbidities that patients have. https://www.resus.org.nz/assets/OHCA_All_NZ_Feb23.pdf https://www.resus.org.nz/assets/OHCA_All_NZ_Feb23.pdf
    - LorenPechtel 3mo ago
      A big increase in a small number can still be a small number.
    - GoodOldNe 3mo ago
      Cardiac arrest is an incredibly heterogenous condition. A witnessed VF arrest in a young person with an inherited electrical type heart condition who gets compressions and a shock on a gym basketball court can wake up and walk away normal. A 98 year old who codes from sepsis or a fentanyl OD who is profoundly hypoxic or acidemic who gets enough Narcan and CPR to start having a heartbeat again after 15 minutes is very different. The statistics reflect this but you can’t generalize from the general to the specific in this case.
- shellfishgene 3mo ago
  What are the statistics for quality of life after CPR even if it saves the patients life? I think this is more what the article is about.
- LorenPechtel 3mo ago
  Note how the data gets contaminated here. CPR is simply buying time, at best it can delay death in the hope the doctors can do something about whatever caused the heart to quit. Usually they can't. AED is different. Despite what Hollywood would have you believe the shocker does not start your heart and it is never used on a stopped heart. Shocking is about the heart beating ineffectively. It has a chance of actually treating the problem, not merely buying time. If the heart is stopped the AED just sits there and says continue CPR. And people blame it for being defective.
2bitencryption 3mo ago
> It's a very energetic intensive process, it cracks ribs. I feel like lately this is becoming more common knowledge - but still something most people don't realize. Part of it is probably the fact that it's impossible to depict "real" CPR in popular culture (movies, TV shows, etc) unless the production goes to extreme lengths to use a fake dummy. Even on The Pitt (which seems to make a point of being hyper realistic) I've seen them do "fake" CPR with shallow compressions.
- tialaramex 3mo ago
  Yeah, akin to the Gell-mann Amnesia Effect, we notice a few things where we're experts but then forget everything else is likely just as bogus. Apparently one reason "Queen's Gambit" was a big deal was that most pop culture chess isn't just not very good chess (as you might innocently assume), it's literally nonsense. Like, pieces on the wrong squares, illegal moves, even simple continuity errors where pieces move between camera shots. So QG begins scoring points for chess fans when it remembers stuff like the White Queen starts on a White square...
- thejazzman 3mo ago
  so on Lost when Jack is really upset about Charlie, and he beats the shit out of his lifeless body, ... and it worked, did he do real or fake CPR? These comments make it sound very real.
  - stavros 3mo ago
    Fake. You can't have fire without oxygen, but that doesn't mean you can't have oxygen without fire. Breaking someone's ribs doesn't necessarily mean you're performing CPR.
biomattr 3mo ago
If CPR is done right ~10% will walk out of the hospital. But that's a big if! Must be near a trained bystander. AED is much better on shockable rhythms, ~70%. Unfortunately most out-of-hospital cardiac events occur in homes which rarely have access to a device. In 2021, a drone-delivered AED was used to successfully shock a 71-year-old man back into a stable rhythm in Sweden. The drone delivered the AED in just over three minutes from a 911 call. Studying years of emergency drone data back up the anecdotes. The AED gets there 10-15 min ahead of medics and boosts survival 70%.
- vixen99 3mo ago
  AED: automated external defibrillator.
- hobo123 3mo ago
  This is very cool and should become a standard feature at least in reasonably dense populated areas.
MajorTakeaway 3mo ago
MY ex-wife who was a CNA had made it a point to me that she had a DNR. How or where, she never told me. Probably for the best.
Loughla 3mo ago
Do you know what is happening with McConnell? Because the news is everywhere from he's fine to he's dead. Edit: this is not meant to be snarky. This is a real question.
- ggm 3mo ago
  No I have no more information than anyone else. But, even at normal response times he was incapacitated for more than 2-3 minutes before CPR and after that, reportage is divergent with frankly bizarre variances around talking to somebody and talking with somebody.
gcanyon 3mo ago
I have a friend who had a spontaneous pneumothorax. He even wrote a song about it after he recovered. I myself punctured and collapsed both lungs. My thinking is: if there's a reasonable chance I'll survive, go for it. If there's not, stop trying to prolong the inevitable. That said, when I had the accident they told my wife to get there as fast as she could because I was likely not going to make it, and that was thirty years ago. So: if they're confident I'm going to die, don't try to prolong it :-)

djoldman 3mo ago

> Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack... He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. > Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. It's interesting that our laws punish homicide with maximum criminal penalties, but the opposite (keeping someone alive against their wishes) seems to be assault and battery at worst, with much much lighter punishment.

gerdesj 3mo ago
Does the US have the concept of DNR (Do Not Resuscitate)?
- glimshe 3mo ago
  Yes
- djoldman 3mo ago
  Yes. If one lives in the US and feels strongly about it, they should file an Out-of-Hospital DNR and POLST with every local hospital. Also consider wearing or carrying official bracelets/necklaces (varies state to state). I'm neither a lawyer nor a doctor. :)
- netsharc 3mo ago
  There was a "culture war" (the rightwing government intervening due to religious reasons) in the 2000's involving a "DNR"-esque case https://en.wikipedia.org/wiki/Terri_Schiavo_case https://en.wikipedia.org/wiki/Terri_Schiavo_case
  - ButlerianJihad 3mo ago
    Let us not forget https://en.wikipedia.org/wiki/Karen_Ann_Quinlan https://en.wikipedia.org/wiki/Karen_Ann_Quinlan And also https://en.wikipedia.org/wiki/Jahi_McMath_case https://en.wikipedia.org/wiki/Jahi_McMath_case But it is disingenuous to invoke "rightwing government", when a Franciscan friar was sneaking into the hospital trying to feed a starving woman [Terri], who was so hated by her husband that he would take extreme measures to get rid of her. I have found it quite elusive to get a DNR properly executed. I could do all the other Advance Directives from home, and I could get them notarized without issue. But in my state, a DNR must be printed on a special hue of orange paper, and shit, if that isn't the most difficult step... Also there are probably at least 12 facilities where it'd need to be filed, because who knows where the EMTs would haul me off to, around here. There are so many health care systems, not to mention the BH ones, which are quasi-medical.

aaron695 3mo ago

[dead]

jordanpg 3mo ago

Can confirm. Top of the article could be about my dad. Same flavor of cancer and everything.

jrapdx3 3mo ago

I'm a physician, an old one. We're lucky to live as long as we do, but life will end. The article emphasizes the value of dying peacefully. Sure, that's how we want it to be, but we have to make it known to assure it goes that way. Don't know what happens elsewhere, but every time I see a doctor someone asks if I have a signed, notarized directive. Yes, I've done that, but so should everybody else concerned about the issue. I have asked aged patients the same question. More than not the answer is "no". Why haven't you? Various versions of "on my list of things to do". We can't really predict future events, in our own interests best to be prepared. Some will take the hint, more than not, people procrastinate. At least I've done what I can do, but we can't save people from themselves. Maybe people in healthcare are more aware of what's at stake, but everyone has the option to make it as clear as possible their wish (no, their demand) to die in peace.

teiferer 3mo ago
> Why haven't you? It is (mentally) painful to think about that this life is going to end. And even more (mentally) painful to think about the consequences of a (physically) painful end. The mind goes to great lengths to avoid pain. Plus, society doesn't exactly create a culture in which this kind of talk and preparations are encouraged.
voiper1 3mo ago
>At least I've done what I can do, but we can't save people from themselves. Why should doctors NEED to save people from themselves? The default should be what the people in the industry have learned, with full permission to say "For myself, I have written a legally binding document that this is my personal wishes. I suggest you make that decision for your loved one, too." Patients have the ability to ask for more, but there shouldn't be a constant need to save people from inadvertently choosing risky/painful low payoff medical care!
deleted 3mo ago
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____tom____ 3mo ago

On the spectrum or go gentle vs fight, I'd have to say, now is the time is history where "fight" makes the most sense. This is not abstract for me. I have not one, but two forms of cancer. Both were considered incurable when I was diagnosed. Both have treatments now that, IN SOME PEOPLE, lead to remission. I still don't know which group I am, but I'd be dead from either one by now, if I hadn't elected to treat. New treatments, for SOME cancers are literally coming out monthly. So the fact that you can't be cured today, does mean there won't be a better treatment by next year, if you can hang on. I should find out soon on my more aggressive one. Either way, I plan on continuing to try.

hirvi74 3mo ago
Keep fighting the good fight, Internet friend. I look forward to reading your remission comment one day.
sghiassy 3mo ago
Sending good wishes
eth0up 3mo ago
Sending thoughts of remission through the aether. And wishing your tries become success.
hexeater 3mo ago
Hero - keep fighting!
- teiferer 3mo ago
  I think it's exactly this attitude which the article is about. Of course I wish the best to whoever decides to fight. But fighting at any cost isn't the best advice.
deleted 3mo ago
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ComputerPerson 3mo ago

Stratoscope 3mo ago

Title should be corrected to the original: --- How doctors die. It’s not like the rest of us, but it should be --- Note to submitters: Check the title after submitting. If the HN algorithm mangled it as badly as this one, edit it!

Alien1Being 3mo ago

Last week one of my patients with preterminal NYHA Stage IV cardiac failure looked into euthanasia. He found predictably that it is now legal in my country but takes months and formidable legal resources to obtain it. Legalisation of euthanasia has, as everyone in the field warned multiple times, made it much harder to obtain and now requires a lot of time, effort and money. The well meaning, naive proponents of legalisation of euthanasia have actually made things a lot harder for those who want it. The potential legal penalties for not getting the paperwork right, include loss of employment, deregistration and homicide charges. So now virtually no doctor wants to be involved for any amount of money. So I told him how to contact the local palliative care unit when he decides to die, gave him documentation attesting to his preterminal , incurable status and taught him the magic words to almost instantly access that terminal, euthanising, life ending dose of mist. morphine... "I have breathlessness and bone pain" Also told him never again to say the word "euthanasia" to anyone, unless he wants a ride on the endless merry-go-round of legal paperwork. Placing the hands in the abhaya mudra is optional...

cowthulhu 3mo ago
If I’m understanding correctly, it was already quasi-legal through a loophole, but formally legalizing it made the loophole much trickier to use? That does sound frustrating. I hope they simplify the legal rails… having to wait around in pain waiting for multiple rounds of paperwork to clear sounds terrible.
teiferer 3mo ago
> The well meaning, naive proponents of legalisation of euthanasia have actually made things a lot harder for those who want it. In your mind, what should have been done instead of legalizing it?
fhdkweig 3mo ago
> The well meaning, naive proponents of legalisation of euthanasia have actually made things a lot harder for those who want it. That sounds like the actions of a politician who wants to claim they are for something while secretly trying to destroy it. It doesn't seem "well meaning" to me. That's what the US Republicans did to the ObamaCare act.

tpoacher 3mo ago

This article is making a LOT of "convenient" assumptions. For all we know, the more likely scenario is that Charlie, like a sizeable percentage of his doctor peers, was burnt out, tired, and depressed, did not really have an overwhelming (some might say "healthy") desire to survive (in fact, perhaps quite the opposite), and saw the cancer as a non-undignified quick "way out". Doctors (and medical professionals more generally) rank among the highest in occupational risk of mental health disease, especially for things like addiction, alcoholism, generalised anxiety, ptsd, depression and suicide. I have no objection regarding the choice he made, but let's not glorify it as the "natural" thing to do either. This narrative is harmful to people who "do" desire to survive but are scared, which may then prevent them from making a dispassionate decision regarding their care.

LaurensBER 3mo ago
This is an interesting point and the article should definitely take these factors into account. It's indeed very worrying what we ask medical professionals to put themselves through for their jobs. I think we can all agree that having a well rested doctor or nurse would be preferable over a stressed/tired one. The amount of hours and night shifts that (young) doctors have to do and the extreme competitiveness of the field (partly) drives this. I understand that it would drive wages down (somewhat) if we educated more doctors and obviously we shouldn't lower our standards substantially but it seems like everyone involved would benefit from this. A friend of mine, whose a doctor, told me once that the best way to ask for medical advice is to ask the doctor what he/she would recommend for their own sister/brother. Siblings are close enough that he would not want them to suffer unnecessarily but it eliminates the personal factors. Obviously it differs per doctor but in my experience it usually leads to a good conversation about the trade-offs for medical care.
LorenPechtel 3mo ago
Why do you think this was basically a form of suicide? Pancreatic cancer still has a dismal "survival" rate, and I hesitate to even call it "survival" as it's more a matter of not having died yet. He's seen what chemotherapy does to patients, he knows it's trading the horrors of chemo for a bit longer life. That article is 10 years old--pancreatic cancer is still very deadly. No reprieve was coming down the road. False hope generally leads to inferior outcomes.

tomhow 3mo ago

Previously... How Doctors die. It’s not like the rest of us (2016) - https://news.ycombinator.com/item?id=28463482 https://news.ycombinator.com/item?id=28463482 - Sept 2021 (291 comments)

tsoukase 3mo ago

As a doctor, I think we are prepared for our own death (not so much for illness though). Especially during the last days or months we know exactly what's happening. I agree that the less-care-but-less-side-effects way is chosen much more often by doctors for themselves and their close relatives (I personally administered to my mother opioid to accelerate death due to terminal cancer a couple of days before the expected end that would be tortuous). For my end stage patients I advise full palliative analgesic and sedative therapy but usually against futile chemos and intubations. There is a discussion where ICU doctors and oncologists have to take part.

ido 3mo ago
> administered to my mother opioid to accelerate death Isn't that illegal is most countries? Does it not count as doctor assisted suicide?
- codemog 3mo ago
  What are you hoping to get out of asking this question? It sounds like you already know the answer.
  - ido 3mo ago
    I don't know, that's why I'm asking! If I'm in that situation I hope this option is available to me, and want to know what to ask for. If the answer is that it's illegal I'd know I can't ask this directly/explicitly (but maybe there's a "secret handshake" way of asking for it). If it is I'd know I can. I wish no harm to OP.
    - warshinder 3mo ago
      I believe it varies by state but typically must be administered by a doctor or hospice nurse.
    - freedomben 3mo ago
      See https://news.ycombinator.com/item?id=48878167 https://news.ycombinator.com/item?id=48878167 IANAD but have paid close attention to this for the same reasons. When my time comes I plan to let them know I'm in serious pain and prefer pain relief to life extension (though maybe in a more subtle way). I expect most will understand that.

sneak 3mo ago

> They want to be sure, when the time comes, that no heroic measures will happen – that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with cardiopulmonary resuscitation (that’s what happens if CPR is done right). I have been seeing so much anti-LUCAS-machine content on the internet lately; it is far too prevalent to be anything but an astroturfing campaign. From whence this meme?

mimo84 3mo ago

I recently read the book Being Mortal by Atul Gawande, a doctor. He emphasized how terminal care should focus on quality of life instead of attempting to prolong it and making it awful.

alex-moon 3mo ago

Here in the UK there is an ongoing debate happening more or less behind the scenes around the language that should be used for families of patients nearing end of life. The standard question is: Should we "do everything possible" to keep someone alive? The proposed better question is: Should we "allow natural death"? Any doctor understands intimately that these two questions are equivalent. Understandably, the average person doesn't. Why wouldn't you "do everything possible"? In most of these conversations the argument against just doesn't come up.

khalic 3mo ago

I really don’t agree here. The focus should be on combating the observational bias that is the cause of these decisions. The doctors remember the “futile” cares for the patients where it had the worst results. We’re wired to concentrate on the negative outcomes, and doctors are bathing in it.

Sam6late 3mo ago

My mother died last month,I have seen that same costly futile care before when it was performed on my father two decades before, but we had no choice. Both were injected with a dozen drugs syringes and perforated with tubes, hooked up to machines. Although I am somewhat healthy, yet looking at rocking 60 made me contemplate and feel contentment just upon reading about psilocybin for patients dealing with life-threatening diagnoses, end-of-life anxiety (plus a dozen documentaries and 2 on Netflix). Learning about it has offered me relief and lasting drop in existential distress, especially as it helps melt the ego into everything. https://pmc.ncbi.nlm.nih.gov/articles/PMC9833165/ https://pmc.ncbi.nlm.nih.gov/articles/PMC9833165/

devonsolomon 3mo ago

I worked for some years in cancer prevention. Last year, my mom was diagnosed with Stage 4 cancer. My family largely agrees with this article: treatment was a mistake and likely worse than the disease (bar palliative care and a stent). The headline we used in cancer education is about 38% of cancer cases are likely caused and perhaps preventable by modifiable lifestyle factors: Tabbaco, infections, alcohol, UV. Widespread vaccination (HPV, Hep B/C etc) and precision prevention (genetic counseling and preventative interventions) add another layer of preventative opportunity, and could significantly move the needle inclusive of and beyond/above lifestyle factors. This leaves a lot of room for change, but requires a changing of economic incentives and cultural factors: which are incredibly slow moving ships. The next layer is early detection (pre-cancer and early cancer); and technology advancements look promising - multi-cancer blood tests like Galleri and whole-body MRI (Prenuvo, Neko, Midjourney) are scientifically and economically promising, but all commercially ahead of their time. These two additional pots potentially provide another significant opportunity to reduce the burden where the cost-benefit on personal suffering makes sense. I’d add as the last personal suffering cost-benefit promising intervention layer targeted immunotherapy (and perhaps to a lesser extent ADCs/smart-bombs), where many patients enjoy results without bearing equal or exceeding suffering. Though with smart bombs, the maths isn’t as convincing, and with both you’re heading into lower odds bets. Ofcourse, many people are helped by classical chemo, but much of the time (and especially in later stages) you’re hoping to be the exception, and at this point, the population wide experience is in many cancer types net negative. Many people pin there hopes on this last, narrow category of intervention for breakthroughs; and hopefully they come; but likely this hope, attention and capital is misplaced.

TomMasz 3mo ago

As the article points out, CPR really is oversold. I was a volunteer firefighter and did CPR multiple times, none of those people survived. I watched (and listened) as firefighters did CPR on my wife after she had a massive heart attack, hanging on to some hope but knowing deep down it was futile. But they transported her to emergency anyway. I watched my father slowly die from sepsis that began with an infection in a toe. Surgery to improve leg circulation failed and his toe was amputated. The antibiotics not only induced the sepsis but led to a C. difficile infection. His mind deteriorated almost overnight. My mom couldn't make the decision to end care and place him in hospice, so the decision was passed to me. He had made his care wishes clear in writing, so while it was a hard decision, I knew it's what he wanted. He died less than a day later. I'm working on my own care directives so my kids know exactly what to do when it's my time. With luck, they'll be able to ensure those directives are followed.

1970-01-01 3mo ago

I thought this was going to speak to the fact of doctors being overconfident in aviation, to the point of crashing more than any other pilot. I see they're still overconfident. :P https://www.faa.gov/data_research/research/med_humanfacs/oamtechreports/1970s/1971/7109 https://www.faa.gov/data_research/research/med_humanfacs/oam...

rimeice 3mo ago

I don’t think you have to be a doctor to come to this conclusion. After therapy I realised that the most traumatic thing that took the longest to get over wasn’t watching my Dad die, it was watching him suffer through futile attempts to prolong his life by a few days in intensive care. I wish the doctors had been clearer with us about his chances of survival, I wish we had been brave/knowledgable enough to accept that it was the end and I vow never to put my loves ones through that when my time comes.

bonsai_spool 3mo ago
> I wish the doctors had been clearer with us about his chances of survival What would they have done differently from what they actually did?
- rimeice 3mo ago
  I think honestly they shied away from really clearly saying this was the end until a couple of hours before he died when really I believe it was clear at least a few days out. For some reason through their communication, bouncing between different doctors and clearly some overwhelming emotions on our part, we thought he had a chance of coming back from the brink so made some decisions in his behalf I wish we hadn’t.

ezoe 3mo ago

I think I've read the exact thing like 20 or 30 years ago. But I wonder... isn't it US specific local trend where medical bill is ridiculous? There is no way ICU cost 10K USD/day... except in US.

blobcode 3mo ago
ICU costs are quite high in general, often 3-4x a regular bed, and about 5k USD average in countries such as Canada and the UK.

fzeroracer 3mo ago

I can't say I agree, I think it's more about the death's you're exposed to. Doctors get to experience the full brunt of how the medical system treats patients, the good and the bad. So they opt out of it when it's close to their time so they can die a peaceful death. But a peaceful death at home is rarely real in my opinion. My father was pretty badly traumatized by his mother who had oral cancer, got a bit through treatment and then refused to continue. His last days with her were spent as she slowly starved and went through terminal dehydration, barely conscious through the drugs hospice used to try and make the passage easier. It's something we tell ourselves post-hoc to try and make ourselves feel better because they died at home with family. This doesn't mean dying in a hospital is much easier and often family keeps people in a state of semi-torture so that they can have more time. But that I think sometimes we have this 'ideal' of how we want to die, and the reality will always be much messier than that.

NalNezumi 3mo ago

I remember reading this article a few years back, and it left an impression enough that I could retell it (but couldn't find it). Which turned out to be helpful, during/after my mother's passing half year ago. Thanks for sharing it, I can now share it to my siblings. A silver lining that despite the cancer she could leave relatively peacefully. The article & some comments do make me wonder: my mother refused any medication, including any painkillers, for 6 weeks after terminal diagnosis. Only on her last day, when breathing got painful did she accept a fentanyl patch to be administered. She lost her consciousness a few hours later, and less than a day later her breath. I wonder if it was dosed for that (as some form of mercy)

kazinator 3mo ago

> Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died. Life imitating Madame Bovary.

temporary_cat 3mo ago

man, what an article. my father's a surgeon, and my aunt was diagnosed with pancreatic cancer recently. he told me he checked the literature to see that there's a very high mortality rate, and seems to have accepted whats to come. but my aunt and her family is doing the "everything" part. I have a feeling that they're resenting my father for not involving as much as they think he should, and I can see from both angles. I have a feeling that my father would also choose the same path of just retiring and patiently waiting to die in a similar circumstance. I wish both him and people who read this comment a dignified and easy end.

Caius-Cosades 3mo ago

I have had the misfortune of having had to work in a nursing home for a while and if there is such thing as torture nexus then that was it. On average dogs get to have a more dignified manner of passing away than people in nursing home.

afarviral 3mo ago

There are so many bold claims in this article. I think this deserves taking with a grain of salt.