How Doctors Die • Hacker News Board

Re: How Doctors Die

#31

Post by OoTheNigerian » Mon, Dec 05, 2011, 10:38 AM UTC

People should differentiate between terminal illnesses and acute illnesses like heart attacks. For the later, I am sure the OP has no problems with treatment.

The leader of the breakaway Republic of Biafra died this week. He was less than a vegetable for 8months until his death. Here was a man who was larger than life reduced to helplessness. At the age of 78, I am wondering why he was tortured for these 8 months so he would be 'alive'.

I am certain if he had the choice, he would have preferred to go with dignity. Unfortunately, people never want to prepare for such things. When it happens, their end is determined by others.

My President Yaradua, also had the most undignified of ends possible. In theory Ariel Sharon is still alive. http://en.wikipedia.org/wiki/Ariel_Sharon

I want my end to be dignified. If God forbid, I have a terminal illness, it will not be a hard decision to make. Quality NOT Quantity.

Re: How Doctors Die

#32

Post by [deleted] » Mon, Dec 05, 2011, 10:38 AM UTC

rdl wrote: post #16

dcurtis wrote: post #6

I was in Best Buy earlier today and the sales guy who was trying to sell me a TV reminded me a lot of the doctors/residents I was dealing with during a few weeks I spent caring for a family member at Mass General Hospital a couple years ago. I don't think they do it consciously, but doctors try to sell you on their philosophies for healthcare. But it doesn't matter. You're sitting in a small room with dim lights and…

I can't imagine not doing #2 unless I'd also be non-functional during the extended life period. If I could read, use the Internet, write, talk to people, etc., it seems like it would be worth pain (which will end when you die, no matter what). The only case where I could see #1 being a reasonable choice is if #2 puts such hardship on those around you that their lives become much worse.

[deleted]

Re: How Doctors Die

#33

Post by Cass » Mon, Dec 05, 2011, 10:41 AM UTC

DanBC wrote: post #25

latch wrote: post #14

This is obviously a very personal topic, but I can't help but ask whether medecine benefits from people undergoing "futile care"? Are some diseases only treatable today because 20 years ago someone went through all the crap? The whole thing reminds me of the average mid-90s movie Phenomenon. I could always understand Travolta's character's reasoning, but I still thought it was selfish.

Science doesn't work like that. To get meaningful results you need a large sample size, with a control group, with patients not knowing whether they're getting the new medicine or the old medicine[1] and with doctors not knowing either. Then you need to write that up and analyse it. Many patients are happy to take part in such trials, but it's hard to get ethics panel approval. [1] you tend to test against current be…

That's how it works in the best case. Unfortunately, medical research is not a perfect science. Realistically, with many medical treatments, you can't have a double-blinded study. With chemotherapy, the side effects will often quickly tell you what treatment you're receiving, and a treatment like for example extracorporeal photopheresis can't ethically be placebo-controlled or double-blinded at all. What are you going to do, hook half your patients up to a machine that will do nothing but run their blood around a bunch of tubes for hours for no reason?

And you can't get a "large sample size" of patients with rare cancers or diseases by definition. Sometimes, the best you can do is a case study of ten patients who agreed to try your treatment because the other option was death. Quite a few medical advances have been made that way, actually.

Re: How Doctors Die

#34

Post by antoinehersen » Mon, Dec 05, 2011, 10:44 AM UTC

dcurtis wrote: post #6

I was in Best Buy earlier today and the sales guy who was trying to sell me a TV reminded me a lot of the doctors/residents I was dealing with during a few weeks I spent caring for a family member at Mass General Hospital a couple years ago. I don't think they do it consciously, but doctors try to sell you on their philosophies for healthcare. But it doesn't matter. You're sitting in a small room with dim lights and…

It is obviously a personal choice but situation #2 may be worse than you imagine.

You can write, read, and interact but only for a few hours each day. Pain and fatigue take over the rest of the time. There is also so many little things you take for granted you will not be able to do anymore, or will require assistance to perform. Eating can become a chore, you may have to be regularly plug to some gruesome apparatus, also loss of mobility. Think about the last time you were sick, or injured, think of the worse moment being your new normal. I personally can`t imagine being happy in those circumstances. I choose #1.

Each person choices should be respected, and people should be better informed on the tradeoff of each choices, which I feel is not the case in our health care system.

Re: How Doctors Die

#35

Post by krig » Mon, Dec 05, 2011, 10:53 AM UTC

Cass wrote: post #27

krig wrote: post #22

Earlier quoted context omitted.

Interesting. I found myself responding to the article in much the same way as you. Also Swedish. The question is: are we being rational or deluded? I have friends who are medical professionals and I don't recognize them in this either: I highly doubt any of them have NO CODE tattoos or anything equivalent. I suspect society shouldering most of the cost might be a factor: with a privatized payment system, there are pe…

This is not a question of being "rational", and there's no right or wrong answer. People make trade-offs between quality and quantity of life every day. Do I want to quit smoking, drinking, drugs, and take up sports, etc for a chance at a longer, healthier life? Or do I grab all the fun I can, and if it costs me ten years, oh well? The right decision will look different for every person - and it's not black or white,…

It can be a rational or irrational choice depending on the available treatment and the specific case. A blanket statement that says "do not resuscitate" ignores cases where resuscitation could have been successful and where the chance of revival outweighs the risk of undue pain and suffering.

In a world where the only available treatment is blood-letting or getting your limbed sawed off by a hacksaw, a "do not resuscitate" policy is clearly more rational than in the Star Trek/sci-fi world where treatment consists of a doctor waving a magic iPad over your head and nanobots cure you painlessly. Since we're somewhere in between those two it becomes more complicated, but evaluating the risks and benefits and making an as informed choice as possible based on the available information still seems to me to be the rational way to look at it. Making future medical decisions based on an emotional reaction to individual cases, on the other hand, seems to me to be irrational and counter-productive.

Re: How Doctors Die

#36

Post by antoinehersen » Mon, Dec 05, 2011, 10:58 AM UTC

Gatsky wrote: post #26

What's the message here? That people shouldn't have chemotherapy? That we shouldn't do resuscitation? That all advanced cancers should just receive palliative care? This seems to be a rant ie. the author has a strongly held notion that he has disguised as an argument devoid of any nuance. The support for his argument is that doctors secretly run a mile away from hospital whenever they get sick. This is not true and a…

The message is that there is another choice.

I read it as giving people a different perspective on end of life care. The system is heavily biased toward all out medical care. This article show the other side, using as examples people who have a better understanding of the tradeoff.

This decision will always be a personal one, there is not right or wrong answer, just different possibilities.

Re: How Doctors Die

#37

Post by rbanffy » Mon, Dec 05, 2011, 11:37 AM UTC

I was married to a doctor for 10 years. Before that, I lived with my aunt, also a doctor.

The one thing that absolutely shocked me is how they thought about aging and death. I kept reminding them their goal should be to find cures for everything, no matter how hard it seems. I approach every engineering problem as solvable. Maybe I can't solve it right now with the tools I have. Maybe I can't figure out a way to solve it and will have to leave it for the next generations. To absolve yourself because something is inevitable is a coward solution.

So, no, thank you. If that's what it takes to survive, I want to be cut open, sliced, probed, and, when everything else fails and I finally die, I want doctors to learn something from my death. I want them not to give up and, if they can't treat some condition, go out and invent a way to do it. You don't give up solving a problem just because it's hard.

It's their job and it's reasonable for us to expect them to do it.

Re: How Doctors Die

#38

Post by krig » Mon, Dec 05, 2011, 11:39 AM UTC

earl wrote: post #28

krig wrote: post #22

Earlier quoted context omitted.

Interesting. I found myself responding to the article in much the same way as you. Also Swedish. The question is: are we being rational or deluded? I have friends who are medical professionals and I don't recognize them in this either: I highly doubt any of them have NO CODE tattoos or anything equivalent. I suspect society shouldering most of the cost might be a factor: with a privatized payment system, there are pe…

I'm an american and for me, it's not an issue of cost. The issue is how do you want to end your life on this earth. My father died of lymphoma when I was 17; he got it twice. The survivorship rates if the first set of treatments didn't work were not awesome. In his case, he died after multiple rounds of chemo and radiation and surgeries, incisions that didn't heal for multiple months, collapsed veins leading to a shu…

I don't think the issue is the cost to the patient, but rather that in a private payer system, it becomes profitable to keep patients alive for as long as possible. In a public payment system, you could crassly say that keeping patients alive is a cost to the system. Now, that would seem to imply that the public option might lead to early termination of treatment in cases where treatment would be feasible but expensive, and perhaps that does happen.

Re: How Doctors Die

#39

Post by RobbieStats » Mon, Dec 05, 2011, 11:52 AM UTC

I'm conflicted about this. On the one hand I don't want to be hooked up to a ventilator or go through extreme suffering to prolong life. On the other hand, my grandmother (who recently passed away) went through late stage breast cancer in her mid-50s, lung cancer in her 60s, had a severe heart attack in her 70s and died in her 80s. It was so bad one time the doctors told us she would die in a matter of days. After she recuperated, she lived another 8 years. She was a tough bird.

How many times have we all heard: "The doctors gave him 6 months to live and that was 5 years ago". So if I knew I could go through 3-6 months of severe pain and get another 5-10 years of high quality life with my family, I'd probably do it. The problem is you may go through 3-6 months of severe pain and then die in month 7.

Right now being in my mid-30s and with a young daughter I enjoy, I'd take on the fight. If I was in my 80s, probably not.

Re: How Doctors Die

#40

Post by vacri » Mon, Dec 05, 2011, 11:53 AM UTC

defdac wrote: post #21

Tonight I will tell the mother of our child that if I reason in any way that resembles this article she should slap me in face and tell me to fight for my life. For my daughter and my own sake. In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later. I want all the tub…

Telling people to give up because of money or some sort of gentleness to yourself or your family is alien to me. Maybe it's our harsh climate uphere. Swedes seems very in tune with our suffering.

It's not about being tough and macho. A lingering decline can be psychologically painful for everyone involved. Pretty much everyone I know that has been involved in caring for someone who suffered a slow decline - particularly alzheimers - don't want to go through that themselves.

You say now that you may want all the tubing and to be bounced around from doctor to doctor (not all of whom know what they're doing, by the way), but it's a very different beast when you're actually experiencing it. Some folks just say 'do what you gotta do'. Others say 'I don't care what you think you'll find with yet another test, the endless battery of tests is worse than the disease'.