This subverts the message a bit, but my grandmother was sent to a hospice to die as comfortably as possible. I was out of state during her treatment up until this point, but when she was being moved to hospice care, I was told to expect her passing very soon. In this case, her doctors really seemed to have run out of good options; she just hadn't responded to treatment. But, after she was moved to hospice care, she began to improve. She actually healed and recovered enough to live a few more years at an assisted living home, well enough to walk the halls (slowly) for quite a while every day, and have her kids visiting all the time.<p>Why did she recover after she was switched to hospice care? The best explanation I have is that in the hospital, her access to opioids had been limited. Letting a patient have too much can be risky. But in the hospice, where death is regarded as impending, those risks don't matter and she could have as much as she needed to actually be comfortable. And not suffering, not being in pain was maybe what allowed her to begin to heal.<p>I don't think exactly that her doctors were wrong in believing that her death was imminent and that a hospice was the right place for her. But what if we created a healthcare system where clinging to life is so exhausting for the patient that embracing the inevitability of death is the most healing option?
The important difference between physicians and non-physicians in relation to death is not that doctors understand disease mechanisms.<p>It is that doctor's are familiar with death.<p>Ordinary people aren't as familiar with death, and don't have a wide range of responses to it because society hides it and pretends it doesn't exist.<p>The main place regular people encounter death is on the news as a statistic of war and crime. Then when it visits their family and friends, they are unprepared, except for what they know of death, which is a calamity.<p>Sitcoms don't include death because they exist to take your mind off work, and provide a platform for advertising consumer goods.<p>Friends and acquaintances don't often talk about death in expansive terms. They only offer a cliche one liner - sorry for your loss - because that's the only response they've learnt. It's a well intentioned sentiment, and also one that's constrained by a fear of death that is unwarranted.<p>That's a shame because death is an expansive part of life. It's the point at which a life becomes whole, and we can see someone in their entirety. Death, along with birth, is the context for life.<p>It's going to happen to all of us, no matter how we try to deny it or hide it. Doctors know this and so they let it in. They do this before life descends into the shadows.
My mom struggled with lung cancer for two terrible years with cutting edge treatment, and died badly. My dad cared for her through that, and when his turn came five years later, he had no doubts. He refused all but palliative care and died in two months. What he saw once, a physician will see over and over ad nauseam. Having seen one of each, I'm not conflicted over which path I'd take.
What ticks me off no end is the folks who (often successfully) fight against physician assisted suicide. Dementia is the interesting test case, but I think should still be allowed.<p>With all the talk about 'controlling our bodies' in terms of abortion, and I can see both sides of that one, your own life is the one thing you really own. To have that control taken away is the worst kind of insult by the state.
Several of my grandparents spent way too long in ICU and hospice care and ultimately it wasn't worth it. I feel terrible about how their final days went, but other family members were adamant about 'throwing everything they could at it.'<p>But the family members making that choice weren't footing the bill and they didn't have to lay in bed all day, so why wouldn't they try? I also feel they had a gross misunderstanding of the capabilities of modern medicine.<p>In each case the doctor's asked, "do you want to give him/her a fighting chance?" Of course, no one wants to say 'no' to that question, because they don't really understand what's possible and don't understand what "winning" actually looks like.
This is a pretty popular topic, and discussed previously:<p><a href="https://news.ycombinator.com/item?id=3313570" rel="nofollow">https://news.ycombinator.com/item?id=3313570</a> (2011)<p><a href="https://news.ycombinator.com/item?id=5104430" rel="nofollow">https://news.ycombinator.com/item?id=5104430</a> (2013)<p><a href="https://news.ycombinator.com/item?id=9260286" rel="nofollow">https://news.ycombinator.com/item?id=9260286</a> (2015)<p><a href="https://news.ycombinator.com/item?id=13122408" rel="nofollow">https://news.ycombinator.com/item?id=13122408</a> (2016)
I long ago decided that if I got a terminal disease, I would refuse any treatment that would extend my quantity of life at the expense of my quality of life.<p>I've seen what chemo does to people. No thank you. If I get cancer, I'll just self-medicate with whatever opioids I can get my hands on until either the cancer kills me or the pain gets bad enough that the opioids stop being able to do anything for it, at which point I'd just intentionally OD by a massive amount while alone in a remote location.<p>(and on top of all the debilitating, crippling effects of chemo, I am also, for multiple reasons, particularly attached to my hair... it's one of the only parts of my body I like, and I would literally rather die than lose my hair)
<i>Years ago, Charlie, a highly respected orthopaedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds – from 5% to 15% – albeit with a poor quality of life.<p>Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.</i><p>I am guessing that he had testing which determined it had spread and was terminal. It seems implausible that an otherwise healthy person would just pass up on a 15% chance of survival.
I'm seeing a lot of people sharing very personal and very difficult anecdotes here, and I am worried that that would make someone decide to reject chemotherapy outright, or recommend a loved one to reject it.<p>Yes, chemotherapy has very adverse side-effects. But it's also the best course of action we currently have for a lot of cancer patients. It varies depending on the type, grade and stage of the illness, as well as the patient's overall health [1]. It should not be rejected outright.<p>Now for my personal anecdata: My sister in law was in her 30s when they detected her breast cancer, and got chemo for some time. It was a very difficult time for her, but it worked - the cancer receded. She kept having to do get periodical checks to keep tabs on it.<p>Unfortunately her cancer came back, and this time it was more aggressive - it resisted all treatments and eventually metastasised. They took her off chemo, but her health deteriorated very quickly anyway. She died 1 and a half years ago, at home.<p>On average, chemotherapy gave her and my brother around 7 years of life, in exchange of some very shitty quality of life moths due to side effects. They definitively made the right choice in taking chemo the first time, and not taking it the second time. A lot of people's cancers never come back.<p>I am not saying that chemotherapy is worth it in all cases. I am painfully aware that it isn't. But it is worth in a lot of cases. Don't reject it outright.<p>PS: I should mention that we live on a country with a civilized health care system where her treatments were paid for by the state's Social Security. No one in this story had to deal with "can we afford this treatment" problems. If you are in that situation, I am sorry for you.<p>[1] <a href="https://www.medicalnewstoday.com/articles/326031" rel="nofollow">https://www.medicalnewstoday.com/articles/326031</a>
This doctor clearly has a vision for how he feels end of life should be, and then implies all (most) doctors share this and non-doctors should follow and doctors should be more vocal about the implied belief.<p>I'm a bit warey of his assertion that all doctors think the same way as him though. He relies pretty heavily on his experience and a few anecdotes. I wonder if there is any actual data on how doctors view "futile" care and end of life.
I once worked with a cardiovascular surgeon who was possibly one of the most brilliant people I'd ever met. His wife was a neurosurgeon, and she was diagnosed with some rare form of brain tumour, and they both knew the prognosis. They ended up selling their little farm and all their cars and equipment, and bought a little float plane to travel the world with for her final years. I believe he passed away shortly after she did, but they got to spend the last of their time together with a very relaxing lifestyle.
I took two psych classes in University. One was "Death and Dying". Perhaps a morbid class to take in your 20s, but it was a full class. The professor happened to be dying herself as she taught it. Very useful and enjoyable. It's one of the few textbooks I've kept since the long-ago graduation. A very useful course to take.
The author implies (by omission) that palliative care results in a peaceful, pain-free death. You can't rely on that!<p>I wonder how often physicians die as a result of taking a drug such as Nembutal - the drug recommended by Exit International. Civilians can't buy this drug - not even illegally, e.g. on the Dark Web, as far as I can see. But physicians can.<p>I don't want to get caught. I don't want the kind of "palliative care" that amounts to death-by-dehydration. If I get throat cancer and can't swallow, no amount of pain-killers will make my death pleasant.<p>I want a stash of Nembutal, so that I can do myself in, if the prospect I'm facing is a nest of wires and tubes or untreatable pain. It's an ethical disgrace that it's illegal for me to manage the end of my own life.<p>Apparently any relative that accompanies me on the plane to Switzerland risks prosecution for assisting a suicide. So if I want to die quickly and peacefully, I'll have to do that on my own.<p>The amount of humbug that swirls around this subject makes my head swim.
Wasn’t this one of the things the “death panels” (as so expertly branded by Republicans) were supposed to help with? Helping people on Medicare decide on how they wanted to approach these kind of issues and what they wanted for advanced directives?<p>Unfortunately so much of this is decided at the last minute as people are terrified or just desperate for any lifeline no matter the consequences. Choices that, had they made them without those immediate pressures they may have made differently and had time to truly think through.
Today's medicine is focused to treat the diseases, refusing to admit that people at 70-80 years old die not from disease, but from the old age.<p>Everybody but a few enthusiasts refuse to treat ageing instead of cancer or heart diseases. People in general refuse to treat ageing as a disease, thinking it is something natural.<p>I would not want a couple more miserable years on earth, I want a few million years of a healthy young life.
My wife and I feel the exact same way - we have it legalized in our will and in statements of health (I can't remember the legal name for them - but documents about what we want to have happen if we are very sick/near death and can't speak for ourselves). Basically neither of us want anything done for us, at all. Just let us die. Please do not try to prolong things through chemotherapy, intubation, tube feeding, etc.
I don't know how much this still applies, but in the 80s and 90s it also seemed like doctors and nurses smoked a lot more than the average population. Maybe it just seemed that way because you just saw them outside hospitals smoking in groups, but I remember driving by a childrens hospital once, and my father, an ex-smoker, saying they were all out there because they were accustomed to seeing death and weren't afraid of it.
To me, this reveals the Christian roots of modern medicine.<p>To me, these weeds are to be uprooted: Christians willingly inflict suffering unto others, as they believe it is the natural state of human being and must be increased in servitude of their God, especially near death.
The book When Breath Became Air by Dr. Paul Kalanithi tells the story of his dying. I found it very liberating to learn more about the process from a trauma expert. I'm also slowly making my way through a more medical book currently called How We Die that outlines the actual body processes of the ways we die. I cannot recommend it highly enough.<p><a href="https://www.goodreads.com/book/show/49286.How_We_Die" rel="nofollow">https://www.goodreads.com/book/show/49286.How_We_Die</a>
The problem with euthanasia is that the certainty of it defies all human survival instincts so it’s psychologically very difficult to press a button that ends our existence. What would be better if you could legally hire a service, while healthy, that would sneak up on you and kill you painlessly if you were in a terrible condition with nothing but pain and misery to look forward to. You could cancel them at anytime, but if you didn’t, they’d bump you off mercilessly when you needed it.
My heart really goes out to those of you who went through long battles. Today would have been father’s birthday, sadly he passed away last year aged 61. I often anguished over how quickly he left us, two weeks from the day I found out he was sick to the day he died, I now realise that although I was robbed of time, he and I were both saved a lot of pain.
It is a personal story, is there any evidence that this is a rule? Like, maybe a research that compares costs and/or procedures rendered to terminally ill patients, doctors vs non-doctors. I also heard, that doctors themselves are horrible patients.
Related and very interesting read: <a href="https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/" rel="nofollow">https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...</a>
Everybody wants to go to Heaven but nobody wants to die.
<a href="https://youtu.be/Lb-EJEWRxlM" rel="nofollow">https://youtu.be/Lb-EJEWRxlM</a>