

Letting Go - eavc
http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande?currentPage=all

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drunkpotato
The author did a good job of laying out the complexities of end of life care
decisions. She did talk about how important it is to have these discussions in
advance, but I don't think she emphasized enough how important it is to have
the whole family involved in discussions.

A child who has discussed these issues with her parents, and makes the right
decisions in accordance with her parents' wishes, still faces guilt and
indecision when the end comes and it's time to let go. If you combine that
with unsupportive and accusatory siblings, that guilt and second-guessing can
continue for years after the parent dies.

It's important to make sure that all children are involved in the discussion,
especially if they don't agree with each other and the parent, and are hostile
to any decision to forego care. Communication is hard, and distances are long,
and it's far too easy not to have these discussions with the dying relative
far away. It takes effort and will to make these discussions happen, but they
are necessary.

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dmor
I absolutely agree with this, it is really important to get the family to buy-
in and support the decision of the dying loved one.

I lost my mother-in-law earlier this year to leukemia, and ultimately she made
the choice to forego care. My husband and his two siblings provided in-home
hospice care for their mother, because she wouldn't even allow any nurses or
doctors in her home. This was a huge commitment, in time and also emotionally,
since we basically became nurses ourselves and had to learn to perform many
procedures. If we hadn't be in complete agreement and totally aware of what we
were signing up for, it could have created a family rift. Instead, it brought
us closer together.

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garply
Thinking about death always puts the triviality of my seemingly dire day-to-
day problems into proper perspective.

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dctoedt
For those who aren't familiar with the author, he's the brilliant Dr. Atul
Gawande (<http://en.wikipedia.org/wiki/Atul_Gawande>), whose most recent book
is the best-selling _The Checklist Manifesto_.

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johkra
This is a good, well-written article, painting a good picture of the issues
involved.

My grand-father is in a similar situation. After years of dementia, he was
diagnosed today with pneumonia after he stopped swallowing last week and
reacting to people some weeks earlier. He'll die soon, but he'll die at home,
where he was nursed by his loved ones until the end.

I'm glad he won't die in a hospital like my other grand-father, who died from
cancer after many chemotherapies. My grandmother never gave up hope and it hit
her hard when he finally died. I wished he could have died at home, even if
that meant his life was some months shorter.

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mbubb
Remarkable quote by Stephen Jay Gould:

“It has become, in my view, a bit too trendy to regard the acceptance of death
as something tantamount to intrinsic dignity,” he wrote in his 1985 essay. “Of
course I agree with the preacher of Ecclesiastes that there is a time to love
and a time to die—and when my skein runs out I hope to face the end calmly and
in my own way. For most situations, however, I prefer the more martial view
that death is the ultimate enemy—and I find nothing reproachable in those who
rage mightily against the dying of the light.” (“The Median Isn’t the
Message”)

A personal hero of mine, Philip Berrigan refused most treatment on his liver
cancer and died within a year of diagnosis. My mother 'got martial' in Gould's
terms and fought doctors and death until she got her lung cancer taken care
of. She is on the 'long tail' of the curve.

Impossible to know how one would react. I can see the reasons in both cases
and respect both decisions.

How does one know that one's "skein has run out"? (what a nice turn of phrase)

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mvoewf
Oh, brother, that first anecdote really got to me. How the hell are you
supposed to let go of life when you just brought a child into the world?

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psynix
Having had to watch my mother succumb to lung cancer (not related to smoking)
very recently, I had to hold back the tears whilst reading. Wonderful article.

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isnoteasy
Gandhi wife died without receiving antibiotic treatment, perhaps this is
something to think about.

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shrnky
For those who aren't familiar with the author he's Atul Gawande who worked on
Gore's 1998 presidential campaign and was Bill Clinton's senior adviser in the
Department of Health and Human Services. Another words this is a political
piece and has no business IMHO on hacker news.

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Gonsalu
Heh, looking at the title, my first thought was this was about the Go
language.

It wasn't, so I closed the tab.

