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How doctors choose to die (2012)

161 pointsby arfliwabout 10 years ago

13 comments

sagoabout 10 years 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&#x27;t uncommon, if you know what to look for.<p>As someone with a degenerative incurable condition, I&#x27;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&#x27;t fill me with excitement.<p>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.
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ColinWrightabout 10 years ago
And the bowl of petunias said: Oh no, not again.<p>For those interested in the collective wisdom of the HN community, here are some previous discussions:<p><a href="https://news.ycombinator.com/item?id=3313570" rel="nofollow">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=3313570</a> : 1206 days ago | 177 comments<p><a href="https://news.ycombinator.com/item?id=4865742" rel="nofollow">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=4865742</a> : 841 days ago | no comments<p><a href="https://news.ycombinator.com/item?id=5017104" rel="nofollow">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=5017104</a> : 807 days ago | no comments<p><a href="https://news.ycombinator.com/item?id=5104430" rel="nofollow">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=5104430</a> : 790 days ago | 94 comments<p><a href="https://news.ycombinator.com/item?id=6040804" rel="nofollow">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=6040804</a> : 618 days ago | 1 comment<p><a href="https://news.ycombinator.com/item?id=6767385" rel="nofollow">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=6767385</a> : 489 days ago | no comments<p><a href="https://news.ycombinator.com/item?id=7446014" rel="nofollow">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=7446014</a> : 368 days ago | 2 comments
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jrapdx3about 10 years ago
When facing terminal illness, doctors probably differ little from comparably educated subsets of the population. I don&#x27;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.<p>After decades in practice, doctors have faced death of patients many times. It&#x27;s not an experience one ever really gets used to. As a result, doctors tend to be realists about illness and its likely outcome.<p>It&#x27;s no surprise that doctors might choose &quot;death with dignity&quot;. Oregon, where I live, was the first state in the US to pass a law legalizing physician assisted suicide. The <i>Death with Dignity Act</i> 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.<p>Comprehensive data&#x2F;stats related to DWDA can be downloaded--the most recent report (2014) is here-- <a href="http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf" rel="nofollow">http:&#x2F;&#x2F;public.health.oregon.gov&#x2F;ProviderPartnerResources&#x2F;Eva...</a><p>Additional info is available-- <a href="http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx" rel="nofollow">http:&#x2F;&#x2F;public.health.oregon.gov&#x2F;ProviderPartnerResources&#x2F;Eva...</a>
mytocharabout 10 years ago
I&#x27;m a little frustrated with this article, but not for the reasons in the article. The doctors were angry at their patients&#x27; family members for putting them through the suffering; but, ... that form of suffering is just where medicine is right now.<p>Medicine is evolving, and growing; and, it&#x27;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.<p>It feels like some of those improvements that, right now only provide a &#x27;15% chance of survival, and include pain&#x27;, will be the stepping stones for 20, 30, 80 or 90% chance of survival, with varying levels of pain, including 0.<p>The article seemed to suggest that the doctors didn&#x27;t approve of those intermediate steps, but ... those are the steps medicine takes, aren&#x27;t they?<p>I dunno. I respected the rest of the article. That part of it bothered me.
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shazadabout 10 years ago
Atul Gawande, who&#x27;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&#x27;re interested at all in how terminal illness and dying are handled in the United States today: <a href="http://www.pbs.org/wgbh/pages/frontline/being-mortal/" rel="nofollow">http:&#x2F;&#x2F;www.pbs.org&#x2F;wgbh&#x2F;pages&#x2F;frontline&#x2F;being-mortal&#x2F;</a>
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mctabout 10 years ago
A few years ago, I heard an NPR interview with a doctor who&#x27;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&#x27;ve tried a number of times to find the story, but I haven&#x27;t been able to. Does it ring a bell for anyone? I&#x27;d love to listen to it again.<p>Thanks!
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hippiefahrzeugabout 10 years ago
This reminded me of an article I&#x27;ve read a long time ago which had a really strong impact on me. I&#x27;ve just found it by googling a couple of words that were still in my head after all these years.<p>Here it is (probably not where I originally read it): <a href="http://www.nbcnews.com/id/21643646/ns/health-behavior/t/what-we-learn-dying/#.VRJtuDTF-l0" rel="nofollow">http:&#x2F;&#x2F;www.nbcnews.com&#x2F;id&#x2F;21643646&#x2F;ns&#x2F;health-behavior&#x2F;t&#x2F;what...</a>
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jimt67about 10 years 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.
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sandwormabout 10 years ago
It isn&#x27;t just how they die. Similar articles could be written on &quot;How doctors loose weight&quot;, &quot;How doctors pick their doctors&quot; or &quot;What do doctors do when their kids are sick&quot;. Insider knowledge and the education to effectively employ that knowledge always has advantages.<p>I do take issue with the concept that these docs are dieing &quot;without treatment&quot;. 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&#x27;s a form of treatment imho.
screature2about 10 years ago
Can&#x27;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.<p>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&#x27;m just suffering a recency bias from this: <a href="http://med.stanford.edu/news/all-news/2015/03/stanford-neurosurgeon-writer-paul-kalanithi-dies-at-37.html" rel="nofollow">http:&#x2F;&#x2F;med.stanford.edu&#x2F;news&#x2F;all-news&#x2F;2015&#x2F;03&#x2F;stanford-neuro...</a>
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mattlutzeabout 10 years ago
I had a conversation about this with a friend yesterday.<p>What I would like to understand, is what the difference is between one incurable terminal condition and the next is, and why we&#x27;re culturally stuck on trying to divide things up into &quot;approved&quot; and &quot;not-approved&quot; categories.<p>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&#x27;t consider all end-of-life conditions to be equal, given their shared terminality and expectation of degeneration.<p>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.
marincountyabout 10 years ago
There&#x27;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?<p>Now, their patients, especially the poor, stereotyped, etc. are sent home, and when a doctor feels like they need Hospice, they give their approval.<p>I had a poor friend die. It was obvious he only had a few months left, but the doctor wouldn&#x27;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&#x27;t know what these Blow Hards wanted to cut.)<p>Why didn&#x27;t he get the right medications; well in the states we assume everyone is going to abuse drugs. It&#x27;s just getting worse. Doctors are not taking away pain.<p>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 &quot;Son--when will this end?&quot; Yea--no shit!<p>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&#x27;s a piece of work.<p>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&#x27;ve gotten older and I don&#x27;t have the fight in me like I did in my 30&#x27;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?<p>Robin&#x27;s wife said she was glad he picked up his ipad when he walked by her. She said, Robin hadn&#x27;t watched tv, nor went on the Internet for the last six months.<p>Robin was found in his stepson&#x27;s bedroom with a belt around his neck. A towel was wrapped around the belt. I&#x27;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&#x27;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.<p>Why did I repeat this story. Because this is how we are forced to die in the United States. I don&#x27;t know why Robin committed suicide. He sounded like he was suffering for a long time, on many levels? I don&#x27;t know if the prescription drugs he was taking made things worse? Either way, he shouldn&#x27;t have had to die like this. I&#x27;ll pass this along too. Don&#x27;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&#x27;t know him personally. I worked for the Cororners office at the time, and picked up hs body.<p>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.<p>And we need a &quot;right to die with dignity&quot; 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&#x27;s something I think about often.
cupabout 10 years ago
This has been posted a number of times in different iterations on HN. I&#x27;m curious why the user group here has such a fascination with medical doctors.
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