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> 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

> 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.
    - fhdkweig 3mo ago
      > 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 don't think he hated her, he just didn't want to be under the crushing medical debt to keep someone alive who wasn't really alive. And absolutely there was Rightwing government involved. Here is an entire wiki article. https://en.wikipedia.org/wiki/Government_involvement_in_the_Terri_Schiavo_case https://en.wikipedia.org/wiki/Government_involvement_in_the_...
      - ButlerianJihad 3mo ago
        > someone alive who wasn't really alive. Wow what a completely horrible and deliberate misunderstanding of the facts. I hope that if you're ever in a state where all it takes to keep you alive is food and water, that people continue giving food and water to you, rather than seeking to starve you to death. Because someone who eats and drinks is alive, usually by definition, and what her husband sought was to kill her off, because her "aliveness" wasn't "useful" to anyone, and in fact was an inconvenience to him and other people. Nobody, at the time or since, said that Schiavo "wasn't really alive" but rather, some people wanted her dead, and they wanted that boundary of "ordinary life-sustaining care" to be moved so that it didn't include food and water, administered into her stomach.
delichon 3mo ago
There is a huge unspoken blind spot for a terminal hospice patient. The medicine cabinet just opens up. My dad asked the doctor exactly how much of what he shouldn't take if he didn't want a quick easy death, and the doctor just told him. He didn't end up using it but it was a comfort to him.
- Loughla 3mo ago
  The amount of morphine available to the patients on hospice that I have known has made it very clear what the actual intent of those scripts is. Granted, my sample size of 6 isn't great, and 3 were in terrible pain so it made sense for them, but they had ALL the opiates. . . One had liquid injectable morphine in case he couldn't swallow. He had no issues with swallowing and wasn't in pain. I wanted to ask the doctor if the intent was to allow a calm end, but chickened out.
  - DANmode 3mo ago
    Open secret. Cowardice of the system, society, that doesn’t allow practitioners to discuss this. Leads to scary grey areas, actually.
    - lostlogin 3mo ago
      > Cowardice of the system, society, that doesn’t allow practitioners to discuss this. This depends on where one lives. Where I am (New Zeland), the arguments getting it into law were pretty grim.
      - DANmode 3mo ago
        Serious stuff is serious! Ignoring addressing it doesn’t make it go away - just forces it into the shadows.
        lostlogin 3mo ago
        Exactly. Abortion being the example that immediately comes to mind.
Simulacra 3mo ago
[flagged]
- croes 3mo ago
  Aren’t that contradicting actions
- Xorakios 3mo ago
  Like many older people I know, my notarized DNR, provided by and on file with my insurance company, local hospital, primary doctor, and medical power of attorney, includes standard language permitting organ harvesting.
  - Loughla 3mo ago
    The step that a lot of people miss is letting their family know their wishes as well in very clear and strong language. Don't forget to do that.
- deleted 3mo ago
  [deleted]
- denkmoon 3mo ago
  These ideas seem to be at odds with one another. I'm reasonably sure you can't harvest organs from a resuscitated person in a vegetative state, coma, severely brain damaged, whatever.
  - wildzzz 3mo ago
    Do you mean technically or legally? Legally you need to be dead for the hospital to recover organs. But technically, the amount of time you need to be without oxygen to go into a persistive vegetative state is much less than the viability window of your organs. The time between death and viable organ recovery varies on the organ itself and how soon the body was chilled. Heart and lungs must be transplanted within 4-6 hours but other organs and tissue can last much longer. It also depends on how you die: starving to death several days after having your feeding tube removed may make your organs unviable but dying shortly after being removed from a ventilator could still produce viable organs.
ourmandave 3mo ago
This reminds me of an interview with neurosurgeon and author Henry Marsh who had prostate cancer. He described how he's arranged to end his own life should he get alzheimer's or dementia as he didn't want to waste away. But he explained that he has access to knowledge and things ordinary people don't.
- dj_gitmo 3mo ago
  I looked into this recently and it seems like it is basically impossible to pre-arrange assisted suicide for alzheimer's or dementia. Even in countries which allow death with dignity. I find it very strange because it’s so common and I’m sure many people would prefer DWD in those circumstances.
  - awakeasleep 3mo ago
    To me, it doesn’t seem strange at all because I’m thinking about how complicated the system would have to be to carry out such a directive.
  - parpfish 3mo ago
    shouldn't finding a way to kill yourself be pretty easy, even without legal DWD? you can overdose on OTC meds, or get a knife, or (in America) pick up a gun.
    - lostlogin 3mo ago
      > DWD? you can overdose on OTC meds, or get a knife, or (in America) pick up a gun. Someone with sound mind is likely to worry about what’ll be left for loved ones to clean up. And someone suffering dementia/Alzheimer’s may well forget the plan.
    - throwaway173738 3mo ago
      None of these things guarantee death and if you fail they come with some awful complications. Overdosing on Morphine is probably the easiest, most humane way to die.
    - 3mo ago
SiempreViernes 3mo ago
> 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 Is it? One action is reversible and the other is not. And it's not very rare that moral systems treat an action and its opposite in different ways (cooperating with police vs hindering, rendering aid vs withholding aid, etc).
- tsss 3mo ago
  It's not reversible. You can't undo the suffering that has been inflicted on the patient.
teiferer 3mo ago
> 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. It's not just the punishment but also how it's investigated / reported / charged. If somebody dies and there is just the slightest hint that another person was involved, by neglect or active help, police gets going right away. If somebody died "of natural causes" while suffering, or isn't even dead, just suffering, who is going to bring the charges? The suffering person won't. They are often unable to do so, that's why they are suffering in the first place. It's just an accepted part of being old and dying. Not even to speak of religious grounds (some of which consider suffering just being part of god's will).

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.
  - fhdkweig 3mo ago
    > 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 don't think he hated her, he just didn't want to be under the crushing medical debt to keep someone alive who wasn't really alive. And absolutely there was Rightwing government involved. Here is an entire wiki article. https://en.wikipedia.org/wiki/Government_involvement_in_the_Terri_Schiavo_case https://en.wikipedia.org/wiki/Government_involvement_in_the_...
    - ButlerianJihad 3mo ago
      > someone alive who wasn't really alive. Wow what a completely horrible and deliberate misunderstanding of the facts. I hope that if you're ever in a state where all it takes to keep you alive is food and water, that people continue giving food and water to you, rather than seeking to starve you to death. Because someone who eats and drinks is alive, usually by definition, and what her husband sought was to kill her off, because her "aliveness" wasn't "useful" to anyone, and in fact was an inconvenience to him and other people. Nobody, at the time or since, said that Schiavo "wasn't really alive" but rather, some people wanted her dead, and they wanted that boundary of "ordinary life-sustaining care" to be moved so that it didn't include food and water, administered into her stomach.

delichon 3mo ago

There is a huge unspoken blind spot for a terminal hospice patient. The medicine cabinet just opens up. My dad asked the doctor exactly how much of what he shouldn't take if he didn't want a quick easy death, and the doctor just told him. He didn't end up using it but it was a comfort to him.

Loughla 3mo ago
The amount of morphine available to the patients on hospice that I have known has made it very clear what the actual intent of those scripts is. Granted, my sample size of 6 isn't great, and 3 were in terrible pain so it made sense for them, but they had ALL the opiates. . . One had liquid injectable morphine in case he couldn't swallow. He had no issues with swallowing and wasn't in pain. I wanted to ask the doctor if the intent was to allow a calm end, but chickened out.
- DANmode 3mo ago
  Open secret. Cowardice of the system, society, that doesn’t allow practitioners to discuss this. Leads to scary grey areas, actually.
  - lostlogin 3mo ago
    > Cowardice of the system, society, that doesn’t allow practitioners to discuss this. This depends on where one lives. Where I am (New Zeland), the arguments getting it into law were pretty grim.
    - DANmode 3mo ago
      Serious stuff is serious! Ignoring addressing it doesn’t make it go away - just forces it into the shadows.
      - lostlogin 3mo ago
        Exactly. Abortion being the example that immediately comes to mind.

Simulacra 3mo ago

[flagged]

croes 3mo ago
Aren’t that contradicting actions
Xorakios 3mo ago
Like many older people I know, my notarized DNR, provided by and on file with my insurance company, local hospital, primary doctor, and medical power of attorney, includes standard language permitting organ harvesting.
- Loughla 3mo ago
  The step that a lot of people miss is letting their family know their wishes as well in very clear and strong language. Don't forget to do that.
deleted 3mo ago
[deleted]
denkmoon 3mo ago
These ideas seem to be at odds with one another. I'm reasonably sure you can't harvest organs from a resuscitated person in a vegetative state, coma, severely brain damaged, whatever.
- wildzzz 3mo ago
  Do you mean technically or legally? Legally you need to be dead for the hospital to recover organs. But technically, the amount of time you need to be without oxygen to go into a persistive vegetative state is much less than the viability window of your organs. The time between death and viable organ recovery varies on the organ itself and how soon the body was chilled. Heart and lungs must be transplanted within 4-6 hours but other organs and tissue can last much longer. It also depends on how you die: starving to death several days after having your feeding tube removed may make your organs unviable but dying shortly after being removed from a ventilator could still produce viable organs.

ourmandave 3mo ago

This reminds me of an interview with neurosurgeon and author Henry Marsh who had prostate cancer. He described how he's arranged to end his own life should he get alzheimer's or dementia as he didn't want to waste away. But he explained that he has access to knowledge and things ordinary people don't.

dj_gitmo 3mo ago
I looked into this recently and it seems like it is basically impossible to pre-arrange assisted suicide for alzheimer's or dementia. Even in countries which allow death with dignity. I find it very strange because it’s so common and I’m sure many people would prefer DWD in those circumstances.
- awakeasleep 3mo ago
  To me, it doesn’t seem strange at all because I’m thinking about how complicated the system would have to be to carry out such a directive.
- parpfish 3mo ago
  shouldn't finding a way to kill yourself be pretty easy, even without legal DWD? you can overdose on OTC meds, or get a knife, or (in America) pick up a gun.
  - lostlogin 3mo ago
    > DWD? you can overdose on OTC meds, or get a knife, or (in America) pick up a gun. Someone with sound mind is likely to worry about what’ll be left for loved ones to clean up. And someone suffering dementia/Alzheimer’s may well forget the plan.
  - throwaway173738 3mo ago
    None of these things guarantee death and if you fail they come with some awful complications. Overdosing on Morphine is probably the easiest, most humane way to die.
  - 3mo ago

SiempreViernes 3mo ago

> 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 Is it? One action is reversible and the other is not. And it's not very rare that moral systems treat an action and its opposite in different ways (cooperating with police vs hindering, rendering aid vs withholding aid, etc).

tsss 3mo ago
It's not reversible. You can't undo the suffering that has been inflicted on the patient.

teiferer 3mo ago

> 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. It's not just the punishment but also how it's investigated / reported / charged. If somebody dies and there is just the slightest hint that another person was involved, by neglect or active help, police gets going right away. If somebody died "of natural causes" while suffering, or isn't even dead, just suffering, who is going to bring the charges? The suffering person won't. They are often unable to do so, that's why they are suffering in the first place. It's just an accepted part of being old and dying. Not even to speak of religious grounds (some of which consider suffering just being part of god's will).