I Lied When I Said We Did Everything We Could • Hacker News Board

Re: I Lied When I Said We Did Everything We Could

#51

Post by sudhirj » Sun, Apr 07, 2019, 6:42 PM UTC

diminoten wrote: post #40

I want to go out as a result of a series of violent mistakes trying to save my life. Why would anyone want anything else? Peaceful death is basically suicide. Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause? At the very least, we could be honest…

This article only talks about useless symptomatic treatments, not about effort at treating root cause.

If you’ve just been diagnosed with something terminal you’d want to try every experimental treatment no matter how violent or dangerous. But if you’ve already established that nothing is working and your body has begun the shutdown process I don’t see why you’d want your last feelings to be shocks to your heart, your ribs broken or your throat being cut and plastic tubes shoved in.

Emergency reactive procedures (codes) for a 20 year old who had an accident on the way to the gym and a 80 year old in the last stages of terminal cancer are the same, the article is arguing that they shouldn’t be.

Re: I Lied When I Said We Did Everything We Could

#52

Post by bo1024 » Sun, Apr 07, 2019, 6:44 PM UTC

diminoten wrote: post #40

I want to go out as a result of a series of violent mistakes trying to save my life. Why would anyone want anything else? Peaceful death is basically suicide. Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause? At the very least, we could be honest…

You seem to be thinking of a case where an otherwise healthy person is dying of an incurable disease, and risky treatments might bring their health completely back.

I don't think that's an accurate portrayal of most sicknesses and death in a hospital for the elderly. It's more like a progression of failures and problems (or a constellation), some mitigated, leading to more or less prolonged suffering with no end in sight but death. An 80-year-old with Alzheimers, diabetes, and cardiac problems doesn't have a "root cause" that you can just fix with an experimental treatment. They're old. We all get old. In that kind of case, I hope the doctors' perspective makes more sense...

Re: I Lied When I Said We Did Everything We Could

#53

Post by colechristensen » Sun, Apr 07, 2019, 6:47 PM UTC

busterarm wrote: post #14

caprese wrote: post #10

Earlier quoted context omitted.

> The families often are in almost some sort of denial It was like pulling teeth to try to get doctors to tell me anything realistic. I don't get the impression that anyone in the medical community is trying to change this. Unlike my other family members, I had seen this person once a month obviously deteriorating in line with what every prognosis and statistic would say. My other family members were there every day…

I know some parents who had a child with an extremely rare degenerative disorder that attacks the nervous system. They were wealthy enough to afford extremely good care and as such, kept their poor suffering child "alive" for 12 years longer than anyone else who had ever had the same disease. Life expectancy of newborns with this disorder is about 1-3 years. At every turn, the doctors and nurses charged with the chil…

>There should be laws

Philosophical problems aren't solved by legislation, it is important that people stop looking towards lawmakers to push their morals.

Telling good stories – tragedies – well enters them into the popular mythos effects better choices.

Re: I Lied When I Said We Did Everything We Could

#54

Post by identity-haver » Sun, Apr 07, 2019, 6:48 PM UTC

diminoten wrote: post #40

I want to go out as a result of a series of violent mistakes trying to save my life. Why would anyone want anything else? Peaceful death is basically suicide. Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause? At the very least, we could be honest…

The Norse of old would agree with you, where if you die a "straw death" outside of battle you don't get to go to Valhalla. But apparently if you stabbed yourself on your deathbed you still got to go to Valhalla?

Re: I Lied When I Said We Did Everything We Could

#55

Post by jdietrich » Sun, Apr 07, 2019, 6:49 PM UTC

whatshisface wrote: post #20

busterarm wrote: post #14

Earlier quoted context omitted.

I know some parents who had a child with an extremely rare degenerative disorder that attacks the nervous system. They were wealthy enough to afford extremely good care and as such, kept their poor suffering child "alive" for 12 years longer than anyone else who had ever had the same disease. Life expectancy of newborns with this disorder is about 1-3 years. At every turn, the doctors and nurses charged with the chil…

> There should be laws preventing family members from prolonging the suffering of their loved ones. I can't think of a way to implement a law like that which wouldn't be fraught with horrible problems. Just imagine the misery associated with doctors deciding to "kill people's children," which in fact in some cases would be unjustified. (Nobody can always get it right, not even doctors.)

>I can't think of a way to implement a law like that which wouldn't be fraught with horrible problems.

Existing child protection laws are for the most part perfectly satisfactory, if they're actually used. The courts routinely decide on whether a parent is fit to make decisions about their child, or whether a particular decision is in the best interests of that child. Many of these cases will individually present very difficult decisions, but the legal principles are relatively straightforward.

The impediment to actually using those laws is largely that of pro-life activism - few hospitals are willing to legally advocate on behalf of a suffering child because of the fear of becoming the centre of a media circus.

Re: I Lied When I Said We Did Everything We Could

#56

Post by cc81 » Sun, Apr 07, 2019, 6:49 PM UTC

cs02rm0 wrote: post #44

vichu wrote: post #24

I recommend this article for another essay on this topic: https://www.zocalopublicsquare.org/2011/11/30/how-doctors-di... It really boils down to quality over quantity. After all, I'm sure most would choose to die comfortably in their bed after a week rather than in a few months all while in excruciating pain.

I'm not so sure. I think I'd lean more towards quantity if it were a choice - my kids are very young though so right now I just want to know them for as long as I can.

It is a difficult question for sure but in some cases your choice is between heavy medication in a hospital that makes you unable to spend quality time with your family. While the other option might mean you would die in 2 months instead of 6 months it might also mean that during those 2 months you would have the strength to play with your kids.

Re: I Lied When I Said We Did Everything We Could

#57

Post by diminoten » Sun, Apr 07, 2019, 6:49 PM UTC

macintux wrote: post #50

diminoten wrote: post #40

I want to go out as a result of a series of violent mistakes trying to save my life. Why would anyone want anything else? Peaceful death is basically suicide. Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause? At the very least, we could be honest…

> I want to go out as a result of a series of violent mistakes trying to save my life. The problem is that excruciating pain is only obviously better than death if there’s something positive at the end of it. Otherwise it’s comparable to being tortured 24 hours a day for the rest of your life.

Sorry, but excruciating pain is always better than death, because death is eternal nothingness. At least excruciating pain is something.

Re: I Lied When I Said We Did Everything We Could

#58

Post by diminoten » Sun, Apr 07, 2019, 6:51 PM UTC

bo1024 wrote: post #52

diminoten wrote: post #40

I want to go out as a result of a series of violent mistakes trying to save my life. Why would anyone want anything else? Peaceful death is basically suicide. Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause? At the very least, we could be honest…

You seem to be thinking of a case where an otherwise healthy person is dying of an incurable disease, and risky treatments might bring their health completely back. I don't think that's an accurate portrayal of most sicknesses and death in a hospital for the elderly. It's more like a progression of failures and problems (or a constellation), some mitigated, leading to more or less prolonged suffering with no end in s…

No, it makes zero sense.

My grandfather had advanced Parkinson's, but had zero intention of dying to it or its cornucopia of related symptoms/effects. So what if he has a major disease that made life many orders of magnitude worse for him? Life is still life, and death is still infinitely worse.

Giving up and accepting death may seem reasonable to some, but not for me or my grandfather. There's always a root cause, and there's always a way to keep going.

Giving up is suicide.

Re: I Lied When I Said We Did Everything We Could

#59

Post by DanBC » Sun, Apr 07, 2019, 6:52 PM UTC

whatshisface wrote: post #20

busterarm wrote: post #14

Earlier quoted context omitted.

I know some parents who had a child with an extremely rare degenerative disorder that attacks the nervous system. They were wealthy enough to afford extremely good care and as such, kept their poor suffering child "alive" for 12 years longer than anyone else who had ever had the same disease. Life expectancy of newborns with this disorder is about 1-3 years. At every turn, the doctors and nurses charged with the chil…

> There should be laws preventing family members from prolonging the suffering of their loved ones. I can't think of a way to implement a law like that which wouldn't be fraught with horrible problems. Just imagine the misery associated with doctors deciding to "kill people's children," which in fact in some cases would be unjustified. (Nobody can always get it right, not even doctors.)

In some US states the doctors propose a plan, and if the parents of the child disagree with that plan they can go to court to get an injunction to prevent the doctors carrying it out.

Compare that with England. The doctors propose a plan, and if the parents disagree with it the doctors go to court to get an order. The court has to look at the child's best interests and the paramountcy principle means that while everyone's (parents and childs) rights are looked at it's the rights of the child that take priority.

> associated with doctors deciding to "kill people's children,"

They can already do this in most of the US.

Re: I Lied When I Said We Did Everything We Could

#60

Post by cc81 » Sun, Apr 07, 2019, 6:54 PM UTC

diminoten wrote: post #40

I want to go out as a result of a series of violent mistakes trying to save my life. Why would anyone want anything else? Peaceful death is basically suicide. Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause? At the very least, we could be honest…

>Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause?

I think one reason is because they see people with terminal diagnosis take a beating from heavy medication like chemo and being unable to spend time with their family instead of just taking pain killers and spending their last months with family and friends.