
How Doctors Die - thomasgerbe
http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/
======
fingerprinter
So, couple of things. Just had my wife read this (she is a doc) and we chatted
about this.

We are in our mid-30s and several years ago she was admitted to the ER and
then ICU for 7 days for an obviously life threatening situation. (She has a
near blanket NO CODE, FYI). She recovered, but there was at least 48 hours
where her odds were "much worse than a coin flip" as on of her colleagues told
me.

So people distinguish the different situations, in that situation she and her
colleagues (she was treated at her own hospital...given that it was the best
hosp in the country) knew about her NO CODE and still treated her. The reason
being that medical intervention was near 100% likely to produce a positive
outcome and bring her back to a normal quality of life.

However, if given a terminal diagnosis such as in the story, my wife, without
hesitation, said she would choose to go without treatment. She went further
and wished that this type of article could make its way to the NYT or some
other outlet to get normal folks to think about. She, like most doctors, has
seen way too many people "try to live" only to saddle their family with huge
expenses, not dramatically effect their prognosis and basically make the rest
of their lives as painful as possible.

Obviously not a fun conversation to have with your SO, but I for sure know
exactly what she wants and how to ask the right questions at the hospital just
in case. She also knows what I would want and how to make the right decisions.

~~~
z2amiller
Is there a good way to phrase (i.e. "Doctor Speak") for something like "No
Code unless a probably positive outcome with intervention"?

------
Cass
To everyone considering a "NO CODE" tattoo after reading this story: Don't. If
you're really that serious about not wanting to be resuscitated under any
circumstances, wear some kind of bracelet or necklace with those words on it,
and, just as importantly, a recent date, and contact info for a person who
knows your exact wishes. Make sure to update the date regularly.

Medicine changes, and so do your life circumstances. If you're presenting an
EMT with a ten-year-old, faded tattoo, you're placing them in an awkward
position due to the lack of context. Is this a decision you made ten years ago
and got stuck with, or are these your current wishes? They might end up
disregarding your wishes just to be safe. A bracelet with a recent date will
be much less ambiguous.

And remember, with all medical decisions, you want the ability to change your
mind when medical advances are made or your circumstances change. Tattoo
removal sucks.

~~~
janzer
Not to mention that at least where I'm from a tattoo will not and cannot be
accepted by EMS personnel as a valid order. Here is the relevant part from our
Medical Control treatment protocols on what can be accepted as a valid do not
resuscitate order:

"Patient is wearing a do-not-resuscitate identification bracelet which is
clearly imprinted wit the words “Do-Not-Resuscitate Order”, name and address
of declarant, and the name and telephone number of declarant’s attending
physician, if any OR

The EMS provider is provided with a do-not-resuscitate order from the patient.
Such an order form shall be in substantially the form outlined in Annex 1 or 2
and shall be dated and signed by all parties."

Anything else and we are required to follow all the regular resuscitation
efforts.

~~~
vacri
How bizarre that they'll accept 'do not resuscitate' on jewellry, but not
tattooed across the chest.

"Do we think he really meant it? Nah, he just got the tattoo - if he _really_
meant it, he'd be wearing one of those constantly annoying bracelets"

~~~
mfringel
What if "NO CODE" is the name of a band?

You're asking someone to make a quick life-or-death decision on ambiguous data
when there is a clearly known and socially agreed upon way to express the
sentiment.

Having it on an annoying bracelet that is explicitly used to signal medical
intent sounds pretty good to me.

~~~
vacri
So what if "NO CODE" is the name of a band? I'm talking about "Do not
resuscitate" - and if you tattoo that on your chest because it's a cool band
name, you're an utter fuckwit. 'No Code' is stupid anyway because not
everywhere uses that jargon, while 'do not rescuscitate' is clear, plain
English.

As for the bracelet, I hate jewellery and anything from my elbows down catches
on anything that I'm working on with my hands, and I'm not alone - and unlike
the tattoo which is only 'present' at parts of the day, a bracelet is always
'present'. Not to mention that there's all sorts of medical accoutrements that
infirm people are _supposed_ to carry with them but don't because they're
annoying (prime example being the 'help, I've fallen' pagers).

~~~
MrMatters
Of course, "do not resuscitate" across the chest is pretty clear of your
intentions when you get it. But I don't think you realize how hard it can be
to have that power over someone's life and make that call. I think the point
about old tattoos is much more relevant than a band named that; if there are
former neo-nazis with ultra racist/symbolic tattoos that regret them, there
could be people that just got a "Do Not Resuscitate" tattoo because they
thought it was hardcore when they were younger but now regret it. I know this
isn't always the case but when you're deciding whether or not to give someone
another shot at life, or to let them die, a RECENT bracelet would be more
definitive with all the thoughts racing through your head.

Also, if getting a tattoo is less annoying than wearing a bracelet you
probably have some of them already and it can become even less clear.

~~~
vacri
_getting_ a tattoo isn't less annoying than a bracelet, but _having_ a tattoo
is much less annoying.

In any case - where is the rash of young people with 'do not rescusitate'
tattoos? Everyone I've seen that is supposed to have had one is a greyhair,
well out of the young-and-dumb age. And even if you do 'later regret' the tatt
and don't want to stump for tatt removal, just tatt a couple of lines through
it or tatt something over it.

And then there's the young people who genuinely do not want to be rescusitated
- what about them? Stigma enough carrying a medical bracelet amongst the young
to begin with. I just don't see this supposed grey area of young people
tattooing themselves with a mythical band name.

EDIT: To put it another way, this mythical youth tattooing himself errantly is
such a vanishingly tiny fringe minority. Plenty of laws exist allowing for
people to freely express themselves to death. The more stringent US states
have a maximum blood alcohol content of .08 for drivers, which is higher than
the level at which measurable cognitive effects occur on your co-ordination
and attention. If we're really concerned about 'free expression' deaths, bring
that number right down. There are tons of laws like it. There is no reason not
to make it another social norm to say "tattoo 'do not resus' on your chest,
and you won't be resuscitated". There's no need to pander to base idiots.

~~~
prodigal_erik
I would prefer we avoid shooting the messengers. Even if there's an argument
that EMTs should honor indelible express wishes, we can't have this debate
with all of them simultaneously. We are being informed that many of the ones
out there today _will not_ , which never would have occurred to me, and
knowing that has some value.

------
dcurtis
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
someone tells you that you have two choices:

1\. You can die a certain death, within months, with very little pain, or

2\. You can try some heroic measure like chemotherapy for a minuscule chance
of a multi-year moderately happy, but extremely painful survival.

Humans are programmed to have hope, and, regardless of any logic, the vast
majority will choose option 2. It's just like playing the lottery. Even now,
as I think about those two options in good health, I am compelled by my nature
to choose option 2.

~~~
rdl
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.

~~~
WettowelReactor
It is easy to say that pain would be worth dealing with but in reality the
majority of the healthy public has no understanding of what true chronic pain
entails. Ask anyone who has worked in long term or hospice care this question
and you will likely find an overwhelming majority choosing option 1. The
reality is that in the US death and dying are still anathema.

~~~
VladRussian
>The reality is that in the US death and dying are still anathema.

And thus with the help of the law people are made to live as long as it is
possible even when they don't want to. I'm afraid that when the policy is
reversed, people would be "encouraged" to quit as soon as possible (and being
afraid of such reversal the society clings to the current policy).

Somehow the society just can't understand the simple thing that the decision
to quit or stay is personal and not for the society to make/enforce either
way.

~~~
WettowelReactor
Agreed, I can think of nothing more personal than having to make that kind of
decision. I do think some safeguards are probably necessary to prevent
reactionary decisions such as cases where pain or disease are temporary. At
the end of the day it comes down to education.

------
defdac
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 tubing. I want the cracked ribs and surgeons transform me to a
piece of blubber and then anlyze the hell out of it so anyone else don't have
to go through the same thing.

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.

~~~
ssharp
"In Sweden medical care is free. I can fight as long as I want without them
getting in trouble."

It's not free. It's free to you, but it is placing additional costs on the
Swedish medical system, which somebody is ultimately paying for. You don't
have to internalize the costs of your decision.

I'm not arguing whether or not you're a making a good or bad decision, or
whether or not "free" medical care is a good thing. I'm just pointing out that
providing such a system skews decision making.

~~~
tibbon
Free or not, it seems to work pretty well for the citizens there. You don't
have a sizable portion of the population filing bankruptcy over medical bills
and they haven't gone bankrupt like Greece. Something Sweden is doing is
right.

~~~
cturner
Greece has socialised healthcare, as do the rest of the European countries
circling the drain. <http://en.wikipedia.org/wiki/Health_care_in_Greece>

It's worth noting that the US health model isn't a free-market system - the
state links health care to employment, which distorts the market away from
individual private health ownership, and creates patterns that make it easy
for costs to creep up. The US health care model is a disaster: the state
doesn't supply health care, but then also prevents the free market from
operating effectively.

~~~
cjy
How is the state linking health care to employment?

My understanding is that health care is linked to employment because of the
adverse selection problem that occurs in a free market of individual health
insurance. Can you elaborate on why you consider this to be the government's
fault?

~~~
onemoreact
Health insurance is not taxed when a company pays for it, but individuals need
to pay for it with after tax dollars.

Assume you can sign up for plan A at your company that costs 200$ a month and
covers everything you want. Or you can buy Plan B which costs 180$ a month for
the same coverage.

Assuming your marginal tax rate is over 10% then plan A costs you less money.
Now, most company's bundle healthcare so it's harder to get that money out of
the equation, but for small company's it easy to negotiate if you can get
heath care cheaper though your spouse etc.

------
rbanffy
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.

~~~
gravitronic
Every single one of us are going to die at some point. If you were a doctor
and your goal is to "find cures for everything" then your eventual success
rate over your career would be 0. Do you realize how hard it would be to do
that for your entire career if you approached it thinking you could beat
cancer?

You don't say in your post if your relatives were practitioners or research
doctors, but if you're putting it on a practitioner to think they can beat the
(studied) odds every day it is unfair in the least.

We are greatly indebted to the people who choose careers this stressful that
benefit everyone else. You don't need to blame them for the current state of
medical science. Trust me, they do it to themselves more than enough.

~~~
rbanffy
Since my father died, 43 years ago, many types of cancer were defeated. He
wouldn't die today - he would undergo chemotherapy, radiotherapy or surgery,
would go bald, but would live to see his grandchildren.

------
OoTheNigerian
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.

------
jonah
Both of my grandfathers died in the past five months.

The one who lives halfway across the country was 97. He woke up at his lake
cabin the morning before he died complaining of chest pain and shrugged it off
but was soon being transported unconscious to the hospital accompanied by his
paramedic neighbor. He slipped into a coma and the next day with several of
his children at his side, was removed from the ventilator.

My other grandfather, who lives in the same town I do, was 93 and had
struggled for the past several years with a progressively debilitating illness
which increasingly kept him from being able to do the things he wanted to do.
A couple weeks before his death his health took a turn for the worse and he
quickly began losing connection with the world. He did go to the hospital and
tests were done and drugs given, but we soon understood that he wouldn't
recover and we brought him home. The hospice nurses and caregivers were
wonderful. All his children came as did many old friends. He died in his sleep
in his bedroom with his wife and children there.

Both had advanced directives requesting minimal effort to prolong their lives.
My grandfather here wanted no heroic efforts and "no machines". Even so, a lot
of intense discussion among his children was involved in coming to peace
and/or acceptance of what exactly that meant, what the moral and ethical
implications of different interpretations were, and how best to carry out his
wishes.

This is what I'm now doing and what I strongly encourage you to do now:

* Create an advanced health care directive for yourself. You can get forms and examples online.

* Consider the various situations one might end up in and lay out as explicitly as you can what you'd like to be done or not done to you. The more specific you are, the more likely your intentions will be followed and the less your family/loved ones may have to struggle with the interpretation.

* Talk to your your family and loved ones about your desires. It's a hard and awkward discussion to have but do it. Be clear and frank.

Takeaway: Have an advanced directive. Be as clear, specific, and explicit as
you can about your desires. Share your desires with your family, loved ones,
and care providers. It is helpful not only you but form them as well.

------
RobbieStats
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.

~~~
mikeash
How was your grandmother's quality of life in those last 8 years after the
doctors said she had just a few days left?

As for "The doctors gave him 6 months to live and that was 5 years ago," keep
in mind that you get a horribly biased sample. People don't generally go
around saying "The doctors gave him 6 months to live and he died 6 months
later," even if that may happen far more often.

------
buyx
Just this weekend I met a relative on the street (mid fifties), doing some
shopping. A few months ago, he had some chest pain, his wife thought it was a
heart attack and drove him to the ER. As he was being admitted, he went into
cardiac arrest, he was resuscitated, and now his four teenagers have their
father back, for a few more years at least (he is back at work, and seems to
be living a full and healthy life). What's interesting about this, in relation
to the OP, is that his wife is a doctor, and she was the one who resuscitated
him.

Yes, it's just an anecdote, but a useful one to balance against those in the
OP. Obviously the situation differs if you have a terminal illness, or other
serious health issues, but I think a blanket NO CODE rule is a little extreme.

~~~
Luc
> I think a blanket NO CODE rule is a little extreme.

That's because it's something of your own invention. No one is advocating
this, especially not the health professionals involved.

~~~
buyx
_No one is advocating this, especially not the health professionals involved._

...except when they wear bracelets and tatoos stating "NO CODE".

~~~
Confusion
Making a choice and making sure that choice will be noted when the time of its
relevance comes is not 'advocating'.

------
pingswept
"It’s easy to find fault with both doctors and patients in such stories, but
in many ways all the parties are simply victims of a larger system that
encourages excessive treatment."

I strongly disagree with this part. Before patients become patients, the vast
majority of us have no interaction with the health care industry and certainly
no significant capability to influence it. Doctors, on the other hand, spend
their adult lives working as professionals in the industry. To say that they,
as a group, are anything but complicit is wrong.

Consider the "Fuck passwords" article[1] that's on the HN front page now. As a
programmer who has dealt with passwords, the sad state of authentication is,
in part, my fault. I could make the same excuse, "Well, the users don't want
long passwords, and Facebook and G+ are part of the problem, and blah blah.
I'm a victim of a larger system" That would be lame.

Like the doctors, I'm one of the professionals in the field, so it's my
responsibility.

[1]: <http://news.ycombinator.com/item?id=3313790>

------
latch
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.

~~~
DanBC
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 best treatment, not placebo, because
almost anything works better than nothing and by the time you test the
treatment in humans you need to know if this is better than what you're
already doing.

Ethics panels have some weird effects -

([http://www.badscience.net/2011/03/when-ethics-committees-
kil...](http://www.badscience.net/2011/03/when-ethics-committees-kill/))

~~~
vacri
Science is _rigorous, repeatable observation_. Double-blind studies and null
hypotheses are excellent ways to achieve this. But case studies and low n
studies are also informative - and are science. That science can _only_ be
control groups and null hypotheses is a myth.

Try and tell the medical fraternity that case studies should be eliminated
because they hold no meaningful result and you'll be laughed out of the room.

~~~
DanBC
Case studies are lousy because they are not rigorous, and often have not had
any meaningful result.

See also knee arthroscopy for patients with osteo arthritis - many of these
surgeries were performed before a trial with a control group was possible.
That trial found that people who got the sham surgery did as well as the
people who got the real surgery. Case studies are lousy, often harmful,
medicine.

~~~
vacri
The thing is that you read case studies with this caveat in mind, recognising
that they're statistically flawed. When you don't have better information
available, case studies and low n studies give some direction, some previously
observed information.

------
boneheadmed
I'm a medical doctor and I'll never forget what one of our respected (and
elderly) liver specialists said when asked what he would do regarding a
patient with a liver cancer with a particularly poor prognosis. During a
roundtable discussion, various younger doctors came up with lengthy
suggestions and lots of different chemotherapy regimens, tests, etc. When it
was this doctor's turn to speak, he said: "Well, if I were to put myself in
that man's shoes, I would go to the store, buy a case of fine liquor and drink
myself happy for the next few weeks until I'm gone."

He had seen enough "therapies" to know enough when to forgo them.

------
ck2
Sometimes knowing too much can be bad for choice making.

As a coder, I worry every time I drive that the computer could accidentally
fire the airbags because of a bug in a poorly coded sensor (this happens far
less frequently now but when airbags were first introduced people were
killed/injured periodically
<http://news.google.com/search?q=airbag+recall+deaths> ).

Not the best example but things like this do affect choicemaking and corner-
cutting. It's like the fable of the plumber's plumbing, never being in good
shape despite his expertise.

Hence doctors probably don't always make the best decisions about their own
healthcare because they are either over-reacting, or under-reacting.

------
tptacek
The CPR example that's used throughout the article is a bit weird, isn't it?
Isn't CPR performed when someone has no heartbeat? What does it matter if you
crack their ribs? It's only painful if the person survives.

I'm not debating whether people should attempt to prolong their lives with
aggressive chemo, just picking a nit.

~~~
wvenable
If I was in an accident or an illness today -- I'd want them to crack my ribs
and so on. In 50 years or so, when I'm 80 and in poor health I'm not sure I'd
want the same thing.

~~~
learc83
Yeah that's the author's point. Chronically ill or terminally ill patients
receiving heroic care, not an otherwise healthy 30 year old who has an acute
illness.

If you're 80 and in poor health, recovery from broken ribs is likely to be
extremely difficult and painful.

------
Gatsky
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 gross generalisation.

Cause guess what, not everyone has a loving family or a house in the hills or
a cousin with a big screen TV to go to when they are dying from a terminal
illness. Some people want to try and fight their disease, and they are
tenacious and brave and admirable and that's dignifying to them and to those
that try and help them.

This article is an attempted justification from someone who has lost faith in
what they do, nothing more.

~~~
antoinehersen
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.

------
js2
Two related stories I thought of while reading this:

1\. A Pacemaker Wrecks a Family's Life -
[http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.htm...](http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all)

2\. A Tale of Two Hearts -
[http://thestory.org/archive/the_story_111811_full_show.mp3/v...](http://thestory.org/archive/the_story_111811_full_show.mp3/view)

The second is an audio program.

------
VMG
One alternative that hasn't been mentioned here is cryopreservation. Once I
have the resources and the technology has progressed, I'd certainly choose
that option above being treated and "NO CODE".

~~~
Jach
Totally on board with cryonics, it's really depressing that it gets swept
under the rug considering it probably has at least 5% chance of working for a
patient suspended today. Though your excuses for presently avoiding it seem
pretty flimsy unless you're really dirt poor (I'd wager unlikely), especially
when life insurance payable to the cryonics company is cheap (you only need
$28-$35k for CI) and so are membership fees ($120/yr or $1,250 once for CI; I
spend more than $120/yr on fast food). But don't get upset, my excuses for not
being signed up yet are pretty flimsy too.

~~~
philwelch
Setting aside how completely fictitious that 5% is, here are my problems:

1\. Cryonics is the sci-fi version of Pascal's Wager. If cryonics is rational,
than by the same reasoning so is Christianity.

2\. Cryonics doesn't guarantee quality of life. If the brain is poorly
preserved, you might be woken up in the far future with profound and
irreparable dementia. And I mean "irreparable" not in relation to the
limitations of medical science at a given future date, but in a purely
information-theoretic sense. There might not be enough information left in
your flash-frozen brain.

3\. Cultures don't evolve because people change their minds, they evolve
because people die and become outnumbered. If there's one thing the future
_doesn't_ need, it's us. And likewise, I think we would be shocked by the
future.

4\. Even if cryonics is theoretically feasible, I would need pretty good
assurance that the cryonics company weren't charlatans. The news so far on
that front isn't promising.

~~~
Jach
1\. Pascal's Wager isn't comparable here for a number of reasons. You're
probably thinking of the reasoning some people give that a finite but
humongous expected payoff justifies a finite but minuscule probability. I
would agree that's a pretty stupid reason to do things; if it's worth doing
there are probably better reasons.

2\. It's not a guarantee, has anyone ever said it is? Hence my own estimate of
at least 5%. (I believe I originally got that figure in my head back from
[http://www.overcomingbias.com/2009/03/break-cryonics-
down.ht...](http://www.overcomingbias.com/2009/03/break-cryonics-down.html)
\-- I don't think it's an unreasonable one.) It's still a better shot than
being buried or cremated and worth it given the low prices available today.

3\. I look forward to being shocked. I'm not going to touch your horrid
comment that death is somehow necessary for progress.

4\. Cryonics is a pretty poor business to be in if you're a charlatan. Where
are you getting that vibe from?

While remembering that old post I linked I also found this comment I thought
I'd share from a "Luke" ( [http://www.overcomingbias.com/2010/07/cryonics-as-
charity.ht...](http://www.overcomingbias.com/2010/07/cryonics-as-
charity.html#comment-450726) ):

 _Cryophobia_ is pure evil. It makes people choose death instead of cryonics.
It makes cryonics more of a struggle for those who are not wealthy; it
deprives the poor of the scaling effects that would make it affordable. It
deprives those who are courageous enough to try it of their dignity and
attacks their character unjustly and without evidence. It splits up families.
It diminishes the chance of the technology working to 5% of its potential. It
is unfair to AIDS and cancer victims who must die an early death _permanently_
because of this. It misrepresents facts, repeatedly, while masquarading as
skepticism. It has no shame, no decency, and no honor.

~~~
philwelch
> Pascal's Wager isn't comparable here for a number of reasons.

Please provide them.

> Hence my own estimate of at least 5%. (I believe I originally got that
> figure in my head back from [http://www.overcomingbias.com/2009/03/break-
> cryonics-down.ht...](http://www.overcomingbias.com/2009/03/break-cryonics-
> down.ht..). -- I don't think it's an unreasonable one.)

I guess if you invent a few data figures and then do math on them, you can get
an aggregate of your own opinion. It's like the Drake equation, except at
least with the Drake equation there are some terms we actually know.

> It's still a better shot than being buried or cremated and worth it given
> the low prices available today.

Every dollar you pay for cryonics is a dollar that you're depriving your
actual living children or family members, or it's a dollar you're depriving
yourself of in the past modulo time value of money.

> Cryonics is a pretty poor business to be in if you're a charlatan. Where are
> you getting that vibe from?

It's the perfect business to be in if you're a charlatan! There's no way to
tell if you're doing a good job or a bad job, you never have to provide any
results (because those happen in the distant and undefined future), and your
customers are already dead.

> I'm not going to touch your horrid comment that death is somehow necessary
> for progress.... Cryophobia is pure evil. It makes people choose death
> instead of cryonics.

Maybe it is horrid, but is it true? Ah, you don't even bother addressing that.
Because as we all know, the most rational response to an argument is to accuse
your opponent of "evil". It seems to me that even if you dress it up in
science fiction and call it "rationality", religion is still religion.

~~~
Jach
The main reason: the decision matrix for Pascal's Wager introduces infinities;
the many various ones you can construct for cryonics to win do not. (I suppose
you _could_ construct one with infinities, though I can't say I've ever seen
one, and I don't think that construction would be tenable anyway.) Another:
the fact that there are many constructs for cryonics decision matrices--
Pascal's Wager is static in time, a "Cryonic's Wager" would be dynamic in
time. Another: cryonics doesn't suppose anything supernatural--if cryonics can
or can't work, there are physical reasons why, we don't just have to suppose
the outcomes as baseless entities. Perhaps you should explain why you think
Pascal's Wager is analogous here.

We're dealing with subjective probabilities representing confidence in
prediction, so yes, we can do math on them and say "If you believe this, you
must believe that if you want to be consistent." Even if all cryonics
estimates are ultimately that person's prior (suggesting there is no
additional information currently to update a person's estimate of cryonics
working given their background information, something I think is false), we
can still reason about different values.

If you think cryonics has epsilon chance of working, fine, it's not for you,
and under the assumption that it doesn't work I'd agree no one should do it,
but I don't think cryonics has epsilon chance of working, and I don't think
it's just my prior. A secondary assumption we might make is that the future
world would become horrible with us introduced to it. If we knew it would,
then we know we'll never be revived, and I'd agree no one should bother with
cryonics. Since we don't know that, you can factor it in as a part of your
uncertainty about being revived, which is a part of your uncertainty about
"cryonics working".

> Every dollar you pay for cryonics is a dollar that you're depriving your
> actual living children or family members, or it's a dollar you're depriving
> yourself of in the past modulo time value of money.

Yes... and? _Every dollar you pay for "X"_ fits that. Do you think "This $10
could go to my friend" every time you spend $10? So what to do? The linked
post, at the end, suggests a dollar-value you can assign if you only think
"cryonics working" has a 5% chance:

"If you make 50K$/yr now, and value life-years at twice your income, and
discount future years at 2% from the moment you are revived for a long life,
but only discount that future life based on the chance it will happen, times a
factor of 1/2 because you only half identify with this future creature, then
the present value of a 5% chance of revival is $125,000, which is about the
most expensive cryonics price now."

(And cryonics can be had for as little as $40k, more or less.) This isn't
quite mathsturbation, since it's legitimate if in fact you match the stated
assumptions.

> There's no way to tell if you're doing a good job or a bad job

Not true. You can rate cryonics businesses by how effective their
vitrification methods are, how quick they are about it, how many patients
they've lost due to any cause, whether they do any research into improving
their methods as well as the currently unsolved problem of reversing it, how
long they've been around, how well their facilities can resist natural
disasters like earthquakes, and probably a bunch of other ways. Furthermore
the market for cryonics is still very small; you stand to make a lot more
money more easily doing other things, whether you're a charlatan or not. (For
example releasing yet another homeopathic sleep inducer.)

Regarding your horrid comment, I'll explicitly say it's horrid and most likely
untrue (but feel free to factor it into your uncertainty about "cryonics
working"). If you're not going to bother defending that one, I'm not going to
bother arguing against that one.

I thought the "evil" comment was interesting since the author noted it's not
meant as a useful argument, it's meant as a response to useless ones. Which is
what this has been. In your original comment "2" was the closest thing to an
actually useful discussion point--how likely is it that enough brain
information is there after vitrification? If you want to think of yourself as
evil, go ahead, I wouldn't go that far but it's an interesting thought.
Especially considering it from the perspective of living to 2070 (when I'll be
80), imagining that it turns out to be the year we successfully revive and fix
whatever would have killed the first cryonics patient suspended in, say, 2000.

Don't conflate religion with religious thinking, and religious thinking with
magical thinking, and magical thinking with bad thinking. While religious and
magical thinking are both subsets of bad thinking, there are other forms, and
they're all distinct from religion itself. (As an example of another issue
where this "You're just a religion too!" criticism has been misused in
relation to the idea of a technological singularity, see
[http://web.archive.org/web/20101227190553/http://www.acceler...](http://web.archive.org/web/20101227190553/http://www.acceleratingfuture.com/steven/?p=21)
)

~~~
philwelch
> The main reason: the decision matrix for Pascal's Wager introduces
> infinities; the many various ones you can construct for cryonics to win do
> not. (I suppose you could construct one with infinities, though I can't say
> I've ever seen one, and I don't think that construction would be tenable
> anyway.) Another: the fact that there are many constructs for cryonics
> decision matrices--Pascal's Wager is static in time, a "Cryonic's Wager"
> would be dynamic in time. Another: cryonics doesn't suppose anything
> supernatural--if cryonics can or can't work, there are physical reasons why,
> we don't just have to suppose the outcomes as baseless entities. Perhaps you
> should explain why you think Pascal's Wager is analogous here.

Not only is it analogous, but by your own reckoning it is in many ways weaker.
I don't think there's any useful meaning or distinction in describing the
Christian afterlife as "supernatural", incidentally--either it's the case or
it isn't. In any case, the decision matrix for Pascal's Wager is something
like:

    
    
                     Believe        Disbelieve
      Christianity   Heaven            Hell
         True        (+ inf.)        (- inf.)
    
      Christianity   No sinning          0
         False       (- fin. net loss)
    

And the decision matrix for cryonics:

    
    
                    Get Frozen         Don't Get Frozen
       Can Be       Get Resurrected    0
       Resurrected   (+ fin. net gain)
    
       Cannot Be    Waste Money        0
       Resurrected   (- fin. net loss)
    

Interestingly, in some formulations of Christianity, hell consists of ordinary
death rather than eternal torment, which would make the Pascal matrix even
more similar to the cryonics matrix. In any case, Pascal's Wager is strictly
stronger than the decision matrix for cryonics, depending on how much you
value being able to sin.

> Yes... and? Every dollar you pay for "X" fits that.

Well, it rather puts the lie to the claim that you have nothing to lose by
having your corpse frozen in liquid nitrogen rather than buried or cremated.
You _do_ have something to lose. $40k-$125k is a lot of money that might
actually be needed by your survivors. If you are ridiculously wealthy or have
no children it might be different.

> Regarding your horrid comment, I'll explicitly say it's horrid and most
> likely untrue (but feel free to factor it into your uncertainty about
> "cryonics working"). If you're not going to bother defending that one, I'm
> not going to bother arguing against that one.

I would be glad to defend that statement: for one small example, you can just
refer to demographic polling on the subject of gay marriage. Support for gay
marriage is dependent upon age more than any other variable, which suggests
that the passing of older generations will push the question into almost
universal consensus within our lifetimes.

Now, let's be clear: this argument is against the wholesale cryonic
preservation of large numbers of dead people. As long as cryonics remains
restricted to a small number of eccentrics, there's no gain or loss either
way; Ted Williams' severed head will not revert the far future back to 20th
century social norms all by itself. If there are only a few frozen people,
they will probably serve more as figures of curiosity and academic study. In
fact, cryogenic preservation might provide useful information to people of the
far future even in the absence of effective resurrection--by analogy, we would
probably be very interested, today, to examine a well-preserved physical
specimen of centuries past, just as we've been interested in dissecting
mummies and ice men. But if we take the pro-cryonics viewpoint to its natural
conclusion, there are probably going to be millions of contemporary people
resurrected possibly centuries from now. At that point, we will have either a
very large politically disenfranchised population of 21st century people or a
severe shock of regressive ultraconservatism. It would be the moral equivalent
of colonialism, except in time rather than in space.

From what I've seen from cryonics proponents, yourself and "Luke" included,
your basic method of argument is to make wild, largely unsubstantiated claims
about life after death and then condemn all disagreement as "horrid" or
"evil". If that's not religion, what is?

(If you want to continue this, feel free to email me. My address is in my
profile.)

------
kghose
Some people on this thread have harped on cost (and used it as a way to insert
their own agenda about the economics of healthcare) but from my reading of the
article it is really about being free to make an informed and _personal_
choice about what the cost/benefit of treatment in terms of _life quality vs
life quantity_ is to you.

It is true the writer writes from the point of view of his own choice, but on
a topic such as this, that is really the only way to do it authoritatively.

The point of the article, I thought, was to make us think - what would I do
when/if the time comes?

------
jballanc
For everyone contemplating the prospect of hospice care vs "fight to the very
end", this study might be of interest [PDF]:
[http://www.nhpco.org/files/public/jpsm/march-2007-article.pd...](http://www.nhpco.org/files/public/jpsm/march-2007-article.pdf)

The salient point:

> _For the six patient populations combined, the mean survival was 29 days
> longer for hospice patients than for nonhospice patients._

------
cturner
I spent a lot of time hanging around nursing homes when I was growing up, and
decided a long time ago that I'd like to do fast and well before I get to that
stage. The NO CODE tatoo is a great idea.

------
conorh
My wife is a surgeon and sees these situations constantly, a patient whose
family has asked that everything be done for them. They spent months in the
ICU hooked up to machines, incredibly uncomfortable and often, if they are
aware, extremely depressed. And then they die. This is traumatic for everyone
involved.

She (and I) would _never_ go through this by choice. I can't stress that
enough. This is not about money, this is about leaving life in the best
possible way, on your own terms, with your family and as comfortable as
possible.

------
mmmmax
Cached version: <http://max.mu/uvwxRf>

------
pauncejones
Hospice nurses helped both of my parents die as quickly and peacefully as
possible. My father had congestive heart failure - a slow death over months,
and my mother had dementia, and eventually started losing the ability to
control her basic functions like breathing and swallowing.

If it weren't for the kind advice of my mother's doctor, who instructed all of
her caregivers NOT to allow her to be taken to the hospital or be picked up by
an ambulance, she might have ended up in a vegetative state in a hospital as
well. He explained how it's a hospital's duty to do _everything_ in their
power to resuscitate someone, regardless of whether it's really humane or not.

It was awful watching them both die, but sitting with your family while you're
given liquid morphine is much better than going through a frightening,
painful, lonely death in a hospital.

------
martin1b
While this article is interesting, it should make clear that basic necessities
for life MUST be maintained. Everybody needs food and water to live by
ordinary means, all medical technology aside. However, life support is not
required and is considered extraordinary.

Quality of life is something to achieve with the inclusion that these basic
needs are met. If not, the quality of life is a personal opinion and can be
interpreted in any way, from conservative, to ridiculous.

------
gbak
For some reason the site is down and the cache link on google takes a while to
load. For everyone that wants to read it I created a public Google Docs file
with the article. You can access it here:

[https://docs.google.com/document/d/1yL1659zNXQ7M9uXIcRrcu9dJ...](https://docs.google.com/document/d/1yL1659zNXQ7M9uXIcRrcu9dJ2i0xTHfTHD5hzJCp5ww/edit)

------
thisisnotmyname
It would be nice if the author provided a citation or two to back up the
sweeping statements he or she is making.

------
pedoh
What are the best ways to make our preferences to our loved ones clear? Is it
sufficient enough to have a living will, for example? Are there documents out
there that I should be carrying in my wallet, and do paramedics seek these
documents out in an emergency?

~~~
philwelch
> What are the best ways to make our preferences to our loved ones clear?

Tell them. I would recommend going through scenarios with them. Everyone
thinks of the persistent vegetative state, but it's very unlikely you'll end
up in one. It's more likely you'll be days away from death and passed out in a
haze of exhaustion and morphine, with a ventilator doing little more than
prolonging this scenario. Do you want the ventilator removed? Do you want CPR
if you're hospitalized for a terminal condition? What if you're hospitalized
for a non-terminal condition?

> Is it sufficient enough to have a living will, for example?

It sure helps, so do that. But also make sure to designate one of your loved
ones in particular as your power of attorney. Make sure it's someone who
understands and is capable of carrying out your wishes. That person will stay
in close contact with health care professionals and has the legal right to
make any and all decisions should you be incapacitated. In my limited
experience, no one even looks at the living will if there's someone with clear
power of attorney telling them what to do.

This person has an even more important job, at least in the American health
care system: they're often the only one who talks to _all_ the doctors and has
the big picture. If you're seeing five different specialists, and they're all
talking about their own specialties, no one is necessarily in charge of the
big picture. In the outpatient world you have a primary care doctor, but when
you're hospitalized, this guy's out of the picture. There is probably a
hospitalist in charge of your care, but just like the nurses, the hospitalists
rotate on shifts, and don't really coordinate with specialists so much as just
trying to keep you alive. You need someone to be power of attorney, and to
take the job seriously. One of the striking things, to me, about Steve Jobs'
biography was that even for him, this was true--his wife was the one
coordinating the doctors and keeping in charge of the big picture.

> Are there documents out there that I should be carrying in my wallet, and do
> paramedics seek these documents out in an emergency?

No. I've had paramedics at my house for my dad twice, and they never looked in
his wallet. On the other hand, I was there both times.

The job of a paramedic is to stabilize you, gather whatever information they
can, and take you to the ER. They probably don't give a shit about your wallet
or your cell phone. Whatever procedure there is for identifying someone's next
of kin and finding their advance directives, it's done in the hospital. Most
of the time they just ask you, if you're conscious, and they ask whoever is
physically with you at the time. They would only resort to searching you and
your effects if you were completely alone, or if no one around you knew
anything or anyone. So designate your power of attorney and designate that
person as your emergency contact at work. If you don't live with that person,
make sure a neighbor or roommate or someone else you live with or close to has
that person's number programmed into their phone and knows to contact them.
You want a _person you trust_ , not just a tattoo or bracelet or document, in
charge here.

------
maurits
Very interesting story, but I do wonder if its assertions universally hold.

This looks like an excellent research question for the guys at freakonomics
(<http://www.freakonomics.com/blog/>) to me.

------
dennisgorelik
Original URL does not work at this moment.

cache:zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-
die/read/nexus/

------
biesnecker
Never been a big tattoo fan, but after reading that, I might consider a big
"NO CODE" tat on my chest.

~~~
pefavre
Experience show that it's sometimes not enough, and if no explicit paperwork
can be found medics will perform CPR anyway...

~~~
JshWright
s/will perform/are obligated to perform/

In most cases, EMS in the field is operating under a fairly tightly defined
set of protocols. Those protocols define what is or isn't a valid "Advanced
Directive"

------
iguanayou
Is it possible that "get medical treatment" or "go in peace" is a false
dichotomy?

~~~
radu_floricica
Of course it is. The dichotomy is between going in peace and doing absolutely
everything possible, regardless of costs, to live a bit more.

------
AznHisoka
can someone please post this entire article or a cached version?? been trying
to read what the commotion/drama is all about for the past 6 hours and I'm
dying here...

------
derleth
cache link:
[http://webcache.googleusercontent.com/search?q=cache%3Ahttp%...](http://webcache.googleusercontent.com/search?q=cache%3Ahttp%3A%2F%2Fzocalopublicsquare.org%2Fthepublicsquare%2F2011%2F11%2F30%2Fhow-
doctors-die%2Fread%2Fnexus%2F&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-
US:official&client=firefox-a)

The site is down for me.

~~~
llimllib
Here's a link to readability: <http://www.readability.com/articles/5r2ckztm>

------
msimonovic
<http://xkcd.com/936/>

~~~
zeynalov
False. Most of computers don't calculate every digit separately but they start
to test most used words then other variables. This means, Igotoschool is much
easier to guess than 8h9. Hacking programs have dictionaries and most of
passwords are plain words.

