11 ms·

How doctors choose to die (2012)

161 points by arfliw 12y ago

cup 12y ago
This has been posted a number of times in different iterations on HN. I'm curious why the user group here has such a fascination with medical doctors.
- Afforess 12y ago
  It has nothing to do with a fascination with doctors and everything to do with a fascination with death. Death today in first world countries is so far removed from what death ought to be, that it's almost unrecognizable. Dying in a sterile white room, in a building that houses thousands of sick people, with bad food, busy nurses, and often alone, is what I'd imagine a dystopian future from a Hollywood movie like Soylent Green would look like, but instead it's what Death looks like today. There is no need for this, and if most of us were asked in advance, few would choose it as the outcome. Yet very few people have living wills created, nor plans communicated with close family for these circumstances. You can't avoid Death, it happens to everyone. So it's bizarre why so few people plan for the only truly predictable event in their entire life.
  - sago 12y ago
    To be fair, in Soylent Green you died by opting for assisted suicide in an environment with good food, beautiful views and classical music. I'll go with that over a lot of other options. I'll swap the environment for home, and be surrounded by family, but yeah. Soylent Green was hardly the worst dystopia, I think.
- sho_hn 12y ago
  Engineers have a peculiar relationship with doctors. When they have need of one, and the doctor decides on a treatment plan for them, they think about the complexity of the problem space the doctor had to navigate to reach that decision. They wish the doctor would chart the parameter space for them, so they can agree or disagree with the choice in an informed manner, and have more of a clue about the competence of the doctor. This is usually not what happens, not to their satisfaction anyway, and it's deeply unsettling having to trust rather than know when it comes to something that appears so much like engineering on the surface. An alternative title for this article might be "what doctors really think", and thus strikes to the heart of this issue.
  - afarrell 12y ago
    I'm saving that paragraph. That was a fantastic explaination.
  - shiven 12y ago
    Or, as a (former) doctor, I love telling my engineer friends: Intuition can't be formalized. Part of the reason simply being the "system level" thinking that has to be developed, practiced and honed by any doctor worth his/her salt. And when you think of it, even with our current understanding of the human organism and the phenomenon called life, we are primarily working using 'heuristics', barely glimpsing the ultra-complex jigsaw that makes everything tick. Someday, when the ken of this knowledge is complete, we may be able to formalize the logic, albeit, the 'computer' it runs on, may well be as complex as our own brains!
    - im2w1l 12y ago
      Want to bet? I'll bet that in 20 years we will have programs that can diagnose a patient and explain how it came to its conclusions.
  - cesarbs 12y ago
    I had a doctor back in my home country who was fascinating. He would give me hard facts about everything and he would explain all the reasoning behind his recommendations with numbers, probabilities, etc., putting everything down on paper. I loved being treated by that guy. I wish every doctor were like this. Here in the US I've only so far had the tipical experience of: 1) Telling my symptoms. 2) Observing that half of what I'm saying is being ignored - this pisses me off because I'm very obsessive about my health, so any interested doctor can hear me give them extremely accurate descriptions of what I'm feeling, and how those things relate to daily activities, eating habits, exercise, other symptoms and a number of other things. 3) Being diagnosed with something I'm very sure I don't have (and I'm right most of the time). It's usually something super generic, like "upper respiratory infection".
- arfliw 12y ago
  I can only say why I shared it here: I thought it would be of interest to hackers. That's what these doctors are doing...hacking the end of life.
  - fsloth 12y ago
    Thanks for sharing. Reading and thinking about this makes me feel rather relieved about the 'Do Not Resusciate' status a close person to me had before dying.
  - shiggerino 12y ago
    I once had a conversation with some ER nurses about the best way to commit suicide. They took indeed a very hacker-like approach to the problem. Some of the suggestions were insulin or potassium overdoses. Maybe not what you'd expect as a layperson. It seems like the go-to drug for terminally ill patients is often hoarded morphine or morphine derivatives, but death is slow and drawn-out, and someone might get the brilliant idea to resuscitate you, leaving you brain damaged and worse off than the situation you tried to escape from.
mct 12y ago
A few years ago, I heard an NPR interview with a doctor who's friend was terminally ill. Rather than opt for treatment, the friend spent his remaining time living with his doctor friend. He died a few months later. The doctor said that this is how she wanted to die, too. I've tried a number of times to find the story, but I haven't been able to. Does it ring a bell for anyone? I'd love to listen to it again. Thanks!
- berberous 12y ago
  That does not specifically ring a bell, but Radio Lab did a piece on this topic once. Perhaps it's in there: http://www.radiolab.org/story/262588-bitter-end/ http://www.radiolab.org/story/262588-bitter-end/
screature2 12y ago
Can't speak for other people, but the fascination for me is a combination of decisions that are difficult and universal and then watching to see how subject matter experts (who view this stuff on a day to day basis) choose for themselves. I think this invariably results in deeply moving meditations on mortality and dignity from both sides of the table (care provider and patient). Or maybe I'm just suffering a recency bias from this: http://med.stanford.edu/news/all-news/2015/03/stanford-neurosurgeon-writer-paul-kalanithi-dies-at-37.html http://med.stanford.edu/news/all-news/2015/03/stanford-neuro...
- deleted 12y ago
  [deleted]
- hkmurakami 12y ago
  There's also a factor of compliance and regulation that affects what doctors are able to say to their patients.
jimt67 12y ago
I thought this was thoughtful and well written but all I see is anecdote...there is no data presented that MDs choose different options than non-MD patients.
- FireBeyond 12y ago
  Adding to the anecdote, I'm a paramedic who has also opted for 'no heroic measures'. Even with CPR survival rates in this county being amongst the highest in the country.
  - deleted 12y ago
    [deleted]
  - gr3yh47 12y ago
    Is breaking of the ribs really a requirement of CPR done correctly? My understanding was that it is possible for ribs to break but by no means a requirement of correct CPR as the article implies.
    - FireBeyond 12y ago
      It depends. Depending on the age of the person and the fragility of the bones. It's not a "requirement" in any sense, more "if it's not a risk, you're not going deep enough" - typical standards call for 1/3 to 1/2 the chest depth. As often as that - it's much more (almost guaranteed) that you'll tear the cartilage between the ribs at the front.
- arfliw 12y ago
  Do you have data disproving the anecdotes?
  - jimt67 12y ago
    I don't, but when you title an article "How DOCTORS choose to die" (caps added for emphasis) you are making a generalization and supporting it with anecdote. I realize "Doctors' death stories" might be less attention-grabbing but more accurate. I did enjoy the article -- it resonated with me, but I still don't know if doctors choose to die any differently than the rest of us.
sago 12y ago
This is anecdotal evidence from a small (2) sample. But not all doctors die without treatment at home. Some (many?) are aware of the drugs they need to hasten their demise in a way that minimises their suffering. One doctor I discussed this with said that assisted suicide, in a very limited and measured way, isn't uncommon, if you know what to look for. As someone with a degenerative incurable condition, I'd like the option of being able to make informed decisions about the end of my life, beyond just refusing treatment. Because spending years dying of starvation (as MS campaigner Debbie Purdy recently did, because she was unable to cope with her symptoms, and there was no other legal recourse to help her die), doesn't fill me with excitement. We have an insane attitude to death in our culture at the moment. We seem to want to find any way to avoid the fact that being alive has a 100% mortality rate. I think our collective attitude needs to change. And the more articles like this the better.
- seanmcdirmid 12y ago
  My mom suffered from MS here entire life, and a few years ago left us on her own terms (with the help of some pills) before the age of 60. I don't blame her of course. I also have no idea if she had any help from a doctor or not.
- themartorana 12y ago
  It's really hard to change perceptions about death when it requires considering one's own mortality. It is in this only that I understand the desperate quest for religion. The idea of going dark forever is terrifying to me, and considering I'm pretty much an atheist, I don't have much hope of anything else. When people ask me if I'm religious, I usually tell them I'm hopeful that I'm proven wrong. I know we all die. I know our lives on a cosmic scale are infinitesimal. But even I - as rational as I am, am extremely scared of facing that reality head on. So convincing the entire nation/world to do so... Well, good luck with that.
  - sago 12y ago
    It doesn't frighten me. It won't go dark forever. Just as there was no 13.5bn years of darkness before I was born. There will be no qualia of time. I think attitudes are changing. The campaign to be able to determine how and when we die is shaping up to be a significant battle for a fundamental civil right. I think we'll win it. Whether it is soon enough for my wife to avoid threat of prosecution if she is with me when I choose to act, I don't know. I suspect not.
shazad 12y ago
Atul Gawande, who's written extensively on end of life issues, had an excellent one hour Frontline special that covered the same topic. I highly recommend watching it if you're interested at all in how terminal illness and dying are handled in the United States today: http://www.pbs.org/wgbh/pages/frontline/being-mortal/ http://www.pbs.org/wgbh/pages/frontline/being-mortal/
- quickpost 12y ago
  His book on the same topic is absolutely enlightening and surprisingly enjoyable to read, despite the sobering topics. Being Mortal. http://www.amazon.com/Being-Mortal-Medicine-What-Matters/dp/0805095152/ http://www.amazon.com/Being-Mortal-Medicine-What-Matters/dp/...
sandworm 12y ago
It isn't just how they die. Similar articles could be written on "How doctors loose weight", "How doctors pick their doctors" or "What do doctors do when their kids are sick". Insider knowledge and the education to effectively employ that knowledge always has advantages. I do take issue with the concept that these docs are dieing "without treatment". They get treatment. They are diagnosed (a big deal) and have ready access to a host of pain management drugs. Having a full understanding of your condition, along with the knowledge that any pain can and will be managed very quickly, is a massive stress reduction. That's a form of treatment imho.
deleted 12y ago
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jrapdx3 12y ago
When facing terminal illness, doctors probably differ little from comparably educated subsets of the population. I don't know of studies specific to physicians, but my guess is quality of life is a priority that shapes decisions about treatment for life-threatening conditions. After decades in practice, doctors have faced death of patients many times. It's not an experience one ever really gets used to. As a result, doctors tend to be realists about illness and its likely outcome. It's no surprise that doctors might choose "death with dignity". Oregon, where I live, was the first state in the US to pass a law legalizing physician assisted suicide. The Death with Dignity Act went into effect in 1997. Studies have consistently shown that the leading motivations among those requesting lethal prescriptions are the desire to maintain independence and minimize reduction of QOL. Comprehensive data/stats related to DWDA can be downloaded--the most recent report (2014) is here-- http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf http://public.health.oregon.gov/ProviderPartnerResources/Eva... Additional info is available-- http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx http://public.health.oregon.gov/ProviderPartnerResources/Eva...
mytochar 12y ago
I'm a little frustrated with this article, but not for the reasons in the article. The doctors were angry at their patients' family members for putting them through the suffering; but, ... that form of suffering is just where medicine is right now. Medicine is evolving, and growing; and, it's that desire to keep living and to keep those around you living, and to improve their well-being that has, in part, grown our medical abilities to the point they are now. It feels like some of those improvements that, right now only provide a '15% chance of survival, and include pain', will be the stepping stones for 20, 30, 80 or 90% chance of survival, with varying levels of pain, including 0. The article seemed to suggest that the doctors didn't approve of those intermediate steps, but ... those are the steps medicine takes, aren't they? I dunno. I respected the rest of the article. That part of it bothered me.
- dragontamer 12y ago
  It isn't the doctor's job to improve medicine, it is a researcher's job. Doctors can only prescribe to you the 15% chance of survival, knowing that there's no greater benefit to medicine. They're too busy seeing patients to improve medicine.
  - mytochar 12y ago
    I'm not sure this is accurate, especially in the case of cancers. Doctors were part of the studies with at least one person I know.
marincounty 12y ago
There's one thing they left out of the article. Yes, we are all going to get sick, and eventually die. Doctors--know the expected survival rates. Doctors do seem to end up with the right medications to really make those last days comfortable, or take the right amout and overdose properly? Now, their patients, especially the poor, stereotyped, etc. are sent home, and when a doctor feels like they need Hospice, they give their approval. I had a poor friend die. It was obvious he only had a few months left, but the doctor wouldn't o.k. Hospice? We went to two clinics, and a pain clinic and neither would give him the medications (Opioids and Benzodiazepines) he needed. One pain clinic(noted one of the better ones--in San Francisco) offered to cut some nerves?(I still don't know what these Blow Hards wanted to cut.) Why didn't he get the right medications; well in the states we assume everyone is going to abuse drugs. It's just getting worse. Doctors are not taking away pain. O.K., but once you have Hospice, everything is fine these fine? Doctors are trained in Pallitive care--if you get lucky. My experience watching my father die of liver cancer was a week of Hell. Hs last words to me before he went onto one of his last comas was "Son--when will this end?" Yea--no shit! The nurse finally came around. She then let my sister manipulate his medications which made his discomfort even worse.(my sister thought he should spend more time with his grand kids, and she wanted him to give her more things?) There I said it. Yea, she's a piece of work. I know this. When I am given that diagnosis of death. I used to think I would go to the bad part of town and buy smack, crack, whatnot, but as I've gotten older and I don't have the fight in me like I did in my 30's; I will probally just suffer through the agony of death like my father endured? Or, I might do what Robin Williams felt he had to do? Robin's wife said she was glad he picked up his ipad when he walked by her. She said, Robin hadn't watched tv, nor went on the Internet for the last six months. Robin was found in his stepson's bedroom with a belt around his neck. A towel was wrapped around the belt. I'm assuming to make the suicide more comfortable? Crude knife marks on his wrists--from a pocket knife. An ipad was found near the body with websites open to the the various side effects of the drugs he was given. I don't know all the drugs he was given, but they found a bottles of Seroquil? and a drug used to help with the neurological disorder he had. Why did I repeat this story. Because this is how we are forced to die in the United States. I don't know why Robin committed suicide. He sounded like he was suffering for a long time, on many levels? I don't know if the prescription drugs he was taking made things worse? Either way, he shouldn't have had to die like this. I'll pass this along too. Don't think suicide is easy. I knew a guy who tried to blow his head off with a shot gun. He blew his frontal cortex off, and spent the next 30 years paralized in a rest home. He died of a lung infection. I didn't know him personally. I worked for the Cororners office at the time, and picked up hs body. Enough, I feel sick from even writing about this gruesome stuff, but nothing changes. Doctors should treat the pain of their patients, and the government shoud not harass them. And we need a "right to die with dignity" law like Oregon passed. They passed it a few years ago, and very few decided to use the kit. Most decided to go naturally, but it must be reassuring knowing you have an alternative? I yacked on, but it's something I think about often.
hippiefahrzeug 12y ago
This reminded me of an article I've read a long time ago which had a really strong impact on me. I've just found it by googling a couple of words that were still in my head after all these years. Here it is (probably not where I originally read it): http://www.nbcnews.com/id/21643646/ns/health-behavior/t/what-we-learn-dying/#.VRJtuDTF-l0 http://www.nbcnews.com/id/21643646/ns/health-behavior/t/what...
- rckrd 12y ago
  Fantastic and relevant read. This was surprisingly well written for an NBC or Men's Health article for those who are skeptical.
ColinWright 12y ago
And the bowl of petunias said: Oh no, not again. For those interested in the collective wisdom of the HN community, here are some previous discussions: https://news.ycombinator.com/item?id=3313570 https://news.ycombinator.com/item?id=3313570 : 1206 days ago | 177 comments https://news.ycombinator.com/item?id=4865742 https://news.ycombinator.com/item?id=4865742 : 841 days ago | no comments https://news.ycombinator.com/item?id=5017104 https://news.ycombinator.com/item?id=5017104 : 807 days ago | no comments https://news.ycombinator.com/item?id=5104430 https://news.ycombinator.com/item?id=5104430 : 790 days ago | 94 comments https://news.ycombinator.com/item?id=6040804 https://news.ycombinator.com/item?id=6040804 : 618 days ago | 1 comment https://news.ycombinator.com/item?id=6767385 https://news.ycombinator.com/item?id=6767385 : 489 days ago | no comments https://news.ycombinator.com/item?id=7446014 https://news.ycombinator.com/item?id=7446014 : 368 days ago | 2 comments
- arfliw 12y ago
  While that certainly is an intimidating set of links you have there, only two of those have any discussion -- one over two years ago, the other nearly four years ago.
  - ColinWright 12y ago
    Indeed - has anything changed? If not, then those discussions are still relevant, and there would be value in skimming them rather than simply repeating all the points again. If so, then it would be of value to see what has changed, possibly by reading the previous discussions. Perhaps the mood of the audience has changed, perhaps the general opinions of the HN community have shifted. Either way, being aware of the past is of value. Those who cannot remember the past are condemned to repeat it. -- George Santayana EDIT: People often misunderstand these back-links. They are not intended to scold people for submitting things that have been submitted before. On the contrary, I believe some things should re-surface from time to time, bringing them back either for the informing of the newer community members, or for re-evaluation in case things have moved on and should be re-considered. My main concern and motivation is that previous contributions should not be wasted.
mattlutze 12y ago
I had a conversation about this with a friend yesterday. What I would like to understand, is what the difference is between one incurable terminal condition and the next is, and why we're culturally stuck on trying to divide things up into "approved" and "not-approved" categories. Death happens for everyone. Most everyone, if they make it to very old age, will have degenerated physically and mentally from where they once were. I wonder, if our sympathies are telling us to consider whether a person with X condition should be allowed to end their life, whether that same thought process shouldn't consider all end-of-life conditions to be equal, given their shared terminality and expectation of degeneration. Or, on the flip side, should we think terminality and expectation of degeneration in these cases is not enough, whether it is appropriate to accept it in this subset of cases.
deleted 12y ago
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161 points by arfliw 12y ago

cup 12y ago

This has been posted a number of times in different iterations on HN. I'm curious why the user group here has such a fascination with medical doctors.

Afforess 12y ago
It has nothing to do with a fascination with doctors and everything to do with a fascination with death. Death today in first world countries is so far removed from what death ought to be, that it's almost unrecognizable. Dying in a sterile white room, in a building that houses thousands of sick people, with bad food, busy nurses, and often alone, is what I'd imagine a dystopian future from a Hollywood movie like Soylent Green would look like, but instead it's what Death looks like today. There is no need for this, and if most of us were asked in advance, few would choose it as the outcome. Yet very few people have living wills created, nor plans communicated with close family for these circumstances. You can't avoid Death, it happens to everyone. So it's bizarre why so few people plan for the only truly predictable event in their entire life.
- sago 12y ago
  To be fair, in Soylent Green you died by opting for assisted suicide in an environment with good food, beautiful views and classical music. I'll go with that over a lot of other options. I'll swap the environment for home, and be surrounded by family, but yeah. Soylent Green was hardly the worst dystopia, I think.
sho_hn 12y ago
Engineers have a peculiar relationship with doctors. When they have need of one, and the doctor decides on a treatment plan for them, they think about the complexity of the problem space the doctor had to navigate to reach that decision. They wish the doctor would chart the parameter space for them, so they can agree or disagree with the choice in an informed manner, and have more of a clue about the competence of the doctor. This is usually not what happens, not to their satisfaction anyway, and it's deeply unsettling having to trust rather than know when it comes to something that appears so much like engineering on the surface. An alternative title for this article might be "what doctors really think", and thus strikes to the heart of this issue.
- afarrell 12y ago
  I'm saving that paragraph. That was a fantastic explaination.
- shiven 12y ago
  Or, as a (former) doctor, I love telling my engineer friends: Intuition can't be formalized. Part of the reason simply being the "system level" thinking that has to be developed, practiced and honed by any doctor worth his/her salt. And when you think of it, even with our current understanding of the human organism and the phenomenon called life, we are primarily working using 'heuristics', barely glimpsing the ultra-complex jigsaw that makes everything tick. Someday, when the ken of this knowledge is complete, we may be able to formalize the logic, albeit, the 'computer' it runs on, may well be as complex as our own brains!
  - im2w1l 12y ago
    Want to bet? I'll bet that in 20 years we will have programs that can diagnose a patient and explain how it came to its conclusions.
- cesarbs 12y ago
  I had a doctor back in my home country who was fascinating. He would give me hard facts about everything and he would explain all the reasoning behind his recommendations with numbers, probabilities, etc., putting everything down on paper. I loved being treated by that guy. I wish every doctor were like this. Here in the US I've only so far had the tipical experience of: 1) Telling my symptoms. 2) Observing that half of what I'm saying is being ignored - this pisses me off because I'm very obsessive about my health, so any interested doctor can hear me give them extremely accurate descriptions of what I'm feeling, and how those things relate to daily activities, eating habits, exercise, other symptoms and a number of other things. 3) Being diagnosed with something I'm very sure I don't have (and I'm right most of the time). It's usually something super generic, like "upper respiratory infection".
arfliw 12y ago
I can only say why I shared it here: I thought it would be of interest to hackers. That's what these doctors are doing...hacking the end of life.
- fsloth 12y ago
  Thanks for sharing. Reading and thinking about this makes me feel rather relieved about the 'Do Not Resusciate' status a close person to me had before dying.
- shiggerino 12y ago
  I once had a conversation with some ER nurses about the best way to commit suicide. They took indeed a very hacker-like approach to the problem. Some of the suggestions were insulin or potassium overdoses. Maybe not what you'd expect as a layperson. It seems like the go-to drug for terminally ill patients is often hoarded morphine or morphine derivatives, but death is slow and drawn-out, and someone might get the brilliant idea to resuscitate you, leaving you brain damaged and worse off than the situation you tried to escape from.

mct 12y ago

A few years ago, I heard an NPR interview with a doctor who's friend was terminally ill. Rather than opt for treatment, the friend spent his remaining time living with his doctor friend. He died a few months later. The doctor said that this is how she wanted to die, too. I've tried a number of times to find the story, but I haven't been able to. Does it ring a bell for anyone? I'd love to listen to it again. Thanks!

berberous 12y ago
That does not specifically ring a bell, but Radio Lab did a piece on this topic once. Perhaps it's in there: http://www.radiolab.org/story/262588-bitter-end/ http://www.radiolab.org/story/262588-bitter-end/

screature2 12y ago

Can't speak for other people, but the fascination for me is a combination of decisions that are difficult and universal and then watching to see how subject matter experts (who view this stuff on a day to day basis) choose for themselves. I think this invariably results in deeply moving meditations on mortality and dignity from both sides of the table (care provider and patient). Or maybe I'm just suffering a recency bias from this: http://med.stanford.edu/news/all-news/2015/03/stanford-neurosurgeon-writer-paul-kalanithi-dies-at-37.html http://med.stanford.edu/news/all-news/2015/03/stanford-neuro...

deleted 12y ago
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hkmurakami 12y ago
There's also a factor of compliance and regulation that affects what doctors are able to say to their patients.

jimt67 12y ago

I thought this was thoughtful and well written but all I see is anecdote...there is no data presented that MDs choose different options than non-MD patients.

FireBeyond 12y ago
Adding to the anecdote, I'm a paramedic who has also opted for 'no heroic measures'. Even with CPR survival rates in this county being amongst the highest in the country.
- deleted 12y ago
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- gr3yh47 12y ago
  Is breaking of the ribs really a requirement of CPR done correctly? My understanding was that it is possible for ribs to break but by no means a requirement of correct CPR as the article implies.
  - FireBeyond 12y ago
    It depends. Depending on the age of the person and the fragility of the bones. It's not a "requirement" in any sense, more "if it's not a risk, you're not going deep enough" - typical standards call for 1/3 to 1/2 the chest depth. As often as that - it's much more (almost guaranteed) that you'll tear the cartilage between the ribs at the front.
arfliw 12y ago
Do you have data disproving the anecdotes?
- jimt67 12y ago
  I don't, but when you title an article "How DOCTORS choose to die" (caps added for emphasis) you are making a generalization and supporting it with anecdote. I realize "Doctors' death stories" might be less attention-grabbing but more accurate. I did enjoy the article -- it resonated with me, but I still don't know if doctors choose to die any differently than the rest of us.

sago 12y ago

This is anecdotal evidence from a small (2) sample. But not all doctors die without treatment at home. Some (many?) are aware of the drugs they need to hasten their demise in a way that minimises their suffering. One doctor I discussed this with said that assisted suicide, in a very limited and measured way, isn't uncommon, if you know what to look for. As someone with a degenerative incurable condition, I'd like the option of being able to make informed decisions about the end of my life, beyond just refusing treatment. Because spending years dying of starvation (as MS campaigner Debbie Purdy recently did, because she was unable to cope with her symptoms, and there was no other legal recourse to help her die), doesn't fill me with excitement. We have an insane attitude to death in our culture at the moment. We seem to want to find any way to avoid the fact that being alive has a 100% mortality rate. I think our collective attitude needs to change. And the more articles like this the better.

seanmcdirmid 12y ago
My mom suffered from MS here entire life, and a few years ago left us on her own terms (with the help of some pills) before the age of 60. I don't blame her of course. I also have no idea if she had any help from a doctor or not.
themartorana 12y ago
It's really hard to change perceptions about death when it requires considering one's own mortality. It is in this only that I understand the desperate quest for religion. The idea of going dark forever is terrifying to me, and considering I'm pretty much an atheist, I don't have much hope of anything else. When people ask me if I'm religious, I usually tell them I'm hopeful that I'm proven wrong. I know we all die. I know our lives on a cosmic scale are infinitesimal. But even I - as rational as I am, am extremely scared of facing that reality head on. So convincing the entire nation/world to do so... Well, good luck with that.
- sago 12y ago
  It doesn't frighten me. It won't go dark forever. Just as there was no 13.5bn years of darkness before I was born. There will be no qualia of time. I think attitudes are changing. The campaign to be able to determine how and when we die is shaping up to be a significant battle for a fundamental civil right. I think we'll win it. Whether it is soon enough for my wife to avoid threat of prosecution if she is with me when I choose to act, I don't know. I suspect not.

shazad 12y ago

Atul Gawande, who's written extensively on end of life issues, had an excellent one hour Frontline special that covered the same topic. I highly recommend watching it if you're interested at all in how terminal illness and dying are handled in the United States today: http://www.pbs.org/wgbh/pages/frontline/being-mortal/ http://www.pbs.org/wgbh/pages/frontline/being-mortal/

quickpost 12y ago
His book on the same topic is absolutely enlightening and surprisingly enjoyable to read, despite the sobering topics. Being Mortal. http://www.amazon.com/Being-Mortal-Medicine-What-Matters/dp/0805095152/ http://www.amazon.com/Being-Mortal-Medicine-What-Matters/dp/...

sandworm 12y ago

It isn't just how they die. Similar articles could be written on "How doctors loose weight", "How doctors pick their doctors" or "What do doctors do when their kids are sick". Insider knowledge and the education to effectively employ that knowledge always has advantages. I do take issue with the concept that these docs are dieing "without treatment". They get treatment. They are diagnosed (a big deal) and have ready access to a host of pain management drugs. Having a full understanding of your condition, along with the knowledge that any pain can and will be managed very quickly, is a massive stress reduction. That's a form of treatment imho.

deleted 12y ago

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jrapdx3 12y ago

When facing terminal illness, doctors probably differ little from comparably educated subsets of the population. I don't know of studies specific to physicians, but my guess is quality of life is a priority that shapes decisions about treatment for life-threatening conditions. After decades in practice, doctors have faced death of patients many times. It's not an experience one ever really gets used to. As a result, doctors tend to be realists about illness and its likely outcome. It's no surprise that doctors might choose "death with dignity". Oregon, where I live, was the first state in the US to pass a law legalizing physician assisted suicide. The Death with Dignity Act went into effect in 1997. Studies have consistently shown that the leading motivations among those requesting lethal prescriptions are the desire to maintain independence and minimize reduction of QOL. Comprehensive data/stats related to DWDA can be downloaded--the most recent report (2014) is here-- http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf http://public.health.oregon.gov/ProviderPartnerResources/Eva... Additional info is available-- http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx http://public.health.oregon.gov/ProviderPartnerResources/Eva...

mytochar 12y ago

I'm a little frustrated with this article, but not for the reasons in the article. The doctors were angry at their patients' family members for putting them through the suffering; but, ... that form of suffering is just where medicine is right now. Medicine is evolving, and growing; and, it's that desire to keep living and to keep those around you living, and to improve their well-being that has, in part, grown our medical abilities to the point they are now. It feels like some of those improvements that, right now only provide a '15% chance of survival, and include pain', will be the stepping stones for 20, 30, 80 or 90% chance of survival, with varying levels of pain, including 0. The article seemed to suggest that the doctors didn't approve of those intermediate steps, but ... those are the steps medicine takes, aren't they? I dunno. I respected the rest of the article. That part of it bothered me.

dragontamer 12y ago
It isn't the doctor's job to improve medicine, it is a researcher's job. Doctors can only prescribe to you the 15% chance of survival, knowing that there's no greater benefit to medicine. They're too busy seeing patients to improve medicine.
- mytochar 12y ago
  I'm not sure this is accurate, especially in the case of cancers. Doctors were part of the studies with at least one person I know.

marincounty 12y ago

There's one thing they left out of the article. Yes, we are all going to get sick, and eventually die. Doctors--know the expected survival rates. Doctors do seem to end up with the right medications to really make those last days comfortable, or take the right amout and overdose properly? Now, their patients, especially the poor, stereotyped, etc. are sent home, and when a doctor feels like they need Hospice, they give their approval. I had a poor friend die. It was obvious he only had a few months left, but the doctor wouldn't o.k. Hospice? We went to two clinics, and a pain clinic and neither would give him the medications (Opioids and Benzodiazepines) he needed. One pain clinic(noted one of the better ones--in San Francisco) offered to cut some nerves?(I still don't know what these Blow Hards wanted to cut.) Why didn't he get the right medications; well in the states we assume everyone is going to abuse drugs. It's just getting worse. Doctors are not taking away pain. O.K., but once you have Hospice, everything is fine these fine? Doctors are trained in Pallitive care--if you get lucky. My experience watching my father die of liver cancer was a week of Hell. Hs last words to me before he went onto one of his last comas was "Son--when will this end?" Yea--no shit! The nurse finally came around. She then let my sister manipulate his medications which made his discomfort even worse.(my sister thought he should spend more time with his grand kids, and she wanted him to give her more things?) There I said it. Yea, she's a piece of work. I know this. When I am given that diagnosis of death. I used to think I would go to the bad part of town and buy smack, crack, whatnot, but as I've gotten older and I don't have the fight in me like I did in my 30's; I will probally just suffer through the agony of death like my father endured? Or, I might do what Robin Williams felt he had to do? Robin's wife said she was glad he picked up his ipad when he walked by her. She said, Robin hadn't watched tv, nor went on the Internet for the last six months. Robin was found in his stepson's bedroom with a belt around his neck. A towel was wrapped around the belt. I'm assuming to make the suicide more comfortable? Crude knife marks on his wrists--from a pocket knife. An ipad was found near the body with websites open to the the various side effects of the drugs he was given. I don't know all the drugs he was given, but they found a bottles of Seroquil? and a drug used to help with the neurological disorder he had. Why did I repeat this story. Because this is how we are forced to die in the United States. I don't know why Robin committed suicide. He sounded like he was suffering for a long time, on many levels? I don't know if the prescription drugs he was taking made things worse? Either way, he shouldn't have had to die like this. I'll pass this along too. Don't think suicide is easy. I knew a guy who tried to blow his head off with a shot gun. He blew his frontal cortex off, and spent the next 30 years paralized in a rest home. He died of a lung infection. I didn't know him personally. I worked for the Cororners office at the time, and picked up hs body. Enough, I feel sick from even writing about this gruesome stuff, but nothing changes. Doctors should treat the pain of their patients, and the government shoud not harass them. And we need a "right to die with dignity" law like Oregon passed. They passed it a few years ago, and very few decided to use the kit. Most decided to go naturally, but it must be reassuring knowing you have an alternative? I yacked on, but it's something I think about often.

hippiefahrzeug 12y ago

This reminded me of an article I've read a long time ago which had a really strong impact on me. I've just found it by googling a couple of words that were still in my head after all these years. Here it is (probably not where I originally read it): http://www.nbcnews.com/id/21643646/ns/health-behavior/t/what-we-learn-dying/#.VRJtuDTF-l0 http://www.nbcnews.com/id/21643646/ns/health-behavior/t/what...

rckrd 12y ago
Fantastic and relevant read. This was surprisingly well written for an NBC or Men's Health article for those who are skeptical.

ColinWright 12y ago

And the bowl of petunias said: Oh no, not again. For those interested in the collective wisdom of the HN community, here are some previous discussions: https://news.ycombinator.com/item?id=3313570 https://news.ycombinator.com/item?id=3313570 : 1206 days ago | 177 comments https://news.ycombinator.com/item?id=4865742 https://news.ycombinator.com/item?id=4865742 : 841 days ago | no comments https://news.ycombinator.com/item?id=5017104 https://news.ycombinator.com/item?id=5017104 : 807 days ago | no comments https://news.ycombinator.com/item?id=5104430 https://news.ycombinator.com/item?id=5104430 : 790 days ago | 94 comments https://news.ycombinator.com/item?id=6040804 https://news.ycombinator.com/item?id=6040804 : 618 days ago | 1 comment https://news.ycombinator.com/item?id=6767385 https://news.ycombinator.com/item?id=6767385 : 489 days ago | no comments https://news.ycombinator.com/item?id=7446014 https://news.ycombinator.com/item?id=7446014 : 368 days ago | 2 comments

arfliw 12y ago
While that certainly is an intimidating set of links you have there, only two of those have any discussion -- one over two years ago, the other nearly four years ago.
- ColinWright 12y ago
  Indeed - has anything changed? If not, then those discussions are still relevant, and there would be value in skimming them rather than simply repeating all the points again. If so, then it would be of value to see what has changed, possibly by reading the previous discussions. Perhaps the mood of the audience has changed, perhaps the general opinions of the HN community have shifted. Either way, being aware of the past is of value. Those who cannot remember the past are condemned to repeat it. -- George Santayana EDIT: People often misunderstand these back-links. They are not intended to scold people for submitting things that have been submitted before. On the contrary, I believe some things should re-surface from time to time, bringing them back either for the informing of the newer community members, or for re-evaluation in case things have moved on and should be re-considered. My main concern and motivation is that previous contributions should not be wasted.

mattlutze 12y ago

I had a conversation about this with a friend yesterday. What I would like to understand, is what the difference is between one incurable terminal condition and the next is, and why we're culturally stuck on trying to divide things up into "approved" and "not-approved" categories. Death happens for everyone. Most everyone, if they make it to very old age, will have degenerated physically and mentally from where they once were. I wonder, if our sympathies are telling us to consider whether a person with X condition should be allowed to end their life, whether that same thought process shouldn't consider all end-of-life conditions to be equal, given their shared terminality and expectation of degeneration. Or, on the flip side, should we think terminality and expectation of degeneration in these cases is not enough, whether it is appropriate to accept it in this subset of cases.

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